Health Articles From Our Providers

                               Swollen, Allergic Eyes

 

August is the time of year for hay fever from ragweed. More people will get worse symptoms now than any other time of the year because of the high pollen counts from ragweed and several other weeds.

 

The eyes are a common site of symptoms since they are a good trap for the small pollen grains, especially when there is a little wind. The pollen makes certain white blood cells release histamines and other substances that make the eyes get watery, itchy and red.

 

When this happens, people usually rub the eyes to try to relieve the irritation. This only helps for a few moments and often leads to further swelling of the lining of the eyes and even greater itching. The swelling of the whites of the eyes may get so bad that they bulge out similar to a large water blisters. This looks bad and is very alarming to the person, but it is actually harmless and will improve.

 

This swelling quickly resolves with proper protection and treatment. Keeping the eyes closed and using cool compresses to relieve the itching is most helpful. Medicines that decrease the redness and inflammation of the eyes are useful, and antihistamines can also reduce the symptoms. Avoid rubbing the eyes.

 

There are many other things you can do to limit your symptoms. Protect your eyes with wrap-around sun glasses that limit how much pollen reaches your eyes. Stay indoors during windy weather. Do outdoor chores in the morning before the wind stirs up pollens for the day. Keep windows shut and use an air conditioner to limit the amount of pollens that enter the house.

 

If symptoms are prolonged or difficult to control, a person should consider allergy testing. This can help a person identify what to avoid and to prescribe shots which can be very helpful in preventing swollen, allergic eyes.

 

                      Excuses to Ignore Heart Pain

 

A person often has warning signs of heart disease—chest pain or shortness of breath—before having a heart attack. Unfortunately, many people find reasons to ignore these important symptoms. "I wouldn't want to bother my doctor," or, "The pain always goes away," many people say.

 

People know that chest pain is a warning sign for heart disease. Yet, heart pain may not feel quite like the pain of a toothache or stubbed toe. It is often difficult for a person to describe. It may be a tightness or pressure in the chest, an uncomfortable shortness of breath or a feeling of doom. So some people ignore it because it is not a typical “pain.”

 

Another reason many people talk themselves out of seeing a doctor is because the pain goes away if they take it easy—a little rest and everything appears to be back to normal. Often the heart pain comes on most easily in the morning, but is gone the rest of the day even though a person may be more active. This gives a person a false sense of security.

 

Some people feel heart pain in the neck, stomach, shoulders or arms. It may act like indigestion. A person cannot worry about the heart every time he gets a little pain in the stomach, neck or arms, but if the pain occurs with exertion, after meals, or is new and different from usual, it should not be ignored. Even if it's not the heart, it may deserve medical evaluation and treatment.

 

No one wants to have heart disease or to take the tests that may give the bad news that the pain is angina, but with early treatment much can be done to decrease the symptoms and protect against having a dangerous heart attack.

 

Do not ignore these important warning symptoms. Whether it is pain, pressure, tightness or a shortness of breath, it could be your heart.

 

Poison Ivy 

 

“Leaves of three, let them be,” is a way to remember how to avoid the misery of poison ivy dermatitis. Unfortunately, poison ivy can mingle with other weeds, and can still cause a rash in the fall and winter after the leaves turn brown.  Additionally, the oils from the leaves can cling to pets, boots, clothing, tires and can affect any skin that comes in contact with these items.  Washing with a strong detergent  within minutes of coming in contact with the oils can prevent the rash, but this is rarely possible. 

 

The oils penetrate the skin immediately and after a short time they will no longer be passed from person to person or from one part of the body to another.  Zanfel is a lotion which can prevent the rash if applied as soon as possible after exposure or after the first signs of a rash are present.  Prescription corticosteroids can help; a gel, lotion  or spray is preferred over creams and ointments. Most of the time we have to use systemic corticosteroids, either orally or by injection.   I prefer to use prednisone starting with 60 mg daily ( 3 tablets , 20 mg each)for 2 days, then 50 mg  for 2 days, 40 mg for 2 days,etc. The patient can refill the prescription if it flares up as the dosage is lowered. I tell the patients to take the daily dose all at once as early in the day as possible, since it can cause insomnia.  If a patient prefers an injection, we use Depo-medrol (a long-lasting cortisone) and dexamethasone in the same syringe. Dexamethsone acts more quickly but wears off sooner. 

 

Do not use bleach, alcohol, other irritating chemicals. You can try Calamine lotion when it is wet and weepy, then Keri lotion when it gets dry. Try to avoid scratching the rash, unless you scratch it with an ice cube, which will calm the itching for several hours and won’t introduce infection.  

                                  Infectious Mono

 

Infectious mononucleosis, or "mono," is an infection caused by a virus similar to herpes. It is well-known for the rather severe symptoms it causes in teenagers and young adults.

 

It often starts out much like strep throat with a sore throat, swollen glands and a fever. Excessive tiredness usually becomes the predominant symptom and the person may be bed-ridden for days or even weeks.

 

About half the time the spleen enlarges along with the lymph glands of the neck. The enlarged spleen can rupture and bleed internally, especially if there is any trauma such as in football or from falls skiing. An enlarged spleen needs to be followed by your doctor until it resolves. Occasionally the liver is involved with hepatitis-like symptoms.

 

The skin may develop a rash. If antibiotics, such as amoxicillin, are used, this rash is much more likely to develop. Antibiotics should not be used for mono unless there is a definite bacterial infection.

 

Mono is spread through body fluids, especially oral secretions. Thus, the virus is usually spread through kissing or communal use of eating utensils, but mono is not particularly contagious. We are all exposed to mono numerous times in our lives, but do not develop the infection unless the conditions are right. People who have had the illness will frequently continue to excrete the virus for years and can expose others for years.

 

There is no specific treatment for mono. Antibiotics do not help, but in more serious cases steroids may be used to alleviate the symptoms. Other helpful steps are to get plenty of rest, use pain pills and throat lozenges, and treat the symptoms until they resolve.

                             Preventing Constipation

 

Constipation is a common problem affecting millions of Americans. There are also medical reasons for preventing constipation. Many doctors believe that a person can decrease the risk of colon cancer by having regular bowel movements using fiber or bulk-forming laxatives, probably by more quickly eliminating any cancer-causing chemicals.

 

There are numerous methods of preventing and treating constipation. The first is by developing good bowel habits and a routine time to use the bathroom each day. Another simple measure is to increase the amount of water you drink. Physical activity is also helpful. Walking routinely or participating in other sports can help promote good bowel habits.

 

Good dietary habits are especially important. By eating foods high in fiber, a person will help keep his body healthy in many ways. First, fiber makes the stool larger and softer and bowel movements will be more frequent. Bulkier stools will also decrease the chance of developing diverticulitis which is a common problem as a person grows older. Other advantages of fiber include a lower cholesterol level, a decrease in the risk of colon cancer, and a more steady rate of absorption of nutrients from the bowel. This is especially important in diabetes.

 

If other measures are needed, there are a variety to choose from. Some medicines, such as polyethylene glycol or milk of magnesia, help draw extra water into the gut to keep the stool softer. There are also "stool-softeners" and lubricants, to make bowel movements easier. Laxatives work by stimulating the colon to empty but they can harm the colon if used on a long term basis.

 

If constipation is a new symptom, you must also consider bowel cancer or other illnesses and consult your doctor for an evaluation.

               

              Breastfeeding Helps Prevent Ear Infections

 

Some simple things can be very important. Breastfeeding is one of the simple things a woman can do to help her child in many ways. For example, it is one way of preventing ear infections in her child.

 

The exact mechanisms of how breastfeeding helps prevent ear infections are not known, but may relate to antibodies in the milk. Breastfeeding also averts one of the common causes of ear infections—putting a child to bed with a bottle. Falling asleep with milk pooling over the Eustachian tubes is a common cause of infections.

 

How long does a woman need to breastfeed? Studies show that as little as two weeks can make a difference. This can cut the risk of infections in half, and breastfeeding longer may reduce the number of cases by 65-70% according to studies.

 

Breastfeeding mothers are also less likely to smoke, especially near the infant. Exposure to cigarette smoke is a huge factor for many children. Many children who have frequent ear infections or need tubes placed in their ears live in homes where someone smokes. If you have children, you should never allow anyone to smoke in the house.

 

Infants who are breastfed are also less likely to be in a day care center and less likely to be exposed to viral infections. Day care centers are a necessary part of life for many families, but they can expose your child to every infection that comes to your town. Children in day care centers have triple the frequency of upper respiratory infections, which is one of the major reasons why infants and young children get ear infections.

                           Fad Diets Can Be Harmful

 

Best-sellers are not always the best buys. New diet books are constantly on the shelves and millions of people buy them. But for each million copies sold, only a few people lose weight. Often, more people are harmed than helped by the gimmicks used in these fad diets.

 

There is no easy way to lose weight--you simply must burn up more calories than you eat. And even this must be done within reason. Some diets recommend 500 or 700 calories a day, but at these starvation levels the body lowers the thyroid activity, and the weight loss will slow down or stop. Then when a person resumes eating normally again, which always happens, the weight rebounds and usually goes higher than before.

 

Many diets rely on getting their quick weight loss by eliminating water from the body. These diets can result in dehydration within the cells and metabolic changes that can be harmful to you. One of the changes is a low potassium which can cause fatigue, muscle damage, and even dangerous heart rhythms. Many people died from the liquid protein diets which were promoted a few years ago.

 

Diet books are usually poor places to learn about basic nutrition. Many books mislead you about the roles of vitamins, talk about enzymes fighting in the stomach, food allergies and even quote studies done over 80 years ago.

 

Perhaps the most harmful effect of fad diets is the disappointment they cause when they are ineffective after promising an easy cure. There is no easy cure. A person must stay physically active and follow a balanced diet on a life-long basis. His calorie intake must consistently meet or fall slightly short of his daily caloric needs, not exceed it.

                       

What Causes Cataracts?

 

Cataracts are opacities in the lenses of the eyes that prevent light from passing through. This results in a loss of visual acuity, the brilliancy of colors, a generalized darkening of one’s vision and eventually loss of vision.

 

Cataracts are so common they can almost be considered a normal sign of aging. Virtually anyone who lives long enough will develop them. But just what causes cataracts, or brings them on at an earlier age, is not entirely known. Presently, ophthalmologists believe that lifelong exposure to ultraviolet light outdoors or from man-made sources is the most significant factor.

 

There are numerous other factors which may play a role for certain people. Injuries to the eye are a cause in some people and can result in cataracts at an early age.

 

Cortisones and cancer drugs may contribute to formation of cataracts. Use of these and a few other uncommon medicines may necessitate regular exams by your ophthalmologist.

Cataracts are also more common in people who have diabetes or a family history of cataracts. Infants can be born with cataracts caused by rubella and other viral infections which had occurred before birth.

 

Whatever the cause, the result is basically the same. The crystal clear cells of the lens become cloudy and opaque and vision is lost. The visual impairment may vary from minor difficulty with needlework and reading to complete loss of useful vision.

 

Cataracts are treated by outpatient surgery which takes less than an hour. Only the eye is anesthetized and unless there are other eye problems, good vision is restored in 98-99% of people.

 

                       

Antibiotic Stewardship

Written by Dr. Rick Jackson

 

A steward is a person or organization trusted with the management of a property or commodity. We in medicine are constantly reminded of our responsibility to practice good antibiotic stewardship. The ability to prescribe or administer antibiotics is a powerful tool and we must not abuse it, or it will become useless in the future. Our patients can help us practice good stewardship by becoming informed about the use and misuse of antibiotics. Please take this test to see how much you know about antibiotics.

 

1) When you have a cold and your mucus turns from clear to green, it is proof that you have a secondary bacterial infection, not a virus. True or false?

 

2) If a child is given amoxicillin for a cold with a fever, then develops a rash, it must be due to a penicillin allergy, and that child should never be given penicillin or related drugs in the future. True or false?

 

3) If you have an artificial heart valve, and need to have a boil lanced, you should take a large dose of an antibiotic 30 minutes before the procedure. True or false?

 

4) Antibiotic eye drops will treat pinkeye and keep it from spreading. True or false?

 

5) If you have chronic obstructive pulmonary disease and get a bad cough, fever, wheezing, and shortness of breath associated with a cold, you should get an antibiotic. True or false?

 

6) If your have an ingrown toenail with redness, swelling and tenderness, an antibiotic may prevent the need for surgery. True or false?

 

7) Some farmers give antibiotics to their cattle, hogs, and poultry to keep them healthy, and there’s nothing wrong with that, since the meat, eggs, and dairy products are still safe to consume. True or false?

 

8) Grandma has dementia and is living in a nursing home. She has become agitated, more confused, and the nurses requested that her urine be checked for infection. The urinalysis showed a small amount of bacteria. Treating with the proper antibiotic, based on the culture and sensitivity results, is good medicine, even though she has no burning

on urination, fever, or other signs of infection. True or false?

 

9) Antibiotics may treat acute appendicitis without surgery. True or false?

 

10) My 2 year old has a sore throat and I was able to look down her throat, and it was red. I need to get her treated for strep throat to prevent rheumatic fever. True or false?

 

11) I have fever, a headache, and my jaws ache when I chew .I really can’t afford to take time off. I’ll get my provider to call in some penicillin and make an appointment to be seen in a couple of days if I’m not better. This is OK, isn’t it? True or false?

 

Answers:

 

1) False. Viruses, as well as bacteria, can cause green mucus. Signs of a sinus infection include facial pain and tenderness, pain radiating to your teeth, fever, especially if it is 7 to 10 days after the onset of a cold, after other cold symptoms were getting better. (“second sickness”.)

 

2) False. Many viral illnesses are associated with a rash. One must consider proper allergy testing by a specialist to see if it is a true penicillin allergy. Up to 90% of self-reported penicillin-allergic patients, (after careful testing) were able to tolerate penicillin.

 

3) True. Most heart valve patients know to receive antibiotics before dental work, but incision of infected tissue anywhere in the body can result in bacteria entering the bloodstream, so prophylactic antibiotics are indicated.

 

4) False. Pinkeye is caused by a virus, and is highly contagious, but antibiotic drops are useless. If there is a large amount of pus, or swelling and redness of the lids, it might be worthwhile to see your provider for further evaluation, possibly including a culture.

 

5) True. COPD exacerbations can be caused or aggravated by a bacterial infection, particularly if there is fever, purulent sputum, and shortness of breath.

 

6) False. The redness, swelling, pain and pus are usually the result of a foreign body reaction. Your own toenail may not be considered “foreign,” but when it has burrowed under the skin, the body “rejects” it. Sometimes prescription cortisone ointments can help, but surgery is usually required and in my experience, systemic antibiotics are a waste of time and money.

 

7) False. The practice of giving antibiotics to farm animals is common (in 2009, 9.3 million Kg of antibiotics were sold for agricultural use, compared to 3.3 million Kg for use in humans). This has contributed to the emergence of resistant strains of bacteria which can contaminate soil and water and infect humans.

 

8) False. Low levels of bacteria are common in urine specimens obtained at nursing homes. It doesn’t contribute to decline unless there is a fever, or symptoms such as burning, frequency, or worsening incontinence. Trying to eliminate all bacteria can lead to the development of resistant organisms, yeast infections, diarrhea, and other side effects.

 

9) True. In selected cases, when the diagnosis can be made, usually by a CT scan, antibiotics can treat the appendicitis without surgery.

 

10) False. Strep throat is extremely rare under age 3. The child should be evaluated, but don’t be surprised if your provider doesn’t do a throat swab.

 

11) False!!!! These are symptoms of temporal arteritis, an inflammation of the blood vessels that can result in permanent blindness if not immediately diagnosed and treated with large doses of cortisone-type medications.

 

Risks of Antibiotics

 

Some antibiotics can cause side effects that have nothing to do with their antibacterial action. Quinolones (Cipro, Levaquin) can cause tendon rupture. Macrolides (erythromycin,clarithromycin, azithromycin) can affect the heart rhythm when combined with certain other medications. Tetracyclines, especially doxycycline, can cause a skin rash if the patient is exposed to sunlight. Long term use of macrodantin can cause lung fibrosis. Broad spectrum antibiotics can cause C diff infections of the colon , which can be very serious and hard to get rid of.

 

Many ear infections will heal without antibiotics. I frequently will give the parents a prescription to be filled only if the child runs a high fever or has worsening pain.

 

Here are some tips for managing colds and coughs without antibiotics:

 

1) Avoid getting sick by using good hand sanitation. Use a hand sanitizer immediately after fueling your vehicle. I keep a pump bottle of Purelle in the map pockets of all my vehicles. Use your own pen or stylus when signing after you use your credit card. Sanitize the handle of a grocery cart before using it. Be careful about shaking hands; consider a “fist bump” instead. Get a flu shot!

 

2) At the first sign of a cold start using zinc lozenges—Zicam or Cold-Eeze. Keep using them for 2 or 3 days .Zicam nasal swabs don’t work.

 

3) Use honey for cough suppression (not for infants).

 

4) Use a sinus rinse twice a day.

 

5) There is weak evidence that Vitamin C and Echinacea can reduce the incidence of colds. Thera-flu, Mucinex and similar OTC medications can help with symptoms, but they won’t help you get over colds and flu. Breathe –Right nasal strips can help, especially at night.

 

In conclusion, it is definitely worthwhile to see your provider when you have a fever, respiratory symptoms, or any signs of an infection. A careful examination will help determine if there is a need for antibiotics. We can usually help with your symptoms, run tests to look for serious underlying conditions, and make sure that anything we prescribe has benefits that outweigh the risks.

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