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Nurse Bridgid

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Thursday, September 30, 2010

This is a little hard to talk about: Erectile Dysfunction

I think that many people are unclear as to what actually Erectile Dysfunction (ED) actually is, despite those really ridiculous Cialis and Viagra commercials on TV, which are really awkward to watch in mixed company at times!!  But ED affects between 15 and 30 million men in the US and approximately 22.3% of all office visits to an HCP is for ED.  It is something that many men are embarrassed about and feel unable to speak to their partner about, and it can cause huge rifts in relationships.  I think it is important to know that signs and talk to your partner about it, it is a physical issue that is normal, and totally fixable, so go to the doctor together and make it a couple problem, and don't let your partner suffer and feel badly alone!

What exactly is the definition of ED?
Its the inability to maintain an erection that is firm enough to have sex, on an ongoing basis, along with trouble getting an erection, difficulty maintaining an erection, and/or a reduced sexual desire.  If you have any of these symptoms, especially if you have diabetes or heart disease, you should go see your HCP and talk to them about it, your options, and to find out what might be going on with your body.  Don't let it get too far that your partner might get upset or think that they are the one causing the open about it and go to see your HCP.

There are SO MANY possible causes of ED, in which some are physical, mental, and a combination of the two.  Some physical causes are: heart disease, atherosclerosis, high blood pressure, diabetes, obesity, metabolic syndrome, Parkinson's disease, Multiple sclerosis, low testosterone, Peyronies disease (a build up of scar tissue in the penis), tobacco use, alcohol (alcoholism), substance abuse, pelvic/spinal cord surgery, enlarged prostate, and prostate cancer.  So, obviously it goes from being something that is easily fixed, to things that are really serious.  As far as psychological issues: stress, depression, anxiety, fatigue, and relationship issues can all cause ED. Another psychological reason that many men have a form of ED, in this current society, is due to the inability to get their partner pregnant; we have a society wrought with infertility and it can case serious relationship problems on many levels. As well, many medications that your HCP might put you on for various health issues, can also cause ED.

Before you go to your HCP appt:
Write down symptoms that you have had even including things that you might think unrelated to ED.  Also, write down any life changes going on, including anything that might be causing relationship stress.  An update list of current prescribed and over the counter medications are always important to bring to every appointment, but especially to an appointment regarding ED.  Try to bring your partner to your appt and both of you talk before you go and both write down list of questions both separately and together.

What might happen at/after your appt?
a physical exam, which is standard at all appointments, but your HCP will inspect your penis, testicles, and check for nerve feelings.  Most likely you will have blood drawn to assess your risk of heart disease, diabetes, cholesterol, and testosterone levels.  A urinalysis may be performed to also look at your risk of diabetes, etc.  An ultrasound may be done to look at blood flow to your penis, it uses a plastic probe on the outside of your penis to project a video of the current blood flow (a non invasive exam). They also might have you go home and perform an overnight erection tests; many men have erections at night during sleep, and have no idea that they had an erection, if the test is positive, then the reason you have ED is psychological.  What they will ask you to do is to put a piece of tape that they will give you (it is easily split) around your penis, and if you wake up in the morning and the tape it split open, you've had an erection.

How do we treat it?
You can take oral pills like Viagra, Cialis, and levitra which are medications that enhance your bodies natural nitric oxide levels which helps muscles relax and allows more blood flow to your penis, allowing for a stronger erection.  You may need to change doses and change times that you take before getting an erection.   You need to talk to your HCP to take these drugs if you also take any nitrate drugs like nitroglycerin, Imdur, or Isosorbide because you can have too much of a build up of nitrates in your blood.  Also be careful with blood thinners and alpha blockers (for enlarged prostate).  Your HCP will have to discuss using medications if you have had a stroke, have either low blood pressure or uncontrolled high blood pressure, heart disease or heart failure, and/or uncontrolled diabetes.
Other medication options:
Alprostadil injections: a small needle is inserted in the base or side of the penis and you inject the medication, due to the small size of the needle there is usually little to no pain, and you can get an erection within 5-20 minutes and the erection usually lasts around an hour.
Alprostadil penis suppository: Using a special applicator, you insert a small suppository 2 inches up the inside of the urethra. The side effects can be pain, bleeding from the urethra, dizziness, and can cause a fibrous build up inside your penis.
Testosterone replacement: if you have low testosterone levels, oral supplements can help to increase your levels and ability to maintain/obtain an erection.
Other options:
Penis pumps: a hallow tube with a hand or battery powered pump, you put your penis inside, pump out the extra air, which causes blood to flow to the penis and cause an erection, you need to put a tension ring on the base of your penis, then remove the pump.  The erection usually lasts long enough to have sex, then remove the tension ring.
Penile implants: implants are surgically places on both sides of the penis, either inflatable or semi rigid rods.  The inflatable implants, are inflated before sexual intercourse to help obtain an erection and the semi rigid rods allow for a firm but flexible penis at all times. Due to it being surgical in nature, there is a risk of infection, and usually a later option for ED.
Blood vessel surgery: at times a leaking vessel can cause a decrease in blood flow to the penis, a simple surgical procedure may be able to fix that problem.
Psychological counseling: if the problems are psychological in nature, counseling can help to talk about the problems and may help to decrease ED issues.

How can you fix it with lifestyle changes?
If you use tobacco, quit. Lose weight to get to a healthy level, exercise regularly, get treatment for alcohol and drug abuse, and work through relationship issues with your partner and with the help of a professional.

Alternative medicine:
Acupuncture is said to help with ED and relieve stress and anxiety, so it can help with some psychological problems.

Due to all of the possible causes, it is not only the first sign that something serious might be going on, but it also is something that might be fixed simply and easily, so I really encourage seeing an HCP early to talk about it.  Be open and honest with yourself, your partner, and your HCP.  ED is not something to be embarrassed about or something that you should allow to ruin a relationship.  If you notice any of these problems with yourself or your partner, please talk about it and go see you HCP ASAP!!

Yours in Good Health

Tuesday, September 21, 2010

Shoo Flu, Shoo!!

With Flu season looming and everyone asking if you've gotten a flu shot, if you plan on it, and hearing (my favorite) "Eh, I'm not going to get it, I'm healthy and it's only the flu, I don't get what the big deal is..." That statement clearly comes from someone who hasn't had the flu!!  Since I became a nurse, I have always gotten the flu vaccine, mostly because it is offered to you at the hospital, and they come to give it to's actually hard NOT to get it!!  But the year that I lived in the UK, I did get my US flu vaccine and considered myself all set, until I flew throughout the EU and to Bali and got the flu; the sickest I had ever been as an adult and it was MISERABLE.  So, yes, I am a believer in the flu vaccine, and it is one of the few vaccinations that I really encourage everyone to get.

Why is the flu shot such a big deal?
Approximately 49,000 people die each year directly from the flu or flu related causes.  In 2009 (Apr-Oct)approximately 34 million people were affected with H1N1, causing millions of hospital admissions, days of lost work, and $$ out of YOUR pocket for co-pays/meds/lost work!!  If getting a quick shot can prevent all that, why not get it?

There are two different vaccines out there for the flu: a nasal spray and a flu shot.  Both are protective of three different virus strains that the CDC research indicates will be most virulent each season.  For example, these 2010-2011 Flu vaccines will protect against the 2009 H1N1 and the H3N2 as well as the Influenza B virus.  After about 2 weeks, you will build up antibodies against the flu that will help prevent you getting infected, and if you do, it will be a very mild form, like a cold. The flu shot (actual injection) is an inactivated (not living) form of the virus that is injected directly into your arm, and is appropriate for people over the age of 6 months, and for people that are healthy or with chronic medical conditions.  After the injection, you can have redness at the site, soreness, fever (low) and some aches that last 1-2 days. The nasal-spray flu vaccine is made with living, but weakened, flu virus  that do not cause the flu and it is approved for healthy people age 2-49 years old who are not pregnant. After the nasal-spray vaccine, you can have some side effects (for adults) such as: runny nose, headache, sore throat, and cough. For children, the side effects can be: runny nose, wheezing, headache, vomiting, muscle ache, and fever.  Since the flu season is technically October to February, you can get vaccinated at any time, but I always suggest to get vaccinated as early as you can!

Who should get vaccinated?
The CDC suggests that EVERYONE 6 months and older should get vaccinated yearly!  But here is a list of "high risk" people who should definitely get vaccinated:
     -Pregnant women
     -Children younger than 5 years old (because they start preschool) but even children under 2 are at risk and have low immune systems- they are also at high risk
     -People 50 year old and over
     -People of any age with chronic conditions (i.e. asthma)
     -People who live in nursing homes or long term care facilities
     -People who live with or care for those at high risk:
                Healthcare workers
                Household contacts of those at high risk for the flu
                Household contacts and home care givers for those less than 6 months old

Who should NOT be vaccinated?
     -People with an allergy to chicken eggs
     -People that have had a severe reaction to Influenza vaccine in the past
     -People who have developed Guillian-Barre syndrome* within 6 weeks of a flu vaccine
     -Children under 6 months of age
     -People with moderate illness that have a current fever (wait until the fever subsides and then you can get a flu shot)

*(Just as a quick aside, Guillian-Barre syndrome is an autoimmune disorder that affects the peripheral nervous system and it is activated by an infectious process- basically you lose control/function of all of your muscles from the bottom of your body up, and remember that your lungs are a muscle, so it usually requires a hospital admission and a breathing tube with an acute attack!! So, you would know if you had it in the past!)

I hope you all are encouraged to go out and get a flu shot soon, they are available at pharmacies and clinics everywhere!!

Yours in Good Health!!


Thursday, September 16, 2010

Acai: the fruit, the myth, the legend

Acai is stated to be a treatment for a ton of different health issues such as arthritis, cancer, weight loss, diabetes, high cholesterol, erectile dysfunction, detoxification, and overall general health and well-being.  There are tons of products out there that have acai in them and have claims of restoring your health in a plethora of different ways.

Acai is a berry similar to a grape, it is round, small, dark purple in color, that is grown on acai palm trees, primarily found in Central and South America.  The acai berry can be found in many different forms in stores in the US; raw, tablets (supplements), added to beverages (smoothies, juices, energy drinks), and foods (jellies, ice creams, etc.)  They are a source of antioxidants, have a decent percentage of fiber present in them.

Acai Palm grove

The problem?  There are basically NO studies that show any of the health benefits that all of these companies are claiming about the acai berry, none of these products have been FDA approved, and you really don't know that you are even getting any acai in any of the supplements that you are ingesting.  There was one study that showed that acai berries have less antioxidants than blueberries, concord grapes, and black cherries but more than oranges, cranberries, and apple juice; sort of a mid-level antioxidant amount.  It has low amounts of vitamin A, Iron, and calcium, and basically no vitamin C present.

If you like the flavor of acai berries, then go for it and eat them as you would any other fruit that you find delicious.  Should you change your world and diet because of them?  No.  They really have no more health benefits than any other fruit, and you would be better off in all honesty eating the fruits with high antioxidant amounts that are less expensive and more common (blueberries, concord grapes, and black cherries.)  If you want to drink your antioxidants, red wine and pomegranate juice have more....depending on if you want an adult beverage or not!

Sorry to ruin the idea that the acai berry is this amazing fruit that will change your life and make all of your health ailments go away, but the research just isn't there to support it!  So, stick with what you know and I will be on the search for the fruit that will fix everything!!

Yours in Good Health

Wednesday, September 15, 2010

Medical marijuana: both sides of the story

There is a rally at the capitol building in Hartford, CT this weekend to show support for a medical marijuana bill.  I will be there to support the bill, but I am not some crazy lady who doesn't fully understand the issues at hand, and it can be beneficial to people, but detrimental as well. In all honesty, marijuana is a lot less detrimental to peoples health than tobacco products and it actually has health benefits, which are not found in tobacco products.  I want to discuss the pros and cons and give some interesting stories from patients who found it helpful and what they have had to go through during their treatments.  You are MORE than welcome to disagree with me and I actually appreciate a good debate!!

It was only in 1972 that marijuana was deemed a Schedule I drug under the Controlled Substances Act by the US government because it was considered to be a drug that had no medicinal use in treatment. Currently marijuana is legal for medical use in 14 of the 50 states (and DC). The debate in a quick synopsis?  The people that are against legalization feel that marijuana is detrimental to peoples health, it has not been FDA approved so it is dangerous to use and you don't know a strength or where it comes from.  As well, they claim it is addictive, it leads to harder drug use, and that it injures lungs, harms immune system and the brain, and sends kids the wrong message.  The pros state that marijuana meets the FDA criteria that the benefit outweighs the harm of a drug (makes you feel good about all FDA approved drugs, right? YIKES), and that it is a safe and effective treatment for multiple sclerosis, glaucoma, cancer, HIV/AIDS, pain, migraines, and epilepsy.

I agree that smoking ANYTHING is horrible for your lungs and I don't encourage smoking of any kind, it does help the patient feel relief faster as the drug reaches the bloodstream within a minute or so, but it does cause damage and the length of time that the drugs stays in the system is much slower than other methods.  But smoking marijuana is the route that most causal users take part in, patients that are legitimately sick, use other methods to gain relief of symptoms from their disease process.   There are methods of vaporizing (like being in a steam room but inhaling cannabinoids along with the vapors instead of eucalyptus on a smaller scale), which is another form of inhalation and can cause burns from high temperature water if done in the wrong way.  AS well, there is making tinctures, by soaking the plant in alcohol and absorbing the THC derivative, allowing patients to absorb the THC directly through the skin (that takes a little longer for them to feel effects and it may not have as strong an effect as smoking or eating, but dulls pain directly at the site) or they can put a few drops sublingually (under the tongue which is great for patients debilitated with pain and caregivers can easily administer without the need for an IV or having to swallow) and is mostly used by pain patients to decrease the pain without all of the psychoactive effects.  And finally, there is cannabutter which is making the cannabis into a butter through simmering over a few hours; the effects of the drugs can be felt for hours for the patients and they can modify the amount they ingest by eating smaller or larger portions, and patients state that this method gives them the best relief of symptoms for the longest amount of time BUT the downside is that they can under/overestimate the potency and eat too much or not enough to relieve symptoms, it can take up to 1 1/2 hours to feel the effects, and eating too much can cause vomiting and loss of consciousness.

As far as long term use of marijuana, there are studies that go back and forth for both sides that solidify and disprove each other, so it is really confusing to read through and sift to get the facts.  One thing I must say, is that one study that was done and is clearly pro legalization of marijuana, stated that long term marijuana smoking doesn't cause lung cancer; as I already stated, smoking isn't good for you, and any constantly inhaled smoke is going to cause damage to the lining of your lungs leading to chronic bronchitis and/or emphysema with the possibility of lung cancer.  Some studies show long term brain damage due to usage of marijuana, but what needs to be studied is the difference between long term marijuana use for pain and long term oxycontin use; this is the real issue here!  Many patients feel better relief from pain with marijuana than standard pain medications that are FDA approved and they have the added benefit of feeling hungry with a decrease in nausea, so with one "medication" they have three treatments, versus taking three or more prescribed drugs that can cause liver/kidney damage and not always feel an effect.

As well, the people who are against the use of marijuana for medical use feel that this gives a poor message to children and that marijuana usage will increase. In states that have legalized marijuana, they have seen no dramatic increase in the use of marijuana by adolescents or adults.  Furthermore, I do think that children already get a confusing view of right and wrong in our society; alcohol and tobacco combined have huge addiction and death rates, but they are both legal, and as stated earlier, tobacco, as distributed currently, has no known health benefits.

I had a patient that was literally wasting away from cancer because of nausea and vomiting from chemotherapy and inability to eat leading to malnutrition, and all drugs that their MD prescribed weren't helping, they literally were dying from the side effects of the medications, while their cancer was actually diminishing. She was on so much oxycontin to diminish her pain that she was constantly dozing off and her life was no longer hers, it was the cancers.   She was staunchly opposed to marijuana because when she grew up in the "Reefer Madness" era, she was told it was a gateway drug and made you crazy, but she finally was so fed up with traditional US medicine that she asked her children to help her find some marijuana and she smoked it one day; her life changed completely.  She was able to eat, and keep the food down!  She felt her depression lift, and she was able to have some pain relief without sleeping her life away.  WIth the help of friends and the Internet, she learned how to ingest the drug by other means, mostly she ate it in her food, and she regained control of her life and her disease.  The problem?  She had to do sketchy drug deals and fear being arrested for buying marijuana, when she was using it as medicine, but just a recreational drug to get high and silly.  How is marijuana any more harmful than oxycontin??  I don't have an answer for you...

I know that this could go on for days and I could write an entire 100 page soliloquy on the topic, and I honestly tried to be neutral, but it clearly didn't come across that way!! There are also governmental monetary issues that i may talk about because the current state of our government economic issues versus the cost of arresting people for marijuana use is ridiculous.   I just wanted to add a chart that shows the death rate of medical marijuana vs standard FDA approved drugs and let you all ponder the true risks of legalizing medical marijuana, and if you support it or not!

Drugs per
Suspect of the Death
Secondary Suspect (Contributing to death)
Total Deaths Reported
1/1/97 - 6/30/05
also known as: Cannabis sativa L
(used to treat vomiting)
(used to treat muscle spasms)
(used to treat psychosis)
(used to treat various conditions including ADD, depression, narcolepsy, erectile dysfunction, and pain)

of Drugs
in Total
Suspect of the Death
Secondary Suspect (Contributing to death)
Total Deaths Reported
1/1/97 - 6/30/05

And check out the website for more info and all aspects of this debate, and any of you nutmeggers that support a passing of the medical marijuana bill in CT, I hope to see you on Saturday!!

Yours in Good Health!!

Tuesday, September 14, 2010

What is the deal with Salmonella and eggs??

Since there has been a major egg recall recently and I have been asked about it a lot, I thought that I would explain about salmonella (signs and symptom of infection)  and how these major egg infections can occur...and also discuss that this is not the first time that Iowa farms have been the source of major salmonella outbreaks across the US!!

First of all, the bacteria, Salmonella enterica, has been around for eons, but it has found easier ways to reach humans because of the way that we currently mass produce and farm our animals for food.  There are roughly 1.5 million cases of salmonella a year and 142,000 are traced back to egg related infections which led to the FDA creating stricter egg safety rules for farmers, and they are hoping that around 80,000 of the infections from eggs will be prevented.  In the 1920-30's people very rarely ate eggs because of the rate of salmonella infections. In 1980 there was a huge outbreak stemming from a few Iowa farms and one that was pretty large infecting most of New England that stemmed from at CT farm.  This caused a huge ruckus leading to huge studies of why  these infections occurred; scientists found that there was, what is known as, vertical transmission (and infected hen can transmit the infection to the egg through the bloodstream), which becomes really important for modern day farmers!

If any of you have seen Food, Inc., you know that fowl is not treated so nicely, and they live in less than ideal housing.  Salmonella can be transmitted through food and fecal matter; these hens live in their own feces and get infected through housing or through their food, and transmit it to the eggs, plus there are so many in each hen house that the Industrial production farmers have no way of finding infected fowl, and thus the outbreak cycle begins and ends up on our tables!  Plus  Industrial farms tend to starve the chicks to make them 'molt' thus they are able to have more egg laying years, but like anyone/thing that is malnourished, they are at a higher risk for infection.

There are over 2000 types of salmonella strains and of those around 12 of them cause an infection, which is usually diarrhea that you wouldn't really think was anything horrible and will pass quickly, but 3 or 4 can cause typhoid fever which can be deadly.  As stated above, it can be contracted by eating raw or undercooked meat, eggs, and egg products.

What are the signs and symptoms of Salmonella infection?
-Muscle pains
-Blood in the stool

The signs/symptoms of Typhoid Fever are a little more specific, and the incubation period is 5 to 21 days:
-Diarrhea or constipation
-Fever over 102F (38.8C)
-Slightly raised rose colored spots on your upper chest
-Change in mental status (confusion)
-Slowing of the heart rate
-Enlarged liver and spleen (abdominal tenderness can occur)

What do you do if you think you have Salmonella?
Call your HCP and they will want you to bring in a sample of your stool (poop), and they may draw blood to test for a bloodstream infection.

Your HCP may suggest and antidiarrheal drug (I tend not to suggest them because it can cause the salmonella to stay in your system for longer, so I think that it is better out than in, and poop it out!!)
Also, you will be placed on an antibiotic to kill of the infection.
If you have typhoid fever, you will be placed on Intravenous fluids and most likely given intravenous antibiotics at first (depending on extent of infection) and it will be cleared in 2-4 weeks.

Remember that salmonella is highly contagious so please wash your hands after going to the bathroom, handling raw meats/eggs, changing diapers, picking up after pets, and after touching reptiles and birds.  As well, be especially careful if you are infected around infants, elderly, and the immunocompromised.

I tend to only purchase eggs from small local farms, where the hens are free range and the birds are fed appropriate food, which puts them at a MUCH lower risk for salmonella, plus I don't tend to eat raw eggs too often, and cooking eggs thoroughly usually kills off the bacteria. I also wash my hands a lot (habit of the job)!  And, if you think you are infected, call your HCP and get in to be seen right away!  I hope this clears up some of the confusion around the egg recall and why salmonella is such a problem with eggs, specifically!

Yours in Good Health

Thursday, September 9, 2010

Running Injury/Prevention Part II

More running injuries, prevention, and treatment…also I want to reiterate for those who didn’t read Part I, that I want you know what could be going on, so try treatments, but if the pain/discomfort persists, please go to a HCP and get diagnoses properly and treated.  Taking ibuprofen before every run can mask and injury and make it worse over time, unless that is the appropriate treatment!!
Stress Fractures
Stress fractures are common amongst runners, in the femur (thigh), tibia (shin) and feet. A stress fracture is a break in a bone caused by repetitive impact and contraction of the muscles. Stress fractures do no go completely through a bone as other fractures sometimes do. Since they are associated with heavy training, stress fractures can be mimicked by injuries to the muscles, tendons, ligaments and other fractures. 

How a stress fracture forms
Resorption and new formation of bone occurs in response to mechanical stresses. This is called bone remodeling. During periods of intense exercise, bone formation lags behind resorption. Without adequate rest, bones become susceptible to micro-fractures. With continued stress, micro-fractures may combine into stress fractures.

Risk factors for developing a stress fracture
A sudden or substantial increase in duration and/or intensity of training is the most significant risk factor for developing a stress fracture. Inadequate muscle strength, inflexible joints and low bone density may play a role when in the formation of stress fractures. In general, females are at greater risk to develop stress fractures. Although the reasons for this discrepancy remain unclear, possible causes include eating disorders, pre-activity conditioning levels, endocrine (hormone) factors, skeletal alignment and lower bone density. Lower bone mineral density is associated with the following, as discussed in earlier blogs: regular intake of carbonated drinks, white race, alcohol and/or tobacco use, low for weight/height ratio, steroid use (prednisone-type for asthma, e.g. not anabolic steroids) and use of depo-provera injectable contraceptive.
Pain that increases with activity and decreases with rest
Pain that occurs earlier in your workout in each successive workout
Pain that increases over time
Pain that persists even at rest
A specific spot on the involved bone that feels tender or painful to the touch
At first, stress fractures may be barely noticeable. But pay attention to the pain. Proper self-care and treatment can keep the stress fracture from worsening.
When to see a doctor

Stress fractures aren't always obvious. They develop over time, so it's difficult to tell exactly when they start to require a doctor's care. Go to your doctor if running or playing hurts your foot or leg even after you've stopped the provoking activity and given yourself time to rest.

The treatment for a stress fracture is rest from the offending activity. Four to six weeks of rest is usually sufficient, followed by a gradual increase to full activity. Immobilization in a brace or cast is done for situations in which there is pain with walking or at rest. Non-stress/non-impact training such as swimming or bicycling is generally safe and helps maintain fitness. For certain fractures, orthopedic referral is necessary if there is a risk that the fracture will not heal properly. 

Pain control is important. Regular ice application to the affected area can reduce both pain and inflammation. Some advocate very little pain medication as it may slow healing. Gentle massage can relieve pain and help increase blood flow. Dietary supplementation with Calcium (1200 to 1500 mg) and Vitamin D (400-800 IU) should be encouraged during the acute phase.

Preventing stress fractures is very important. Avoiding significant changes in frequency or intensity of training will help avoid multiple types of injuries, including stress fractures. Good footwear with limited wear and shoe inserts that absorb shock are helpful. A diet with substantial vitamin D and calcium can help improve bone density for individuals with this risk factor. Eating disorders rob the body of essential nutrients and hormones needed to maintain good bone health. If any problem exists with eating behavior or if a woman is having no periods, these issues should be addressed immediately. Avoiding carbonated beverages, alcohol and tobacco helps to reduce the risk of low bone mineral density.

Snapping Hip
Snapping hip syndrome is a condition that is characterized by a snapping sensation, and often an audible 'popping' noise, when the hip is flexed and extended. There are several causes for snapping hip syndrome, most commonly due to tendons catching on bony prominences and "snapping" when the hip is moved.
Iliotibial Band Snap
The iliotibial band is a thick, wide tendon over the outside of the hip joint. The most common cause of snapping hip syndrome is when the Iliotibial band (or "IT band") snaps over the greater trochanter (the bony prominence over the outside of the hip joint). If this is the cause of snapping hip syndrome, patients may develop trochanteric bursitis from the irritation of the bursa in this region.
Iliopsoas Tendon Snap
The iliopsoas tendon is the primary hip flexor muscle, and the tendon of this muscle passes just in front of the hip joint. The iliopsoas tendon can catch on a bony prominence of the pelvis and cause a snap when the hip is flexed. Usually when the iliopsoas tendon is the cause of snapping hip syndrome, patients have no problems, but may find the snapping annoying.
Hip Labral Tear
The least common cause of snapping hip syndrome is a tear of the cartilage within the hip joint. If there is a loose flap of cartilage catching within the joint, this may cause a snapping sensation when the hip is moved. This cause of snapping hip syndrome typically causes a snapping sensation, but rarely an audible "pop." This cause of snapping hip syndrome may also cause an unsteady feeling, and patients may grab for support when the hip snaps.
Most people do not bother seeing a doctor for snapping hip unless they experience some pain. Your doctor will first determine the exact cause of the snapping. You may be asked where it hurts, what kinds of activities bring on the snapping, whether you can demonstrate the snapping, or whether you have experienced any trauma to the hip area.
You may also be asked to stand and move your hip in various directions to reproduce the snapping. The doctor may even be able to feel the tendon moving as you bend or extend your hip.
X-rays of people with snapping hip are typically normal, but they may be requested along with other tests so that the doctor can rule out any problems with the bones or joint.
If your snapping hip is painless, no treatment is needed.
If the snapping hip bothers you, but not to the point of seeing a doctor, try the following conservative home treatment options:
Reduce your activity levels and apply ice.
Use nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen, to reduce discomfort.
Modify your sport or exercise activities to avoid repetitive movement of the hip. For example, reduce time spent on a bicycle, and swim using your arms only.
If you are still experiencing discomfort after trying these conservative methods, consult your physician for professional treatment.
Stretching exercises prescribed by your physician or a physical therapist can help reduce discomfort.
If you have hip bursitis, your physician may recommend an injection of a corticosteroid to reduce inflammation.
In the rare instances that snapping hip does not respond to conservative treatment, surgery may be recommended. The type of surgery will depend on the cause of the snapping hip; arthroscopy of the hip may be indicated.
The key to preventing snapping hip syndrome is a balanced stretching routine. Stretch both the abductors and adductors evenly. The abductors are the hip muscles that move the
leg away from the midline of the body. The adductors are the hip muscles that bring the leg back to the midline of the body. It is recommended that athletes include an iliotibial-band stretch as part of their warm-up and stretching routines.

Also, I wanted to include a diagram so you can understand what muscles and bones I am referring to, for those of you who are visual learners like me!!

Yours In Good Health!

Wednesday, September 8, 2010

Running Injury/Prevention Part I

OK, So I started this blog and realized that it is a LOT longer than intended, so I am going to make it a two-part blog :)

Enjoy, read up, and I want you to be aware of these injuries and how to prevent them.  And, while these are mostly due to running, you can get them from walking, and sometimes get these issues from other form of exercise, so please take note if you have any of these pains and see an HCP to get diagnosed and DON’T just take ibuprofen and run through it; you can cause serious injuries!!

IT Band Syndrome:
Runners Knee (Iliotibial band syndrome)
The IT band is a thick, fibrous band of fascia which runs down the outside of the thigh and inserts just below the knee. If this band becomes tight it can rub against the outside of the knee causing pain and inflammation. It attaches at the top to both the iliac crest (hip bone) and the Tensor fascia latae muscle. It then runs down the outside of the thigh and inserts into the outer surface of the Tibia (shin bone). Its purpose is to extend the knee joint (straighten it) as well as to abduct the hip (move it out sideways). 
As the ITB passes over the lateral epicondyle of the femur (bony part on the outside of the knee) it is prone to friction. At an angle of approximately 20-30 degrees the IT band flicks across the lateral epicondyle. When the knee is being straightened it flicks in front of the epicondyle and when it is bent, it flicks back behind.
Signs and Symptoms of ITB Syndrome:
Pain on the outside of the knee
Tightness in the IT band
Pain normally aggravated by running, particularly downhill.
Pain during flexion or extension of the knee, made worse by pressing in at the side of the knee over the sore part.
Weakness in hip abduction (widening the hip)
Tender trigger points in the gluteal (upper and lower butt muscles) area may also be present.
What can the athlete do to prevent Runners knee?
RICE- Rest Ice Compress and Elevate
Avoid downhill running.
Stretch the IT band after training.
Massage techniques can also be very helpful in correcting excessive ITB tightness.
 An HCP may get you into Physical Therapy (PT) to work on ways to stretch and strengthen the surrounding muscles, and may even administer a cortisone injection to the area to decrease swelling in extreme cases.

Shin splints is a common name for pain at the front of the lower leg, usually to the inside of the protruding Tibia (shin bone). The most common cause is inflammation of the periostium of the tibia (sheath surrounding the bone). Traction forces on the periosteum from the muscles of the lower leg cause shin pain and inflammation. This has lead to the use of terms such as Medial Tibial Traction Periostitis.
Symptoms of shin splints:
Pain over the inside lower half of the shin.
Pain at the start of exercise which often eases as the session continues
Pain often returns after activity and may be at its worse the next morning.
Sometimes some swelling.
Lumps and bumps may be felt when feeling the inside of the shin bone.
Pain when the toes or foot are bent downwards.
A redness over the inside of the shin (not always present).
Shin Splints Treatment
Treatment for shin splints is as simple as reducing pain and inflammation, identifying training and biomechanical problems which may have helped cause the injury initially, restoring muscles to their original condition and gradually returning to training.
What can the athlete do about shin splints?
Rest to allow the injury to heal.
Apply ice in the early stages, particularly when it is very painful. Cold therapy reduces pain and inflammation.
Stretch the muscles of the lower leg. In particular the calf muscles associated with shin splints.
Wear shock absorbing insoles in shoes- this is for heel runners and is the common suggestion by HCP’s, not as much of an issue for forefoot runners.
Maintain fitness with other non-weight bearing exercises such as swimming, cycling or running in water, to rest the muscles
Apply heat and use a heat retainer or shin and calf support after the initial acute stage and particularly before training; it causes blood vessels to dilate and increases the flow of blood to the tissues to aid healing.
Overpronation of the feet
Oversupination of the feet
Inadequate footwear (debatable….as mentioned before!!)
Increasing training too quickly
Running on hard surfaces
Decreased flexibility at the ankle joint

In order to properly treat shin splints and prevent them recurring, the cause must be taken into consideration. No matter how much rest, anti-inflammatory medications and massage are used, without correcting the cause of the injury, the symptoms will continue to return.
Biomechanical problems such as overpronation and supination can be corrected using running shoes or insoles (or orthotics). As a basic rule of training, distances should not increase by more than 10% per week. This helps to ensure the muscles are not overworked.
For runners, try to avoid always running on hard pavements as they provide no shock absorption. Try running some of the time on tarmac, grass, or sand to reduce the shock passed through the legs.
Shin splints can be caused by overly tight muscles in the lower leg, including the calf muscles (gastrocnemius and soleus) and the shin muscles. Stretching on a daily basis and even receiving sports massage can help improve flexibility.

Anterior compartment syndromes arise when a muscle becomes too big for the sheath that surrounds it causing pain. The big muscle on the outside of the shin is called the tibialis anterior and is surrounded by a sheath. This is called the anterior compartment of the lower leg. Compartment syndromes can be acute or chronic.
 Acute anterior compartment syndrome can occur as a result of:

An impact which causes bleeding within the compartment that causes swelling.
A muscle tear which also causes bleeding/swelling
Over use injury, which also causes swelling.
Symptoms of anterior compartment syndrome include:
A sharp pain in the muscle on the outside of the lower leg, usually the result of a direct blow.
Weakness when trying to pull the foot upwards against resistance.
Swelling and tenderness over the tibialis anterior muscle. (upper calf)
Pain when the foot and toes are bent downwards.
What can the athlete do?
Rest, but try to exercise your upper body or cycle if it is not painful (swim, bike, Physical Therapy)
RICE in 20 minute cycles
What can an HCP do?
Prescribe anti-inflammatory medication (ibuprofen)
Fit for orthotic devices.
Refer to an Orthopedic Surgeon to operate; a small cut or two in the muscle sheath  will allow the muscle to expand out.
Chronic anterior compartment syndrome can occur as a result of:
Over use and over developing the muscle through training.
At rest the blood vessels are not at capacity. During exercise these blood vessels fill up much more and expand putting pressure on the sheath (can be painful due to varicose veins)
Symptoms include:
Pain which increases during exercise which eventually makes running impossible.
Pain goes after a short rest but comes back again during exercise.
Difficulty in lifting the toes and foot up.
Pain when pulling the toes and foot downwards.
What can the athlete do?
Rest until there is no pain- RICE when possible
Apply sports massage techniques to increase the elasticity of the muscle sheath.
Apply heat before exercise.
See a sports injury specialist/Physical Therapist
What can a sports injury specialist or doctor do?
Prescribe diuretics and anti-inflammatory medication.
Analyze your training methods, running gait and types of shoe to determine any contributory factors.
Use sports massage techniques to stretch the muscle sheath.
Prevention of Running Injuries
Running injuries are very specific due to the repetitive nature of the sport. Injuries are caused either by the bodies own intrinsic factors or by extrinsic factors.
The body works on a closed chain system when running i.e. when the foot is in contact with the ground, the forces and mechanics are transmitted along the leg to the spine. This is repeated every step and means if anywhere along this chain is out of line then potential injuries can happen.
Intrinsic factors
Intrinsic factors relate to the body itself. They are factors from inside the body rather than outside injury risk factors. Everybody has their own individual mechanics, some better than others. Some break down more than others. Everyone has their own unique threshold of injury.
What can go wrong?
If there is a biomechanical abnormality anywhere along the chain from the feet up, then injuries can occur. The most common problem is feet that collapse and overpronate causing the leg to turn in and pressure on the achilles, shin, knee, hip and spine. If you over pronate then you need stability trainers or running shoes to support the foot. In extreme cases where the runner is injury prone, orthotics may be prescribed.
Most specialist running shops will be able to look at your feet and tell you what foot type you are. Squinting patella and hips and knees that turn in are also common problems especially in women. Again, this means these areas and those above and below are placed under extra strain, leading to injuries.
A lot of biomechanical problems can be corrected using Physical Therapy (PT) For example, knees that fall in (giving a knock-kneed appearance) are usually the result of weak hip abductor muscles which would usually act to pull the thigh and so knee outwards. Tight hip flexors are also a very common problem with runners as the hip flexors are repeatedly contracted and shortened. I would advise all runners to include a simple hip flexor stretch in their warm up:
Hip flexor stretch
On one knee, other foot rested in front, tighten the stomach muscles and lean forwards.
If this is painful on the knee then try standing , pull one heel to the bum and pull knee backwards, keeping the spine still.
Hold both stretches for 30 seconds.
Tightness in the calf muscles can lead to over pronation due to lack of range and then shin pain. It is important to stretch the 3 layers of calf muscles.
Calf stretch
Standing on a step initially let the heels drop and stretch the large superficial muscles. Then repeat this stretch with the knee slightly bent to stretch the Soleus muscles which runs deep to the larger Gastrocnemius. This muscle is often forgotten!
Tightness in the spine is a very common cause of all running injuries treated. It is good to do some basic spinal mobility exercises to try and get the spinal joints moving before running. These can include pulling the knees to the chest, then lying on your front pushing up on the arms, and then you can rotate the spine lying on your back with the knees bent.

Extrinsic factors
Before training for any running event and even throughout your training you should be asking yourself the following questions

Running shoes
Have they worn out?
Are they the correct type?
Are you wearing racing shoes for slow mileage?
Do you pronate and have appropriate shoes? Go to a running store, and they can help to assess your feet, and your running style and find the best pair of shoes for you!!
Do you perform a warm-up prior to training? (The answer should be yes!)
Have you been increasing your training too quickly? A basic rule is a 10% increase in mileage per week. 
Are you running on a different surface to usual? Concrete pavements and roads offer very little shock absorption 
Are you doing a more hilly route than usual? Running up and down hills alters your body mechanics.
It’s a good idea to keep a training diary so you can look back and see what may have changed in your training; I use my Nike + for this so it is all online and I can keep track of my times, distances, and I usually note what kind of run it was.
Core strength
If the central part of the body is not strong then you will be more susceptible to injuries especially when you become tired at the end of a run.
 Make sure you do some abdominal exercises and gluteal strengthening. Try and get your club to organize a circuit session, include all the basic exercises like squats, lunges and calf raises.  Also, A good idea is to go to the gym and do a lot of muscle strength training in the legs on your days off from running; when running you repeatedly use the same muscles, so at the gym, strengthen the ones that aren’t used as much!!
Try to eat a balanced diet with lots of fresh fruit and vegetables and plenty of carbohydrates following training and protein to repair muscle damage. It is also vitally important to stay hydrated before and after training. 
There are some videos on Here