September 30th, 2013 | The Blog
An apple a day might do more than just keep the doctor away. It might help keep a patient’s cholesterol at a healthier level.
Low-Density Lipoprotein (LDL)
Low-density lipoprotein (LDL) is the bad cholesterol. It is important to keep the number low. The lower the LDL, the lower the risk of heart disease or stroke. LDL is a better indicator of heart disease risk than the total cholesterol number.
The optimal LDL level is less than 100mg/dL.
Antioxidants and Polyphenols
Apples have a lot of powerful antioxidants, especially the type called polyphenols.
There are three common polyphenols in a fresh apple:
Polyphenols have a few natural functions, which include:
Polyphenols have many medical benefits, especially for the following medical conditions:
A recent study suggests that apple polyphenols help with the oxidation of low-density lipoprotein (LDL) or bad cholesterol.
The New Apple Polyphenols Study
In a recent study of apple polyphenols and their benefits, there were three study groups:
Both the apple eating and polyphenol capsule groups resulted in an improvement of oxidized LDL levels. The group who actually ate the fresh fruit had the most significant improvement in their LDL level.
There was positive effect from both the fresh fruit and the polyphenol capsules but the actual apple effect was better. The improved benefit is due to:
One apple a day reduces the LDL by as much as 40%, according to the study. Is there an apple in your lunch box today?
September 23rd, 2013 | The Blog
Feeling tired all of the time? If you are, you need to read this. Do not think that you can get caught up on this week’s missed hours of sleep with one solid night’s rest. You cannot.
Many studies in the past have suggested that sleeping or catching up with one 12-hour night’s rest can repay weekly sleep debt. A recent study published in the American Journal of Physiology-Endocrinology and Metabolism (AJP), found results to the contrary.
Sleep debt is the difference in the amount of sleep a person should get and the amount of sleep that they actually do get. The average adult needs seven to nine hours of sleep each night for optimum health, performance and safety.
According to the National Sleep Foundation, the average American sleeps 6.9 hours per night. That averages out to 6.8 hours during the week and 7.4 hours on weekends. According to the experts, Americans do not get enough sleep.
Sleep deprivation can cause a wide variety of physical and psychological symptoms including:
Short Term Effects
Long Term Effects
The New Study
According to the AJP, even if a person feels better and less fatigued after a recuperative full night’s rest, their brain might not be fully recovered from the sleep debt they owe.
Here is how the comparative study worked:
The extra hours of sleep lowered the usual and expected elevated levels of stress hormones resulting from sleep deprivation. This is a positive and anticipated result when sleep debt is replenished.
Now the BUT. But, even with the extra hours of sleep, study participants had lower cognitive scores than they recorded at the beginning of the investigative study, when they were clearly well-rested. Cognitive tests measure mental alertness and reaction time.
Sleep Study Interpretation
So, can sleep debt be repaid? Yes, according to the study experts, it can be repaid but will take longer than previously expected to restore the brain to full and effective function.
One marathon night of sleep will not correct the sleep debt. Sleep experts recommend taking on an extra hour or two each night as the best plan to catch up on lost sleep.
September 16th, 2013 | The Blog
According to the World Health Organization (WHO), there are 235 million people with asthma throughout the world. In the United States alone, there are 25 million. That number represents, an astounding, one out of every twelve Americans being diagnosed with asthma.
Asthma symptoms include:
The human airways are lined with smooth muscle. In a patient with asthma, the smooth muscle becomes thickened. This narrows the airway. The severity of asthma symptoms varies from patient to patient. They range from mild to life-threatening.
Traditionally, asthma patients take daily and as needed medication to control their symptoms. Some patients use only inhaled medications while others use a combination of inhalers and oral medication. With recent advances made in the field, asthma patients now have a new drug-free option to control their symptoms.
Who is a Candidate?
Roughly, only 10% of all asthma patients are potential candidates for the surgery.
A patient with mild, occasional asthma
Patients with Forced Expiratory Volume (FEV1) of less than 50% of normal; they are actually too sick to undergo the procedure
Patients who are taking all the medication possible to treat their asthma but are still having symptoms
The surgery is called bronchial thermoplasty and is performed by an interventional pulmonologist. A patient must be 18 years of age to undergo the U.S. Food and Drug Administration (FDA) approved surgery. It works by applying radiofrequency heat directly to the smooth muscles in the bronchial passages.
Patients are given intravenous sedation for the surgery. Then, a broncoscope, which is a long, flexible tube, is inserted through the patient’s mouth or nose. It is threaded down as deep as it can travel into each airway.
The broncoscope contains a thermoplasty device, the Alair System, whish has electrodes at the tip. The electrodes are heated with radiofrequency energy, which causes the smooth muscle to contract and enlarge the airway.
It takes three separate procedures to complete the process. Each procedure is performed to treat a different area of the lungs with their many bronchial branches. Multiple electrode activations are done during each procedure. Each activation treats less than one inch of the patient’s airway.
Most patients are able to go home several hours after the surgery. There is no pain associated with the procedure because there are no nerves in the bronchial airways. Patients do feel uncomfortable for a few days after the surgery. They have a sore throat from the tube and a very productive cough.
This is invasive surgery and carries risks. The risks include:
Bronchial thermoplasty costs $12,000 to $18,000 to perform.
The surgery delivers the following results:
This is not a cure but it does give better control to asthma symptoms and flares. Patients might still need asthma maintenance medication but this procedure helps to dramatically reduce the need for rescue inhalers. It also allows most patients to more actively engage in strenuous activities they were not able to before the surgery.
Follow-up studies on patients who have had the surgery reveal that after more than four years, the muscle has not grown back. Patients still have good relief from the surgery.
It is worth exploring the procedure as a treatment option, in some cases.
September 9th, 2013 | The Blog
Cellulite is not pretty. It is not a medical condition or an illness. It is purely a cosmetic issue.
Causes of Cellulite
Fat deposits that sit beside collagen fibers and are anchored to the underlying muscle cause cellulite. If the collagen fibers pull tight or the fat content in the area enlarges, the fat deposits create bulging areas. This is cellulite.
Risks a Person Can Control
Risks a Person Cannot Control
Signs and Symptoms
Here are the signs and symptoms of cellulite. The facts, whether a person likes them or not:
Losing weight loses fatty deposits. Losing fatty deposits improves the appearance of cellulite, in most people.
There are several topical creams that can improve the appearance of cellulite.
When the skin is kneaded through massage and suction, cellulite can be temporarily reduced. The protocol requires 35-minute sessions twice a week for about 14 weeks. Unfortunately, once the treatments stop, the cellulite usually returns.
The heat delivered via radiofrequency causes damage to the fatty deposits and connective tissue. This tightens the skin and smooths out the cellulite bulges.
Laser affects the connective tissue and pushes it to produce more collagen, which creates thicker skin. This helps to cover the bumps and bulges more effectively.
Laser-assisted liposuction is the only laser method that is effective in treating cellulite. It uses short pulses of energy to destroy and extract the underlying fatty deposits.
While a sweet smelling, warm wrap might feel wonderful, if anything, it might temporarily tighten the skin and reduce inches in the treated area through dehydration, not cellulite removal.
This is an invasive treatment choice during which a needle is used to clip the underlying connective tissue, which causes the dimple effects of the skin. This treatment is still being evaluated for safety and effectiveness.
There is no true cellulite cure. Here is what can happen:
The U.S Food and Drug Administration and the Federal Trade Commission have enforced guidelines to be sure that companies cease making false claims of a cellulite cure. In the meantime, it is important to note that, with diligence, the appearance of cellulite can be improved.
September 3rd, 2013 | The Blog
Everyone enjoys a great cup of coffee, the patients and medical staff alike. There are many little known facts about coffee that shed a new light on this hot or iced beverage that we all enjoy on a regular basis.
Here are a few Coffee 101 facts to ponder:
Coffee was first recognized in the tropics of Africa, specifically Ethiopia.
How Much Coffee a Day?
In the U.S., three-quarters of the population drink coffee. More than half of the coffee drinkers have coffee every day.
In reality, the average American drinks the equivalent of a full bathtub or 24.1 gallons of coffee a year.
Two or three cups of coffee a day is the limit, which experts recommend.
Is it Really Decaf?
Most decaf coffee has some caffeine. The experts say that five to ten cups, an excessive amount of decaf coffee a day, can deliver the same amount of caffeine as one cup of regular, caffeinated coffee.
Instant versus Ground
Ground coffee has 115 mg of caffeine per 5-ounce cup when brewed in a drip brew pot. Instant coffee does not actually brew and has only 80 mg caffeine per 5-ounce cup.
Size is Everything
A grande coffee (16 ounces) contains 330 mg of caffeine, about three times the amount found in a regular size cup of coffee. How about a grande coffee versus a can of diet cola? The can of soda has only 47 mg of caffeine per can.
There are 6,000 species of the plant family, Rubiaceae. The coffee plant and the fragrant flowering gardenia plant are members, making them distant relatives in the world of plants.
Coffee Affects Health
It can cause an increased heart rate and raise the blood pressure. New research shows that caffeinated, not decaf, coffee can also be beneficial to health because it lowers the chances of:
Coffee has more antioxidants than most fruits and vegetables.
The Best Storage
A glass or ceramic container is the best vessel in which to store coffee. Moisture can ruin coffee so it is best stored on the kitchen counter at room temperature, not in the fridge or freezer as previous generations once believed.
If needed, coffee can be stored in the freezer but only once; do not refreeze coffee.
Tooth protection from coffee acid
It is best to rinse teeth with tap water after drinking coffee, wait about one half hour and then brush the teeth as usual. Brushing teeth too soon after drinking coffee can hurt the sensitive surfaces of the teeth.
Also, drink coffee directly out of a cup. Do not swish it around in the mouth. Do not use a straw to drink coffee; it makes the coffee hit the teeth faster and potentially cause more damage.
What is Civet Coffee?
Civet coffee is made from the droppings of the Indonesian civet cat or Iuwak. The cat eats fresh coffee cherries but the beans within go undigested. The traditional coffee bean is actually a seed within a cherry-like fruit called a coffee cherry.
The coffee processors wash the beans found in the cat droppings. This rare coffee is sold for about $110 per pound. Are you kidding?
The Bottom Line
So, coffee has its pros and cons. The majority of the U.S. population drinks coffee on a daily basis. Ongoing research continues to enlighten us to further developments in the good and the bad of coffee drinking. For now, the best rule of thumb is everything in moderation.
How do you take your coffee? Black, regular, cream with one sugar, milk with Equal?
August 26th, 2013 | The Blog
Malaria is a mosquito-borne disease caused by a parasite. What does that mean? It means that a disease-carrying parasite infects a mosquito, which in turn, feeds on a human.
Malaria can be prevented with the proper precautions and now, with a potentially effective immunization.
Symptoms of the Disease
The malaria species that affect humans are Plasmodium vivax and P. ovale. Interestingly, a patient can be symptomless for 2 to 4 years after being infected. During this time, the parasite lies dormant in the liver.
When symptoms do appear, they present as the following:
Complications of Malaria
Left untreated, people with malaria can develop severe complications and subsequent death. Here are some statistics to illustrate the population and severity of this disease:
New Vaccine for Malaria
There is a new vaccine on the horizon, PfSPZ, which offers the promise of total protection from malaria, according to the U.S. National Institute of Allergy and Infectious Diseases. It has been tested on a small group of people and will soon be expanded to a larger population to determine:
The vaccine contains sporozoites (SPZ), which are weakened or immature malarial parasites called Plasmodium falciparum. Disease-borne mosquitoes in the tropical areas of Africa, Central and South America, India and Southeast Asia carry these parasites.
Previous malaria vaccines have proven poor efficacy. The difference in the new SfSPZ vaccine is that it contains the whole parasite, not just the parasite protein as was found in earlier malaria vaccine formulas.
The Mode of Delivery
SfSPZ is given intravenously. This mode of administration presents a logistics problem for the delivery of the drug. Research is ongoing to determine if a higher dose of the vaccine injected into the skin would be as effective as the proposed standard intravenous dose. Earlier malaria vaccines were injected into the skin.
According to infectious disease experts, it can take 8 to 10 years to clinically prove, approve and distribute the SfSPZ vaccine among the world population. In the meantime, exposure to mosquitoes and protection from mosquito bites is critical, especially in the most affected countries of Africa.
The quest to control malaria is an active one. This new vaccine can be a game changer for those so wholly affected by the disease in African countries.
August 19th, 2013 | The Blog
For those patients with seasonal rhinitis or other allergy symptoms, Nasocort AQ Nasal Spray is an important and effective medication. This popular drug offers good relief from bothersome seasonal allergy symptoms. There are 1.7 million prescriptions written for the Nasocort AQ each year in the U.S.
Nasocort AQ has always been a prescription drug but was recently approved by a federal advisory panel to be sold over-the-counter. It has not yet been approved by the U.S. Food and Drug Administration (FDA) for over-the-counter (OTC) sales and must do so before it can transition from prescription to OTC.
Nasocort AQ is currently sold over-the-counter in 10 countries, other than the United States.
The Drug Use
According to the manufacturer, Sanofi, Nasocort AQ is used for the treatment of seasonal and perennial rhinitis for the temporary relief of hay fever and other respiratory allergies (nasal congestion, runny nose, sneezing, itchy nose).
Nasocort AQ, if approved for OTC sale by the FDA, will be the first intranasal corticosteroid spray to attain this status in the U.S. Steroid nasal sprays are considered to be more effective in treating the common allergy symptoms than other over-the-counter allergy medications like antihistamines and decongestants.
Detailed and informative labeling is critical to ensure patient safety with this drug. It is a much stronger drug with more potential long-term side effects than other OTC allergy medications.
In addition to the standard directions for use, Sanofi plans to label the medication with specific instructions regarding use for patients 12 years and younger. It is important that a child’s pediatrician is notified when a child starts using over-the-counter Nasocort AQ.
Federal panel members also advise that the labeling should clearly state the potential risks to growing children.
Nasocort AQ works by reducing swelling and inflammation in the nasal passages. The usual dose is two sprays into each nostril once or twice a day, as directed by a physician.
Blowing the nose before using the medication can increase the effectiveness of the drug. It is important not to blow the nose for about 15 minutes after taking the drug to prevent removing it from the nasal passages before it has time to be completely absorbed.
There are Still Things to Do
The U.S. Food and Drug Administration still needs to approve the OTC sale of Nasocort AQ. The details of safe labeling still need to be confirmed. Patients need to be educated in the safe use of this more potent and effective nasal corticosteroid.
It is important that primary care and/or allergy and immunology physicians are made aware of patient use of Nasocort AQ.
August 12th, 2013 | The Blog
So, what is the Cinnamon Challenge? Simply stated, a person swallows one tablespoon of cinnamon without drinking any fluid. This is done, preferably, while being videotaped. Then, the video is uploaded to the Internet for all to view. Only then is the Cinnamon Challenge complete.
While it might sound like an easy task, it is not. Why? The main issue is that the cinnamon coats and dries the throat. This triggers a severe gag reflex. After coughing, gagging and vomiting to accomplish the feat, most people are okay. Some people end up exhaling cinnamon through their noses after the frightful gagging session.
Others are not okay with the challenge because there is a great risk of the cinnamon clumping up and clogging the airway. Those who are not as lucky end up with cinnamon in their lungs, which causes wheezing, pneumonia and potentially serious lung damage.
The Population of Participants
Adolescents are the main group who are up to the challenge. There has been a dramatic increase in the number of calls regarding the Cinnamon Challenge to Poison Control Centers around the country, according to the journal, Pediatrics.
Adolescents have brains that are still maturing, especially the frontal lobe, which is the last area to mature. The frontal lobe controls a person’s insight and judgment. Without mature judgment skills, adolescents can make bad decisions, like participating in a Cinnamon Challenge. This is not a smart life choice.
Social Media Impact
There have been thousands of YouTube videos, Twitter mentions and Facebook likes about the Cinnamon Challenge. There are more than 40,000 Cinnamon Challenge videos on YouTube.com, one of which has been viewed more than 19 million times, according to the recent study in Pediatrics. This social media frenzy has sparked an increase in the challenge participation.
So What is the Problem?
Is the real problem the Cinnamon Challenge or is the root of the issue the social media frenzy that it has created? It is both.
The physical challenge is dangerous and can be deadly.
The social media aspect simply creates more peer pressure and social acceptance issues.
It is not easy being an adolescent in this crazy world. Although there are other age groups who participate in the Cinnamon Challenge, this is the largest group represented. The young adults in our lives need guidance and frank discussion about what is safe and what is not.
Parents, adult role models, pediatricians and others need to be on cue with what is trending in the world of adolescence and take every opportunity to keep our children safe.
August 5th, 2013 | The Blog
Fingernails can indicate a lot about a person’s health. The color and markings on fingernails can be a sign of a variety of diseases or health concerns.
It is important to note that all patients with nail discoloration do not necessarily have a specific health issue and all patients who have a specific disease do not necessarily have discolored nails.
The Anatomy of a Fingernail
Nails are layers of keratin, which is protein found in skin and hair. There are six parts to a fingernail:
Fingernails grow from an area at the base of the nail called the matrix. How fast do they grow? Fingernails grow 2 to 3 millimeters a month while toenails grow 1 millimeter a month. Nails on the dominant hand also grow faster. Interestingly, all nails grow faster during the summer.
For healthy fingernails, it is important to do the following:
This is a look at the possibilities:
Pale nails can signify serious illnesses like anemia, congestive heart failure (CHF), liver disease or malnutrition.
White nails with a dark rimmed edge often indicate liver issues like hepatitis.
Green drainage indicates a bacterial infection.
When fingernails are yellow, it is most often an indication of a fungal infection in the nail bed. Left untreated, such an infection can worsen and cause the nail bed to retract and the fingernail to thicken and begin to crumble and peel.
There are rare instances when yellow nails indicate more serious medical conditions like thyroid or lung disease, diabetes or psoriasis.
Fingernails with a bluish hue indicate that the body is not getting sufficient oxygen. The medical term for such a condition is cyanotic. It can indicate either a lung problem like pneumonia or a cardiac or heart condition. This can be serious and warrants medical attention.
Dark stripes at the top of the nails occur with aging and can also be an indication of congestive heart failure.
Lack luster nails signify a vitamin deficiency.
Wavy or rippled nails, along with pitting of the nail bed, can be the sign of psoriasis. According to the American Academy of Dermatology, psoriasis starts in the nails about 10% of the time. Nail discoloration usually accompanies this malformation.
Rippled nails can also indicate arthritis.
Nails that are concave and have raised ridges can indicate an iron deficiency.
Cracked or Split Nails
Brittle nails are associated with thyroid disease. Cracked nails that carry a yellow tinge indicate a fungal infection.
When skin is red and puffy around the edge of the nail, it can be a sign of lupus or a connective tissue disorder. Redness can also indicate an infection.
Dark Line Under Nail
A dangerous type of skin caner, melanoma, can be seen as a dark line under the fingernail. This condition needs immediate medical care.
While nail biting is an age-old habit for some, it can also indicate acute anxiety or obsessive-compulsive disorder (OCD). Both of those conditions can benefit from professional treatment.
Warts around fingernails often evolve into squamous cell cancer.
The End Result
Fingernails are not just a canvas for polish. They are an important indicator, in some case, of a serious or concerning medical condition. Primary care physicians and dermatologists are the best at determining if the appearance of a patient’s fingernails warrants further medical evaluation.
July 29th, 2013 | The Blog
It is the midst of a high activity vacation and travel season. It is appropriate to ponder what would happen, with regard to medical care, should there be a medical emergency on an aircraft traveling high over the Atlantic Ocean or just a commuter flight to a major city hub.
Think about it. The U.S. airlines have carried 732 million passengers annually in recent years and, by 2024, that number is projected to climb to 1 billion.
The Fears and Phobias
Many passengers, 20 to 30% of the population, have a fear of flying but need to do so in order to get to a specific destination in a timely manner. Their fears include:
The in-flight medical emergency is one of the most likely to happen, as compared to the other fears.
There were about 12,000 in-flight medical emergencies reported over a recent two-year period. That statistic translates into about one in-flight medical incident per 11,000 passengers each year.
According to a study published by the New England Journal of Medicine, there are some interesting findings about in-flight medical emergencies:
There are a few added body stressors when flying. Here are a few that can add to medical stress:
Most of the medical emergencies that occur in-flight are due to a pre-existing condition or acute illness.
Unfortunately, medical personnel on board a flight, who are just ordinary passengers when they enter the aircraft, do not often work in the specialty they might be confronted with treating in an emergency. For example, a plastic surgeon might be the only medical personnel on board to deal with a potential heart attack or a gerontologist or physician who cares for the elderly might help to deliver a baby in-flight.
When medical personnel are on vacation, they are actually always unofficially on call aboard a flight. The potential for the need to step up to aid someone is real. This makes is difficult for the doctor or nurse to sit back, relax and have an alcoholic drink or to take an anti-anxiety medication to allay his or her own fear of flying.
The True Emergency
When a true medical emergency happens in-flight, it is important to know that the flight crew does have some emergency medical training. They are CPR trained, can use an AED and have knowledge of basic first aid. There is also an emergency medical kit on board.
In 2001, the Federal Aviation Administration (FAA) mandated that all aircraft carry:
If it is a true in-flight medical emergency, an emergency landing is very costly to the airline and inconvenient to the passengers. A diverted domestic flight can cost $30,000 while a diverted international flight costs the airline $70,000-$230,000.
The flight crew does rely upon medical back-up by passengers with medical training. The U.S. Aviation Medical Assistance Act of 1998 legally protects healthcare providers who respond to in-flight medical emergencies. It states that they are not liable for their actions unless there is gross negligence or willful misconduct displayed.
Is there a doctor on board?