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.

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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.

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.

 

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.

What Type of Headache do You Have?

When you are looking at headaches, it is important to look at location, quality, severity, duration, and unique features of that headache. There are many types of headaches.  They are caused by cough, cranial nerve inflammation, infection, Injury, substance abuse, bone structure of the head or face, blood flow to and from the brain, changes in brain chemistry, tumors, and seizures.

Ice cream headaches cause brief, stabbing head pain when you eat, drink, or inhale something cold. “Brain Freeze” occurs when the blood vessels constrict (narrow) to prevent heat loss, and then dilate (open)to let blood flow rise.

There are 4 Main Types of Headache:

  1. Sinus– Sinus infections may erode through the bones of the sinus and structures in the face. The pain and tenderness is frontal, at the brow, and/or below or behind the eye. The sufferer may also experience bilateral pressure and fullness of cheeks, fever, fatigue, sore throat, cough, and decrease ability to smell.
  2. Cluster– is a stabbing or sharp pain, which may cause swelling around eyes or to eye lids. Cause is unknown
  3. Tension– This type of headache may be caused by fatigue, bad body posture, stress, and extreme exertion. The discomfort felt is bilateral head tightening. Complications include dependence on analgesics, and the risk of epilepsy is 4 times greater.
  4. Migraine– tends to start in childhood or adolescence. Women are 3 times more likely to get a migraine headache. Menstrual migraines are often treated by taking oral contraceptives. Researchers find there may be an imbalance of the brain chemical- serotonin. Complications include chronic migraines, seizures, migraine infarction (symptoms of stroke with blood loss to an area of the brain), medication over use (rebound headache), and abdominal complaints. Serotonin syndrome is when the body has too much serotonin due to taking migraine meds along with antidepressants called SSRI’s (Zoloft, Prozac, Paxil) or SNRI’s (Cymbalta, Effexor). There is a genetic predisposition to migraines. 80% of migraine sufferers have a family history.                                                                                                              Migraines have 4 phases:
  1. First- Pro-drome- up to 48 hours before the migraine. The sufferer may experience emotional changes, yawning, urinary frequency, fluid retention, stiff neck, and thirst or food cravings.
  2. Aura-warning, flashes of light or wavy vision, tingling on one side of face or body, speech disturbance.
  3. Headache- Throbbing, sensitive to light, noise, odors, movement, nausea, vomiting, blurred vision. Severe, debilitating head pain.
  4. Post-drome- after pain resolves, fatigue, irritability, euphoria that lasts a day or longer, and feels drained.
  1. Seek immediate medical attention:Sudden, severe headache that feels like a thunderclapHeadache after a head injuryNew headache after the age of 50.
  2. Persistent headache after straining, or exertion
  3. Headache with fever, seizure, confusion, difficulty speaking, double vision, numbness.
  4. THE WORST HEADACHE OF YOUR LIFE- This is a medical emergency and needs Emergency Room evaluation.
  5. Triggers- foods that contain tyramine-in aged foods like deli meat, aged cheeses, avocado, bananas, dried fruit. Foods that contain MSG. Also, chocolate, aspartame, beer, and wine. Environmental- stress, irregular sleep patterns, odors, weather changes, bright light. Women- notice migraine pattern with hormonal changes, and worsens at time of period, and improvement during pregnancy and menopause.
  6. Treatment works best when symptoms are treated early. Medication over-use headaches can occur when treatments for more than 3 days a week. Over use can worsen an underlying condition and decreases response to treatment. Prevention Treatments- for 1 or more headaches a week or for those with severe headaches that interfere with normal activities. Useful for 6 months and then begin to taper.
  7. Natural remedies to prevent headaches include Vitamin B2, Magnesium, Co-enzyme Q10, butterbur, and feverfew. First check with your doctor as there may be drug-drug interactions with other medicines.
  8. Diagnosis- Blood Tests and Spinal Tap to look for infection or toxins, CT Scan and MRI to look for tumors, infection, brain damage, and bleeding.
  9. Treatment:
  1. Pain- Relief
  1. Aspirin, Acetaminophen, Ibuprofen, Excedrin, indomethacin.  Use with caution as over use can cause liver and kidney damage.
  2. Triptans- block pain in the brain, constrict blood vessels. Pill, Nasal spray, injection. Imitrex, Maxalt, Axert, Amerge, Zomig, Frova,Treximet (Imitrex with Naproxen), and Relpax. Side effects: nausea, dizzy, drowsy, muscle weakness. Do not take if at risk of heart attack or strokes.
  3. Ergots- Ergotamine and Caffeine combination- can cause nausea and vomiting, Migranal- ergot derivative with less side effects than ergotamine, and people respond better to it. It comes in nasal spray and injection.
  4. Anti-nausea- helps to take with migraine medication
  5. Opioid meds- narcotics, but are habit forming.
  6. Glucocorticoids- prednisone or dexamethasone
  7. Pain- Prevention- reduces the frequency, severity, and length of migraine.
  8. Cardiac drugs- beta blockers- Inderal, Lopressor, betimol. ACE Inhibitors- lisinopril,  calcium channel blockers- calan
  9. Anti-depressants- amitriptyline, Effexor
  10. Anti-seizure- Topamax
  11. Botox- injected every 12 weeks.
  12. Alternative Medicine
  1. Acupuncture, biofeedback- how to control physical responses to stress, massage therapy, cognitive behavioral therapy- teaches you how behaviors and thoughts affect how you perceive pain.
  2. Herbs, Vitamins, Minerals
  3. Muscle relaxation exercises- meditation or yoga, Reduce Stress
  4. Get enough sleep
  5. Rest and relax- dark quiet, cool room
  6. Headache diary, don’t skip meals
  7. Preventive therapies-
  1. Transcutaneous supraorbital nerve stimulation (t-SNS)- FDA approved
  2. Learn coping strategies.
  3. Consistent daily schedule with sleep, meals, and medications
  4. Reduce intake of estrogen

11 Ways to Treat Bell’s Palsy

Bell’s palsy is defined as one sided facial paralysis due to an inflammation of the 7th cranial nerve of the face, that results in weakness or paralysis of the muscle on the affected side. The inflamed and swollen nerve becomes so compressed that it becomes damaged.

Bell’s palsy has a rapid onset, there is a slower recovery in elderly patients. There is complete recovery in majority of patients. Partial recovery can occur if contractures (tightening) occur on the affected side of the face. It may recur, but this is rare.

Up to 40,000 Americans a year get Bell’s Palsy. It can affects any age. The most susceptible are pregnant women, those who have diabetes, the flu, and a cold or other respiratory conditions.

The cause is unknown, but may be related to vascular ischemia [decreased oxygen to tissue causing damage to tissue], a virus (herpes, chicken pox, Flu, Measles, Mononucleosis), Lyme’s disease, tumors, a bacterial infection, or autoimmune disease that cause inflammation to the nervous systems (Multiple Sclerosis).

Characteristics include tearing of the affected eye, painful sensation to the face, pain behind the ear, pain in the eye, difficulty speaking and eating on the affected side, drooping eye, difficulty opening and closing eyelid on the affected side (can cause corneal ulceration due to drying of the eye), drooping of face and lips on the affected side, change in taste, sensitive to sound, drooling, and headaches.

Diagnosis is based on the characteristics mentioned, MRI or CT scans to rule out a tumor or other pressure to the facial nerve as the cause. An Electromyography, a test for nerve damage and to test for severity, can also be performed.

The goal of treatment is to maintain facial muscle tone and prevent further nerve damage. This is not a stroke and recovery can take 3 weeks to several months, and in a few up to a year.
1. Corticosteroid (prednisone) help to reduce inflammation and swelling, which then reduces compression to nerves and blood vessels. This helps to decrease severity of the paralysis, decrease pain, and prevent permanent nerve damage.
2. Remove the cause of the damage to the nerve, such has a tumor.
3. Oral care is important to prevent cavities.
4. Protect eyes from dryness with sunglasses and natural tears eye drops
or wear an eye patch at night.
5. Take pain medication such as Acetaminophen or NSAIDS (Ibuprofen, Aleve).
6. It is rare but surgery may be necessary to decompress the nerve
7. Gentle facial massages, and facial exercises to maintain muscle tone.
Physical therapy can help return muscle functioning.
8. Apply moist heat to relieve pain
9. Emotional support due to change in body image
10. Alternative therapy: L-lysine 500-1000 mg daily, and Vitamin B12 5000
once a day, help to heal nerve damage
11. Antivirals can be prescribed by your doctor.

Seek immediate medical attention if you ever have paralysis to rule out stroke.

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.