Author Archives: gingerbrdl
So, your significant other begs to be allowed to fall asleep first. You avoid camping or sharing a room with anyone because when you fall asleep, you’ve been told that you saw logs. You could have sleep apnea. Sleep apnea is when you stop breathing repeatedly during sleep, and is considered a serious disorder.
If left untreated, sleep apnea can result in a number of health problems, including:
- High blood pressure
- Heart failure, irregular heart beats, and heart attacks
- Worsening of ADHD
Untreated sleep apnea may also be responsible for poor performance in everyday activities, such as at work and school, car accidents, underachievement at school in children and adolescents, and having to sleep on the couch…or elsewhere.
A sleep study, or polysomnogram, is needed to diagnose sleep apnea. This is a multiple-component test that electronically transmits and records specific physical activities while you sleep. The recordings are analyzed by a qualified sleep specialist to determine whether or not you have sleep apnea or another type of sleep disorder. Most of the time, this study is done at a sleep disorder clinic or sleep lab.
If your sleep apnea is mild, you may be asked to:
- Lose weight
- Avoid alcohol and sleeping pills
- Change sleep positions to improve breathing
- Stop smoking. Smoking can increase the swelling in the upper airway, which may worsen both snoring and apnea.
- Avoid sleeping on your back
Sometimes sleep apnea is severe enough that other measures are needed. Continuous Positive Airway Pressure, or CPAP, may be prescribed. This involves a mask that you wear over your mouth or nose. It’s hooked to a machine that blows air into your airway. This way your airway stays open, preventing you from snoring or holding your breath. Depending on the person, a dental device may be a better option, or even surgery, if an anatomical problem is causing the airway to be blocked.
Consider these questions:
- Are you a loud, habitual snorer?
- Do you feel tired and groggy on awakening?
- Are you often sleepy during waking hours and/or can you fall asleep quickly?
- Are you overweight (BMI > or = 35) and/or do you have a large neck (> or = to 16in)?
- Have you been observed to choke, gasp, or hold your breath during sleep?
If you or someone close to you answers “yes” (or plays you a recording of your snoring!) to any of the above questions, you should talk to your healthcare provider about getting tested for sleep apnea. ¡Salud!
Have you been told that your blood pressure is a little high? Maybe you’ve been given a blood pressure medicine by your healthcare provider, but you’ve resisted taking it. The most common thing I hear is, “I don’t want to have to take a medicine every day.” So what lifestyle changes could you try to keep from taking a medicine for your blood pressure?
Besides getting at least an hour and a half of exercise in per week and losing weight, cutting back on your salt intake could make a difference. Salt may make our food taste better, but too much can have bad effects on our health. It can raise blood pressure, make the kidneys work harder, cause swelling in the tissues, and make us at higher risk for heart disease. Educating yourself on the foods that have more salt than others may help you lower your intake of salt by making better choices.
Foods that are typically higher is sodium are
- Fast foods,
- Canned foods,
- Frozen meals,
- Snack foods like chips, pretzels, crackers and nuts,
- Marinades and flavorings, especially Teriyaki sauce and Soy Sauce, and
- Packaged deli meat.
Read the nutrition label for how much sodium per serving a product contains and how many servings are in the container or package to see how much sodium you’re taking in when eating the above types of food. It might be an eye-opener!
The American Heart Association recommends no more than 2300 mg a day of sodium for most people. For those age 51 years and older, and those of any age, including children, who are
- African American (more salt sensitive than other races) or
- have high blood pressure,
- diabetes, or
- chronic kidney disease,
should limit their intake to 1,500 mg of sodium per day.
Sometimes, even with lifestyle changes, you may still need a blood pressure medicine; family history can play a strong role in whether you’ll develop it. I’m usually willing to allow my patients at least 3 months of lifestyle changes before putting them on a medicine. So–get out there and exercise, drop a few pounds, and cut back on your salt! ¡Salud!
“I just feel so tired all the time.” I hear this usually once, if not two or three times a day from different patients. Depending on who I’m looking at, here are a few of the conditions I consider:
- Hypothyroidism–A blood test is used to determine if the thyroid is functioning the way it should. Besides fatigue, it can also cause constipation, cold intolerance, and dry skin.
- Iron Deficiency Anemia will cause fatigue in men and women. Women who have heavy periods are at risk for this. For men, a blood count, or hematocrit, of less than 40 is generally considered low, and should be seen by a Gastroenterologist (GI) for evaluation of possible bleeding in the gut. Women who have stopped menstruating , but are anemic, should also be considered for referral to a GI doctor.
- B12 Deficiency Anemia— Most B12 deficiencies are caused by not eating enough foods with B12 in them, such as meat, fish, poultry, shellfish, eggs and dairy products. A blood test is used to find out the B12 level in the blood; lower than 300 ng/ml means a deficiency. The quickest way to replace B12 is through an injection once a week for four weeks, then once monthly after that. Any person who has any kind of gastrointestinal disease, such as Crohn’s or Celiac Disease, or who has had any part of their gut removed such as with gastric bypass or colon resection, will need to replace their B12. Alcoholics also need B12 replacement.
- Diabetes— High blood sugars cause fatigue. Any person who is obese, has high blood pressure, high cholesterol or a family history of diabetes should be screened for this.
- Depression— There are two questions used to screen for depression:
- “In the past two weeks, have you felt down or sad on more days than not?”
- “In the past two weeks, have you lost interest or pleasure in doing things you used to enjoy?”
If the answer is “yes” to either of these two questions, than a more thorough evaluation for depression is done. If depression is diagnosed, treatment options would be counseling, medication, or a combination of these. A healthy lifestyle is also encouraged as mood can be affected by diet and exercise.
If you think that you are more tired than you should be, or than you used to be, please see your healthcare provider to see if you need to be screened for these common conditions. ¡Salud!
Keep in mind, this is not meant to be a comprehensive list, and each patient’s assessment is based on his/her health history and physical exam.
The question of what to do with leftover medications is a good one. As a healthcare provider, I need to know the answer for my patients, and wanted to pass the information I found on the FDA’s website along to my readers.
- Medicine Take-Back Programs On April 27, 2013, there will be a National Prescription Drug Take-Back Event. Follow this link for your state information: http://www.deadiversion.usdoj.gov/drug_disposal/takeback/
- Disposal in Household Trash If no Take-Back Program is available, follow these steps to get rid of your unwanted meds:
- Mix medicines (do NOT crush tablets or capsules) with an unpalatable substance such as kitty litter or used coffee grounds;
- Place the mixture in a container such as a sealed plastic bag; and
- Throw the container in your household trash.
- Before throwing out a medicine container, such as a pill bottle, remember to scratch out all information on the prescription label to make it unreadable.
- Flushing of Certain Medications Some medicines could be so harmful to others if taken that the best thing is to flush them down the toilet. These medications are:
|Abstral (PDF – 1M), tablets (sublingual)||Fentanyl|
|Actiq (PDF – 251KB), oral transmucosal lozenge *||Fentanyl Citrate|
|Avinza (PDF – 51KB), capsules (extended release)||Morphine Sulfate|
|Daytrana (PDF – 281KB), transdermal patch system||Methylphenidate|
|Demerol, tablets *||Meperidine Hydrochloride|
|Demerol, oral solution *||Meperidine Hydrochloride|
|Diastat/Diastat AcuDial, rectal gel [for disposal
instructions: click on link, then go to “Label information”
and view current label]
|Dilaudid, tablets *||Hydromorphone Hydrochloride|
|Dilaudid, oral liquid *||Hydromorphone Hydrochloride|
|Dolophine Hydrochloride (PDF – 48KB), tablets *||Methadone Hydrochloride|
|Duragesic (PDF – 179KB), patch (extended release) *||Fentanyl|
|Embeda (PDF – 39KB), capsules (extended release)||Morphine Sulfate; Naltrexone Hydrochloride|
|Exalgo (PDF – 83KB), tablets (extended release)||Hydromorphone Hydrochloride|
|Fentora (PDF – 338KB), tablets (buccal)||Fentanyl Citrate|
|Kadian (PDF – 135KB), capsules (extended release)||Morphine Sulfate|
|Methadone Hydrochloride, oral solution *||Methadone Hydrochloride|
|Methadose, tablets *||Methadone Hydrochloride|
|Morphine Sulfate, tablets (immediate release) *||Morphine Sulfate|
|Morphine Sulfate (PDF – 282KB), oral solution *||Morphine Sulfate|
|MS Contin (PDF – 433KB), tablets (extended release) *||Morphine Sulfate|
|Nucynta ER (PDF – 38KB), tablets (extended release)||Tapentadol|
|Onsolis (PDF – 297KB), soluble film (buccal)||Fentanyl Citrate|
|Opana, tablets (immediate release)||Oxymorphone Hydrochloride|
|Opana ER (PDF – 56KB), tablets (extended release)||Oxymorphone Hydrochloride|
|Oxecta, tablets (immediate release)||Oxycodone Hydrochloride|
|Oxycodone Hydrochloride, capsules||Oxycodone Hydrochloride|
|Oxycodone Hydrochloride (PDF – 100KB), oral solution||Oxycodone Hydrochloride|
|Oxycontin (PDF – 417KB), tablets (extended release) *||Oxycodone Hydrochloride|
|Percocet, tablets *||Acetaminophen; Oxycodone Hydrochloride|
|Percodan, tablets *||Aspirin; Oxycodone Hydrochloride|
|Xyrem (PDF – 185KB), oral solution||Sodium Oxybate|
This information was taken from the Federal Drug Administration’s website. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flushing_list
For anyone concerned about about the impact on the environment, the FDA makes this statement:
“We are aware of recent reports that have noted trace amounts of medicines in the water system. The majority of medicines found in the water system are a result of the body’s natural routes of drug elimination (in urine or feces). Scientists, to date, have found no evidence of harmful effects to human health from medicines in the environment.
Disposal of these select, few medicines by flushing contributes only a small fraction of the total amount of medicine found in the water. When a medicine take-back program isn’t available, FDA believes that any potential risk to people and the environment from flushing this small, select list of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.”
Remember to never share your prescription meds with another person.
Now, have a good day and annoy others with your newfound knowledge!
Have you ever wondered if you drink too much? The CAGE questionnaire is a screening tool that can be used by yourself or your healthcare provider to see if you have a problem that needs evaluation. It’s not used to diagnose alcoholism, only as a way to see if a person possibly needs help or support.
The questions are:
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves
or get rid of a hangover (eye-opener)?
If you answer “yes” to 2 or more questions, that’s an indication of an alcohol problem.
There are the different levels of misuse:
- Risky or hazardous use–having more than 4 drinks in one day for men or more than 3 drinks in one day for women
- Harmful use–drinking that causes physical or mental harm (i.e. falls, high blood pressure, unclear thinking)
- Alcohol abuse–drinking that causes a person to lose his job or have decreased work or school performance, neglect home responsibilities, driving while drunk, and/or have legal or social problems
- Alcohol dependence (alcoholism)–a craving for alcohol, physical dependence (get the shakes without a drink), loss of control over drinking, and a need to drink an increased amount to feel the effect.
For those with a positive screen that fall under the “Risky or hazardous use”or “Harmful use” categories, brief counseling with more than one session has been found to be effective. For those who fall in the “Alcohol abuse” or “Alcohol dependence” categories, brief counseling hasn’t been shown to work well; a treatment program with ongoing support would be more effective.
I’ve noticed that a lot of my patients are really not aware of what is considered “drinking in moderation.” For men, this would be no more than 2 drinks a day or no more than 14 drinks per week. For women, moderate drinking is no more than one drink a day or no more than 7 drinks per week. A drink is considered to be 12 oz of beer, 5 oz of wine, or 1.5 oz of liquor.
Please see your healthcare provider if you have questions or concerns about your alcohol use.
Did you know that the Affordable Care Act requires health insurance plans to cover preventive services with no cost sharing? This means your health insurance can no longer charge a co-pay, co-insurance, or deductible when you see an in-network provider for these services.
Services for Adults include screenings for:
- Abdominal Aortic Aneurysm
- Alcohol Misuse
- Aspirin use
- Blood pressure
- Colorectal Cancer
- Type 2 Diabetes
- Sexually Transmitted Infections
- Tobacco Use
For more detailed information: http://www.healthfinder.gov/HealthCareReform/Adults.aspx
Services for Women and Pregnant Women include screenings for:
- Anemia (pregnancy)
- Bacteriuria (pregnancy)
- Breast Cancer Mammography
- Breast Cancer Chemoprevention
- Cervical Cancer
- Chlamydia Infection
- Domestic and Interpersonal Violence
- Folic Acid
- Gestational Diabetes (pregnancy)
- Hepatitis B (pregnancy)
- HPV DNA Test
- Rh Incompatibility (pregnancy)
- Sexually Transmitted Infections
- Tobacco Use
- Well-woman Visits
For more detailed information: http://www.healthfinder.gov/HealthCareReform/Women.aspx
Services for children include screenings for:
- Alcohol and Drug Use
- Blood Pressure
- Cervical Dysplasia
- Congenital Hypothyroidism
- Fluoride Chemoprevention
- Height, Weight, and Body Mass Index
- Hematocrit or Hemoglobin
- Medical History
- Oral Health
- Sexually Transmitted Infections
For more detailed information: http://www.healthfinder.gov/HealthCareReform/Children.aspx
I found out quickly when I got out of school that a lot of people schedule an appointment to see their healthcare provider as soon as they get a stuffy nose, low-grade fever, or sore throat. When these patients came in to see me, most expected to get an antibiotic. According to the CDC, “antibiotic resistance has been called one of the world’s most pressing public health problems,”http://www.cdc.gov/getsmart/antibiotic-use/fast-facts.html, so it might help to know how to tell the difference between a viral illness and bacterial illness.
A viral illness:
- usually begins with feeling achy, tired, maybe a fever of <100.5.
- may include a stuffy nose, sneezing, a cough and sore throat.
- tends to be worse the first three days or so, then you start feeling better, but may keep a stuffy nose and cough. (“I sound bad, but I feel better.”)
- may cause a stuffy nose, sneezing or a cough that can last up to two weeks.
With a viral illness, no antibiotic is needed. Over the counter products for symptom relief are recommended.
- Acetaminophen or ibuprofen is effective for sore throat, headache or body aches.
- Decongestants work really well for a stuffy nose (but are not recommended for people with high blood pressure).
- Saline nasal spray or a sinus wash work well for some people.
- A cough suppressant like Delsym or Robitussin can be effective.
- Throat spray and lozenges may be used for sore throat.
- Read the labels on combination products, like Tylenol Cold or Advil Sinus, to make sure you don’t double up on any ingredients.
- Remember, children under the age of 4 should not be given cough medications. Always read the label for age recommendations and proper dosing on any medications for children.
How do you know when to go and be seen by your healthcare provider?
- Fever > 100.4, or any fever that lasts longer than three days.
- No improvement after 7 days of being sick.
- Sore throat without a cough or runny nose.
- Symptoms that don’t improve with over-the-counter products.
Remember, it’s not the color of your mucous that means you need an antibiotic, it’s how long you’ve been sick and how bad your symptoms are. ¡Salud!
Europeans opting for a frozen meal may choose to prepare their own dinners now. Horse meat has been found in Bird’s Eye brand Chile Con Carne. Earlier, Nestle had taken some Buitoni beef pasta products off the market when traces of horse DNA were found in batches of meat used to make these meals. It seems that most countries in Europe have been affected by the contamination of beef with horse meat.
In a Reuters’ article, “Horsemeat blame game ricochets across Europe,” Alastair Macdonald states, “Dutch prosecutors launched a criminal investigation into an as yet unnamed company believed to have been falsely labeling beef mixed with horsemeat after searching a plant in the south. They said it was “suspected of forgery, fraud and money laundering” and added: “It is believed the company processed horse carcasses from Ireland and mixed them with beef.” (end quote)
Thankfully, there have been no reported illnesses from those who have eaten the less than 100% beef, other those heartsick that they might have dined on Black Beauty or Ginger.
17 medical specialty organizations have come up with their top five tests or procedures that they feel are unnecessary or harmful to patients. For example, women younger than 21 and those who have had a hysterectomy for any reason other than cancer should not get Pap smears at all. This is a change from 2008 when I was in school, when we were taught that a sexually active woman younger than 21 years should have a pap smear every year for three years. If these were all normal, then it could be done every other year.
In Sharon Begley’s article, “Just say don’t: Doctors question routine tests and treatments,” she states that “For the most part, the medical specialty groups did not consider cost when they made their lists”. She quotes Dr. John Santa, director of Consumer Reports’ Health Ratings Center and a partner in Choosing Wisely as saying, “If their advice is followed, however, it would save billions of dollars a year in wasteful spending.” He calculated that in a practice with 300,000 patients, just doing away with routine EKGs and bone density scans would “reduce it’s billings by $1 million a year.” If done nationally, “that translates into some $1 billion in savings.”http://www.reuters.com/article/2013/02/21/healthcare-tests-choosingwisely-correcte-idUSL1N0BL3EB20130221
Of course, less spending does translate into less revenue for the healthcare practitioner. A woman coming in every three years for her Pap means that my clinic will lose the revenue for the two she doesn’t get.
There’s always the question of, “What if I miss something because I followed these recommendations?” Ah….well, we are given the option in some cases of ordering a test if we suspect something unusual. Note that some procedures are questioned while some start with the word “don’t.”
For a complete list of organizations that gave their top fives, follow this link: