February 8th, 2016 | The Blog
Inhalers are used to treat chronic obstructive pulmonary disease (COPD), bronchitis, emphysema and asthma.
Types of Inhalers Explained
Dry powder inhalers or DPIs are breath activated medications that stay in an inhaler until a patient’s inhalation releases and activates the medication. DPIs are different from pressure metered-dose inhalers or MDIs because they do not need hand-breath coordination. Since some patients have trouble with the hand-breath coordination, DPIs are a good treatment choice.
There are differences between the medication delivery with DPIs and MPIs. They include the following:
Dry Powder Inhalers
Most DPIs require the patient to push a button, twist the device, load a separately packaged capsule or slide a lever down to release the medication. This requires coordination and, sometimes, some extra help from a caregiver.
There are new DPIs on the market that load the medication doses automatically, once the inhaler cap is opened.
There is a new albuterol DPI, ProAir RepiClick, which loads the medication when the cap is opened. Ellipta, used to treat COPD, is another automatically loading inhaler that is new to the market.
Inhaler Use and Care
There are a few important guidelines to using a dry powder inhaler:
How to use an inhaler:
When using a DPI inhaler, it is important to follow the manufacturer and prescriber’s instructions for the most effective treatment.
There are many inhalers available on the market so it is also critical that patient’s keep a log about their symptoms and potential side effects so the prescriber can reevaluate the efficacy of a particular inhaler. There are plenty of options from which to choose and sometimes, adjustments need to be made and inhalers changed to accommodate a patient’s symptoms.
February 1st, 2016 | The Blog
There is something new to worry about. The Zika virus has reared its head as a mosquito-borne illness. It is important to learn the facts to prevent the spread of this virus, especially among pregnant women.
Zika Virus 101
Zika virus is spread by the Aedes species of mosquito, which is the same carrier of the dengue and chikungunya viruses. Currently, there are two Aedes species responsible for the Zika virus, Aedes albopictus or the Asian Tiger mosquito and the Aedes aegypti.
The mosquitos infect their prey during the daylight hours, which is different from other mosquito-borne viruses that are most often spread during dusk and dawn hours.
The Zika virus illness lasts about one week but the true concern is the link to potential birth defects like microcephaly. Microcephaly is a neurodevelopmental disorder in which an infant’s head fails to grow while the facial features continue to develop at a normal rate. These babies often have delays in movement and speech, mental retardation, dwarfism, seizures and hyperactivity.
Brazil has experienced an alarming ten-fold increase in cases of microcephaly since October 2015. Some cases have been confirmed to be the result of Zika and others have been negative for the virus.
While there is a link between the Zika virus and microcephaly being investigated, at this time, the virus is not thought to be transmitted via breastfeeding.
Many people who are exposed to and infected with the virus do not show any overt symptoms. According to the CDC, 1 in 5 infected people develop symptoms of Zika. The illness is typically confirmed by a blood test. There is usually no need for hospitalization with the Zika virus and even rarer cases result in death. A rare case evolves into Guillain-Barr syndrome, which is a serious and potentially fatal autoimmune disorder.
The symptoms of Zika virus include:
Treatment of the Virus
There is currently no treatment for Zika and there is no vaccine available. The best advice is preventing mosquito bites. Comfort measures for those infected with the virus include:
Controlling the Virus
The U.S. Centers for Disease Control and Prevention (CDC) issued a level 2 travel alert on January 22, 2016 for anyone traveling to areas affected by the Zika virus. The level 2 travel alert recommends practicing enhanced precautions. Pregnant women should avoid travel to these areas. The virus is typically found in tropical climates. The areas affected include:
The Aedes species of mosquitos is found around the world with a concentration in tropical areas. Areas of concern in the U.S. are tropical-like climates like Houston and New Orleans. Places with wet lowlands, warm temperatures and higher level of poverty are the main focus of concern by healthcare authorities.
Zika virus is confirmed to be transmitted by infected mosquitos but another theory is that it can also be spread via sexual contact or through the infected blood of an affected patient. There is one confirmed case of spread through sexual contact, according to the CDC.
The typical avoidance is important to prevent mosquito bites. The CDC recommends:
Zika virus is a potential threat to the Americas. Infectious disease experts are on alert for the spread of the mosquito-borne illness, especially among the pregnant population.
January 25th, 2016 | The Blog
Proton pump inhibitors or PPIs are a popular class of drug that is used to treat heartburn, indigestion and acid reflux. They have been approved by the U.S. Food and Drug Administration (FDA) since the 1980s and have been widely used since that time. Commonly prescribed PPIs include trade name drugs like Nexium, Prilosec, Protonix and Prevacid.
What Are Proton Pump Inhibitors?
These drugs work to dramatically reduce the production of gastric acid. PPIs have a potent and long-lasting effect on inhibiting acid secretion.
By decreasing the acid in the stomach, gastrointestinal ulcers can heal and indigestion and heartburn symptoms are significantly reduced.
Who Takes PPIs?
About 15 million Americans take proton pump inhibitors. They are sold by prescription, as well as in a lesser strength, which are available for purchase over-the-counter.
PPIs are one of the most widely prescribed medications sold throughout the world, not just the U.S. According to the FDA, proton pump inhibitors should be taken in 14-day cycles and for not more than three times per year. Certainly, there are exceptions to this recommendation according to individual patient symptoms and circumstances. Patients should strictly follow their physician’s prescribing orders for the safest and most effective results.
There are some commonly experienced side effects reported by patients taking PPIs, which include, but are not limited to:
New Safety Concerns
Proton pump inhibitors were considered safe until recent concern spread about the overall effect of taking the drugs on a long-term basis. The relatively new concerns about PPIs include the risk of developing chronic kidney disease, bone fractures, infections and possibly heart disease.
A recent study looked at PPIs and, specifically, the risk for developing chronic kidney disease when taking them. Of the 322 patients included in the study, the estimated absolute 10-year risk for developing chronic kidney disease was 11.8%, when the expected risk was only 8.5%.
Other medical issues contributing to chronic kidney disease were not factored into the study. The length of time a patient took PPIs was also not a contributing factor in the study. The study looked only at whether the patient was actually prescribed proton pump inhibitors or not.
Other Treatment Options
Medication does not always have to be the first line of treatment, according to recent findings. Patients should try other treatment options to deal with heartburn, indigestion and acid reflux before resorting to taking proton pump inhibitors. A few suggestions include, but are not limited to:
The Final Answer
There are more side effects to proton pump inhibitors than were first indicated when they hit the global market in the 1980s. The information collected during the study suggests that patients should only take PPI medication when they truly need it, not as a routine, long-term maintenance drug therapy.
January 18th, 2016 | The Blog
Sleep apnea is a serious medical condition, which affects normal breathing while sleeping. Breathing becomes shallow with short interruptions, which last between 15 to 20 seconds, in the patient’s normal air exchange.
Facts About Sleep Apnea
Why Is It So Serious?
When sleep apnea occurs, it stops the flow of oxygen to various parts of the body. Restful sleep is interrupted and the patient experiences light, unrestful sleep. When the body does not have the opportunity to recover strength during sleep, the result is low energy, low productivity and irritability.
If left untreated, sleep apnea can cause daytime sleepiness and dulled reflexes. Serious health problems like obesity, high blood pressure or hypertension, diabetes and cardiovascular disease are negatively impacted for patients who suffer from sleep apnea.
Symptoms of Sleep Apnea
A family member or partner is often the one to notice interrupted breathing when someone has sleep apnea. The patient is often not aware of the actual occurrence.
The signs and symptoms of sleep apnea include, but are not limited to, the following:
Causes and Risks for Sleep Apnea
There are risk factors that influence a patient developing sleep apnea. They include, but are not limited to:
Other treatment suggestions for sleep apnea:
Sleep apnea diagnosis and confirmation is found through a sleep study during which the patient is wired and observed in a clinical setting for a full night’s sleep. The results of the study help to determine the treatment plan. Some sleep apnea treatments evolve into choices like a CPAP or continuous positive airway pressure machine to force air into the lungs while the patient sleeps.
Sleep apnea is an important and potentially dangerous medical concern with far-reaching consequences and effects, which should be treated by a qualified healthcare provider.
January 11th, 2016 | The Blog
Sudden Infant Death Syndrome or SIDS is a scary and tragic possibility for parents to worry about every single night and day when they have an infant. SIDS refers to when a baby goes to sleep and does not wake up. This is a totally unexpected death of an otherwise healthy infant.
Tragically, about 2,300 babies die every year in the United States. This number needs to be reduced or, preferably, totally eliminated. There is no medical explanation for Sudden Infant Death but recent research suggests that unsafe sleep practices contribute to the problem.
Sudden Infant Death Syndrome Explained
SIDS is defined as, “the sudden death of an infant under one year of age that cannot be explained following a thorough case investigation,” according to David Patterson, PhD, instructor of pathology at Boston Children’s Hospital.
Some facts about SIDS:
Smoking effects on SIDS:
SIDS is a diagnosis of exclusion. It’s listed as the cause of death in cases where no other cause of death can be identified through a death scene investigation, an autopsy or a significant clinical history.
Theories About SIDS
The cause of SIDS is unknown but there are a few theories about why it happens. They include the following scenarios:
In simple terms, if a baby sleeps on their stomach, they rebreathe exhaled CO2. Usually, when CO2 levels rise, it activates nerve cells in the brainstem and this, in turn, stimulates the respiratory and arousal areas of the brain. Ideally, the baby awakens, turns his/her head and breathes faster to take in more oxygen. With a case of SIDS, a baby fails to rouse and impending doom and death occur.
Safe Sleep Practices
Here are some safe sleep practices that should be followed every time a baby is napping or in their crib for a night’s sleep. These practices are thought to help babies avoid succumbing to Sudden Infant Death Syndrome.
Other safety guidelines include:
Now, let’s look at the sleeping environment and how to keep it safe. According to the American Academy of Pediatrics or AAP, the following guidelines should be followed:
One caveat to all of the back sleeping position is that babies should spend some “awake time” on their tummy. This is important to enhance motor development of the shoulders and also works to prevent flat spots from developing on the back of the baby’s head.
SIDS is a real and concerning health issue in the U.S. Teaching parents about the basic safety guidelines to prevent SIDS is critical to reducing the number of deaths.
January 4th, 2016 | The Blog
Welcome back for a look at Healthy Diet Tips for 2016-Part 2. Continuing to build on last week’s discussion, there are a few more tips listed below that will help you eat healthy and even drop a few pounds along the way.
Experts have said for generations that, you are what you eat. It is important to eat healthy in order to be healthy; that is a given fact. Not only is it important to eat the proper vitamins and nutrients, it is also important to maintain a healthy weight and follow a fitness program. Of course, no one should start a new exercise regime without first getting the okay to do so from their physician.
Building on last week’s blog, which offered several health diet tips for 2016, here are a few more ideas that will carry and maintain a healthy lifestyle for you in 2016:
Choose dips carefully
Forget about sour cream-based dips. They are high in calorie and have a high fat content. If you insist on using that special recipe (because you always have!) that calls for sour cream, try substituting non-fat Greek yogurt instead. Better yet, choose hummus or white bean dips that have fewer calories and less saturated fat.
Use boneless, skinless chicken breasts
Chicken is an excellent source of protein. The skin might be tasty but it is high in calorie and high in fat so choose boneless, skinless chicken breasts, which have 40% fewer calories and 25% less saturated fat then those with the skin on.
Fish, fish, fish
The American Heart Association recommends at least two servings of fish per week. Forget the breaded or fried fish and forget the creamy (albeit delicious) sauces like Newburg sauce. Stick with broiled or baked fish recipes. Salmon is a great choice because it has significant heart-healthy omega-3 fatty acids.
Brown versus white rice
The choice is simple, go with brown rice. White rice is a refined product and brown rice is whole grain. Brown rice also has a low glycemic (minimally affects the blood glucose level) index so helps reduce the risk of diabetes. Another perk is that brown rice can be made ahead and freezes well until it is needed.
Lots of veggies
Veggies have far less calories than the preferred starches that Americans so typically enjoy. It is important to eat more fresh vegetables and eat less starchy foods to reduce overall caloric intake.
Adjust the (s)mashed potatoes
Smashed or mashed potatoes are the best. They are warm and gooey and laden with fatty whole milk and butter. Instead of the traditional recipe, try substituting the milk and butter with low-fat buttermilk. Why? Low-fat buttermilk has 49 calories and less than one gram of saturated fat per one-half cup.
Do not use cream to thicken sauces and gravies. Instead, use low-sodium, fat-free broth with some cornstarch as a thickener. This will reduce the calories and eliminate the unhealthy addition of fat.
Eat dessert only on special occasions
A birthday, an anniversary or another special celebration is a good reason to enjoy dessert. Otherwise, eat a piece of fresh, healthy and sweet-enough fruit instead of a high calorie dessert.
Following these healthy diet tips will not make the weight melt off of your frame but the resulting excellent overall health benefits will be seen over time.
Cheers to 2016!
December 29th, 2015 | The Blog
The New Year is upon us, so now is the time to start eating healthy, if you do not already do so. This is not to say that everyone needs to start a diet on January 1st. It says that eating healthy is the first step towards good health and potential weight loss along the way.
The easiest way to start eating healthy is to remove the temptations from your home; clean out the fridge, the cabinets and the pantry of all the hidden goodies and sweets. If there isn’t any junk in the house, it can’t be eaten. That is step number one. Now, adapt a few of the suggestions below to start eating healthy.
Basic Tricks to Eating Healthy
Do not drink fruit juice; eat whole, fresh fruit instead.
Fruit juice has a lot of calories and very little fiber. Fresh fruit, on the other hand has fewer calories and a lot of good, healthy fiber. Fresh berries on top of cereal or mixed in with yogurt is a good way to incorporate fresh fruit into your diet.
Use lower fat dairy products.
Dairy products contain saturated fat. It is important to reduce saturated fat intake anywhere possible in your daily diet. Whole milk has 3.5% fat, which adds a lot to your daily intake. Alternate choices include 1% low-fat milk and fat free milk. Other dairy products like yogurt, cottage cheese and some other cheeses are available in reduced fat choices, as well. The more you can lower your overall dietary fat content, the better.
Oatmeal is healthy
Oatmeal has an abundance of fiber and is 100% whole grain. It works to lower LDL or bad cholesterol. Adding fresh berries or dried fruit and nuts to oatmeal adds flavor and good nutrients to breakfast.
Eat Whole-Grain Bread
Reduce unhealthy belly fat by eating more whole-grains. The product packaging should say, 100% Whole Grain, not whole wheat, multi-grain or stone-ground. The latter three choices are not true whole-grain products. It is important to carefully read labels.
Don’t Use High-Fat or High Calorie Spreads
Forget about spreads like mayonnaise and butter on a sandwich. They add saturated fat and unnecessary calories to a sandwich. Instead, use fresh, juicy veggies to add moisture to a sandwich or switch to using mustard. Just look at this and it will help you decide to make the switch:
Stay Tuned For More Healthy Diet Tips
This is only a partial list of the best healthy diet tips for 2016. Most of the tips offered here are simple to institute and maintain, once you get started. Follow this blog for the remaining list of special tips next week to get you through a slim, trim, healthy and happy 2016.
December 21st, 2015 | The Blog
Should you hit the gym for an hour or just step up your pace throughout the day? Recent research supports the theory that every minute of high intensity exercise will help prevent weight gain over a lifetime.
The Fact(s) of the Matter
Maintaining a healthy body weight and body mass index (BMI) are important factors for everyone, throughout their lifetime. There are fad diets, weight loss programs, aerobic exercise, weight lifting and more to keep weight gain to a minimum.
The basic facts about exercise include the following:
Moderate to vigorous activity is defined as:
The Study Explained
During the study, physical activity, both time or duration and intensity or pace, was measured in both men and women. The study was conducted over a three-year period.
The Results of the Study
There were several interesting and remarkable results concluded from the research study. They include the following:
The study shows that the weight management benefit runs tandem with the reduction of other medical risks like heart disease, Type 2 diabetes, bone fractures, some cancers and it improves overall mental health.
What Counts in the End?
There are simple and effective physical activities that can render help in weight management over the long-term. Trying some of these very simple changes to a daily activity routine can be the secret to preventing weight gain over the course of time. Add them into a regular routine or substitute a few on an otherwise more sedentary day.
The bottom line is simple. It is best to move quickly whenever possible. Every step and every minute of high-energy activity adds up, in the end, to prevent weight gain through the years.
Ready, set, get going and keep moving!
December 15th, 2015 | The Blog
Body Mass Index or BMI has been the standard measurement for obesity and, subsequently, for predicting a patient?s risk of heart disease, heart attack, diabetes, high blood pressure (hypertension) and stroke.
Recently, a British study has found that there is a better and more reliable predictor for these cardiac issues. The study states that waist to height ratio is a better predictor and can actually extend a patient’s life expectancy.
The Difference in Measurement Tools
Let’s look at Body Mass Index versus the waist to height ratio.
A patient’s Body Mass Index measures obesity. It represents the ratio of a patient?s weight in kilograms to the square of their height in meters. The downside of the BMI measurement is that it does not factor in the fat distribution on the patient’s body, which is critical to maintaining healthy organs.
Abdominal fat is especially detrimental to the heart, kidneys and liver. Fat around the hips and buttocks is not as concerning to the overall health of a patient. Measuring a patient’s weight to height ratio is more accurate in predicting cardiovascular disease because it includes assessment of the fat distribution around the body, especially in the critically important abdominal area.
The study leader is recommending that the new measurement, waist to height ratio (WHtR), should be used as a screening tool for all patients.
Using the WHtR is not a new idea but seems to be gaining popularity as further studies are supporting the theory.
The Best Case Scenario
The best waist to height ratio is to keep waist circumference to less than half of a person?s height. According to the study, this will increase the life expectancy for every person on Earth, whether male or female.
Examples of the perfect waist to height ratio include:
The best way to accurately measure the WHtR is to accurately measure the waist circumference. According to the World Health Organization (WHO), measure the waist circumference mid-way between the lower rib and the iliac crest or the top of the pelvic bone at the hip.
Looking Ahead and Health Goal Planning
Patient awareness of a waist to height ratio is far easier to understand and logically maintain than is the idea of calculating a Body Mass Index.
With obesity on the rise in the U.S., especially childhood obesity, it is important to have a simple measurement, which all patients can understand and comply with to keep the general population healthy for years to come.
Patients should discuss any diet and/or exercise plan with their physician before changing or increasing their routine to attain and maintain an acceptable and healthy waist to height ratio. It is all about the numbers, which in this case can increase life expectancy. Who’s in?
December 10th, 2015 | The Blog
How do surgeons prepare to perform an intricate life-saving procedure? They observe a lot of operations and assist with some of the procedures. At Boston Children’s Hospital, that is the old-fashioned way to learn. The new regime is to practice with hands-on life-like models until they get it right without risking the health or safety of a live patient.
Residents training at Boston Children’s Hospital are doing practice runs on plastic body parts. The plastic models look and feel real on the outside with 3-D printed organs on the inside.
The models are created and manufactured by a California make-up and special effects company, Fractured FX. Fractured FX usually produces special effects for television but now, they are working with Boston Children?s Hospital to perfect life-saving surgical procedures.
The Simulator Program (SIM)
The surgery practice program is called the Simulator Program. It allows surgeons to actually rehearse and perfect complex procedures before touching a live patient.
Standardly, some training physicians use a cadaver. The downside of using cadavers is the expense and the fact that they are not reusable. There is also not realistic pulsing when using a cadaver, which is an added feature in the SIM models.
A profitable by-product of the Simulator Program is that Boston Children’s Hospital and Fractured FX is planning to sell the simulators to other medical institutions starting in the coming year.
The Creation of SIM Models
In order to most accurately create SIM models that are closest to a live patient situation, the Fractured FX creators studied CT scans of the human body and consulted Boston Children’s Hospital surgeons.
The creation team paid special attention to the replication of membranes, cartilage and other important and palpable landmark within the body. The goal was to make this a life-like and realistic model.
The simulated pulsing of membranes in the brain, when using the SIM model, creates a realistic situation in which to practice surgical procedures.
The Simulator Models
There are a couple of SIM models available, so far. One is a Caucasian tween, complete with a freckly face, and the other is a life-like model of a newborn.
The tween model is currently used by neurosurgeons to practice intricate brain surgery techniques. Surgeons practice specialized lung and heart surgery utilizing the newborn SIM model.
The SIM model parts are 3-D printed and snap together like LEGO bricks. They can be used or operated on several times. And are then replaced within the SIM body model.
The SIM model program is apart of a larger program called SimPEDS, which has been developing teaching tools for training MDs at Boston Children’s Hospital for the past 12 years.
The program also has a 3-D printing unit that makes scaled replicas of organs for learning and teaching.
The Simulator Program has a sizable staff of 18 full-time employees. Every year, about 250 different clinicians utilize a variety of SIM models and program software while they engage in about 1,500 simulation events that literally save lives while they hone their techniques and anticipate issues that can present in the live-patient situation.
The next step in the evolving Simulator Program is to include a virtual clinic with areas to simulate operating and recovery rooms. The plan is to have the entire Simulator Program in one space.
Boston Children’s Hospital is leading the way in training residents in perfecting surgery before they perform a procedure on a live patient. There is much to be learned from their research and Simulation Program.