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Nurse Bridgid

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Friday, December 31, 2010

How can I deal with these scales?

Psoriasis is an autoimmune disease that affects the life cycle of skin cells so they build up quickly, layering on top of each other, and it causes thick scaly skin, and or areas of dry, red, itchy patches.  It is a chronic disease and it has periods of latency (no problems at all )and then flare ups, which can have all sorts of different triggers. And, it can also be associated with arthritis, which can be super painful. There is no cure for psoriasis, unfortunately. The key is learning what are your triggers, what treatments work best with your lifestyle/beliefs, and how to live with this disease.

What are the symptoms?
- Red cracked skin that may have silvery patches
-dry, cracked skin that may bleed
-itching, burning, and soreness along these dry skin
-swollen joints
* they can range from small spots of these areas to large patches and can be on your scalp under your hair, and affect your hands and nails.

What IS actually happening?
It is an immune system response.  In your blood, you have White Blood Cells (WBCs) that are the fighters; when they sense any sort of pathogen (attack on your system from a virus, bacteria, etc) they go to the site, and attack. One of the types of WBCs is a T cell, the true surveyors of the body that go around and attack and kill any foreign substance as the first line.  When you have overactive T cells, the cells attack your skin cells as if they were any other virus or bacteria despite the fact that they are normal healthy cells that are NOT a risk to your system.  So, the t cells attack, then more WBC's come to the area and also attack (can cause swelling) then the body produces new skin cells, and this is a constant cycle; this forms the scaly plaques because as soon as your body is creating healthy cells, your T cells are attacking.  The dead skin cells and WBCs cannot slough off quickly enough and young new skin cells move to the outer most layer of the epidermis too fast....the cycle of skin cells dying and renewing goes from weeks to days, like a fast forward for your skin.  

What  causes psoriasis?
True causes of psoriasis are unknown BUT there are certain "causative factors" that are thought to possibly start a reaction.
-Infections (strep)
-Injuries (cuts, scrapes, bug bites, sunburns, burns)
-weather (cold)
-Alcohol use
-medications (lithium, certain beta blockers for high blood pressure, and anti-malarial pills)

Does anything put me at risk?
-Family history of psoriasis
-Medical history (HIV, chronic infections, etc)

Are there any complications?
Due to the nature of the disease, it can cause depression (from altered body image), constant pain/discomfort, bacterial infections (from scratching at the skin and allowing bacteria in), stress, anxiety, and possible isolation (because especially if on the face people don't feel comfortable with others).

You are diagnosed by your HCP usually by physical exam as well as from what you tell your HCP about your symptoms and how they show up, if they come and go, etc.  There are a few other skin disorders that can mimic psoriasis: sebhorric dermatitis, pityriasis rosea, and ringworm of the body (tinea corporis).  

Medical Treatment options:
Topical treatments: corticosteroids (anti-inflammatory drugs), Vitamin D analogues (slow the growth of skin cells), Anthralin (normalizes DNA in cells and can remove scales form the skin), retinoids (Vitamin A which can decrease inflammation and normalize DNA in cells), calcineurin inhibitors (alter and slow T cell activity- but not yet FDA approved for psoriasis treatment),  salicylic acid (promotes sloughing of skin and helps to remove plaques), coal tar (the oldest treatment, decreases inflammation, scaling, and flaking...but it is smelly and a pretty gross treatment), & regular moisturizers (they can help with the dryness, itchiness, and cracking of the skin).

Light therapy (phototherapy): UV rays (kill the T cells therefore they are unable to activate and slows the cycle), UVB treatment (needs to be done supervised and will start with 2-3 times weekly then decrease to maintenance exposure to prevent the cycles from re-starting), & photochemotherapy (apply a UV sensitive medication and then expose to sunlight- a very aggressive treatment and significantly increased the risk of melanoma).

Oral/Injected Medications: Retinoids (vitamin A medications- can cause birth defects for up to three years after taking the medication, and help to normalize the DNA function), Methotrexate (decreases inflammation and decreases production of skin cells), cyclosporine (decreases the immune system, therefore the immune response), Immunomodulator drugs (like Enbrel or Remicade- are used for people who have failed other treatments and/or have psoriatic arthritis and they block certain interactions within the immune system).

What can I do to make living with psoriasis easier?
- Daily baths help to soften and remove scales, and adding bath oils or other emulsions softens and soothes the skin.
-Use heavy, thick moisturizers frequently throughout the day (especially in the cold) can use OTC like Cetaphil or Goldbond
-Use a moisturizer before bed and wrap the affected areas in saran wrap and/or use specialty gloves/socks for hands and feet.
-Expose your skin (with SPF 15 or above) to sunlight for small amounts of time (if possible) ** this is NOT an excuse to go to tanning beds for everyone, but talk to your HCP about how best to expose your skin to treat your psoriasis
-Avoid alcohol and smoking
-Try to make time for yourself to relax and de-stress

Alternative therapies:
-Taking Omega-3 supplements is thought to decrease inflammation, although the research is not all that great, but it is worth a try, and I see no harm.
-Capsaicin cream (an extract from chili peppers) can help to decrease itchiness and reduce the severity
-Aloe vera (topically) can decrease redness, itchiness, scaliness, and soothe the skin.

Despite this being a chronic disease, there are very clearly different levels of the disease and tons of different treatment options, you just need to work with your HCP and find what works best for you, your lifestyle, and your level of disease.  And, with all the therapies out there, you may even be told to go out and sunbathe....I wouldn't mind that!!

Yours in Good Health


Friday, December 24, 2010

Don't turn into a tree!!

Ever heard of "tree man"? Well, what he suffers from is  verrucous carcinoma, and it is a slow growing squamous cell carcinoma that can not only grow on the skin of your face and hands but can manifest itself in your genitals as well.  Strangely, there have been more cases of the genital form lately, and people are hesitant to go to their HCP because they really don't know what it is, and are worried that it might be an STD.  Honestly, I don't really get that thinking...if I thought I had an STD my butt would be waiting to see the doors open at my HCP's office to get treated!  But, I digress.  I want you to be aware of the various forms and signs of a verrucous carcinoma because it can be surgically removed and has a better response when treated early as opposed to waiting until you look like a tree.

What is it exactly?
A locally aggressive, slow growing squamous cell carcinoma (a tumor of the epithelium- your top layer of skin, that doesn't usually metastasize, and it usually affects the oral cavity, larynx, genitals, skin (hands and feet specifically), and esophagus.  It is also known as an Ackerman tumor OR in the genitals a Buschke-Lowenstein tumor.  And, it has not yet been proven, but it is thought to be due to the HPV (Human Papilloma Virus) that either activates the cancer to grow or is the tumor. HPV-16 (that strain) has ben found with almost all (some weren't studied) penile, vulvular, and anal verrucous carcinomas, which is tough to study, kind of a "chicken or the egg" type of question, but it is assumed that in those cases the HPV causes the tumor.

What are the signs and symptoms?
Oral Verrucous Carcinoma:
-White patchy lesions on the back of the throat
-The patchy lesions will progress to more cauliflower like lesions that are white, soft, and cover larger areas in your throat
-They can occur on your tongue, tonsils, under your tongue, on your gums, and in the inside of your lips
-Usually patients present at a later stage because they don't report the signs early
 Anal/genital Verrucous Carcinoma:
-Begins as a small ulceration in the genital or anal area
-They also progress to larger cauliflower-like white lesions that are painless
-They are commonly seen on the glans penis in uncircumcised men, but can also be found in the vaginal, bladder, cervix, perianal, scrotal, vulvular, and pelvic organs.
-They grow deep roots and have a high rate of recurrence, despite surgical and laser removal techniques
Palmoplantar Verrucous Carcinoma:
-Usually found on the bottom of the feet but can also be on toes, over toe knuckles, and can be on amputates stumps.
-Found on long standing scare specifically after gun shot wounds and burn scars.
-Start as ulcerations that drain foul smelling fluid
-Can start as one ulceration and it will get larger and spread

Who is more apt to get it?
White males ages 55-65 are at highest risk for all forms of verrucous carcinoma EXCEPT the genital/anal form is highest in white males ages 18+.  Your risk is increased if you smoke, use chewing tobacco, alcohol consumption, betel nut chewing, and chronic inflammation (from poor oral hygiene in oral VC and chronic cellulitis or decubitus ulcers for legs/feet).  As well, the scars from prior gun shots and wounds can put you at higher risk (as stated above).

- A skin biopsy is performed to learn what is causing the lesion and determine an exact diagnosis.
-A CT scan will be performed once you are diagnosed to assess how deep the lesion goes internally so that your surgeon can plan your operation for removal.

Depending on the depth of the lesion, either laser removal or surgical excision will be performed.  Surgical excision is usually required as the patients with VC usually present at a later stage and the lesions have grown internally as well as externally. The surgeon will need to cut out the lesion and around the area until the margins are clean, meaning until they get to healthy skin that is non-affected.  There is also the option with early presentation of VC that they can be "frozen" off with liquid nitrogen, but it is like laser removal that the tumors need to be very early in development.  As well there are options of radiation and topical chemotherapy, but radiation has a high rate of transformation of the tumor to a more aggressive form of skin tumor and chemotherapy use has not been proven highly successful as a treatment.

There is an average of 6-40% recurrence rate (couldn't be a more ridiculous statistic, right?) but it depends upon your other health problems, and at what stage the tumor was caught.  When caught earlier, with proper treatment, the recurrence rate is lower.

Due to the cause of VC being not completely understood, the best advice is to treat the risks like those of HPV and any other STD (use condoms, limit your sexual partners, get regularly tested), assess your body for new skin lesions or any changes and go to your HCP when you notice any changes, and get skin mapped yearly and build up a relationship with an dermatologist that you trust. If you have any chronic swelling due to any other medical problems, just be aware that this is a risk, and look for the signs and symptoms, and discuss your risk with your HCP. 

Prevention, knowing what to look for, and open communication are the cornerstone to good health.  So, Happy Holidays to all and don't turn into a tree!!

Yours in Good Health

Wednesday, December 22, 2010

Should I get this checked out?

There are many times that you get a cramp or discomfort, and especially for women, it is easy to pass off and think that it isn't a big deal.  Even if it lasts a couple of days....sometimes it really is nothing more than horrible menstrual cramps (ladies) or a pulled/strained muscle, but it can be something much more serious, like appendicitis.

Why is appendicitis a big deal?
Your appendix, when infected, can easily rupture when it is infected which can cause the infection to spill into your abdominal cavity and cause a very serious infection that can lead to death if it isn't treated quickly.  If the appendix does not rupture, but stays infected, the infection can cause an abscess in the abdomen that also runs the risk of rupturing.  This rupture causes severe, excruciating pain and a  form of infection that is overwhelming to your body...basically, its NOT GOOD!!

What are the signs and symptoms of appendicitis?
-Aching pain and tenderness from your belly button usually down the right side of your abdomen
-The aching pain can become more intense over time
-Rebound tenderness: if you push in on the lower right abdomen, then release, the sharp pain occurs upon release.
-Nausea and vomiting
-Loss of appetite
-Low-grade fever
-Abdominal bloating

Is there a cause?
Truly, what causes appendicitis is unknown but it is occurs many times after people have had a GI virus and the virus is thought to get trapped in the appendix, also if some food particles from the small intestines get trapped in the appendix, it can fester and cause an infectious process.

What will happen when I go to see my HCP?
The will draw blood looking for an increased white blood count (WBC) which shows that an infection is present, check a urine sample to rule out a urinary tract infection/bladder infection/kidney stone, and possibly perform a CT Scan to look for actual appendicitis through imaging your abdomen.  Most importantly HCP's will do an abdominal assessment to look for a specific area of pain.  Also, ladies, please be aware that you will most likely have a pelvic exam to rule out that the pain is from an STD or PID (Pelvic inflammatory disease).  Depending on your symptoms, some HCP's will not perform any or of imaging and send you directly for surgery.

What is the treatment?
Surgery!  If you have straight uncomplicated appendicitis, you can have laparoscopic surgery where 5 small holes are poked into your abdomen, the surgeon inserts a video camera and small surgical tools into your abdomen, and you can usually leave the day of surgery or stay overnight.  The benefit is faster healing.  But, due to other situations (like past abdominal surgeries or ruptured appendix) you may need to have open surgery in which the abdomen is opened through a 2-4in incision and it allows for full visualization of the abdominal cavity and allows the surgeon to wash out your belly when infection is present.  You usually are required to stay 2 days after surgery to ensure that you are passing gas and can eat without nausea, then you are free to go home.  At home, with either surgery, you need to assess incision sites for signs of infection (pus oozing from incision, redness, swelling, fever greater than 100.3, or trouble with nausea and vomiting/keeping food down) and call your HCP if you have any of these symptoms.
*If you have an abscess, you may have a drain placed and put on oral antibiotics, then come back in a week for your surgery.

What happens after I get home?
As stated above, look for signs of infection and call your HCP if you have them.  Also, limit exercise and heaving lifting for the first 10-14 days, but get up out of bed and walk around as much as you can.  When you feel tired, sleep- your body is healing from a major infection and surgery, and the best thing you can do is sleep and allow it to heal.  To prevent a pneumonia after surgery, getting up and walking around helps, but if you feel like you need to cough, do it!  It will be uncomfortable, but hold a pillow over your belly with both hands (pretty tightly as a splint) and cough; it will decrease the pain and allow you to clear your airways.  And talk to your HCP before returning to school/work/working out to make sure that they think it is OK too.

You will have pain after your surgery and will be prescribed pain medication.  Try to take it as ordered, and if your pain is still present, even with the medication taken as prescribed, call your HCP to write you or something else. Also, the use of music can help to decrease your pain symptoms and guided imagery; basically distract yourself by meditating or thinking of things that make you feel happiest and best (for example, I think of being really warm on a beautiful beach in Bali, and I imagine everything down to the smells that I remember.)  It helps distract your brain from the pain that you are feeling, and it won't take care of all of your pain, but can help you between doses of pain medication.

Appendicitis is something that can be easily missed by the patient, and it can make you very sick.  So please go to your HCP or ED if you have any of these signs and symptoms.  As stated on earlier blogs, sometimes women will actually have PID (pelvic inflammatory disease) or another STD that will present like appendicitis, so be ready for some questions that you might think are not appropriate, but trust me, they are!!  Get any pain in your abdomen checked out, but especially if it gets worse!

Yours in Good Health

Tuesday, December 21, 2010

Trying to lose weight??

So, especially around the New Year, I get a lot of questions related to weight loss and looking for tips on dieting.  Honestly, I am not much of a dieter myself, I work out and I do eat pretty healthy.  Don't get my wrong, I strap on a feedbag every now and again...BUT I use my workouts as my evening keel.  So, I know a lot of people will say " Oh, I will have dessert tonight and just work out really hard tomorrow."  What do I do?  I allow myself treats AFTER a hard workout, it is my own form of positive reinforcement for a job well done!  I hate going into my workout knowing that I have to workout extra because I went batty with the food the night are setting yourself up for failure.  How do we not set ourselves up for failure?  Read on....

The cardinal rules of weight loss:
1. If you are into weighing yourself (I am not a big fan and I usually encourage people not to, but I know that some people hop on 10 times a day!!) only weight yourself ONCE A WEEK!!  Weight yourself at the same time (usually morning after you have pooped/peed and feel skinniest) and ensure that you only weight yourself weekly...ladies please take into account your cycle and you may be retaining water!

2. Shoot for a weight loss goal of 2lbs per week; anything more than that and you will have trouble keeping it off.

3.  Eating foods that are high in fiber will fill you up and be colon friendly!  I totally understand that during the winter you will want more yummy warm foods, but instead of a high fat, meaty stew, try a black bean stew or instead of regular pasta use spaghetti squash as the "pasta."

4.  Try to limit sodas and take in around 2 Liters of water and/or coconut water a day.  It will help to flush out  toxins from your body and keep you feeling full.

5.  Keep your fat intake to less than 25% of your total daily caloric intake.

6. Hold yourself to your workout goals of working out 3-5 times a week (whatever works for you) and if you have trouble doing that, then work out with a friend, group classes, OR hire a personal will hold you accountable for work out and/or weight loss goals.

7. Make plans with your friends that also want to lose weight so that you will do something active and watch what you eat!

8. Lay off the alcohol for a while...if you are trying to be really active and watch what you eat, one hangover day will make you not only feel like crap because you are hungover but will make you feel super guilty about "cheating" on your diet, and that mental downer will make it much harder to get back into gear.

9. Allow yourself a "cheat day" each week. Give yourself a day where you don't go crazy, but if you want pizza (for example) go and have some, but just try not to eat the whole pie!  Or allow yourself some ice cream- whatever it is you are craving, allow yourself to have it, and do so completely guilt-free!

10.  Don't STARVE yourself!  If you allow yourself to get so hungry that by the time you see food, you eat everything in front of you...not a good plan! I find that the best tip is to go and eat 6 small meals (snacks a day). Eating small one serving size snacks every 6 hours will keep your metabolism revved and you will never feel hungry.

11. Get sleep!  If you are exhausted, you will be less likely to make your own food, and your cortisol levels will be up due to stress and make you crave carbs/high fat foods.  So, make sure that you are getting adequate sleep, and making time for relaxation before that you can wind down before hitting the pillow.

12. Don't set goals that are outrageous!  I have friends that say "I just want to lose 10 lbs" when losing 10 lbs would A) make them look anorexic and B) never be attained.  Every body is different and not everyone can look like a super model...but you can be healthy and shapely!

13. Start your day with a smoothie full of fiber and fresh fruits!  It will fill you up and keep your glucose levels maintained so you won't be starving and you will be full of healthy vitamins and minerals to start off the day!!

I hope that some of these tips help you out.  Basically, you need to make lifestyle changes...and keep at them.  If you make changes and lose weight, going back to your old ways will just allow the lbs to pack back on.  So make a commitment to yourself and your decision to become healthier, and have people join you on your path to a healthier you, I promise, it will be so much easier!

Yours in Good Health

Monday, December 20, 2010

Do you tolerate lactose?

Lactose intolerance is technically a lactase can't digest the sugar found in milk. There are easy treatments that you can implement into your diet so that you can eat lactose without any of the side effects.  Some people tend to think they have an intolerance when they really don't, just a dislike for milk!

Signs and symptoms after ingesting milk:
Stomach cramps

Are there causes?
Some people are just born with a lactose intolerance, they don't produce the enzyme to break down lactose.  But, lactase levels decline with age, so it is part of the aging process that it becomes harder to digest milk products.  When we are young we have high levels and as we get older they diminish (makes eating that block of cheese more of a pickle).  As well, sometimes after surgery, specifically to the small intestine, people can have difficulties breaking down lactose due to the physical changes of their anatomy.  Also, with people that may have an underlying disease such as Crohn's or a random gastroenteritis, taking care of the symptoms of the disease/virus will allow the stomach to get back to its normal ability to process lactose.

Does anything increase my risk of becoming lactose intolerant?
Increasing age
Radiation to the abdomen: for cancer treatments
Premature birth: the body may not make that enzyme due to changes at birth
Ethnicity: Indian Americans, Black, Asian, and Hispanic populations have higher rates of lactose intolerance
Surgery to the small intestine
Diseases of the small intestine: Clostridium Dificle (overgrowth of bacteria), Crohn's disease, and celiac sprue.

So there are a couple of tests that actually diagnose a lactose intolerance, instead of you just deciding that you have one!  A lactose tolerance test is when your HCP gives you a liquid to drink with high levels of lactose, then check your blood glucose levels after two hours, if your blood glucose levels don't rise, you are not absorbing the high lactose drink they gave you. There is a similar test where they give you a similar drink but test your exhalation for hydrogen, if you have high levels, then you are not absorbing the lactose.

Alternative treatments and Lifestyle changes:
You can use over the counter lactose enzyme pills before eating lactose, they do help with absorption.  Also, because of the active enzymes in yogurt, eating a yogurt before dairy prevents many of the signs and symptoms of lactose intolerance.  You can also try to drink raw milk, as there are active enzymes and bacteria present there too!  Try experimenting with different forms of lactose; some cheeses have different levels than others, as do milks (i.e. goat vs. cow).  Also studies have shown that ingesting lactose containing products with other foods slows absorption times and allows for less discomfort when eating lactose.  Ingesting probiotics can help you to absorb lactose without any of the bad side effects.

So, if you have difficulties tolerating lactose, go talk to your HCP to get tested for a true diagnosis (you could have something else) and try different changes to your diet, ingest smaller amounts at a time, eat lactose with meals, and try adding probiotics and enzymes to your diet.  Plus, there are tons of products on the market that are dairy without lactose!  Give these tips a go, and let me know if you become more tolerant!! ;)

Yours in Good Health

Friday, December 17, 2010

Pheromones: Do they really attract the opposite sex?

There are tons of companies out there selling products that contain synthetic pheromones and claim to help you to attract the opposite sex, but do we know how it works?  If it works?  And I want to explain what pheromones are and how they work on the human brain. There IS a reason that you are attracted to the people that you are attracted to, and it is a little more than skin deep!

What are Pheromones?
Pheromones are chemicals excreted that triggers a response in members of the same species.  There are pheromones that alert as a danger alarm, territorial, food, aggression, informational, trail, and sex and they can only be sensed within the same species.  For example, to keep certain animals out of your garden, you can use pheromones to send the "danger" message and keep them out.  You can also use pheromones to help trap insects and prevent them from laying eggs.  And, in theory it works on humans....right?

Do pheromones work on humans?
 It was first studied in the 1890's in Germany and determined that your skin and hair follicles combined help to make your own signature scent, which therein lies your pheromones! The best example is of women who spend a lot of time together; subconsciously their bodies sync and they begin to have their menstrual cycles at the same time....and that is just from getting a slight whiff of some perspiration! So, pheromones do have an active role between humans, but will they help you land Mr./Ms. Right?

How do they work in sexual attraction?
Numerous studies have been performed that show that heterosexual women and homosexual men react the same way to male pheromones in sweat.  Male sweat contains androstadienone, which is easily detected by your olfactory sense (sense of smell).  Also, it was shown that homosexual women did not respond to the sweat with androstadienone but responded appropriately to sweat with higher cortisone levels (i.e. female sweat/pheromones).  MRI's were done of subjects brains whilst exposed to pheromones and it was found that they olfactory portion of the brain was stimulated along with the right hypothalamus (contains olffactory senses and stimulates your nerves...i.e. gets you really jazzed up!), right fusiform cortex (allows for face and body recognition), and the right orbitofrontal cortex (which aides in decision-making).  Basically, all of the parts of your brain that make you feel those wonderful tingly, attraction feelings!  So, there is a reason that you are attracted to the ones you love, and while it sounds pretty gross, you don't mind smelling their sweaty bodies after a workout...and why doing active things together will actually keep you attracted to each other long term!!

Do synthetic pheromones work?
There are tons of companies that sell colognes/perfumes with pheromones in them, and they claim that it will make you more attractive to the opposite sex.  Sadly, there is absolutely no research to support that synthetic pheromones work; it is only the real deal pheromones that work.  They have been studied extensively and there is nothing that shows they work like straight animal sweat!  Good smelling perfume/cologne can mix well with your natural pheromones to enhance them; which is why some colognes smell great on certain people and not so great on others.

So, skip the expensive synthetic pheromones and go sniff some armpits at the gym if you want to find your mate!! Pheromones are something that go to work without you even realizing it, but it makes sense why you are super attracted to certain people, and not others, it isn't all looks when it comes to physical can be sweat too!!

Yours in Good Health

Thursday, December 16, 2010

Asparagus pee- it doesn't happen to everyone?!?

Asparagus has been long known as a low calorie food that is high in potassium, folate, Vitamin C, and fiber (green asparagus), and high in antioxidants, as well as delicious.  Historically, not only was it eaten as a vegetable (apparently the Egyptians were big fans) but it was used as medicine because it has a diuretic property (meaning it makes you pee).  Why am I talking about this particular subject?  I served asparagus the other night and it became quite the topic of conversation between a few nurses...and everyone had a different theory, and some claimed that their pee didn't smell, so I decided to delve deeper, and I must say, I just proved my theory wrong!!  I have to give kudos to a friend that doesn't know a lick about geography, but knows about asparagus pee!!

Back to asparagus...along with making you pee, because of the compounds present in asparagus as it is metabolized in the body, some of the compounds are sulfur related (sulfur usually gives that rotten egg smell).  What are the exact derivatives making some of the pee flowery and some of it nasty resulting in that very specific asparagus scent?  methanethiol, dimethyl sulfide, dimethyl disulfide, bis methane, dimethyl sulfoxide, and dimethyl sulfone.  The first two tend to smell more pungent and the last two more sweet...and that's how you get the ever-dreaded asparagus pee!!  (At least I dread it, but always forget about it until it happens!)

Apparently the smell is strongest after eating younger/fresh if you eat it and you don't get super smelly pee, you can tell your host that their asparagus wasn't fresh!  Also, it starts within 15-30 minutes of ingestion, which is super fast!

In the 1980's there were three studies in France, China, and Israel that showed that it is a direct human trait to have asparagus smelling pee after they eat it. I had learned years ago that some people had an enzyme in their bladder that negated the smell, so some people didn't have the smelly pee, and that was the info I had been living off of my whole life...turns out that that theory was disproved by the Israeli study that showed that 22% of the worlds population simply has an autosomal gene (meaning that it affects one of the 22 non-sex chromosome of the 24 that you get from your parents in your DNA) that allows them to detect the smell in the urine.  So, whilst everyone excretes the smell, not everyone can smell it, weird right?  They also found that the people who claim that their urine doesn't smell (because they can't smell it) are able to have the scent detected by other people with the gene!  I try not to go around smelling peoples pee, but I may have to prove this one out, seeing as I am the only person in my family who has asparagus pee (or so they claim!!!)

Because of the high amounts of potassium, if you have renal failure or insufficiency, you should be careful of your intake.  But, to everyone else, eat up!  It is great for pregnant women due to the high amounts of fiber AND folate (to prevent neural tube defects in your little growing ones).  And no longer feel the need to be embarrassed about asparagus pee, apparently it happens to us all, just feel empowered that you are one of the 22% that has super smelling powers!

Yours in Good Health

Wednesday, December 15, 2010

Osteoarthritis: What is it? Do any alternative therapies exist to treat it?

There are three main forms of Arthritis: Rheumatoid arthritis is a chronic inflammation disorder that usually affects the small joints in hands and feet, Gout which is a build up of uric acid in the small joints (usually in feet) and is preventable and reversible, and Osteoarthritis (OA) is the most common, which is a degenerative joint disease that occurs when the cartilage between bones wears down, the bones rub and cause significant pain. It is caused by the normal wear and tear of the body and repetitive motions, the aging process, obesity and extra stress on the joints, heredity, and muscle weakness.   There is no cure but there are plenty of ways to live a healthy active life with it, and many treatments both modern and alternative medical treatments.

Where does it most likely occur?
Lower back

What are the symptoms?
They are gradual and develop over time, so they may be difficult to notice at first.
Pain: after using the joint
Tenderness: When you put light pressure on the joint
Stiffness: When you first wake up in the morning or after long periods of inactivity
Loss of Flexibility: you may notice that you don't have full range of motion, or are unable to move your joints the way that you could.
Grating sensation: You may hear or feel a grating sensation when you use the joint, you can sometimes feel the bone grating on bone
Bone spurs: sometimes extra bits of bone will form around and in the joint and make it feel/appear misshapen.

What are some Risk Factors?
Age: Older than 40 years old is when the signs of OA usually start to occur.
Sex: Women are more likely to develop OA than men
Bone Deformities/Injuries: Sometimes people are born with malformed joints at birth or have had joint injuries due to sports, etc., and those joints are more likely to have OA.
Obesity: Being overweight puts more stress on the joints and increases your risk of OA.
Occupation: As repetitive motions can cause the cartilage to wear down, any job with repetitive motions.  For example, Nurses have a high rate of OA in their hand joints from using their hands to manipulate IV tubing and doing other fine motor movements with their hands.
Genetics: Having Gout or Rheumatoid Arthritis (RA) increases your risk of developing OA.

The main complication is that it is a degenerative disease that doesn't stop, and it can be very painful for people and make it difficult to get through your day, so it can make your life harder.  You don't realize how much you use your joints and how easy life is when they don't cause you any pain!  So, learning to live with the disease is the main complication.

How am I diagnosed?
Usually you are diagnosed by your reported joint pain to your HCP, then through the use of X-Ray and MRI (Magnetic Resonance Imaging).  Your HCP may draw some fluid out of the joint to test that the pain isn't due to infection.

What are some medical treatments?
Medications: Acetaminophen (Tylenol) can help with moderate pain but you need to limit intake if you drink alcohol, Ibuprofen (Advil/Motrin) Naproxen (Aleve) will help with moderate pain and diminish and swelling that might occur but you need to be careful to eat when you take ti to prevent ulcers and also you cannot take these medications if you have a history of bleeding ulcers or renal disfunction.  Tramadol (Ultram) is a prescription analgesic that takes care of moderate to severe pain but should only be used short-term to prevent wide effects of constipation and nausea. Other stronger prescription pan medications (oxycodone) can be used but there is the risk of addiction and side effects of drowsiness and inability to drive or perform other daily tasks.  Finally, for extreme pain, your HCP may opt to administer cortisone shots directly into the joint and the pain is most often completely relieved for up to 6 weeks BUT too many injections can caused added joint destruction so they may only be administered when absolutely necessary.

Therapy: The use of physical therapy can aid in keeping functionality and range of motion of the joint. Some orthotics/shoe inserts can decrease stress on your joints and help to relieve pain. As well, group therapy with other people that have OA can discuss ways that they live with their disease and support each other.

Surgical/Invasive procedures: Viscospplementation is when substances similar to the fluids that are normally in your joints (which comes from rooster combs) is put into your joint and adds cushioning to the joint and can diminish pain, currently only approved for OA of the knee but is being studied in other joints.  Joint replacement therapy is when the damaged portions of your joint are removed and a plastic and metal prothesis is put back in its place that lasts up to 20 years and you can have basically ANY joint replaced (even in small hand joints) but there is a small risk of bleeding and infection along with the surgery.  Another surgical procedure is called bone realigning, and it is when you cannot get a joint replacement, part of the bone is removed to allow for decreased pressure on the joint (usually performed for knee OA).  And bone fusion can also be done surgically which increases stability and decreases the pain, so an ankle that becomes fused will have no pain with full weight bearing, but you will no longer have your full range of motion.

Alternative Therapies:
Acupuncture can assist in decreasing your pain by inserting needles directly into certain pressure points (please read my acupuncture blog from last week).
Ginger can assist in decreasing OA pain, and can be ingested candied, cooked, as tea BUT it can interact with blood thinning medications, so you need to discuss with your HCP.
Glucosamine and Chondroitin have mixed studies (please see my earlier blog) but some people report feeling better with their use.  Just be aware that they can also interact with blood thinners.
Avocado-soybean unsaponifiables (ASUs) are newly being studied but have shown that the oils from both when taken together decrease the degeneration of the cartilage and can assist in cartilage repair in hips and knees.  I really have high hopes that this will be a great treatment for people with OA!!
Tai Chi/Yoga help with OA because of the easy moving and stretching and as people learn to breathe and feel their bodies it aides in de-stressing and studies have found that people report a decrease in OA pain.  It allows for range of motion without heavy stress on the joints.

How do I live with OA?
You need to keep your joints warm and moving, the pain occurs mostly in the morning or when you don't use your joints a lot, but if you have swelling and perform repetitive motions, try to rest your joint to decrease the swelling and try not to do repetitive motions (as much as possible- I know, easier said than done!) Light exercise that has low impact, such as tai chi, yoga, and swimming can help with joint pain because it decreases the stress on the joints but allows you to keep them moving.  If you re overweight, try to lose weight as it will significantly decrease the stress on primarily your hip and knee joints. Also, some over the counter pain relief creams gels can really help, such as icy hot, etc.  One cream that I am a huge advocate of is called Sombra cream and it is amazing at relieving joint pain, I sometimes slap some on my knees before going for a long run, if they are sore, and they feel great (I'm trying to find research on Sombra...I may have to do my own to show how great it is!!)  And, if your joint pain is really severe and makes it difficult to go through the day, you can go see an occupational therapist (with referral from your HCP) and you can get assistive devices to help you get through your day (such as grabbers, stability devices, walking aides, etc.)

OA can be difficult to live with but there are numerous ways to live with it, and even adding yoga to your exercise routine might help to prevent it (studies are still being done).  As well, I really have high hopes that the ASUs that will help to stave off cartilage degeneration and prevent the pain of OA, and I will update you all with the research as it comes out.  I hope that some of these treatments, whichever way you choose to go with your OA works for you, and if there are any treatments/alternative therapies that I am missing I would love to hear them!!

Yours in Good Health

Friday, December 10, 2010

Goji berries: do they stand up to the hype?

Goji berries are also known as wolf berries from a plant primarily grown in southeastern Europe and Asia.  That are claimed to have some pretty decent healing powers such as anti-aging, and are claimed to be the healthiest food source in the world; being jam packed with vitamins, minerals, and antioxidants.  Each company that sells its Goji products claims that they have "scientific research" to back up their claims of this amazing berry and the numerous health benefits, but it is impossible to find said research.

What nutrients do Goji berries contain?
Low amounts of calcium
Vitamin B12
Vitamin C

Health Benefits?
There was one weak study in the Journal of Alternative and Complementary Medicine that showed no health benefits between the Goji berries and the placebo, but they claimed that it could be helpful and needed further studying. All of the claims that were made on one particular infomercial stating that Sloan Kettering in NY found that Goji helped to cure breast cancer were false claims and it has never even been studied in that hospital.  Basically every study claim related to Goji's in advertisements are false or not reproducible.

Any bad side effects?
There have been two reported cases of older adults had serious medical complications after using Goji products because it interacts with the blood thinner coumadin (warfarin) by increasing the effects allowing for increased bleeding times.  This can easily put people at harm and lead to certain death, because the interaction is not completely understood, therefore it will make it very difficult for medical professionals to treat and reverse the effects and increased bleeding times.

This is an unregulated product, just like many other health supplements.  The FDA has put a few companies that made claims of healing on warning, as it is not a medication regulated by the FDA and companies cannot claim that is it used as a treatment or cure, as well there has been a class action suit against one certain Goji product company due to false claims and misinterpretations of their products, and results from clients.   It is a fruit with various vitamins and minerals that you body can use an absorb.  Is it the healthiest thing that will every cross your lips?  Probably not, but it isn't the worst either.  Based on the lack of ability to prove the benefits of this fruit in research, and the cost of buying Gojis (not to mention the taste- I dubbed them "poop berries" in my house"- yuck) it is not worth it.  But, if you do choose to add Goji to your diet, just make sure to talk to your HCP if you are on and medications before you start the regimen, and stop if you notice any symptoms that are uncomfortable and tell your HCP so that you can be worked up for a possible interaction, and ensure your health and safety.

Yours in Good Health

Thursday, December 9, 2010

I'm on pins and needles!

So many of us that grow up on Western medicine think that acupuncture is a ridiculous idea, and others, who have tried the traditionally Eastern medicine since the mid 20th century in this area of the world, have long benefitted from the bodies response to the long thread-like needles inserted into our meridians and realigning our Qi.  These needles are inserted at certain specific points and depths along the meridians that, according to traditional Chinese medicine, contain vital levels of your Qi.  Just to clarify, qi is your circulating life energy.  I totally understand how people can easily scoff at what they don't understand, it is even a really difficult practice to study because you really can't use a placebo.

According to the World Health Organization (WHO), acupuncture is considered medically appropriate to treat around 40 different medical problems, and there are numerous other problems that acupuncture provides therapeutic effects.  A study from a major university in Germany that people with tension headaches and migraines had significantly decreased symptoms (to no symptoms) with use of acupuncture as treatment.  As well, a study at M.D. Anderson in Texas showed that neck cancer patients, who have a side effect with treatment of severe dry mouth, had a significant improvement of symptoms with acupuncture when added to their treatment regimen. Most commonly acupuncture is used to treat: migraines/headaches, stress, infertility, PMS, depression, allergies, addictions, hypertension, GI disorders, menopause, the symptoms related to cancer treatments, osteoarthritis, and many other ailments.

How are treatments performed?
It usually involves several weekly or biweekly treatments, as you are treating your whole body, which involves an exam, a past medical health questionnaire, insertion of needles, and a consultation for advice and follow-up.  Usually the treatment sessions can last from 30-60 minutes.  Make sure that your acupuncturist is using single use, disposable needles, an when they are inserted the the correct depth, you may feel an aching sensation, they will stay there for 20 minutes, then be removed.  Most people feel immediately better, despite the need to have multiple treatments.

How does it work?
In Traditional Chinese Medicine it is described that health is the result of a balance of   the yin and the yang (also known as yan) of the life force (Qi).  There are 350 acupuncture points in the body and all of these energy pathways need to be assessed and the ones with poor flow need treatment with acupuncture to allow for increased flow and personal balance.  If needles are inserted into the areas where there is illness or improper energy flow, the needles can help to change the balance and bring back the proper balance and energy flow.

Who should go?
The best part of acupuncture is that besides a few contraindications, mostly anyone can get treatment, even for just feeling like you have low energy.  Although many insurance companies are starting to cover part of the cost of acupuncture for certain medical diagnoses (check with your specific insurance company to find out if they cover and how much).   The only people that should be wary of treatment are people with bleeding or clotting disorders or if you are taking blood thinners, you are at a higher risk for bleeding at insertion sites or bruising; it should be discussed with your HCP before being treated.

The benefits?
It is safe, very few side effects, and it is a good alternative for some patients as adjunct to medications OR for people who do not wish to take medications.  And there are so many benefits, including reduced stress and overall feeling better.

Any Risks?
Besides the bleeding risks, as discussed above, there is a risk of the needle breaking or going into an internal organ and causing damage (which is extremely rare), and if unsterilized needles are used (which should NEVER be done) there is a risk of infection.

There is always a risk when using an unregulated alternative therapy that you are going to someone who doesn't know what they are doing, and that they are not appropriately trained for what they are doing, so always talk to your HCP about acupounctire treatment before going, and get referred by them OR by a current client.  Meet the acupuncturist and if you feel uncomfortable at any point, just leave, and don't be discouraged, just talk around and find one that is right for you. You can try looking online for acupuncturists, just beware and talk to current clients as references.  Also, don't be discouraged if your HCP doesn't "believe" in alternative therapies, it is your body and your treatment, happiness, and health is your decision and no one else's.  So go out and get some needles stuck in you, and let me know how you feel!!

Yours in Good Health,

Friday, December 3, 2010

It's not just from a dirty toilet seat....

Apparently I am doing a bit of an "STD week" here, due to the rates of STD's rising AND issues with long-term complications. One thing that people need to know more about is Pelvic Inflammatory Disease (PID).  PID is an infection of the uterus and fallopian tubes (the tubules that the eggs travel down to get fertilized).  The CDC estimates that 750,000 women get acute PID every year and because of this infection, 75,000 women become infertile every year.  With the rates of US infertility raising yearly, this is important to know about because it is a complication of STD's, primarily Chlamydia and Gonorrhea, that goes unnoticed and can lead to severe long-term complications.

How do I get PID?
PID is a complication of STD's, which is usually from unprotected sex.  If women have and STD that goes unnoticed and untreated for an extended period of time, and it is totally person dependent on that time period, the infection can spread up the uterus and into the fallopian tubes causing a wide spread infection.  The infection can lead to chronic uterine pain, abscesses in the uterus or fallopian tubes, and ectopic pregnancies (pregnancies in the fallopian tubes or in other places that where they should be).

What are risk factors?
Women who are sexually active, usually of childbearing years under the age of 25 are at highest risk of PID
People with prior PID infection
The higher the number of sexual partners, the higher your risk becomes
Using douche can increase your risk of PID by pushing bacteria higher up into your vagina, and causing an infection (such as PID)
IUD's can increase the risk of PID UNLESS the women is tested before the IUD is placed and has concurrent STD testing.

What are the symptoms?
The scary thing is that you can have absolutely no symptoms or pretty severe symptoms.  Usually with Chlamydia, there are very very few symptoms, as most often the women don't know they have an infection.  But, some of the noticeable symptoms are lower abdominal pain ( I know, who doesn't get that on occasion?), fever, unusual discharge, painful sex, pain with peeing, and irregular menstrual bleeding.  One very rare but VERY serious complication is called Fitz-Hugh-Curtis syndrome which causes right upper quadrant pain (under the right side of the rib cage on your stomach); it causes your liver to adhere to lungs and can cause respiratory problems....there is no real treatment and no treatment unless is causes other issues.  Also, of note, the fevers and abdominal pain can mimic that of appendicitis/a ruptured appendix, so it can be an emergency and require emergent surgery and at least an overnight hospital stay.

There are no precise tests for PID because it is a complication from other STD's, so the best tests are getting regularly STD tested.  And it is also based upon the clinical findings of your HCP in your abdominal exam.  Also, an ultrasound may be performed to rule out abscesses or other problems that may mimic PID.

Are there any treatments?
Usually PID is treated with two antibiotics (orally) to ensure that the bacteria is being treated and preventing it from doing further damage to your reproductive system.  In cases where a women is pregnant, or having severe symptoms, they may be admitted to the hospital for IV antibiotics for treatment and for monitoring of the baby.  And, as stated above, the symptoms may mimic a ruptured appendix requiring emergent surgery, which is why any abdominal pain symptoms in a women require an abdominal exam in the Emergency Room.

How do I prevent PID?
Use protection with every sexual partner unless you are in a monogamous relationship and you are both getting tested.  Get tested regularly regardless of your use of protection or not, it is your body and you need to make sure that you are safe and healthy.  If you have ANY of the symptoms above, go get tested and talk to your HCP. Also, regular Gynecological exams are a way to prevent the infection from getting  to far and having your HCP notice any changes that you might have in your cervix that you did not know of.

So, please spread the word, be safe, get tested, and go talk to your HCP if you have any inkling that you might have PID.  Infertility is such a horrible price to pay for a mistake of having sex with the wrong person, getting an STD, and not getting it treated...there is no excuse these days with free/low cost STD clinics in every city!  (Go to your local Department of Public Healths website to find where the low cost/free clinics are)

Yours in Good Health

Thursday, December 2, 2010

Is BV an STD?

Bacterial Vaginosis, more commonly referred to as BV, is the most common vaginal infection in women, and despite the fact that you can get it after having sex with a new partner, it is NOT a sexually transmitted disease; your new partner doesn't infect you.  I can't tell you how many times women have gone screeching into their GYN's office freaking out that they got an STD because something smells funky down there (which is a good practice to have, btw) but BV isn't an STD and you don't need to trash your new partner all over town about it!  Here is an explanation of what it is, symptoms, diagnosis, and treatment options.  I want you all to be aware of what could be going on down there...

What is BV?
Basically it is an overgrowth of one of the natural occurring bacteria in your vagina, and when the delicate balance that is your vagina gets an overgrowth of one bacteria, there can be foul smelling discharge, itchiness, odor, pain, and/or burning.  Most commonly it smells like a dead fish down there....not good, ladies.  And, if it takes someone saying something to you about it, even worse.  Pay attention to what's going on in your vagina, and notice if something smells off or looks funky.

So, How do I get BV?
Well, unfortunately, it is not completely known why some people are more prone to these infections than others.  But, new sexual partners and having multiple sexual partners can cause a BV infection; it may be due to the use of numerous condoms and your body is reacting, or due to the change in your natural flora from having everything disrupted frequently down there.  Some women know that after they have sex with a new person, they will get BV, so they preemptively have a plan with their HCP about it (which is some smart thinking!)  If you have unprotected sex, it can just be that mixing their bacteria with yours causes an upset, and your body reacts the way it knows how and can.  Also, women who douche tend to have a higher frequency of BV; although this is a little bit of the chicken/egg debate.  Women who douche tend to think that their vagina smells, and they may already have an overgrowth of bacteria just because they do, so they douche, and flush that bacteria all over the place, and cause an even bigger disruption in their flora, causing a more widespread BV, so they link the douche to BV, whereas they probably had the infection anyway.  OH, and women who are NOT sexually active can get BV infections; some peoples vaginal floras are just more sensitive than others.  It is a bit of a medical quandary though....

What are the signs/symptoms?
Strong fishy odor, that increases after sex
White/gray thin discharge
Itchiness around the outside of the vagina
Stinging/burning with peeing
OR no symptoms at all!

How can BV affect me?
Having a BV infection can increase your risk of contracting HIV if you are exposed to the virus
It also increases the risk that you will pass along HIV to a partner (if you are infected)
Having BV (past infections) increases your post operative risk for infection (post hysterectomy, abortion, or other gynecological surgeries)
Having BV increases your risk of also contracting HSV (Herpes simplex virus), Chlamydia, and Gonorrhea (your vaginas natural defense mechanisms are down due to the BV infection)
A BV infection while pregnant can increase your rate of complications such as pre-term labor, lead to low birthweight babies (under 5.5lbs), and premature babies.
Also, undiagnosed BV can lead to PID (Pelvic Inflammatory Disease)

Are there any tests to determine BV?
The only "test" of determining BV is based upon your complaints (i.e. grey discharge, smelly odor, etc) and with a pelvic exam and taking a small sample of discharge from your cervix and examining a smear by your HCP.  There are no blood tests or anything fancy to diagnose the infection, but seeing as it is so common, if an HCP even suspects it, without you complaining of symptoms, they may treat you anyway.

Is there a treatment available?
Honestly, many times it will clear up without treatment on its own, as long as you abstain from sex and using douche; the vaginas natural flora will fight to get back to normal BUT due to possible complications that can occur with long term infections, most likely you should get treatment if it is suspected.  Also, of note, male sexual partners do not need to be treated, but women partners do to prevent to possible spread!  There are two different antibiotics used to treat BV (you only need one): metronidazole or clindamycin orally (and the same treatment is for HIV+/-).  All pregnant women with any signs should be treated, and most HCP's require that all women post gynecological surgeries be preemptively treated.

How do I prevent BV infections?
The best way is to limit your sexual partners and don't douche!  Honestly, I am not sure why douche is still on the market, there is nothing good that comes from please don't!  Also, use all of the medication given to you to treat your BV, for the ENTIRE prescription, so that you actually kill off the bacteria and allow for your flora to re-grow.

It is important to note that BV infections can come back, and some people think that using probiotics can help encourage the regrowth of the natural bacteria and get it to normalize, there is no literature to support that, but if you are a chronic BV'er, it might be worth a try.  And, if you do get BV infections after sex, talk to your HCP about different things to might try, like different kinds of condoms (you may have a small allergy), if you are in a monogamous relationship an don't use protection maybe you need to clean your partners penis with antibacterial soap and you shower before intercourse.  This doesn't have to be a horrible life affliction, but to those who don't know about it, you need to be aware and get proper treatment because it can have longterm health effects!

Yours in Good Health