Endometrial Cancer

Endometrial Cancer is the genetic mutation in the lining of the uterus called the endometrium resulting in cancer. The abnormal cell growth forms a mass or tumor.

Symptoms include vaginal bleeding after menopause, bleeding between periods, abnormal watery or blood tinged discharge from your vagina, and pelvic pain.

Risk factors include fluctuating hormone levels of estrogen and progesterone causing changes to the lining of the endometrium, irregular ovulation, PCOS (polycystic ovarian syndrome), obesity, diabetes, starting period at an early age, no history of pregnancy, and hormone therapy for breast cancer.

Prevention includes reducing risk by talking to your doctor about hormone therapy after menopause, as they can cause various cancers. Birth control pills may reduce cancer risk, managing your weight, and exercise can also reduce risk.

 

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What is Endometriosis?

Endometriosis is the event where tissue normally inside the uterus (endometrium) begins to grow outside of the uterus, the ovaries, intestines, and the lining of your pelvis cavity. This tissue grows normally as if it was inside your uterus, but it has no way of leaving your body and can form scar tissue and adhesions (abnormal tissue that binds organs together).
Symptoms include pelvic pain, painful periods, pain with intercourse, pain with bowel movements or urination, heavy bleeding, fatigue, diarrhea, constipation, nausea, bloating, and infertility.
The cause for endometriosis is unknown, but there are many unproved theories. Researchers, however, have found it tends to run in families. Increased risk factors include never having given birth, if period starts before the age of 12, if there are uterine abnormalities, and a history of pelvic infections. Pregnancy can temporarily deter endometriosis, and permanently treat with menopause unless you take estrogen.
Treatment for endometriosis includes pain medication (NSAID’s), hormone therapy (reduce pain, reduce growth of endometrial tissue and bleeding), and surgery to remove tissue. A hysterectomy with or without removal of ovaries is considered the last resort. Complications of endometriosis are infertility, and ovarian cancer.

3 Causes of Heart Attacks!

Heart attacks (myocardial infarction; MI) can be caused by a blockage of the arteries that take oxygenated blood to the heart. The muscle of the heart does not receive this oxygen and the muscle can die off. It is crucial to make sure your heart gets a continuous supply of oxygenated blood for it to continue to function. The CDC reports someone in the United States has a heart attack every 40 seconds. Heart attack symptoms can occur over time, or be sudden.

Heart attacks can be caused by:
1. Atherosclerosis, a fatty plaque that builds up in the arteries and prevents blood and oxygen from going to your heart.
2. Blood clots which can occur when a plaque breaks off in the artery and blocks the artery going to the heart.
3. Arterial spasms are when the artery contracts and cuts off blood flow to your heart.

Risk factors for a heart attack include those with high blood pressure (hypertension), high cholesterol or triglyceride, diabetes, smoke, are overweight, have a stressful life, do not exercise, drink alcohol, use street drugs, have a family history, history of autoimmune disease such as lupus or rheumatoid arthritis, are over 45 years old, and are male.

Symptoms include shortness of breath heartburn, sweating, dizziness, upper back pain, jaw or shoulder pain. Chest pain tends to feel more like a heaviness, or tightness sensation. Women tend to have feelings of nervousness, nausea, indigestion, heartburn, excessive yawning, tooth ache, tingling in the arms and hands, and pain between the shoulder blades and back. Those over 65 years old may experience more sweating, shortness of breath, fatigue, or flu like symptoms. If you have these symptoms, get medical attention immediately. Do not wait to see if they will go away. The longer you wait the greater the damage to your heart. Time is muscle. Call 911, and take nitroglycerin if already prescribed by your doctor for chest pain. If instructed to do so by the operator, take 81 mg Aspirin 4 baby chewable tablets for a total of 325 mg. Do not dissolve.

Diagnosis is done by EKG and blood tests called cardiac enzymes. Sometimes a stress test may be ordered to see how your heart and blood vessels handle exertion. An angiogram may check to see which blood vessels are blocked.

Complications include arrhythmias or abnormal heart rhythms, heart failure where your heart cannot pump oxygenated blood sufficiently, heart rupture, or heart valve damage.
Treatment includes:
1. Break up or dissolve the clot in the artery of the heart
2. Angioplasty and balloon pump therapy is when a catheter is inserted into the artery and a balloon inflated to widen the arteries and allow blood flow.
3. Cardiac stent is when a metal mesh is inserted in to the artery to keep it from closing
4. Coronary artery bypass graft (CABG) is when arteries or veins are inserted around the blocked arteries of the heart to restore blood flow to that area of the heart.

Medications typically given to treat heart attacks include:
Aspirin helps prevent blood from clotting, allowing oxygenated blood flow.
Clot busters or Thrombolytics, such as Alteplase or Reteplase. The sooner you have it the better.
Antiplatelet drugs prevent the clot that is present from getting larger. An example is Clopidogrel or Plavix.
Pain medication, such as morphine may help improve circulation and reduce pain.
Nitroglycerin is used to treat chest pain and widen the blood vessels to allow for blood flow.
Beta blockers, such as Atenolol and Carvedilol, relaxes, slows the muscle of your heart, and reduces blood pressure making it easier for your heart to work.
Ace Inhibitors, such as Lisinopril and Enalapril, also reduce blood pressure, and stress on the heart.

Lifestyle changes include exercise, eating a healthy diet, stop smoking, reduce alcohol intake, stop using street drugs, better management of diabetes, and stress reduction. This is usually done by a cardiac rehabilitation program. Some patients become depressed or have issues with sexual dysfunction after a heart attack. It is important to discuss this with your doctor.

Hiccups!

Is an involuntary tightening of the diaphragm in the abdomen forcing your vocal cords to close and resulting in the “hic” sound we are all familiar with. For the most part hiccups resolve on their own. If hiccups last more than 48 hours they are called persistent hiccups. If they last longer than a month they are called intractable hiccups, and may present as painful, frequent, and can interrupt breathing, cause GERD, irregular heartbeat, fatigue, difficulty sleeping, and weight loss due to difficulty eating. It may present as a tightening feeling in your chest, abdomen, or throat. Men are affected more than women.

Causes of hiccups include coughing, swallowing too much air, eating fast, smoking, drinking something really hot and then really cold, abdominal hernia, GERD, fast eating, intense emotions, carbonated drinks, dry rice or bread, alcohol, or laughing. Other causes include irritation of the medulla in the brain from kidney failure, stroke, multiple sclerosis, meningitis, cancer, infections, mental health problems, or damage to the vagus nerve after having surgery. From the brain to neck vertebrae C3 and C5 there is a nerve called the phrenic nerve. It is also called the hiccup center. This area allows a person to breathe out or exhale. If this area is irritated in any way the diaphragm may spasm and pulls air into the lungs, closing the wind pipe or trachea, which results in the “hic” sound.

Treatment is usually not necessary as it often resolves on its own. However, for chronic hiccups, the first treatment is the cause. For example, if the cause is GERD, omeprazole may be prescribed to treat the GERD. There is no specific treatment otherwise. Medications used in the past have been Gabapentin, Proton Pump Inhibitors, Reglan, chlorpromazine, and baclofen. Sometimes the phrenic nerve can be blocked temporarily with Procaine 0.5%, or removal of the phrenic nerve can be performed. Lidocaine gel 2% in the ear canal can trigger a reaction from the vagus nerve that may help stop the hiccups. Anti-psychotics, muscle relaxants, and sedatives have provided some help, as well as rectal massage. Home care remedies include swallowing crushed ice or dry bread to stimulate the gag reflex and thereby stimulating the vagus nerve. Holding one’s breath or breathing through a paper bag may help. Drinking something cold fast, eating a teaspoon of sugar, honey, or peanut butter are other home remedies that have been tried.

Chronic Fatigue Syndrome (CFS)

CFS is a complex set of symptoms the cause of which is unknown. Researchers have identified symptoms of CFS up to the 1930’s. Risk factors include those over 40, although teens have been noted to have overlapping symptoms, and females. Women tend to have more severe symptoms than men. Depression is extremely common. Stress may be a trigger, as well as emotional trauma, and genetic factors. It is non curable, but managed long term.
Overlapping conditions that intersect include Fibromyalgia, multiple chemical sensitivity, eating disorders, chronic headaches, difficulty concentrating, memory problems, bladder pain, irritable bowel syndrome, sleep problems, and jaw pain.

Fibromyalgia is fatigue and muscle aches for long periods of time. It is often confused with CFS. CFS is more severe fatigue, and Fibromyalgia is more chronic pain. Additional symptoms of Fibromyalgia include tenderness to side of the neck, shoulder blade, hips, buttocks, and inside of the knee, sore throat, headache, fever, and depression. It is not curable.

Multiple chemical sensitivity occurs when certain chemical exposures cause specific symptoms.
The chemical products are common everyday items such as fabric softeners, perfumes, and air fresheners. These items may not have affected the individual in the past and symptoms go away once the chemical is removed.

There is no known specific cause for CFS, but may be a combination of viral infections, genes, psychiatric problems, immune or hormonal problems, allergies, or brain anomalies.

Diagnosing CFS is very difficult. According to the center for disease control (CDC), you must have unexplained fatigue for at least 6 months, and is not relieved with rest, and everyday activities are significantly reduced, including work, education, and social activities. You must also have at least 4 of the following during or after the 6 months: changes in concentration, or memory, sore throat, tender lymph glands, muscle aches and pain, joint pain, headaches, poor sleeping, feeling unwell after exertion for more than 24 hours.

Additional symptoms that may be felt include dizziness, nausea, flu like symptoms, and palpitations. There are many blood tests that can be performed to determine cause of fatigue, as well as other medical conditions that cause long term fatigue. These include Mononucleosis, and Epstein-Barr Virus, lupus, rheumatoid arthritis, post-lyme disease syndrome, diabetes, hypothyroidism, cancer, anemia, depression, and bipolar disorder.

If you are feeling the following symptoms without the physical symptoms then it is likely depression: feeling sad every day, weight loss or gain, difficulty or excessive sleeping, very low energy, feeling helpless or worthless, difficulty concentrating, loss of enjoyment or interest in everyday life, or restless.

Due to the severity of CFS, people tend to have difficulty working, and fulfilling responsibilities at home. They often lose their jobs, and often have little support. Memory and concentration is the most difficult symptom for many. Adults often improve or have recovery after about 2 years. Teens tend to miss school frequently, and may take up to 4 years for recovery.

Treatment involves a combination of therapies including eating a healthy diet, antidepressants, physical and cognitive-behavioral therapy, and sleep management.

Cognitive-behavioral therapy involves working with a therapist to change negative perceptions to positive perceptions about themselves and the world around them. It involves setting limits, keeping a diary, pacing activities, addressing negative thoughts, adapting to changes, and developing coping skills. CBT has shown the most successful response compared to other types of treatments.

Additional treatment efforts include balancing times of rest and activity, making tasks more manageable, and avoiding exertion, stress reduction such as deep breathing exercises, meditation, hypnosis, and yoga.

Treatment with medications depends on the individual. NSAID’s (Aspirin, Ibuprofen, etc.) reduce pain and inflammation. NSAID’s are good for a limited amount of time as they can raise blood pressure, and should not be taken by those with kidney disease, or gastric disorders. Other anti-inflammatory drugs, such as, Celebrex, can be prescribed but also have side effects.
Antidepressants can be helpful, but side effects include constipation, and dry mouth. Stimulants, such as, Adderall, and Ritalin, can help with concentration and short term memory problems.

Alternative therapies include vitamins, minerals, and dietary supplements, such as, co-enzyme Q10, Vitamin B12, St. John’s Wort, Melatonin, and Gingko. All of these drugs have been on the investigative end and there is no evidence they are beneficial.

2017-2018 Seasonal Flu

Flu season is here. The best guard against the flu is to educate yourself about it, how to prevent it, and if you get it, how to take care of yourself, and most importantly get the flu vaccine every season. The flu is caused by a virus that strikes the respiratory system. This is not the same stomach flu (Gastroenteritis), which causes nausea, vomiting, and diarrhea. There are several types and sub types of flu. We often hear most about type A and B. Type A is the flu recognized during the winter months when flu is expected to be most active. Widespread flus occur about every 10 years, and people tend to get sicker than when the usual annual flu comes around.

Transmission is through direct contact from one person to another through coughing, sneezing, or touching someone (handshake) or an object like a tissue used to blow their nose or cough into. You are contagious from the day before you start having symptoms up to 7 days after they develop. Symptoms often develop 1-4 days after your exposure. The flu should pass in 5-7 days, but you may feel tired for several weeks.

Risk factors include those who are very young, elderly, live in nursing homes, those whose immune system is compromised, such as HIV, and cancer patients, those who have respiratory problems already, such as, asthmatics, and COPD, heart problems, pregnant women, and those who are overweight.

Diagnosis of flu is now often made using a rapid test, but it is not 100% accurate, and is usually diagnosed by the provider based on symptoms, exposure history, and community alerts to outbreak by the local department of health.

Symptoms include fever, body muscle aches, runny nose, chills, sweating, headache, cough, fatigue, weakness, nasal congestion, and sore throat. Sometimes vomiting can be seen in children. Smoking worsens symptoms. Complications include Pneumonia, sinus infections, dehydration, Bronchitis, Asthma flare-ups, ear infections, and heart failure for those with heart problems.

Antiviral medication early in illness can shorten the flu, reduce severity, and prevent complications. The antiviral may not work though. The medication must be taken within 48 hours of the first symptom, and does not mean you should not get the flu vaccine. Two medications used are Oseltamivir (Tamiflu), and Zanamivir (Relenza). Antibiotics, Vitamin C, and Echinacea cannot prevent or treat the flu. Other treatments include plenty of rest, and increased fluid intake. Treat aches and pain with Tylenol or Ibuprofen. Cough medicine and nasal decongestants may help those symptoms.

Seek immediate medical care if you have trouble breathing, have a severe headache with a stiff neck, feel confused, or you cannot stay awake. You should see your doctor if you have very high fever that lasts more than 3 days, if your child is less than a year old and has a fever, pain to ears, chest, throat, sinuses, or wheezing.

Prevention includes vaccine against the flu every year, frequent hand washing, cough and sneeze in a tissue and then dispose of the tissue in a garbage container, and avoiding crowded areas. The CDC currently recommends vaccination for children over 6 months of age. Higher dose vaccination is available for those over 65 years of age. There are different types of flu vaccines. Ask your doctor which one is best for you. The most common are made with or without eggs, and have no preservative. Make sure to notify your provider if you are allergic to eggs, have a history of Gillian Beret, or feel sick the day of your vaccination. Wearing a surgical mask is a good idea for caregivers. Sanitizers that contain alcohol may help with cleaning surfaces, such as door knobs, remote controls, and cell phones. Bleach is also effective, but may not be appropriate for cleaning some objects as it may cause damage.

What You Need to Know About Irritable Bowel Syndrome (IBS)

IBS is a condition affecting the large intestine marked by alternating periods of diarrhea and constipation, abdominal cramping, and straining. It is sometimes called a spastic colon. It is not a disease, and there is no cure for IBS, but it can be managed over one’s lifetime. IBS has a high incidence in women under the age of 40, if there is a family history, and those with anxiety and stress. The same is true for children, but may include a history of gastroenteritis, or food poisoning. The cause is not well-defined. Normally, the muscles of your intestine contract and relax in rhythm, but in IBS the contractions may be stronger and longer, resulting in diarrhea, or weaker and slower, resulting in constipation. Poor communication between your brain and your intestines can lead to a change in reaction time while you are digesting.

Possible causes include anxiety, stress, hormones, laxative abuse, food or drug allergies, and lactose intolerance. Also, diet seems to be a large factor, such as fiber, raw fruit, coffee, alcohol, spicy or highly seasoned foods, and cold foods. Additional symptoms include abdominal pain, stools that are very thin and pencil like, heart burn, mucus on stool, bloating, gas, fatigue, and weakness. Tests include checking stool for blood, parasites, or bacteria, blood tests, lower GI test, where you swallow a liquid barium and have x-rays, and a sigmoidoscopy. Complications of IBS includes inflammation of hemorrhoids, and malnourishment. In children seek medical attention if growth is poor, rectal bleeding, abdominal pain, difficulty swallowing, or if having vomiting or diarrhea at night.

Immediate treatment includes stress management, and change of lifestyle. Dietary changes which are based on patient’s symptoms. A food log will help identify foods that cause symptoms. List what you ate and symptoms appearing after your meal. Slowly add foods to your diet to allow yourself to adjust. If you have cramps or diarrhea try to stick with a low fat, high carbohydrate diet. Avoiding high gas foods such as cabbage, broccoli, cauliflower, and raw fruit. Fatty foods, chocolate, alcohol, caffeine, and carbonated drinks. Lactose containing foods, such as milk and cheese should be avoided, as well as certain grains. For children avoid foods, and drinks with sugar. Also, do not let your child eat large meals. Increasing dietary bulk with supplements, and fluid intake help manage symptoms. Medications include supplements in high fiber to control constipation, such as, psyllium (Metamucil), methyl cellulose (Citrucel), Milk of Magnesia (MOM), and polyethylene glycol (Miralax). Hyoscyamine (Levsin), and dicyclomine (Bentyl) help stop spasms. Loperamid (Immodium) helps stop diarrhea. Other meds that can be used are laxatives, and meds to treat nausea. For anxiety and stress mild tranquilizers and/or an antidepressant may be prescribed. Aloestron (Lotronex), and Lubiprostone (Amitiza) are new medications on the market and are treatments currently geared towards women. Seek immediate medical care if you have rectal bleeding, continuous abdominal pain, and weight loss.

Resources
http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/definition/CON-20024578

http://www.webmd.com/ibs/tc/irritable-bowel-syndrome-ibs-treatment-overview

Cold Sores, Herpes, Shingles. Oh My!

Copyright © 2006, John Pozniak

The Web MD reports Cold Sores affect 90% of the world. A cold sore is a Cluster of tiny blisters, usually on the lip, that burst, drain, and then crust over, and is caused by Herpes Simplex Virus I. Symptoms include fever, red, swollen, painful blister, and swollen lymph glands. Healing time usually takes place within 2 weeks. Transmission occurs through contact with a sore through kissing (saliva), sharing eating utensils, razors and tooth brushes from an infected person. There is no cure. Exposure to sunlight or wind, stress, immunocompromised, before onset of menstruation, fatigue, colds, flu, can increase the risk of an outbreak. Prevention techniques include avoid touching, sun-sunscreen, wash hands often. Cold sores can be contagious even if you don’t see them. Treatment options are limited as they can heal on their own, but antivirals can speed up their healing, and NSAID’s can be taken for pain. Seek med care if you have a weak immune system, sore that doesn’t heal within 2 weeks, increased frequency of cold sores, and irritation to eyes.

Genital Herpes is a common STD caused by Genital Herpes II. The Mayo clinic reports they appear as small, red bumps or tiny white blisters that are painful, itch, or sore or you may not have any symptoms. After the first infection, the virus becomes dormant, but can reactivate at any time. There is no cure. Antiviral medication can decrease the symptoms and speed recovery. To prevent transmission from your infection use condoms. Risk factors include having multiple partners, or another STD’s. Genital herpes causes increase risk of transmission to newborns, bladder problems, meningitis, and rectal inflammation. There are three ways to diagnose. One is having your doctor perform a viral culture of the sore itself. Second is having a test called a PCR, which tells you the type of herpes you are infected with. Finally, a blood test can tell you if you have had genital herpes in the past. Treatment includes a prescription for an antiviral medication such as Acyclovir, Famciclovir, Valacyclovir. Pregnant women should discuss a C-section to prevent infection to newborn.

Shingles is a viral infection that results in a painful rash, caused by Varicella Zoster or Herpes Zoster Virus. It is the same virus that causes the Chicken Pox. The virus lies inactive in nerve tissue near your spinal cord and brain. When it reactivates it does so in the form of shingles. Shingles can last 2-6 weeks. Symptoms include pain, burning, numbness, and tingling, sensitivity then red rash, fluid filled blisters that open and drain a clear liquid and then crust over. Other complaints noted are fever, headache, sensitivity to light, and fatigue. Shingles can spread if person has never had the chicken pox and had direct contact with the sore. Shingles is dangerous to those with weak immune system, newborns, pregnant, over 50, HIV, cancer, and organ transplant. Complications are post herpetic neuralgia- damaged nerve fibers, well after blisters have cleared. Vision can be affected if shingles develops in the eye. Brain, facial paralysis, hearing, balance can cause neurological imbalance. Bacterial infections can occur when shingles appears on the skin.
Treatment includes antiviral medication, pain medication, such as capsaicin cream, gabapentin, lidocaine gel or cream, or narcotics.

The CDC reports the Shingles Vaccine reduces shingles 51%, and reduces post herpetic neuroglia by 67%. They
Recommend the vaccine if you are over 60 with or without history of chicken pox to prevent future occurrences. The vaccine protects for 5 years. FDA has approved the vaccine for over 50, but insurances may not cover. Avoid the
vaccine if you are allergic to gelatin, neomycin, weak immune system, or are pregnant. This is a live vaccine.

Throat Infection vs. Strep Throat

A throat infection, also known as pharyngitis, can occur in the throat and tonsils. Throat infections are most commonly caused by the common cold, and do not require an antibiotic to treat.  Another virus that can cause throat infection is Mononucleosis, which is mostly seen in young people. Symptoms include a sore throat, fever, lymph gland tenderness and swelling around your neck and throat.  A blood test, known as a Mono spot, can diagnose.  Antibiotics are not the treatment.  Additional conditions that can cause throat infection is dry air, smoking, post-nasal drip, allergies, singing, yelling, and sexually transmitted diseases such as gonorrhea.

The CDC reports Strep pharyngitis is caused by Group A Strep bacteria. It can be easily transmitted to others, and highly contagious via droplets from cough, sneeze, or sharing personal objects like cups, tooth brushes, etc.  Symptoms include sore throat, painful swallowing, fever, headache, swollen lymph glands, nausea, vomiting and stomach ache.  Redness to the throat and pus on tonsils may be noted upon examination.  Testing can be done via rapid strep test, or a throat culture.

The Mayo Clinic reports the treatment of choice is antibiotics such as penicillin or amoxicillin. If the individual is allergic to penicillin, they can be given Keflex, Zithromax, Biaxin, or Clindamycin.  Warm broth or apple juice, throat lozenges, gargling 1 tablespoon of salt with warm water can provide some comfort.  For pain and fever, Acetaminophen, Ibuprofen, or Naproxen can be bought over the counter.  Additionally, it would help to eat soft foods, drink plenty of fluids, and rest.  Avoid smoking to reduce irritation to the throat.  A humidifier can moisten the air to reduce irritation from dry air. Also, change your toothbrush to prevent re-infection.  Make sure to perform frequent handwashing to prevent spreading, as well as covering your mouth and nose when coughing or sneezing.

Seek immediate medical care if you are struggling to breath, drooling, spitting out saliva because you can’t swallow, unable to open your mouth completely, high fever, severe sore throat (could be tonsil abscess), wide spread rash (rheumatic fever), or ear pain. Strep infections can affect the tonsils, sinuses, skin, blood, middle ear, and kidneys. Complications include tonsil abscess, rheumatic fever, and kidney infection.

You can return to work or school after 24 hours fever free, and on the antibiotics for at least 24 hours.

 

Bursitis vs. Tendinitis

The bursa is a fluid filled sac that provides cushions and protects areas between the joints, muscles and bones of your body from frequent movement. When the bursa is inflamed it is called Bursitis.

Symptoms of bursitis include pain, stiffness, redness, warmth and swelling as fluid builds up in the sac. Pain often continues even at rest, and if the area becomes infected, fever and chills.  The joints of the knees, elbows, hips, and shoulders are most often affected. Bursitis is caused by an injury, such as a direct impact from a fall, or repetitive use of a joint.  Sometimes infection and diseases can cause the bursa to become inflamed, such as gout and rheumatoid arthritis.

Those at greatest risk for getting bursitis are those who have a job or activity that has repetitive movements to the same joint of your body, those who have suppressed immune system (diabetics, cancer), lift their arms over their heads frequently, lean or kneel on hard surfaces often, run, or walk often.

Treatment for mild cases of bursitis is R.I.C.E. or rest, ice, compression, and elevation. Moderate to severe cases may require NSAID’s to treat pain, and inflammation. Corticosteroids may be injected in and around the bursa for inflammation and improve movement.  If there is an infection, an antibiotic is given.  Physical therapy may suggest splinting or a brace to support the injured area.  If the case is severe, surgery may be required to remove the bursa.

If you are prone to getting bursitis, do your best to prevent yourself from another painful episode. Wear knee pads if you kneel often, avoid or take frequent breaks from repetitive activities. Warm up before exercise.  Seek medical attention if you develop fever or chills, or home treatments are not working.

The tendon is a strong rope of tissue that attaches muscle to bone. When the tendon is inflamed it is called Tendinitis.  The most frequent tendons affected are those of the shoulder (rotator cuff), ankle (Achilles tendon), elbow (triceps tendon), and any one of the wrist tendons.

The most common cause of tendinitis is repetitive use of a tendon or muscle. Additional causes include injury, ageing, wear and tear, arthritis, and some medications. Symptoms include pain, swelling, and tenderness. Treatment is the same as for bursitis.  Seek medical attention if you do not improve with home care or if you develop numbness or tingling to the extremity near the injury.

Aspirin and your Heart

Aspirin is an anti-inflammatory and anti-platelet drug, and is used to treat pain, fever, blood clots, heart attacks, and strokes.

The benefits of taking aspirin daily include if you:

Have had a heart attack or chest pain

Had open heart surgery

Had coronary angioplasty

Had a stroke or TIA (Transient Ischemic Attack)

Have peripheral vascular disease (PVD)

Have heart rhythm problems, such as atrial fibrillation (A.Fib)

Risks of taking aspirin every day include minor bleeding or bruising, worsening of asthma, upset stomach, or allergic reaction. Children should not be given aspirin due to the risk of Reye’s syndrome (rapidly progressive brain dysfunction).  Contraindications for use of aspirin include allergies to NSAID’s, peptic ulcers, GERD or gastritis, hemophilia, kidney disease, and gout.

There are 2 forms of aspirin you can take. Please ask your doctor which is best for you. The first type is called non-enteric coated.  This means the aspirin does not have a protective coating that keeps your stomach from being upset, but is best to take when having active chest pain.  This type comes in a chewable form.  The enteric coated aspirin has the protective covering that keeps your stomach safe.  This type cannot be chewed or crushed.  Do not take any aspirin with alcohol as it increase chance of bleeding and stomach distress.

Please seek immediate medical attention if you have an allergic reaction, stools are black or bloody, vomit or cough up blood, there if blood is in your urine or you feel shortness of breath.

 

Information obtained from Elsevier Interactive Patient Education, Elsevier Inc. (2017).

The Importance of Vitamin D

Vitamin D is very important because it helps your body metabolize calcium and phosphorous (muscle, bone, and dental health), thought to support your immune system; prevent diabetes and multiple sclerosis, and functions of the heart. When there is not enough vitamin D you have Vitamin D Deficiency.

You can get vitamin D from milk, and other dairy foods, a Vitamin D supplement, and being in the sun.   When you have a severe deficiency of Vitamin D your bones can become soft.  In adults this is called osteomalacia, and in children rickets.  Research is showing vitamin D supplements can prevent multiple sclerosis (MS) or keep symptoms of it from worsening. They have found the farther away a person lives from the equator the greater the chance they will have MS.

Deficiency can be caused by a poor intake of foods having vitamin D, not enough sun exposure, digestive disorders that cause poor absorption of vitamin D, such as Crohn disease, pancreatitis, and cystic fibrosis. Deficiencies can also be caused by being overweight, having stomach or small intestine surgery, and having kidney or liver disease. Breast fed babies are also at risk for deficiency.

Those at greatest risk are the elderly, those who do not expose themselves to the sun, those with broken bones, those with osteoporosis, those who have a disease of condition that prevents proper absorption of vitamin D, dark skinned people, those on steroid and seizure medications, and those who are overweight.

Symptoms include bone, and muscle pain. Frequency of falls, bone fractures, abdominal pain, nausea, vomiting, and constipation. Deficiency can be diagnosed by a blood test.  Test results differ in males and female.  The optimal range for Women is 18-78 pg/ml, and Males 18-64 pg/ml per the 1,25-dihydroxyvitamin D test.  For the 25-hydroxy D test 20-30ng/ml indicates insufficiency, while less than 20 ng/ml is deficiency.  Over 30ng/ml is considered optimal for this test.  High levels of Vitamin D can be seen in those over taking supplements, hyperparathyroidism, high calcium levels, kidney stones, sarcoidosis and kidney disease.

Treatment includes improving diet with foods that contain vitamin D (fortified dairy, cereal, juice, fish, and eggs), Infant formula, and dietary supplements of vitamin D and calcium. Exposure to sunlight is important, but use caution to prevent sunburn or if you are at risk for skin cancers. Using a tanning bed is not recommended. If found to be deficient the treatment for an adult is typically vitamin D 50,000 IU three times a week for three months and then a daily over the counter daily use of up to 4,000 IU once daily. For healthy individuals that have normal vitamin D levels, daily International Units or IU’s recommended are as follows:

Infants: 400 IU once daily

Children (>1 year old): 600 IU once daily

Adults: 600 IU once daily

Elderly: 800 IU once daily

Pregnant and breast feeding: 600 IU once daily

Each of these is to be taken with your largest meal of the day for the best chance of absorption.

Talk to your primary care physician to get tested.

Lyme Disease

Lyme disease is an infection caused by bacteria called Borrelia burgdorferi. An infected tick transmits the bacteria to its victims by biting.  The tick must be attached to your skin for 36 hours or more for transmission of bacteria to take place.

A circular rash surrounding the tick bite is the first sign of infection, and can appear up to 30 days after tick removal. Additional symptoms include flu-like symptoms, fatigue, headache, chills and fever, generalized body aches, joint pain, and swollen lymph glands.

States with the most frequent exposure to these ticks are the New England, Mid-Atlantic States, and the Midwest. These ticks are often found on deer and like wooded, grassy areas. Lab tests can confirm diagnosis but must be several weeks into the infection so the body has time to develop antibodies.

Treatment of choice is an antibiotic, which may have to be taken for several weeks. The most common antibiotics used are amoxicillin, and cefuroxime. Treatment is more effective if started early. If the infection is serious, IV antibiotics may be needed.  Reinfection is possible with another tick bite by an infected tick. If left untreated, neurological problems can develop, including meningitis, and heart rhythm disturbance.

To prevent a tick from attaching itself to your skin wear clothes that covers your skin. Spray your skin and clothes with an insect spray that contains 20-30% DEET.  Try to stay away from wooded, grassy areas.  Check yourself and your pets for ticks when you return indoors. If you find a tick remove it with tweezers near the head.

Make sure you seek medical attention if you start having symptoms after a tick bite, you have an irregular heartbeat, nerve pain, and your face feels numb.

 

Dehydration!

Dehydration occurs when you use or lose more fluids than you are taking into your body. This results in your body not being able to perform its usual functions that require proper fluid intake.  If you don’t replace these fluids, you become dehydrated.  We lose water and salt daily through vapor from breathing, sweat, urine, and stool.

Causes include poor fluid intake due to illness or mouth sores, or nausea, intense physical activity,

hot weather, severe diarrhea or vomiting, fever, sweating, poor fluid intake with increased activity and hot weather, and increased urination due to a medical condition such as diabetes or medications.

Symptoms

Mild to Moderate symptoms include dry, sticky mouth, thirst, decrease in urination, fatigue,

no wet diapers for at least 3 hours, few or no tears when crying, dry skin, headache, constipation, dizziness, and muscle cramps.

Severe symptoms are considered a medical emergency. If you experience great thirst, are irritable or confused, feel weak, have a very dry mouth, little or no urination or sweating, eyes look sunken in, a

low blood pressure, rapid heart, rapid breathing, tenting of skin, fever, fainting, and a swollen tongue, you need immediate medical attention.

Complications of dehydration include heat exhaustion or heat stroke, swelling of the brain, seizures, low blood volume shock (Hypovolemic Shock), kidney failure, coma and death.

Treatment for kids includes small frequent sips of rehydrating solutions, such as Pedialyte, popsicles, and water.  In adults, Gatorade, PowerAde, water, and ice chips are effective.  Additionally, wearing

loose clothes, air conditioning, fans, cool wet towels, spray bottle with water, avoid alcohol, caffeine.

You can also break up exposure to heat by spending 10-20 min in heat then going inside to get cool.

Milk, caffeinated drinks, fruit juices and gelatins don’t relieve dehydration and can worsen diarrhea.

Heat Exhaustion!

When it is hot outside your body cools itself by sweating. Your body cools as the sweat evaporates from your skin.  But if you are overexposed to heat or are doing strenuous physical activity your body loses its ability to cool itself properly.  This is called heat exhaustion. This can be caused by loss of water and electrolytes through sweating as a result of hot, sunny, humid weather, and physical exertion in that weather.  Elderly and children are at greater risk due their body’s inability to regulate body temperature, and lack of cool air. Drugs, such as, ecstasy, cocaine and amphetamines, can cause rapid rise in body temp.

Symptoms of heat exhaustion include, nausea, dizziness, irritability, headache, thirst, weakness, high body temperature, excessive sweating, decreased urine output, confusion, vomiting, muscle cramps, which is related to low blood sodium and potassium.

Heat exhaustion can occur in the elderly because they are less likely to drink enough fluids or sense significant changes in temperature. Heat exhaustion in kids can occur as babies and young kids are very sensitive to extreme heat.  Keep cool and hydrated. Don’t leave them in the car, even with the window open.

Treatment- When the temp is over 91 you need to take precautions

  1. Go to a cool area
  2. Remove layers of clothes
  3. Fanning and wet towels
  4. Dizzy may be related to low BP, so lay down and put your feet up
  5. Drink water or sport drink, and sip slowly
  6. If you have continuous vomiting get medical attention immediately

Heat exhaustion can progress to heat stroke, which is a medical emergency.

Heat Stroke (Sun Stroke) occurs when there is a high body temp of 103 or higher. It is considered hyperthermia without fever.  Symptoms include hot, red, dry or moist skin, rapid and strong pulse, and loss of consciousness.  Call 911, move person to cool area, cool person down with cool cloths or bath, DO NOT GIVE FLUIDS.

Those at risk for heat stroke are those wearing dark, heavy, padded clothes, and over dressing, has a high percentage of body fat, dehydration, Fever, beta blockers (cardiac medication), antipsychotic medication, alcohol and caffeine.

The most important thing to remember is to not wait until you are thirsty to drink fluids.

Managing your Sunburn!

Sunburn is radiation burn due to overexposure to Ultraviolet (UV) radiation mostly from the sun or sun tanning.  Too much exposure can be dangerous, but a lesser amount of exposure would lead to a tan.  Sunburns are considered a superficial burn.  Extreme burns can result in hospitalizations. Sunburns can occur in less than 15 min.  Some medications can create greater sensitivity to UV radiation, such as, antibiotics, birth control pills, and tranquilizers.

Suntan is a result of slight to moderate exposure that causes a release of melanin, a protective pigment that is the skin’s natural defense against overexposure.  Suntans are viewed as exotic and desirable.  Repeated extreme exposure over time can lead to damage to your DNA and skin tumors, dry wrinkled skin, dark spots, and freckles.

Those with the greatest risk for skin burns are those with fair skin, living or on vacation somewhere sunny or at a high altitude, work outdoors, and participate in outdoor recreation.

UV Index is the risk of getting sunburn at a specific location and time of day, such as:

  1. Time of Day 10 AM-4 PM- sun’s rays are at their strongest
  2. You can even get burn on cloudy days
  3. Reflective surfaces, such as, snow, ice, water, and concrete
  4. The position of the sun, which is greatest late spring and early summer
  5. The higher the altitude the greater the risk of a sunburn.
  6. Proximity to the equator- closer you are to the tropical regions of the planet 50% greater chance of getting sunburn.
  7. Incidence and severity of sunburns have increased worldwide because of damage to the ozone layer of the planet due to ozone depletion.Complications include skin cancers (Melanoma, basal-cell carcinoma, squamous cell carcinoma), and sunburn to the corneas of your eyes.
  8. Appearance of sunburns include red skin that feels hot is caused by the increase of blood to the area to heal the burn. Also there is pain, fatigue, dizziness, swelling, itching, and peeling skin, rash, nausea, fever, and chills. Fluid filled blisters that can burst and become infected. After exposure, skin may turn red from 30 min to 2-6 hours. Worst of the pain is 6-48 hours after exposure. The burn continues to progress for 1 to 3 days. Skin peeling can last about 3-8 days.

Prevention is the Key:  use hats/caps, clothes that cover arms and legs, and use wraparound sunglasses.

Moderate sun tanning without burning can prevent sunburn. A diet rich in vitamin C, and E can help reduce the amount o sunburn.  Beta-carotene (Vitamin A) helps protect against sunburn.  Protect your skin with sunscreen or sunblock.  The higher the SPF the less the DNA damage is to the skin.  Sunscreen helps prevent some forms of skin cancers. Apply 30 min before exposure and 30 min after exposure, and any time you get wet.

Treatment options include

  1. Pain medication- ibuprofen, naproxen
  2. Corticosteroids- for itching
  3. Cool the skin- cool compresses, cool shower
  4. Moisturizer- aloe vera, hydrocortisone cream
  5. Don’t break blisters- it is a protective layer, and breaking it will slow healing. If it breaks clean with soap and water and apply antibacterial cream and cover with a wet dressing.
  6. Drink plenty of water
  7. Avoid further sunlight
  8. Products that contain benzocaine can irritate the burn and cause allergic reaction.

4 Types of Travel Notices that Can Save Your Life!

The CDC provides travel health notices for travelers regarding possible health issues at their destination site. Health issues at any destination can be created by severe weather (floods, hurricanes, etc.), no power resources available, no potable (drinkable) water, insect or animals, outbreaks of diseases or wars.  The CDC provides a travelers health page, as well as the US Department of State on their Travel Alerts and Warnings page.  For weather conditions, visit the NOAA International Weather Selector page.

4 Types of Notices

Watch A (Level 1) notice encourages travelers to practice usual precautions, such as, vaccinations, hand washing, and avoiding mosquitoes.

Alert (Level 2) notices encourage travelers to practice enhanced precautions, such as, additional vaccinations, and monitoring for local disease outbreaks.

Warning (Level 3) notices encourage travelers to avoid non-essential travel because they are at risk for exposure, such as, a large scale outbreak, war.

Avoid (Level 4) notices instruct travelers to avoid all travel due to dangerous situations that can put their life at risk.

Safety Considerations

Animal safety, such as, exposure to bites, scratches, saliva, and fecal/urine from cats, dogs, bats, rats, and insects, can result in long term or permanent illness or death. Rabies is still a very common infection around the world.  Insect bites from fleas, flies, mosquitoes, ticks, and bed bugs can cause a host of infections from mild to serious.

Hypothermia and frostbite can be acquired from destinations with cold weather.

Sun or heat exposure from hot weather destinations and UV rays can cause sunburns, and heat stroke.

High altitudes can cause altitude sickness which can then result in flu like symptoms, carbon monoxide poisoning, pulmonary and cerebral edema. High altitudes have a low pressure of oxygen that affects humans more than animals.

Natural disasters can cause injury by blunt trauma, drowning, and crush related deaths.

Food and water safety is crucial to the traveler. Fresh cold pasteurized milk, alcohol, and steaming hot drinks and food should be safe.  Heat kills germs.  Bottled and canned water and drinks are safe if the traveler opens them.  Buffets can lose heat and get contaminated.  Dry or packaged foods are usually safe as long as it is not handled by others.  Avoid raw food, street food, and bush meat as Ebola and SARS can be spread to the traveler. Tap water is risky for drinking, showering, and brushing teeth. Fountain drinks and ice are also risky.  Fresh juice is safe if washed in safe water and squeezed by you.

Heartburn!

Heartburn, or acid indigestion, is a burning sensation mid chest that worsens when you bend over or lay day. It usually occurs after eating and at night.  It is caused by reflux. Reflux occurs when the acid in your stomach backs up into your food pipe (esophagus), resulting in inflammation.  It is considered a disease when you have symptoms more than 2 times a week.

Gastroesophageal Reflux Disease (GERD) is a condition of digestion that allows stomach acid to go up the esophagus due to a weakening of the muscle at the point where the esophagus ends and your stomach begins. GERD often interferes with routine daily activities, and result in damage to your esophagus.

Symptoms- heartburn, vomiting or spitting up blood, bitter taste in mouth, burning chest pain, dry cough, painful throat, painful swallowing, and hoarse voice.

Complications- scarring of esophagus, bleeding in stomach or esophagus, ulcer formation in esophagus or stomach

Risk Factors

Spicy or hot foods

Alcohol, soda, caffeine

Fatty foods

Gassy foods (certain vegetables)

Pregnant

Obese

Smokers

Abdominal hernias

Treatment for GERD

Antacids– help to neutralize the acids in your stomach, but will not treat the inflammation of the esophagus. Over use can cause constipation and diarrhea.

Gaviscon

Tums

Maalox

Mylanta

Rolaids

Histamine-2 (H2) Blockers -Reduce production of acid in stomach. May not be as good for treating esophagitis (inflammation that occurs in the esophagus). Histamine stimulates acid production, especially after meals, so H2 blockers are best taken 30 minutes before meals. They can also be taken at bedtime to suppress nighttime production of acid. Examples of prescription H2 blockers:

Nizatidine (Axid)

Famotidine (Pepcid)

Cimetidine (Tagamet)

Ranitidine (Zantac)

 

These drugs are useful at relieving heartburn, but may not be as good for treating esophagitis (inflammation that occurs in the esophagus).

Side effects can include headache, abdominal pain, diarrhea, nausea, gas, sore throat, runny nose, and dizziness.

Proton Pump Inhibitors (PPIs)

Drugs that block acid production more effectively and for a longer period of time than the H2 blockers, PPIs are best taken an hour before meals. They include:

  • Rabeprazole (Aciphex)
  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec, Zegerid)
  • Pantoprazole (Protonix)
  • Dexlansoprazole (Dexilant)

Many doctors do not believe that one drug is more effective than the others in treating GERD. These medications are also good for protecting the esophagus from acid so that esophageal inflammation can heal.

Side effects can include headache, diarrhea, abdominal pain, bloating, constipation, nausea, and gas.

Home Care

Avoid eating foods and drinks that trigger heartburn. fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, citrus fruits (Pineapple, strawberries), vinegar, foods that can cause gas (peppers, cabbage,) and caffeine may make heartburn worse.

Do not over eat.  Try eating smaller frequent meals.

Do not lie down after a meal, and wait 2- three hours after eating before lying  down or bending over

Elevate the head of your bed

Do not smoke.

Avoid medications that can irritate your stomach, like NSAID’s (Aspirin, Aleve, Ibuprofen)

Weight loss may help to reduce abdominal pressure pushing acid into the esophagus

Avoid wearing tight clothes

Seek medical attention if symptoms occur for more than 2 times a week, and over the counter medications do not help, if you have difficulty swallowing, nausea, vomiting, or weight loss.

6 Key Symptoms of Asthma

The Mayo Clinic defines Asthma as “…a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult…” The Environmental Protection Agency (EPA) reports there are 24 million people with Asthma, 6 million of which are children. Over 14 million doctor office visits were related to asthma, and 1.8 million emergency department visits.

6 Symptoms Key to Asthma

1. Wheezing
2. Cough
3. Frequent episodes with difficulty breathing or shortness of
breath, with or without wheezing.
4. Frequent episodes of chest tightness.
5. Symptoms worsen when exposed to respiratory irritants, such as
cigarette smoke, pollen, animal fur, exercise, etc.
6. Symptoms worsen at night.

Asthma is a controllable condition through an action plan. According to the National Heart, Lung, and Blood Institute, and the National Asthma Control Initiative the goal of therapy is control by prevention of asthmatic episodes. An action plan allows asthmatics to be healthy, and active, and involves:

a. Following your treatment plan prepared by your medical doctor.
b. Managing environmental triggers.

Knowledge is power!
It is important to be aware anxiety does not cause asthma. Asthma is caused by an inflammation. Asthmatic medications do not cause addiction. Asthmatic medications do not lose their effectiveness over time. Never delay starting treatment to see if the asthma will improve by itself. Always check you have enough medication left in the inhalers, as well as for expired dates. Corticosteroids are safe, and are not the same as anabolic steroids. Watch for asthma triggers such as respiratory irritants (pollutants, second hand smoke, flu, etc.) that can worsen symptoms. Rinse mouth after using inhaled medication. No eating peanut butter.
Daily control is demonstrated by good breathing, no cough or wheeze, being able to have a good night sleep, and the ability to play and exercise. If you have cough, mild wheezing, chest tightness, especially at night use your quick relief medication. If your symptoms are not controlled within 20 minutes or after 2 efforts of quick relief, call your doctor or go to urgent or emergency care. If quick relief medication is required more than 2 times a week, then call your doctor. Do not wait to get emergency help if you are breathing hard and fast, your nose is flaring, your ribs are moving deeply in and out, you have difficulty walking and talking, you have blue lips, fingernails or earlobes. Get the flu vaccine every year.