Health Articles From Our Providers

Trees Cause Spring Allergies

By Dr. Rick Jackson


"Spring colds" are often caused by the first pollens of the year—tree pollens. Trees start to pollinate in the early spring months. March, April and May are the most common months, but some trees even bloom in February depending on the year and the location.


Each species of tree blooms for a relatively short time. Many only last for several days to a week, so the allergy symptoms act like a cold and last about as long. Oak trees, however, have many species and varieties and will cause symptoms for about a month, usually beginning in April or early May. Pines seldom cause significant allergies despite producing visible yellow clouds of pollen.


Exactly which trees are causing allergies can be determined by skin testing. Since the period that trees are in bloom is relatively short, the easiest treatment is usually with medicines that treat the symptoms and avoiding pollen exposure. If that doesn’t work, allergy shots may be considered.


Many useful medicines are available without prescription, such as antihistamines and decongestants. The newest antihistamines are popular because they are not likely to cause drowsiness. Many other excellent medicines are available by prescription. These include eye drops, steroid nasal sprays and antihistamines.


To use nasal steroid sprays (Fluticasone, for example), proper technique is essential. The tissue that gets congested is on the lateral sides of the nasal cavity, not the septum (the narrow cartilage dividing the right and left nostrils). Therefore, when you spray the medicine, aim it up and out, toward the ear. One way to do this is to use your right hand to spray your left nostril, and your left hand to spray your right.


It is also wise to stay indoors during the heavy pollen seasons and use air conditioning to decrease the indoor pollen count. Windy days are particularly bad for stirring up the pollen. Do outdoor chores in the morning or late in the day if possible.


If medicines do not control the symptoms, desensitization shots can greatly decrease the symptoms. Your doctor can help arrange testing and schedule the shots if they are indicated.

Prevent Firearm Injuries


The cost of firearm injuries is high—not just in dollars, but in loss of innocent lives. Each year about 40,000 Americans die from firearm injuries. Many of these are young children or teenagers playing with guns their parents left loaded and unattended in their homes. Sometimes the guns are hidden, but often they are in plain view.


There is rarely justification for having loaded weapons in the household. A study published in the New England Journal of Medicine reported that guns in the home were 43 times more likely to kill a family member or friend than an intruder. Later studies have shown a lower risk.


Having loaded guns in a house is a risk in many different ways. Toddlers and young children think they are toys and accidentally shoot themselves or others. A depressed teenager might find a loaded gun during a very vulnerable period in his life and carelessly take his own life. Most successful teenage suicides are committed with guns.


Guns are a significant risk during domestic quarrels. Women are especially at risk, but there is also risk to children, men, relatives, neighbors, bystanders and police.


There will always be people who want to own guns. And there are many good reasons for owning guns, such as hunting, sport shooting, collecting and investing. However, guns must be stored safely. That includes having the guns locked up and not loaded. The ammunition should be locked up in a place separate from the gun. And every time you pick up a gun, check the breech.


Finally, trigger locks are an inexpensive and easy way to prevent a gun from being fired accidentally or used impulsively. If you own guns, store them in a safe way—it can prevent accidents and even deaths.

Many Causes for Poor Sleep


As people grow older, they have more and more problems with sleep. The problems commonly begin around age 40 and increase with age.


There are several significant causes of poor sleep in older people. One common cause is sleep apnea. Normally a person may have a few pauses in his breathing for up to 10 seconds while sleeping, but when it happens dozens to hundreds of times a night, a person does not get the rest that he needs. Sleep apnea is commonly associated with snoring.


Another problem that develops after age 40 is nocturnal myoclonus. With this, a person will have frequent violent kicking motions which disturb his normal sleep pattern and stages of sleep. Although the person may not be aware that he has such movements, his partner will certainly be aware of them.


Depression is another common cause of poor sleep. Here a person may fall asleep okay only to awaken in the middle of the night and not be able to sleep well after that. Antidepressants will work well for the depression as well as help with the sleep disturbance.


Alcohol is a depressant and tends to make people fall asleep, but it also interferes with the deeper stages of sleep and causes frequent awakenings during the night. Avoid alcohol if you have any difficulty sleeping.


Exercise is usually helpful in promoting good sleep but it should be done at least a few hours before going to bed. Stimulants, such as caffeine and decongestants, should be avoided in the latter half of the day. Sleeping pills should generally be avoided since they are often effective for only short periods. If poor sleep persists, a person should consult his physician for further evaluation.

RSV--The Bad Respiratory Virus


Each winter, one of the most troublesome respiratory viruses of childhood makes the rounds. Most older children tolerate the respiratory syncitial virus (RSV) well and just suffer the symptoms of a cough, sore throat, runny nose and fever.


For some children, however, the virus can be very serious. These are usually children who are between the ages of two and five months. They are old enough that they have lost the immunity they received from their mothers and too young to tolerate such a harsh virus. Children who have lung, heart or immune problems are also at greater risk of complications from RSV. One of the other problems with this virus is that it may take two or three infections before a child develops good immunity to it.


The virus is spread by coughing and close contact, such as touching hands. The virus is so common that most children have had the infection by three years of age. After this age, RSV infections are seldom a problem.


The virus causes a great deal of irritation to the lining of the airways and lungs. Increased mucus and sloughed cells cause the tiny airways to plug up. This plugging slows the air that is leaving the lungs, so the lungs become over-expanded in a way similar to emphysema. In the more severe cases, the airways become completely plugged up and the airways collapse.


Treatment is usually aimed at reducing the symptoms and making sure a child is getting adequate oxygen. Infants often need to be hospitalized for RSV infections. A steroid syrup or shot is commonly used and can decrease the severity of symptoms. In severe cases, an antiviral antibiotic can be used, but its usefulness is still being studied.

Exercise May Cause Missed Periods


Exercise is good for you, but sometimes you can get too much of a good thing. Many female athletes, as they increase their training, begin to have trouble with irregular periods. With even greater amounts of training, their periods may stop entirely. If the training is decreased for any reason, however, periods usually resume in a couple months.


For younger teenage girls, excessive exercise in running or ballet tends to delay the onset of their periods for one to two years compared to less physically active girls.


The women who develop this loss of periods are usually young runners who have a relatively light body weight. The stress of training combined with the weight loss cause a lowering of the female hormone levels. This in turn affects their periods as well as their body in general.


When a woman has her periods suppressed for a long time, there can be adverse effects on the body. One problem is that the bones actually grow thinner rather than stronger with exercise. Also, there is a slightly increased risk that the lining of the uterus will develop abnormal pre-cancerous cells if the lack of normal cycling is prolonged.


If an athlete stops having periods, it is wise for her to have an evaluation. There are many other causes for missing periods, such as pregnancy, thyroid disease, and other illnesses, which should be diagnosed and treated early.


If the exam is normal, the bones and uterus can be protected and the cycles resumed by using birth control pills. Women should take a gram or more of calcium a day, and probably vitamin D, to protect the bones from further calcium loss.

Know Your Medications

Written by Dr. Rick Jackson


According to one study, when a patient is asked, “what medications are you taking?” and the answer is compared with the patient’s medical record, a discrepancy is detected over half of the time. The discrepancy is harmless 61% of the time, but 33% of the time a moderately severe risk is discovered. Six per cent of the time a SEVERE risk is present.


There are many possible causes for these errors. A patient may be seeing several providers from different specialties. Ideally, the specialist should be provided with an accurate list, and not prescribe something that would interact with chronic medications. It’s essential to have an accurate, up-to date list, but this sometimes doesn’t happen. Other times, a patient might not want to pay for the med or stop it due to a real or imagined side effect, and not tell the provider.


Decades ago, an elderly patient was transferred form a nursing home with multiple medical problems. She had an irregular heart beat that required chronic anticoagulation to prevent a stroke. She had a minor bleeding problem, since her blood was too “thin.” We stopped her anticoagulant and planned to resume it at a lower dosage when she returned to the nursing home. When it was time to send her back to the nursing home, we reviewed her medications, and wrote orders for them to be given, but the anticoagulant was left off. Two weeks later, she had a minor stoke. She recovered, but we used that incident to start our own medication reconciliation policy to prevent future problems. The policy assured that the discharge medications were compared with the admitting meds.


Two of our nurses took it upon themselves to develop a more formal protocol, and it was so successful that they gave presentations to local hospitals and health care meetings. We now have a very good program at the hospital and the clinic to assure that every time a patient is admitted or discharged, the medication list is updated. The only way for this to succeed is for the patient or caretakers have an updated medication list that includes over-the-counter meds, supplements, and any dosage adjustments.


Be sure that you take a current medication list with you when you see a specialist, and I’m pretty sure that most specialists provide you with an updated list after you are seen, so that any of the medications they add will be included in your list.,


When you are being seen for a scheduled appointment, it doesn’t hurt to bring along all of your medications in their original bottles to prevent any doubt.


If you have Medicare, you are eligible for Chronic Care Management. Studies have shown that when a patient is phoned 2 weeks after an office visit, they frequently can’t recall what medications they are taking, or how to take them. If you participate in CCM, a nurse will call you from time to time to go over your medications and treatments and ask if you have any new concerns. This would help with medication reconciliation and is covered by Medicare. Your provider may suggest it to you at the time of a visit, or you could contact your provider to enroll you.

Guard Against Pneumonia


"Shots" are not just for children. We are getting more and more useful vaccines for more infections and many of these are for older age groups. One of the most important vaccines is the pneumonia shot.


Pneumococcus is a bacteria which frequently causes pneumonia as well as a number of other serious infections, including meningitis. This shot will protect a person against 90% of the important strains of this bacteria and help prevent or lessen the severity of pneumonias. It does not protect against pneumonias from other bacteria or viruses, however.


Often a pneumococcal infection strikes and spreads so rapidly that it becomes life-threatening before antibiotics can take effect. This is especially true in the elderly, whose immune systems are usually weaker and respond more slowly. The vaccine may give a person that extra protection he needs to keep a serious infection at bay or at least slow the spread of infection until antibiotics and white blood cells take effect.


Who should get the vaccine? Like with flu shots, those who are at highest risk are persons over 50 and anyone with chronic illnesses such as diabetes, heart, lung or kidney disease. The vaccine is especially important for anyone who has had his spleen removed. Your doctor can advise you about the many other indications that might exist for you.


PCV13 is the newest pneumonia vaccine. You will receive this vaccine if you have never received a pneumonia shot. PVC23 is an older pneumonia vaccine that will be given one year following the PCV13, or as a booster.


Serious side effects from the vaccine are rare, but soreness at the site of the injection, a low-grade fever, and mild muscle aches are not uncommon.


In most respects it is similar to the flu shot, but the one big difference is that the shot is not given each year. It is given as a series of a couple shots over time according to various regimens determined by an individual’s health conditions.

Treat Low Back Pain


Back pain is something that plagues almost everyone at one time or another. Usually it is from strains or overuse of the lower back, but sometimes there is a disk, arthritis or other causes for the pain.


Determining the exact cause of the pain may be difficult, but the treatment should not be difficult. There are several important things you can do to make the pain go away and stay away in most cases.


The first thing to do when the pain begins is to place the back in a relaxed position. The proper position for this is lying with some bend at both the hips and knees. Pillows can be placed under the knees when lying on your back, and they are also helpful when placed between the knees when lying on your side. You should not lie on your stomach. One or two days of bed rest may be necessary, but usually it is better to intermix frequent rest periods with light activity.


Medicines are very useful in decreasing the pain and relaxing the muscles. Sore muscles always tighten up and cause the pain to worsen. Ibuprofen is very helpful; you should use up to 8-12 per day, taken with food. Acetaminophen helps pain, but it does not decrease inflammation. There are also many excellent prescription medicines that are taken only once or twice a day. It is important to use these medicines early to control the pain and inflammation, rather than wait until the pain is incapacitating.


After an injury or strain to the back, immediately apply ice packs for 15-20 minutes several times a day to limit the pain, swelling and muscle spasm. After two or three days, warm packs or baths can give excellent relief, but if used too soon, heat may make the swelling worse.


Finally, physical therapy is very useful in teaching a person back exercises and appropriate posture that will strengthen the back and help prevent low back pain.

Soap is Hard on the Skin


Cleanliness may be next to Godliness, but it is awfully hard on the skin. Especially in the winter. 


Washing is something we do daily or even more frequently, and we tend to use plenty of hot water, soap and scrubbing. Often the soap has a nice fragrance. But soaps and fragrances do not make the skin any healthier. The skin is healthiest if it is left alone to take care of itself.


As a person grows older, the oil glands of the skin produce less oil, so it is important to protect and preserve what oils you have.


The face, armpits and groin produce adequate oils, but the arms and legs become excessively dry during the winter if the natural oils are removed. Moisturizers are often used but they do not protect like the natural oils.


A person cannot completely stop washing the skin just because of dry skin or eczema, but a person can cut down on the frequency and length of baths or showers and lower the temperature of water of his bath or shower.


The type of soap used can also be helpful or harmful. The stronger, scented soaps are among the worst for drying and irritating the skin. And regardless of what causes the rash in the first place, strong soaps are likely to be what keeps a rash from clearing up. Unfortunately, the natural reaction a person has with a skin problem is to wash more often, use stronger soaps and scrub harder.


The treatment is to use "super-fatted" soaps such as Purpose® or Basis® which contain oils that remain on the skin to help protect it. But even with these, do not wash too often or scrub too vigorously


Stop Winter Itch


When the humidity drops very low in the winter, the skin suffers. Not only does the skin dry out from the low humidity, but also from many things we normally do, such as bathing which washes away the skin’s protective oils. When the skin gets dry it begins to itch, and scratching it only makes it worse.


The first step in helping the skin is to increase the humidity in your house. Use a vaporizer or humidifier and be strict about keeping it clean. Lowering the temperature also helps because heating dries the air.


A person should bathe less frequently and use a superfatted soap, such as Basis®, Dove®, or Caress®. These help replace the oils and keep the skin moist.


Keri Lotion® or Eucerin® are other oils that can be added to the skin after a bath. If the oils are added to the bath water, they make the tub very slippery and dangerous. After a bath or shower, you should pat your skin dry and then apply the bath oil to seal in the water that has entered the skin.


Carmol® and Nutraplus® are lotions which draw moisture into the skin and help hold it there.


Antihistamines can be used for severe itching, especially at night when itching is much more noticeable. Antihistamines may cause drowsiness which can help you sleep through the night, but drowsiness during the daytime can be troublesome. Cortisone creams will help if there is any inflammation of the skin and help to moisturize the skin if they are in an ointment base.


Using these and similar products, either singly or in combination, will help stop the winter itch. For the best results, remember to use these products regularly during the winter season.



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