Month: August 2016

Arthritis is simply defined as joint inflammation.  Though commonly associated with the elderly, arthritis affects people of all ages, with nearly two-thirds of those affected being under the age of 65.  Arthritis occurs slightly more commonly in women, and affects all races and ethnicities.

Symptoms.  The most common symptoms of arthritis are pain, aching, stiffness, and swelling in or around the joints.

Risk Factors.  Risk factors of arthritis include increased age, female gender, family history, being overweight, and a history of joint injuries.  Additionally certain occupations that involve repetitive knee/back bending and squatting (such as construction), may also increase your risk of arthritis.

Diagnosis.  Arthritis is diagnosed using the patient’s history, a physical exam, X-rays, and bloodwork.  Early diagnosis and treatment initiation is important to maintaining a good quality of life, so if you notice pain, stiffness, or swelling in your joints be sure to talk to your doctor as soon as possible.

Nonpharmacological Management.  Physical activity decreases pain and improves function.  Anyone with arthritis should strive for 150 minutes of mild/moderate exercise each week.  Additionally, maintaining a healthy weight can limit the severity of the disease.  Some people also find physical therapy and assistive aids such as braces and splints to be helpful.

Pharmacological Management.  Osteoarthritis is generally treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) and naproxen (Aleve). It is important to note that NSAIDs should generally not be used in patients with hypertension or a history of GI bleeding.   Acetaminophen (Tylenol) can help to reduce pain, but it is important to keep in mind that is has minimal anti-inflammatory effects.  Occasionally steroids, such as prednisone, may be used.  Steroids should be used cautiously in people with diabetes as they may increase your blood glucose.

Why is quitting so hard?  Nicotine, a substance even more addictive than heroin or cocaine, is found in tobacco products.  Over time a person becomes both physically and psychologically dependent on nicotine.  The physical dependence causes withdrawal symptoms, while the psychological dependence makes it difficult remain smoke-free.  To optimize your chances at being successful with quitting, both the physical and mental aspects of the addiction should be addressed.

Why should I quit?  Quitting smoking decreases your risk of certain types of cancer, lung diseases, heart disease, gum disease, and vision loss.  The CDC reports that female smokers lose an average of 14 years of life due to complications from smoking.

In addition to improving your own health, quitting will also help to improve the health of your loved ones.  Exposure to second hand smoke is especially dangerous for children and the elderly, as they are more prone to associated eye irritation, headaches, nausea, and dizziness.

Quitting smoking will also save you money.  The national average cost of a box of cigarettes is $5.95.  If you are a one pack per day smoker, that would be a savings of $2172 per year.  Now imagine what you could do with an extra $2000 each year.  Plan a trip to Europe?  Start a college fund for your kids?  Use it as a down payment for a new car or home?

What services are available to help me quit?  Some people are able to quit smoking cold turkey without any assistance.  For someone who wants extra help though, counseling services and self-help materials are available.  Click the links below for additional information and resources:

• http://www.heart.org/HEARTORG/HealthyLiving/QuitSmoking/QuittingResources/Resources-for-Quitting-Smoking_UCM_307934_Article.jsp#.V5VHgzb6tYc
• https://smokefree.gov/
• http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/resources/index.htm
• http://www.lung.org/stop-smoking/i-want-to-quit/how-to-quit-smoking.html

What products are available to help me quit?  The FDA has approved 5 types of nicotine replacement therapies: patches, gum, lozenges, nasal spray, and an inhaler.  When used, these products release a controlled amount of nicotine into your system.  The goal is that over time you are able to use less and less to control your cravings, eventually becoming completely nicotine free.

Bupropion (Zyban) and varenicline (Chantix) are two prescription medications available to help control nicotine cravings.  Bupropion is an antidepressant that balances chemicals in your brain to reduce your withdrawal symptoms.  Ideally it should be started a week or two before your anticipated quit date, and is taken twice daily.  Bupropion would not be appropriate for someone with a history of seizures, eating disorders, or alcohol abuse.

Varenicline works by blocking the nicotine receptors in your brain. This helps to lessen the pleasure experienced when smoking, and also reduces withdrawal symptoms.  Varenicline should be started about a week before your planned quit date and is also taken twice daily.  Varenicline has been linked to changes in behavior and thoughts of suicide, so it would not be recommended for someone with a history of mental illness and suicidal thoughts.

 

If you or someone you love has been able to quit smoking, please share your tips for success in the comments section!

Our previous post discussed sleep hygiene techniques.  If you’ve put these techniques into practice, and still haven’t been able to acquire a restful night’s sleep, you may have a sleep disorder.

Obstructive Sleep Apnea.  Someone who has sleep apnea has disruptions in their breathing while asleep.  The most prevalent symptom of sleep apnea is snoring loudly and periodic gasping or “snorting” noises which occur when breathing is interrupted.  People with sleep apnea often also feel tired even after a full night’s sleep.  Sleep apnea most commonly occurs in men, and its incidence increases with increasing age and weight.  Treatment includes weight loss and the use of an assistive breathing device such as a continuous positive airway pressure (CPAP) machine.

Insomnia.  In simple terms, insomnia is difficulty falling asleep or staying asleep throughout the night.  Common causes of insomnia include depression, anxiety, and pain. If still unable to fall asleep after addressing the underlying cause, possible medication options for insomnia include sedatives (Ambien, Lunesta), benzodiazepines (Ativan, Restoril), and sedating antidepressants (Elavil, Remeron).  Your doctor will work with you to determine which medication is best.

Narcolepsy.  Narcolepsy is marked by excessive daytime drowsiness despite sleeping at night.  People with narcolepsy may fall asleep while doing activities such as walking or driving.  The mainstay treatment of narcolepsy is stimulant medications such as Provigil, Nuvigil, Ritalin, and Dexedrine.

Jet Lag.  Travelers who frequently cross multiple time zones may experience jet lag.  It is usually temporary, and occurs because the body’s internal clock is out of sync.  Fatigue during or after travel is the primary symptom.  Sleeping medications such as Ambien, Lunesta, and Halcion may be beneficial for improving sleep duration and quality while traveling.

Restless Leg Syndrome (RLS).  RLS is characterized by “creepy crawly” sensations in the legs while sleeping.  Leg movements such as walking or kicking can bring relief, but this in turn interrupts sleep.  As RLS is thought to be caused by abnormalities of dopamine, a neurotransmitter in the brain, the primary pharmacological treatment options are dopamine promoters such as Sinemet, Requip, and Mirapex.

If you feel that you might be experiencing symptoms of either of the sleep disturbances above,  you can use the assessment here for more information: http://www.webmd.com/sleep-disorders/sleep-disorders-assessment/default.htm.  Also be sure to discuss your concerns at your next doctor’s visit.

A good night’s sleep is one of life’s simple joys.  Restful quality sleep promotes both physical and psychological healing.  Specific benefits may include boosting your immune system, helping you to maintain a healthy weight, lowering your risk of hypertension and diabetes, improving your mood, reducing stress, and heightening your focus during the day.

How much sleep do I need?  Most of us need 7-9 hours of quality sleep to feel our best.  Keep in mind that a full sleep cycle lasts approximately 90 minutes.  Ideally, you want to wake up at the end of a sleep cycle.  So if you find that you are still sleepy after getting 8 hours of sleep (meaning you’ve woken up in the middle of a sleep cycle), you may notice that you actually feel better rested with 7.5 hours of sleep (full completion of your 5th sleep cycle).

What may be preventing me from getting quality sleep?  Many things can disrupt your sleep including stress, pain, caffeine, certain medications, and untreated sleep disorders.

How can I improve my sleep hygiene?  Sleep hygiene is defined as “habits and practices that are conducive to sleeping well on a regular basis”.  Some simple sleep hygiene habits include:

• Following a regular sleep schedule.  It is important that you set an internal clock by going to sleep and waking up around the same time each day, even on the weekends or while on vacation.
• Trying to limit daytime naps to 30 minutes or less, and avoiding them altogether after 5:00pm.  Generally, the longer we nap during the day, the less sleep we need at night.  Frequent or extended napping may disrupt your natural sleep pattern over time.
• Trying to use your bed only for sleeping and sex.  Avoid eating, watching TV, reading, playing with your cellphone/laptop, etc in your bed during the day.  You want your mind to associate your bed with sleep, and not wakeful activities.
• Avoiding stimulating substances such as caffeine (coffee, tea, soda, chocolate, etc), nicotine, and alcohol during evening hours.
• Exercising during the day, at least three hours before bedtime.  When you exercise, cortisol and endorphins are released.  Endorphins create a burst of energy, while cortisol keeps you alert.  Releasing these hormones right before bed may cause difficulty with falling asleep.
• Finishing dinner several hours before bed.  It is especially important to avoid eating large, greasy, sugary and/or spicy meals immediately before bed.  Foods that are high in protein, amino acids, antioxidants, and vitamins help promote sleep.
• Begin reducing your fluid intake 2 hours before your bedtime.  Also try to empty your bladder before bed.  This should limit your trips to the bathroom in the middle of the night.
• Waking up in the middle of the night once or twice to go the bathroom is normal.  But if you find that you are unable to go back to sleep within 20 minutes or so, get out of bed, and do a quiet or relaxing activity (i.e. reading) until you are able to go back asleep.  Avoid stimulating activities such as watching TV or playing on your cellphone.  Also don’t try to perform challenging or engaging activities like housework.
• Starting to wind down about an hour before bed.  Take a hot bath or shower before bed to relax.  Do some stretches. Once in the bed, take a few deep breaths, then spend a few moments reading or praying to clear your mind. (Note: e-readers are not advised as the light they emit is similar to daylight, and can delay your body’s release of melatonin, a hormone that promotes sleep.)
• Creating a good sleep environment by making sure your bedroom is dark.  Use blackout curtains if there are sources of light outside your windows.  Buy a comfortable mattress and pillow(s).  Also maintain a comfortable cool temperature in your bedroom.  Keep your room quiet, and avoid stimulation of electronic devices like TVs, cell phones, and computers right before bed.
• Trying to avoid lying in bed worrying about things.  If there is something weighing on your mind, write it down, and deal with it in the morning.  If you have not fallen asleep after being in the bed for more than 20 minutes, get up and read or listen to soft music for a while until you begin to feel sleepy.

What OTC medications are available as sleep aids?  There are a few different OTC options that may be appropriate for managing occasional insomnia:

• Diphenhydramine (Benadryl) is a sedating antihistamine, and the active ingredient most commonly found in OTC sleep aids.  Side effects might include prolonged drowsiness in the morning, dry mouth, constipation, and urinary retention.
• Doxylamaine (Unisom) is another sedating antihistamine, and its side effects are similar to diphenhydramine.
• Melatonin is a natural hormone produced by your body that helps to control your natural sleep/wake cycle.  Melatonin supplements may be helpful in treating jet lag and decreasing the time it takes you to fall asleep once in bed.  Side effects may include headache and daytime sleepiness.

If you’ve improved your sleep hygiene habits, tried OTC medications, and still have difficultly falling asleep, you may have a sleep disorder.  Potential signs of a sleep disorder include loud snoring, interruptions in breathing while asleep, difficulty waking up in the morning, and/or trouble staying awake during the day.  If you experience any of these symptoms, you should see your physician.   Prepare for your appointment by keeping a sleep diary.  Log your number of naps, sleeping/awake hours, number of times you wake up during the night, and also which sleep disruptions you are experiencing.  This should aid in diagnosing whatever sleep disorder you may have.  Our next post will further explore symptoms and treatment options for common sleep disorders.

Do any of you have any additional tricks you’ve found that have helped you get a good night’s rest?  Please share them in the comments section below!

Zika is a virus primarily spread from one person to another through certain species of mosquitos.   An infected man can also transmit the disease to his female partner during sex.   The Zika virus is especially dangerous for pregnant women because they can transmit the disease to their fetus, which may lead to certain birth defects.  Currently, there is no vaccination or medication available for prevention or treatment of the Zika virus.

Countries affected. In mid-July, the Florida Department of Health identified one neighborhood in Miami where Zika is being spread by mosquitos.  Additionally,  lab tests have confirmed that 1,403 US travelers returning home from other countries have been infected.  Active Zika transmission has also been found in countries in Central & South America, the Caribbean, the Pacific Islands, and Africa.  A complete and updated listing can be found here: https://www.cdc.gov/zika/geo/active-countries.html.

Symptoms.  The majority of people infected with the Zika virus do not experience any symptoms.  Those who do have symptoms may experience fever, rash, joint or muscle pain, headache and/or eye irritation.  Symptoms may last several days, or up to a week.  Typically infection does not require a hospital visit, nor is it a fatal illness.

Diagnosis.  A person’s recent travel history, along with the presence of the symptoms mentioned above, may lead your doctor to suspect Zika .  The virus may be confirmed through a blood or urine test.

Risk during pregnancy.  Though generally benign, the Zika virus is especially dangerous for women who are pregnant as it may lead to microcephaly (a small head), eye defects, hearing deficits, and impaired growth for the baby.

Management.  There is no vaccine available for prevention of the Zika virus, nor are there any medications available for treatment.  If infected, you can treat the symptoms by:

• Getting plenty of rest
• Avoiding dehydration by drinking plenty of fluids
• Taking Tylenol to reduce fever or pain.  Be sure to avoid aspirin and NSAIDs such as ibuprofen.

Prevention.  The best way to prevent transmission of the Zika virus is to avoid being bit by mosquitos.  You can minimize your risk by:

• Wearing long-sleeved shirts and long pants.
• If spending a significant amount of time outdoors, such as while camping, you can pretreat your clothes and gear with permethrin.
• Using insect repellants which contain DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol.  These chemicals have been proven strong enough to prevent transmission of the Zika virus, but are also safe enough to be used for pregnant/breastfeeding women and children [Note: All insect repellants should be avoided in children younger than 2 months; lemon eucalyptus and para-menthane-diol should be avoided in children younger than 3 years].
• Mosquito nets can be used to cover carriers, strollers, and cribs to protect young children.
• Removing standing water from around your home (think flower pots, buckets, animal bowls for feedings, tire swings, etc)

Additionally, if sexually active, be sure to use protection to avoid sexual transmission of the virus.  If planning to travel internationally, check to see if your desired destination has reported cases of Zika.  If reports have been confirmed, you may want to consider a different location, particularly if you are pregnant or trying to get pregnant.

 

Source: https://www.cdc.gov/zika/index.html