November 17th, 2014 | The Blog
There is never a totally wrong time to call a doctor but there are definitely times when it is imperative to call one. What might those it is time to call the doctor moments be?
These guidelines are important for everyone, adults and children, but especially essential for parents to keep in mind when and if their child complains about any concerning symptoms.
The it is time to call the doctor symptoms include:
Severe allergic reaction
Bad pain, regardless where it is
Persistent vomiting and/or diarrhea
Pediatricians, especially, find themselves sometimes asking a parent why they waited so long to seek medical evaluation of their child. On the other hand, some parents repeatedly call the pediatrician and the physician wonders why a child was brought in for evaluation.
Key guidelines for calling a doctor include the specifics listed above but also some general thoughts listed below:
So, there is no ultimately correct or wrong “time to call the doctor.” A level head should prevail in making an informed decision.
November 12th, 2014 | The Blog
Childbirth is approached with many different treatment options for the mother’s comfort. Some choose to go the natural route while others opt for an epidural spinal or, sometimes, pain medication. Read on to learn about another option.
There is a new, or actually renewed, treatment option to alleviate the discomfort of childbirth. As long ago as 1881, laughing gas was used in childbirth. In the 1930′s, using nitrous oxide during childbirth was fairly common. Shortly thereafter, options like twilight sleep, IV narcotics and epidural blocks stepped into the picture. These options were used for a long period of time during which nitrous oxide was no longer used. Everything old is new again even, sometimes, in medicine.
Laughing Gas and Childbirth
Laughing gas or nitrous oxide is currently and frequently used in countries, other than the U.S., during childbirth:
Only 1% of U.S. hospitals have been using nitrous oxide during childbirth, according to a 2011 report. Currently, over 30 hospitals and birthing centers are offering or making plans and policies to offer laughing gas as a treatment option.
Nitrous Oxide Explained
What is nitrous oxide?
When can it be used?
How does it feel?
What are the benefits?
What are the side effects?
Sometimes, just taking he edge of the pain off is enough to get a woman through labor and delivery of their baby. This innovative approach to childbirth is just what the doctor ordered.
November 3rd, 2014 | The Blog
The first question many dentists ask a patient is whether they floss their teeth daily. Do you?
Flossing is an important part of every oral health care plan, according to the American Dental Association. The daily oral hygiene practice should start as early as 2 years of age (or as soon as a child has two teeth that touch) and continue for a lifetime. The act should actually become a habit, a part of every person’s daily routine.
Benefits of Flossing
Dental floss cleans places where a toothbrush cannot reach. Flossing helps to prevent gum disease by removing pieces of food and plaque between the teeth.
Plaque is a sticky substance made of bacteria. The bacteria can irritate the gums and cause swelling or inflammation, which leads to gum disease. If that is not removed it can develop into tartar or calculus, a very hard material.
Types of Floss
In the early 1800′s, thin silk thread was first used for flossing. In the 1940′s, floss turned to nylon because it did not shred like the silk thread.
Current day floss comes in many options:
This is nylon floss with a light wax coating, which makes it less likely to break. Waxed floss is a little more difficult to slip into tight spaces between teeth.
This is thin floss consisting of 35 strands of nylon twisted together. It fits in between teeth that are close together but shreds or breaks easier than some other floss choices.
This option is wider and flatter than standard floss. It, too, comes in waxed and unwaxed versions. People with wider spaces between their teeth often find dental tape to be a good floss option.
Polytetrafluorethylene (PTFE) floss
PTFE is the material used in resilient Gore-Tex fabric. This floss option slides easier between teeth and does not shred as easily as standard dental floss. One brand of PTFE floss is Crest Glide.
This option is made of a yarn-like material and has a stiffer section at one end, which can be used to clean around braces and bridgework.
If standard floss does not fit the criteria to clean between teeth, there are other options like wooden plaque removers, dental picks and pre-threaded flossers.
How to Floss
Flossing should be done once a day, either before or after brushing, which should be done at least twice a day. Flossing before brushing is the usual recommendation so the fluoride from the toothpaste can get to the areas between the teeth. It is important to do a thorough flossing job.
Here are the simple steps to effective flossing:
It is important to floss around each tooth and the sides of the teeth at the back of the mouth.
What to Expect
When flossing if first started, the gums might be tender and bleed. The bleeding will stop as the gums become healthier.
Any discomfort from initially starting to floss should lessen in a week or so.
An Interesting Fun Fact
The Guinness World Record title for flossing is held by a North Carolina elementary school. Here is what they did:
1,470 students, parents and teachers flossed for 55 seconds using a 6,000-foot piece of dental floss!
October 30th, 2014 | The Blog
It is amazing how many people suffer from persistent headaches and often migraines. The statistics surrounding migraines is significant in the U.S.
According to the National Library of Medicine, a migraine is defined as:
A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head. Some people who get migraines have warning symptoms, called an aura, before the actual headache begins.
Migraines by the Numbers
Physical Effects of a Migraine
Most common migraine symptoms
Who Gets Migraines?
The Lifestyle Effects
The Bottom Line
Migraines affect a wide range of the American population, probably more people than expected. They can be debilitating but with the proper combination of treatment choices, migraines can be managed.
October 20th, 2014 | The Blog
The cold and season is approaching or actually active in some places. It is difficult to know at what point, if any, in the illness that medical evaluation is needed. Patients are often sent home with a proclaimed virus so are hesitant to even make the effort to get to the doctor.
One important caveat to note is that strep infections do not present in any specific season, they circulate among the population throughout the year.
Strep Throat Facts
Strep throat is caused by a bacteria, not a virus. The bacteria is called Group A streptococcus.
It is important to have a prolonged sore throat checked. Strep can evolve into a serious illness. How often is a strep test positive? Less than one in four strep tests, when a patient has a sore throat, prove the presence of the bacteria. The one in four positive cases results in about 10% of cases in adults and 30% in children.
So when is it the right time to go to the doctor? Boston Children’s Hospital has developed a risk assessment tool, which tracks a patient’s symptoms along with the incidence of strep infections in the area where they live. It will work in a similar fashion to the current flu tracker app.
The new app, which is still in the throes of development, measures a home score, which is a combination of patient symptoms and demographic data regarding local strep throat activity. The score is calculated using these patient symptoms:
A low score indicates a low risk of the infection and potentially prevents an unwarranted trip to the doctor.
If the geographic area is rampant with strep and the patient presents with a combination of identified symptoms, the likelihood of having a strep throat is naturally increased. At this juncture, professional medical evaluation is warranted.
The app allows patients and parents of young children to make an informed decision about seeking further medical evaluation.
A higher risk of having a positive strep test was noted in patients who have a sore throat with an accompanying fever but no cough. This patient population, especially those under 15 years old, should seek medical care. The American Academy of Pediatrics recommends that any patient under 15 years old with a sore throat should get it checked by a physician. This age group more commonly carries bacterial infections.
If the strep evaluation app is consistently used, it can potentially prevent about 230,000 doctor?s office visits annually. On the other hand, about 8,500 actual strep cases could also be missed.
October 14th, 2014 | The Blog
Hypertension or high blood pressure is a serious medical condition, which warrants the attention of a qualified healthcare professional.? There are about 1/3 of Americans who are currently diagnosed with hypertension. Surprisingly, 90% of them developed hypertension after age 55.
High blood pressure can cause a stroke or other health problem, especially heart disease.
There are relatively new guidelines to determine if a patient needs to treat their hypertension or not. The new guidelines will reduce the number of older Americans, specifically those over 60 years old, who take anti-hypertensive medicine.
First, let?s be aware of the 10-year-old recommendation to treat hypertension for those over 60 years of age. It used to be 140/90 mmHg.
A report in a recent Journal of the American Medical Association states that no medication is needed until blood pressure reaches 150/90. There is no benefit to keeping the blood pressure at 140, instead of 150.
The side effects associated with blood pressure medications taken by an elderly population are a far greater risk than of a 150/90 reading. The risks include dizziness and lightheadedness, which can lead to a fall and subsequent bone fractures.
Secondly, let?s look at the guidelines for diabetes of any age or those with kidney disease. The recommended blood pressure used to be below 130mmHG but the new guidelines suggest that below 140 mmHg is adequate.
Lastly, recommendations for the younger population remain unchanged. Blood pressure should be maintained at 140/90 or below for this group.
The First Line of Defense
Lifestyle changes should be the first line of defense in lowering blood pressure. These measures include:
If these things work, medications can be avoided. They should be continued even when anti-hypertensive medications are added into the medical regime.
Blood Pressure Medication
Cardiologists, primary care physicians or family practitioners regulate hypertension medications. The simplified guidelines are intended to keep the suggested treatments the same, across the board.
There are four classes of medications for high blood pressure. They include:
Calcium channel blockers and ACE inhibitors are most effective at lowering blood pressure.
There remains a need to clarify the specific treatment protocols for patients who have issues beyond simple hypertension. Those who have congestive heart failure (CHF), coronary artery disease (CAD) and/or cardiac arrhythmias are not specifically detailed in the new guidelines.
Unfortunately, no major medical group issued the new guidelines so some cardiologists are concerned. The National Heart, Lung and Blood Institute (NHLBI), for unknown reasons, pulled out of the reporting process.
October 9th, 2014 | The Blog
Glaucoma is the leading cause of irreversible blindness in the world. It is an eye disease in which the ocular pressure is elevated and causes damage to the optic nerve.
The disease is asymptomatic until the end stage when vision is irreversibly diminished. Damage to the optic nerve causes vision loss and blindness.
The key to treating glaucoma is early detection so the proper and effective eye drops can be prescribed and administered to lower the ocular pressure.
Traditional Glaucoma Treatment
Glaucoma is routinely treated by medications, laser treatments and conventional surgery. A brief overview of each approach includes:
Looking at the Medication Administration-Specifically, Eye Drops
Eye drops like latanoprost or Xalatan are effective in treating glaucoma. They lower the eye pressure and prevent vision loss. These drugs do not reverse glaucoma.
The only way they are truly effective is if the patient is compliant with the drug administration. Poor patient compliance limits the benefits of the drugs. A recent study shows that eye drop compliance in glaucoma patients is only slightly higher than 50%.
The side effects of the drugs like burning and stinging add to the poor compliance rate. Patients cannot sense any positive feedback like pain management or immediately clearer vision after taking the drops so often do not bother to take them.
New Treatment Option
A new treatment option to increase compliance with the eye medications is a contact lens that dispenses latanoprost and other eye medications. Boston Children?s Hospital, in collaboration with the Massachusetts Institute of Technology (MIT) has developed this contact lens concept.
The contact delivers the drugs in a large quantity for a long period of time at a relatively consistent rate, according to the development team at Boston Children?s Hospital.
The contact lens is a pairing of two polymers, which encapsulate the drug and modulate its release into the eye.
The contact lenses will be available in prescription form for those who are near or far sighted. This benefit will also increase compliance.
The U.S. Food and Drug Administration (FDA) do not yet approve this drug-eluting contact lens for use.
October 1st, 2014 | The Blog
The Enterovirus D68 is usually a rare illness but has seen a rapid increase in cases over the recent weeks, according to the U.S. Centers for Disease Control (CDC).
The Enterovirus D68 was first identified in 1962 in California. Thereafter, it was rarely seen or diagnosed until about 2009 when there were cases reported mostly in Japan, the Philippines and the Netherlands.
Generally, enteroviruses affect 10 to 15 million people in the U.S. every year. These illnesses are typically mild and often without any overt or untoward symptoms.
Who is Affected?
The current Enterovirus D68 respiratory virus is affecting children across the country. The virus started to evolve in the Midwest during the month of August and is spreading east.
The patient population for the Enterovirus D68 (EV-D68) is children and teenagers. The primary group affected by the illness is 2 to 6 year olds. Of those who contract the virus, about 68% have a history of asthma or wheezing.
With the cold and virus season hitting its stride in the month of September, it seems that the EV-68 is taking the lead from the basics of the common cold virus.
The Symptoms of Enterovirus D68
The illness causes a severe respiratory infection, which has required many hospitalizations including admission to intensive care units for some patients.
A runny nose and/or the sniffles do not identify the virus. Difficulty breathing does define EV-D68. It commands immediate medical attention.
The symptoms include:
Most people recuperate from the Enterovirus D68. A few need to be hospitalized but the recent uptick in cases has resulted in more hospitalizations for supportive care. While there is no cure for the illness, oxygen therapy is helpful.
The real prevention of spreading the virus comes with basic infection control common sense around this cold and flu season:
Children with asthma need to be sure that it is well controlled during the active virus season. Extra caution should be taken to watch this population closely. It is very important that asthmatics take their daily medications everyday.
If an asthmatic child starts to develop cold-like symptoms, they should be closely monitored and seek medical care if respiratory distress develops.
As of now, there have been no deaths reported due to the illness. Children recuperate from EV-D68, although some have a more difficult road to recovery than others.
September 24th, 2014 | The Blog
Let’s talk antibiotics. When needed to treat a bacterial infection, antibiotics are usually curative.
With the season of colds, flus and other contagious illnesses fast approaching, this is a good time to talk about the use and abuse of antibiotics. Everyone moves to inside activities and germs are more readily shared, like it or not.
There is a time and place for antibiotic use and a mission to prevent antibiotic misuse and overuse in the country
Just like all other living organisms, bacteria seek to grow and thrive. So, the more often they are exposed to antibiotics, the more opportunities they have to adapt to them and build up a resistance to them. This renders the antibiotics less effective, especially when they are really needed.
This cycle of exposure and growing resistance due to misuse and overuse of antibiotics leads to the general public’s lowered ability to fight against infections.
When to Use Antibiotics
Antibiotics are meant to treat bacterial infections. Period.
When Not to Use Antibiotics
Antibiotics do not treat viruses. A virus, not bacteria, causes the common cold and most other respiratory infections. Antibiotics will not help in this medical situation.
Problems Created by Antibiotics
Antibiotic resistance is a big and growing public health issue. Over time, this is a situation created by the overuse of antibiotics.
Common side effects of antibiotics can range from an upset stomach and diarrhea to a skin rash. Serious and potentially fatal reactions, from the sloughing skin of Stevens Johnson Syndrome to anaphylaxis, can also occur from antibiotics. Children, taking a new antibiotic for the first time sometimes end up making an emergency room visit due to a bad drug reaction.
Taking leftover antibiotics from a previous illness or someone else’s prescription for antibiotics is a bad decision. Specific antibiotics are prescribed for a specific illness and should not be crossed over with other illnesses or people. This is a dangerous practice.
Unless a prescribed antibiotic prescription is taken as directed and until it is gone, a bacterial infection will not be fully treated. It can recur and/or worsen without the full and proper treatment. Patients must be educated to take the entire prescription of an antibiotic to achieve the intended results.
Interestingly, 50% of prescribed antibiotics, whether inpatient or outpatient, are not indicated or necessary. One major example is the patient who sees their PCP for a common cold and leaves the office with an antibiotic prescription. This is a common occurrence in the general population.
When antibiotics are indicated, they are a good and proper treatment. When they are unnecessarily prescribed, they create a public health threat of resistant bacteria.
September 15th, 2014 | The Blog
Sleep apnea affects all facets of life, by day and by night. It is important to diagnose and treat sleep apnea. Management of the condition improves the quality of life and general wellness.
Sleep apnea studies are traditionally done in a hospital setting. There are sensors, electrodes, microphones and infrared cameras involved in the process. Sleep technicians monitor the patient throughout the process, which can be uncomfortable because someone watches them sleep.
Some interesting statistics about sleep apnea include:
The warning signs of sleep apnea include:
The biggest concern:
Sleep apnea can be fatal. When sleep apnea occurs, the brain does not get sufficient oxygen. When this happens throughout the night, the risk of having a stroke is four times greater than someone without sleep apnea.
An Updated Process
There is a new home sleep test, manufactured by NovaSom, which eliminates hospitalization. Instead of someone watching the patient sleep, the test is done in the privacy of the patient’s home.
How it Works:
The Benefits of the Home Test
The cost of a home test is dramatically less than the traditional hospital-based test. The home sleep test cost averages $300 versus the hospital cost of about $3000.
The testing device is more portable so allows the patient to turn onto either side to sleep. In the hospital, patients are restricted to sleeping only on their back because of the equipment configuration.
If a piece of equipment comes loose, there is an audible reminder to check it for proper placement.
What the Home Test Does Not Do
The NovaSom home test does not record brain waves or activity. The hospital-based test does record these. What is the concern?
A home sleep apnea test can be inaccurate if the patient lies awake all night staring into the darkness because the brain waves are an indication of whether they are actually asleep or not. While lying awake, sleep apnea is not a problem so this could give an inaccurate assessment of the patient.
Who Should Not Use the Home Test?
Those with some medical conditions are not candidates for the home test. They include:
Sleep apnea is measured by the number of times a person stops or almost stops breathing for at least 10 seconds per hour. The data collected represents the following results:
When apnea occurs, the oxygen level in the body drops significantly. The normal oxygen level is at least 90%. With sleep apnea, it can drop into the 70% range.
The equipment also monitors snoring. In this case, snoring is qualified as any loud breathing, not just the traditional snoring sound. The NovaSom monitor has a very sound sensitive microphone.
Some sleep specialists project that hospital-based sleep apnea tests derive higher rates of the condition because the patient has to sleep on their back to accommodate the equipment. This back-lying position further closes an already narrow upper airway.
Treatment Options After Diagnosis
The treatment options for sleep apnea include:
The treatment downsides include:
Patients dislike wearing the CPAP; it is cumbersome and restrictive
So what really works? Lifestyle changes that include weight management and less alcohol intake are key factors in reducing sleep apnea.