So many are coming down with the flu over the past month that the media are putting out only the scary stories causing widespread panic! I see so many people every day that think they have the flu and they only have a cold commonly called "Upper respiratory infection" or "URI" - which may feel bad but does not require any medical intervention in most cases. What are the symptoms of a cold or the flu you ask? Well let me show you:
COLD: Usually starts with a slight scratchy or sore throat, followed by a runny nose and nasal congestion, then by day 4 or 5 a cough. The sore throat is usually better after a few days when you develop the other symptoms. At first the drainage out of your runny nose is clear and it may start to thicken up and change colors. This is common and does not necessarily mean you have a bacterial infection or need any antibiotics. Drinking more water than normal, taking something to relieve any aches or thick congestion (fever reducer and/or expectorant such as guaifenesin) and lots of rest. Some studies have shown chicken soup helps - shoot, it isn't going to hurt anything (unless you are allergic) so go ahead and have some.
FLU: Starts rather suddenly - you are fine all morning then after lunch you feel very achy, develop a headache or just feel really bad with a headache. Then within a few hours you may have a fever, usually around 100.4, chills, achy and a headache. Sometimes people develop a stuffy nose, sore throat and head congestion with a cough. Most importantly is how suddenly it happens.
Those that have always thought their common cold was the FLU realize it wasn't so when they do finally get the flu. It really makes you feel pretty darned bad and makes you want to sleep it off for a few days. Not a bad idea.
Staying out of the public is number one for those that do have a confirmed case of the flu or even think they have the flu. No need to rush to your medical provider or an urgent care to see if you have the flu, unless you have other health conditions that make you susceptible to complications such as pneumonia. Those people have a strong history of asthma, lung disease, heart problems, cancer etc.
Here is a great site from the Web MD that talks about the 10 things NOT TO DO when you have the flu. http://www.webmd.com/cold-and-flu/features/swine-flu-10-things-not-to-do - Another great site for anyone is "FluFacts" http://www.flufacts.com/about/cold.aspx on this site you can type in your Zip code and track the flu in your area. It also has some very good facts about the flu and colds and other topics I think are very handy to have at your fingertips!
With the number of people who have already had the H1N1 flu and the number expected to come down with it this season there is not enough Tamiflu to give to everyone. Most providers have started holding back on prescribing it to only those with a medical condition, such as asthma, lung disease, heart disease etc and suggesting the normally healthy individuals try over the counter products for their symptoms.
My favorite OTC product for the flu is Oscillococcinum - it is a homeopathic product that works great for the flu symptoms. It works the best when started early in the illness and taken three times a day as directed. It can be given to anyone down to age 2 and it has no side effects and will not interact with any other medications. I love that part of it! Many of my patients have taken it this year and I have heard back from them that it worked wonderfully and they have recommended it to their family and friends. My son took it this year as he didn't really need any Tamiflu - within one day he felt almost normal. He only had a cough and stuffy nose and slight fever, but acted like he was back to normal with no complaints of body aches, chills, or sore throat - AT ALL. We have a lot stockpiled up in case any of us come down with the flu now or in the winter - I don't want to waste any time. Plus if you have a stuffy nose you can pull out your Neti Pot and rinse out your nose using the saline that comes with it or make your own. This will open up your stuffy nose and clean out all that yucky green or yellow mucus so you can breath a little easier.
Here is the site for the product if you want to learn more about it - http://www.oscillo.com/about-oscillo/default.html
I hope this blog has something of use for those that read it - with one more note - Wash your hands frequently, use hand gel and cover your cough.
Stay well and be healthy!
Thursday, October 8, 2009
Wednesday, September 9, 2009
Menopause...... the mystery of it all
Menopause, and it's sister perimenopause, has always been a secret process that sneaks up on women without any warning and throws many into a world of complete dissarray. I too found the whole process quite disturbing and a complete surprise as I was barely in my 40's!
I had a partial hysterectomy (only uterus removed) when I was only 37 and very shortly after I started developing some trouble staying awake all day, I couldn't loose the weight from my last child who was already 4 years old and I felt so sluggish. I then found out my thyroid was not functioning properly (very common problem). Once this was straightened out I started feeling so much better. I felt like the light was finally turned on and I was back on track. Then about 2 years later I gained weight, my cholesterol went wacko, I started having these horrendous headaches which were diagnosed as migraines. With this new found problem I felt like I was falling apart! Turn 40 and everything quits working.
About a year later I felt angry all the time, I gained 10 pounds in about 4-5 months, and my hot flashes got so bad I had some labs done to see if I was in menopause or not (since I didn't have a uterus I hadn't had a period in years so I had NO idea if I was having irregular periods or not). It was inconclusive at one point so I went back to my PCP and had my thyroid checked again and sure enough it was off kilter. So, we upped my medication and I felt a little better. Not long after this I started having a lot of trouble sleeping at night, I woke up constantly - sometimes sweating and sometimes just woke up! I was mad all the time, my temper flared for no reason at all and I had no idea what was going on. I had heart palpatations and I felt depressed. I was recently married and I didn't want to scare off my sweetheart. Since I couldn't figure out what was going on I tried a new medical provider and she tried me on several anti-depressants, sleeping pills, and Xanax as needed and sent me to have a sleep study done. I am not fond of taking so much medication as I rather fix the problem and not mask it. Well, the sleep study showed I was not have any apnea and my sleep was disrupted some but overall the study showed no problems. Ok, once again, I felt like I was going crazy. I quit taking the sleep medication and I only took the xanax if I was feeling completely ugly - I wanted to keep my husband and I felt this was more for him than me!
I also started developing horrible pains and some swelling in my hip, finger joints, wrists, and wherever it decided to flare up. I felt like a cripple. I started seeing an endocrinologist and he started me on some medication that helped a lot. Then my liver started having problems with the medication and I had to take a short break. The pain came right back! Well, this MD took a sudden leave of absence and I had to find another one... ughh! I found a great endocrinologist and he worked me up again to try and figure out what was going on. Nothing came up positive, but one MRI showed something that looked like a type of spondylosis type arthritis ( we ruled out lupus, Lyme disease and other autoimmune problems)....... hmmm - What else could go wrong? We have tried several medications, all of which require labs every 6 weeks to be sure my liver function is still good as these medications are cleared through the liver and can cause problems if not watched closely. I tried to tell my endocrinologist about all my other problems and he too was puzzled and unfortunately they weren't in his field of practice.... so more labs to be sure there wasn't some hidden reason and those were all fine. At least I wasn't dying, but I wanted to understand what was happening. Being a Nurse Practitioner I was always trying to self diagnose - not a good idea.
I tried to keep working out, but didn't do anything on a regular basis and couldn't revive my motivation.
Well, my hot flashes got worse and worse - I would sweat profusely while seeing my patients and my face would get all flushed - this was not acceptable to me! I finally had enough of all this and went to my PCP and asked, no, told her I wanted on estrogen and I wanted it now or I would not be a functioning humban being! She made a deal with me, I get a mamogram ( I do this every year anyway) and she would prescribe me estrogen. After just one week on the estrogen I felt like a whole different person! I slept almost all night long, my hot flashes were very tolerable, if I had one it was so faint I barely knew it was there. I quit having palpitations, I wasn't angry all the time and I wasn't depressed either! I went back to my endocrinologist and told him how miraculously my life turned around once I started on my estrogen and he laughed and said "So, it was all hormonal" - and told me he didn't want to say that before because it probably wouldn't of gone over very well and he was right! Funny thing is my pains all went away and I wanted to stop the medication given to me by the Endocrinologist, but he convinced me not to stop right now. I am still taking what he has me on and my thyroid medication and my estrogen (premarin) and lots of supplements - that's it! I work out at least 6 - 7 days a week and eat healthy as I can with only minimal cheating and I feel better than ever and I am 47 years old.
*I also started taking Evening Primrose Oil twice a day about 6 months ago and I firmly believe this also helps my hot flashes and night sweats. I should be taking it 3 times a day but for me twice a day fits my schedule. This is an herbal product available over the counter and for me it works very well. It took a few months before I realized any benefits, and ever since if I miss a few doses I start to have increased hot flashes and I quickly remember to take it! As with any herbal medication everyone must let their PCP knows they are taking it because there can be some serious interactions between herbal and OTC/prescriptions medications. Just because it is herbal doesn't mean it won't have any serious interactions. Always research and discuss any OTC products with your medical provider.
Estrogen is not a cure-all drug for every woman out there having menopausal symptoms, but each woman who is thinking about taking it needs to have a good understanding of the risk versus benefits of the drug. With proper research and a good discussion with their PCP they can make a wise choice of treatment for their symptoms.
As wonderful as I think estrogen is for me, there are always reasons a woman should not take it. These include: a personal or family history of breast or uterine cancer, heart disease, blood clots
or strokes. I am sure many of you are familiar with the Women's Health Initiative - a very large study on women and the effects of hormones. Here is one site with some great information about the study - http://www.whi.org/findings/ They abruptly stopped the study on women taking estrogen alone due to the possible increase in strokes in the women in the estrogen only group. That scared a lot of people and providers, the study showed more women had strokes and blood clots in the estrogen group compared to those taking a placebo. The study showed in one year out of 10,000 women there were 12 more strokes in the estrogen only group than the placebo group. The number of women who had blood clots was smaller but still more than the placebo group. On the benefit side of the study for the particpants taking only estrogen - their level of coronary artery calcium was much lower than the women on placebo - "When taken for an average of 7.4 years, estrogen-alone is not likely to increase heart disease risk in recently menopausal women who are considering hormone therapy for menopausal symptoms." (WHI.org June 2007). It also found the placebo group had fewer hip fractures and breast cancer (which needs more investigation). WHI study reports - "We consider CEE to have no important (neutral) effect on heart attacks, colorectal cancer, and death because the differences were very small." *CEE is conjugated equine estrogen.
In my case I do not have any of the health risks mentioned above, and my immediate family does not either so I feel I have more of a benefit with the estrogen than without. I will of course continue to monitor myself for breast cancer and will get an annual physical to be sure I am not having any complications from the estrogen. I do not plan to take it forever, but will try to wean myself off from time to time by testing my symptoms as I cut back from a daily dose to every other day and so forth. I am having a much healther and happier life right now so estrogen will continue to be close by no matter where I may go!
I had a partial hysterectomy (only uterus removed) when I was only 37 and very shortly after I started developing some trouble staying awake all day, I couldn't loose the weight from my last child who was already 4 years old and I felt so sluggish. I then found out my thyroid was not functioning properly (very common problem). Once this was straightened out I started feeling so much better. I felt like the light was finally turned on and I was back on track. Then about 2 years later I gained weight, my cholesterol went wacko, I started having these horrendous headaches which were diagnosed as migraines. With this new found problem I felt like I was falling apart! Turn 40 and everything quits working.
About a year later I felt angry all the time, I gained 10 pounds in about 4-5 months, and my hot flashes got so bad I had some labs done to see if I was in menopause or not (since I didn't have a uterus I hadn't had a period in years so I had NO idea if I was having irregular periods or not). It was inconclusive at one point so I went back to my PCP and had my thyroid checked again and sure enough it was off kilter. So, we upped my medication and I felt a little better. Not long after this I started having a lot of trouble sleeping at night, I woke up constantly - sometimes sweating and sometimes just woke up! I was mad all the time, my temper flared for no reason at all and I had no idea what was going on. I had heart palpatations and I felt depressed. I was recently married and I didn't want to scare off my sweetheart. Since I couldn't figure out what was going on I tried a new medical provider and she tried me on several anti-depressants, sleeping pills, and Xanax as needed and sent me to have a sleep study done. I am not fond of taking so much medication as I rather fix the problem and not mask it. Well, the sleep study showed I was not have any apnea and my sleep was disrupted some but overall the study showed no problems. Ok, once again, I felt like I was going crazy. I quit taking the sleep medication and I only took the xanax if I was feeling completely ugly - I wanted to keep my husband and I felt this was more for him than me!
I also started developing horrible pains and some swelling in my hip, finger joints, wrists, and wherever it decided to flare up. I felt like a cripple. I started seeing an endocrinologist and he started me on some medication that helped a lot. Then my liver started having problems with the medication and I had to take a short break. The pain came right back! Well, this MD took a sudden leave of absence and I had to find another one... ughh! I found a great endocrinologist and he worked me up again to try and figure out what was going on. Nothing came up positive, but one MRI showed something that looked like a type of spondylosis type arthritis ( we ruled out lupus, Lyme disease and other autoimmune problems)....... hmmm - What else could go wrong? We have tried several medications, all of which require labs every 6 weeks to be sure my liver function is still good as these medications are cleared through the liver and can cause problems if not watched closely. I tried to tell my endocrinologist about all my other problems and he too was puzzled and unfortunately they weren't in his field of practice.... so more labs to be sure there wasn't some hidden reason and those were all fine. At least I wasn't dying, but I wanted to understand what was happening. Being a Nurse Practitioner I was always trying to self diagnose - not a good idea.
I tried to keep working out, but didn't do anything on a regular basis and couldn't revive my motivation.
Well, my hot flashes got worse and worse - I would sweat profusely while seeing my patients and my face would get all flushed - this was not acceptable to me! I finally had enough of all this and went to my PCP and asked, no, told her I wanted on estrogen and I wanted it now or I would not be a functioning humban being! She made a deal with me, I get a mamogram ( I do this every year anyway) and she would prescribe me estrogen. After just one week on the estrogen I felt like a whole different person! I slept almost all night long, my hot flashes were very tolerable, if I had one it was so faint I barely knew it was there. I quit having palpitations, I wasn't angry all the time and I wasn't depressed either! I went back to my endocrinologist and told him how miraculously my life turned around once I started on my estrogen and he laughed and said "So, it was all hormonal" - and told me he didn't want to say that before because it probably wouldn't of gone over very well and he was right! Funny thing is my pains all went away and I wanted to stop the medication given to me by the Endocrinologist, but he convinced me not to stop right now. I am still taking what he has me on and my thyroid medication and my estrogen (premarin) and lots of supplements - that's it! I work out at least 6 - 7 days a week and eat healthy as I can with only minimal cheating and I feel better than ever and I am 47 years old.
*I also started taking Evening Primrose Oil twice a day about 6 months ago and I firmly believe this also helps my hot flashes and night sweats. I should be taking it 3 times a day but for me twice a day fits my schedule. This is an herbal product available over the counter and for me it works very well. It took a few months before I realized any benefits, and ever since if I miss a few doses I start to have increased hot flashes and I quickly remember to take it! As with any herbal medication everyone must let their PCP knows they are taking it because there can be some serious interactions between herbal and OTC/prescriptions medications. Just because it is herbal doesn't mean it won't have any serious interactions. Always research and discuss any OTC products with your medical provider.
Estrogen is not a cure-all drug for every woman out there having menopausal symptoms, but each woman who is thinking about taking it needs to have a good understanding of the risk versus benefits of the drug. With proper research and a good discussion with their PCP they can make a wise choice of treatment for their symptoms.
As wonderful as I think estrogen is for me, there are always reasons a woman should not take it. These include: a personal or family history of breast or uterine cancer, heart disease, blood clots
or strokes. I am sure many of you are familiar with the Women's Health Initiative - a very large study on women and the effects of hormones. Here is one site with some great information about the study - http://www.whi.org/findings/ They abruptly stopped the study on women taking estrogen alone due to the possible increase in strokes in the women in the estrogen only group. That scared a lot of people and providers, the study showed more women had strokes and blood clots in the estrogen group compared to those taking a placebo. The study showed in one year out of 10,000 women there were 12 more strokes in the estrogen only group than the placebo group. The number of women who had blood clots was smaller but still more than the placebo group. On the benefit side of the study for the particpants taking only estrogen - their level of coronary artery calcium was much lower than the women on placebo - "When taken for an average of 7.4 years, estrogen-alone is not likely to increase heart disease risk in recently menopausal women who are considering hormone therapy for menopausal symptoms." (WHI.org June 2007). It also found the placebo group had fewer hip fractures and breast cancer (which needs more investigation). WHI study reports - "We consider CEE to have no important (neutral) effect on heart attacks, colorectal cancer, and death because the differences were very small." *CEE is conjugated equine estrogen.
In my case I do not have any of the health risks mentioned above, and my immediate family does not either so I feel I have more of a benefit with the estrogen than without. I will of course continue to monitor myself for breast cancer and will get an annual physical to be sure I am not having any complications from the estrogen. I do not plan to take it forever, but will try to wean myself off from time to time by testing my symptoms as I cut back from a daily dose to every other day and so forth. I am having a much healther and happier life right now so estrogen will continue to be close by no matter where I may go!
Sunday, August 30, 2009
Health Reform
Now that Health reform is frequently the biggest topic in the news I found some wonderful websites that can be used as resources for anyone interested in what is being discussed, debated and critiqued. These were found in the Austin American Statesman on August 30, 2009. Just note if you type in the URL it is cAse SEnSitIvE so be careful when you transcribe it.
Interactive tools that show outcomes of different policy options (I found this to be quite interesting) http://bit.ly/ayVfn
Compare how competing proposals deal with key issues http://bit.ly/1jmVR
Washington Post's indepth coverage of the debate and the issues http://bit.ly/mdCHa
Glossary of health care terms and phrases http://bit.ly/L15cE
Do prominent voices in the debate have their facts straight? http://bit.ly/415OC
http://bit.ly/IJTG5
Obama administration's Web site http://bit.ly/1BOvjg
Full text of House bills http://bit.ly/ldzqU
http://bit.ly/tqQ3Z
Long-term study of wasteful medical spending in Texas and other states http://bit.ly/3GsgNx
Congressional Budget Office information http://bit.ly/1BOvjg
I hope these sites provide some good information and education for everyone interested in healthcare and the health of our nation!!
What exactly is health reform? This is a very big question requiring a broad response.
The first issue that needs to change is how people use the healthcare system. After years of working in numerous emergency departments (ED) I saw lines of patients coming in all hours of the day for colds, chronic headache conditions, mild rashes, sore throat, ear pain... you get the picture. These conditions could and should have be handled by a primary care provider (PCP) - i.e. your family Doctor (MD), Nurse Practitioner (NP) or Physician Assistant (PA) and not in the ED. Ok, I know - if it is after 5pm and your provider is closed then where do you go? Now there are numerous Retail Clinics located in drugstores, grocery stores, big discount stores and in some malls that can be utilized. Some common names are MinuteClinic, Take Care, RediClinic, The Little Clinic and many more. Visit http://www.ccaclinics.org/ to learn more about the retail clinics. Most are open during the evening hours and on weekends and charge much less than an ED. We don't need to use up precious space and skills in the ED for a cold! It would cost 8-10 times more to see someone in the ED than their PCP or a retail clinic.
How about taking something to relieve the symptoms? If a person has a cold (stuffy/runny nose, fever up to 102, headache, sore throat, tired, achy) then take a fever reducer/pain reliever such as tylenol or ibuprofen - depending on your health history and allergies. Maybe using a saline nasal wash to clear up the nasal passage and stop the runny nose and dripping. More on the saline rinse in my blog on sinus infections. Rest is always a good idea. Good hand washing skills and using a tissue to cough or sneeze and throw it away immediately can help prevent the spread of most colds and the flu. Most importantly - stay home when you have a fever, a cold or have been diagnosed with the Flu, this is the best way to prevent spreading your illness to others.
You get the idea - retraining people to not run the the ED or their PCP at the first sneeze or cough will help keep costs down. Next we need to make sure our providers (MD, NP, PA) are using the latest guidelines and evidence based medicine when treating their patients. This means not prescribing antibiotics for colds or stuffy heads or sore throats without any evidence the patient has a bacterial infection. Many times the patient will drive how the PCP practices because they come into the office and state "I know I have a sinus infection and I need an antibiotic" - the provider is the one who needs to perform an exam, run any pertinent tests i.e. rapid Strep A or Flu test, sinus or chest X-ray, before they prescribe an antibiotic or antiviral. I know sometimes it is just quicker and easier to not argue with the patient and write the prescription and go on to the next patient, but is this the best evidence-based practice? I recently read that Physician prescribing of antibiotics for Acute Respiratory Illnesses is down http://firstwatch.jwatch.org/cgi/content/full/2009/819/3 but the use of stronger antibiotics is up, which is not without it's risks. I am hopeful the trend to not prescribe antibiotics for a virus will continue to go down. We don't need to give any unecessary medication that can cause more problems than good.
If the providers will stand up to their patients and take a few minutes to educate them on their symptoms and what the patient can do to feel better before prescribing an antibiotic they will probably have healther patients who won't come in for every sniffle or cough. I can't tell you the number of people who have told me they have gotten over an illness without an antibiotic and simply used an over-the-counter (OTC) saline nose spray and drank plenty of water and rested.
If people are more educated on common illnesses, what they can safely take for their different symptoms, and when to seek medical care then we will have more health-smart patients that will save the insurance companies money.
One idea I have is for a provider to develop a list of common OTC medications, what they are used for, and when to take them/stop them. Then when their patients come in for a physical or illness then the PCP can hand them the list with the appropriate OTC's checked off that the patient can safely take considering their medical history. For instance the list could contain Ibuprofen, acetaminophen, pseudoephedrine, diphenhydramine, guiafenisen, dextromethorphan, saline nasal wash, loratadine, cetirizine, etc... next to each item is a description of what the medication is used for, what it will do for the patient and any pertinent side effects plus how much to take and how often. Then when a patient comes in and has a stuffy and runny nose, sneezing and headache but no fever or cough and it is determined the patient has a cold (upper respiratory illness) - the PCP can check off saline nasal wash, and any other products they feel will help and write how each should be used and how often. Another example would be to hand this sheet to your healthy patient and mark the medications they can safely take and how each is used for the next time they come down with any symptoms. The sheets would need to be specific for each patient according to their medical history.
Another point I would like to mention in health reform is what a patient needs to have ready when they have a visit with their PCP or any medical provider. This website has a nice list - http://www.abms.org/who_we_help/consumers/educate.aspx. This basically tells the patient how to have a smart visit with their PCP such as be ready to list your current and past illnesses, have a list of your current medications (including OTC, vitamins, herbals and Rx), pertient family history, why specifically you are there to see the provider. The last part seems to be hard for some people because they don't go to their provider very often and aren't sure what information is important and what isn't. Basically the provider wants to know:
1) When did your current problem start
2) What was your first symptom (i.e. headache, fever, body aches, pain in my stomach etc.)
3) What happened next and what did you take for your symptoms
4) did the medication you took help your symptoms
5) What makes it worse or better
6) Have you had the symptoms before and if so what was your diagnosis if there was one
7) Do you have any idea what caused it? (such as your daughter was diagnosed with strep last week and now you have a sore throat and fever, or several people in your office have the Flu, or I was working in the garden and when I got up my lower back started to hurt and spasm).
This small amount of information will help the provider narrow down what they will focus on and they won't have to play detective and dig for the information needed.
Now that Health reform is frequently the biggest topic in the news I found some wonderful websites that can be used as resources for anyone interested in what is being discussed, debated and critiqued. These were found in the Austin American Statesman on August 30, 2009. Just note if you type in the URL it is cAse SEnSitIvE so be careful when you transcribe it.
Interactive tools that show outcomes of different policy options (I found this to be quite interesting) http://bit.ly/ayVfn
Compare how competing proposals deal with key issues http://bit.ly/1jmVR
Washington Post's indepth coverage of the debate and the issues http://bit.ly/mdCHa
Glossary of health care terms and phrases http://bit.ly/L15cE
Do prominent voices in the debate have their facts straight? http://bit.ly/415OC
http://bit.ly/IJTG5
Obama administration's Web site http://bit.ly/1BOvjg
Full text of House bills http://bit.ly/ldzqU
http://bit.ly/tqQ3Z
Long-term study of wasteful medical spending in Texas and other states http://bit.ly/3GsgNx
Congressional Budget Office information http://bit.ly/1BOvjg
I hope these sites provide some good information and education for everyone interested in healthcare and the health of our nation!!
Interactive tools that show outcomes of different policy options (I found this to be quite interesting) http://bit.ly/ayVfn
Compare how competing proposals deal with key issues http://bit.ly/1jmVR
Washington Post's indepth coverage of the debate and the issues http://bit.ly/mdCHa
Glossary of health care terms and phrases http://bit.ly/L15cE
Do prominent voices in the debate have their facts straight? http://bit.ly/415OC
http://bit.ly/IJTG5
Obama administration's Web site http://bit.ly/1BOvjg
Full text of House bills http://bit.ly/ldzqU
http://bit.ly/tqQ3Z
Long-term study of wasteful medical spending in Texas and other states http://bit.ly/3GsgNx
Congressional Budget Office information http://bit.ly/1BOvjg
I hope these sites provide some good information and education for everyone interested in healthcare and the health of our nation!!
What exactly is health reform? This is a very big question requiring a broad response.
The first issue that needs to change is how people use the healthcare system. After years of working in numerous emergency departments (ED) I saw lines of patients coming in all hours of the day for colds, chronic headache conditions, mild rashes, sore throat, ear pain... you get the picture. These conditions could and should have be handled by a primary care provider (PCP) - i.e. your family Doctor (MD), Nurse Practitioner (NP) or Physician Assistant (PA) and not in the ED. Ok, I know - if it is after 5pm and your provider is closed then where do you go? Now there are numerous Retail Clinics located in drugstores, grocery stores, big discount stores and in some malls that can be utilized. Some common names are MinuteClinic, Take Care, RediClinic, The Little Clinic and many more. Visit http://www.ccaclinics.org/ to learn more about the retail clinics. Most are open during the evening hours and on weekends and charge much less than an ED. We don't need to use up precious space and skills in the ED for a cold! It would cost 8-10 times more to see someone in the ED than their PCP or a retail clinic.
How about taking something to relieve the symptoms? If a person has a cold (stuffy/runny nose, fever up to 102, headache, sore throat, tired, achy) then take a fever reducer/pain reliever such as tylenol or ibuprofen - depending on your health history and allergies. Maybe using a saline nasal wash to clear up the nasal passage and stop the runny nose and dripping. More on the saline rinse in my blog on sinus infections. Rest is always a good idea. Good hand washing skills and using a tissue to cough or sneeze and throw it away immediately can help prevent the spread of most colds and the flu. Most importantly - stay home when you have a fever, a cold or have been diagnosed with the Flu, this is the best way to prevent spreading your illness to others.
You get the idea - retraining people to not run the the ED or their PCP at the first sneeze or cough will help keep costs down. Next we need to make sure our providers (MD, NP, PA) are using the latest guidelines and evidence based medicine when treating their patients. This means not prescribing antibiotics for colds or stuffy heads or sore throats without any evidence the patient has a bacterial infection. Many times the patient will drive how the PCP practices because they come into the office and state "I know I have a sinus infection and I need an antibiotic" - the provider is the one who needs to perform an exam, run any pertinent tests i.e. rapid Strep A or Flu test, sinus or chest X-ray, before they prescribe an antibiotic or antiviral. I know sometimes it is just quicker and easier to not argue with the patient and write the prescription and go on to the next patient, but is this the best evidence-based practice? I recently read that Physician prescribing of antibiotics for Acute Respiratory Illnesses is down http://firstwatch.jwatch.org/cgi/content/full/2009/819/3 but the use of stronger antibiotics is up, which is not without it's risks. I am hopeful the trend to not prescribe antibiotics for a virus will continue to go down. We don't need to give any unecessary medication that can cause more problems than good.
If the providers will stand up to their patients and take a few minutes to educate them on their symptoms and what the patient can do to feel better before prescribing an antibiotic they will probably have healther patients who won't come in for every sniffle or cough. I can't tell you the number of people who have told me they have gotten over an illness without an antibiotic and simply used an over-the-counter (OTC) saline nose spray and drank plenty of water and rested.
If people are more educated on common illnesses, what they can safely take for their different symptoms, and when to seek medical care then we will have more health-smart patients that will save the insurance companies money.
One idea I have is for a provider to develop a list of common OTC medications, what they are used for, and when to take them/stop them. Then when their patients come in for a physical or illness then the PCP can hand them the list with the appropriate OTC's checked off that the patient can safely take considering their medical history. For instance the list could contain Ibuprofen, acetaminophen, pseudoephedrine, diphenhydramine, guiafenisen, dextromethorphan, saline nasal wash, loratadine, cetirizine, etc... next to each item is a description of what the medication is used for, what it will do for the patient and any pertinent side effects plus how much to take and how often. Then when a patient comes in and has a stuffy and runny nose, sneezing and headache but no fever or cough and it is determined the patient has a cold (upper respiratory illness) - the PCP can check off saline nasal wash, and any other products they feel will help and write how each should be used and how often. Another example would be to hand this sheet to your healthy patient and mark the medications they can safely take and how each is used for the next time they come down with any symptoms. The sheets would need to be specific for each patient according to their medical history.
Another point I would like to mention in health reform is what a patient needs to have ready when they have a visit with their PCP or any medical provider. This website has a nice list - http://www.abms.org/who_we_help/consumers/educate.aspx. This basically tells the patient how to have a smart visit with their PCP such as be ready to list your current and past illnesses, have a list of your current medications (including OTC, vitamins, herbals and Rx), pertient family history, why specifically you are there to see the provider. The last part seems to be hard for some people because they don't go to their provider very often and aren't sure what information is important and what isn't. Basically the provider wants to know:
1) When did your current problem start
2) What was your first symptom (i.e. headache, fever, body aches, pain in my stomach etc.)
3) What happened next and what did you take for your symptoms
4) did the medication you took help your symptoms
5) What makes it worse or better
6) Have you had the symptoms before and if so what was your diagnosis if there was one
7) Do you have any idea what caused it? (such as your daughter was diagnosed with strep last week and now you have a sore throat and fever, or several people in your office have the Flu, or I was working in the garden and when I got up my lower back started to hurt and spasm).
This small amount of information will help the provider narrow down what they will focus on and they won't have to play detective and dig for the information needed.
Now that Health reform is frequently the biggest topic in the news I found some wonderful websites that can be used as resources for anyone interested in what is being discussed, debated and critiqued. These were found in the Austin American Statesman on August 30, 2009. Just note if you type in the URL it is cAse SEnSitIvE so be careful when you transcribe it.
Interactive tools that show outcomes of different policy options (I found this to be quite interesting) http://bit.ly/ayVfn
Compare how competing proposals deal with key issues http://bit.ly/1jmVR
Washington Post's indepth coverage of the debate and the issues http://bit.ly/mdCHa
Glossary of health care terms and phrases http://bit.ly/L15cE
Do prominent voices in the debate have their facts straight? http://bit.ly/415OC
http://bit.ly/IJTG5
Obama administration's Web site http://bit.ly/1BOvjg
Full text of House bills http://bit.ly/ldzqU
http://bit.ly/tqQ3Z
Long-term study of wasteful medical spending in Texas and other states http://bit.ly/3GsgNx
Congressional Budget Office information http://bit.ly/1BOvjg
I hope these sites provide some good information and education for everyone interested in healthcare and the health of our nation!!
Friday, August 28, 2009
What is a Sinus Infection?
What exactly is a sinus infection? That is probably the number one complaint seen in the medical office/ER. Sometimes people will present with a complaint of pain in their sinuses, stuffy nose, pressure around their eyes or in the cheeks. Often the symptoms have been there only 1-3 days and they feel they have a sinus infection. Well, from what I have seen and read this isn't a sinus infection. It is uncomfortable and often painful at times, but it rarely requires an antibiotic to clear it up.
What usually happens is someone starts with either a cold or allergy type symptoms, (stuffy/runny nose, dripping down the throat and headache) so they take their allergy/cold medication and/or sudafed every day for a few days. Each day the stuff coming out of their nose or down their throat gets thicker and thicker and changes color, leading them to believe they have an infection. The color of the drainage is not always indicative of an infection - in some cases it is - but for the most part it is not. What happens when you take too much antihistamine (Zyrtec, Claritin, Allegra, OTC cold products) or decongestants (Sudafed, Sudafed PE) it starts to dry up the secretions (snot) making them thicker and thicker. When you have a cold (Upper respiratory Illness ) your body is busy trying to fight the virus by sending tons of white blood cells to do the battle causing the drainage in your nose or throat to change colors. Many times when children have those green ugly boogers, it is because their immune system is so good at fighting the cold their boogers become full of the white blood cells making them thick and colorful! This doesn't mean they need an antibiotic.
The best way to help ease the sinus pressure and thick congestion is to use a saline nasal wash! - Ask any Ear, Nose & Throat practitioner or Allergist and most will agree - these nose washes are really good at keeping all the bad stuff out of there allowing you to feel much better. There are many brands of nasal washes, often called a Neti Pot - it just depends on which type of dispenser you prefer. Personally I perfer the squeeze bottle, though I have used the genie shaped pot before and it worked fine. Here is some information from "Up to Date for patients" - http://www.uptodate.com/patients/content/topic.do?topicKey=~WWw0K5jHohInh1 They have a great section about nasal washes. You can even find examples of how to use the saline nose wash on http://www.youtube.com/.
Next, don't over do it with the allergy/cold medications or Sudafed products. If you are taking these and notice the secretions in your nose or throat are getting thicker, then back off and start drinking more fluids and try using a saline nose wash. Last, but not least, do not use any nose sprays that contain oxymetazoline (there is a whole section of these products - aka Afrin) for more than 2-3 days as this will only increase the nasal stuffiness. The body can become quickly addicted to the effects of this kind of spray making it very hard to stop using it. I promise the saline nose wash will help - plus good old patience since the worst part of most colds only last 3-5 days.
If you are using a saline nose wash for the first time then be sure to fully read the directions and warnings so you don't cause any other problems such as an ear infection. I can't tell you how important it is to NOT blow your nose really hard after using the rinse - ouch! I only gently blow it and do not pinch one side closed like normal - this increases the pressure in your ears and can cause the water and snot to back up into your ears. Not a good thing.
Here is some more good information I found on Google Health about sinus infections https://www.google.com/health/ref/Sinusitis It mentions a really good point - most sinus infections do not require antibiotics - really, they don't. If you follow all the above steps, do not have any kind of deformity in your nose/sinus passages, and you keep well hydrated then you can usually get over the sinus pressure, stuffiness and drainage in about 7-10 days. Now this does not apply to anyone with recent history of sinus/nasal surgery, foreign body up their nose, other deformity that puts them at a higher risk of infections. What I'm talking about here is the common cold/ allergy stuffiness with sinus pain/ pressure, nasal drainage-both out the nose and down the throat type symptoms........
I hope this helps - the main thing to remember is try to keep the drainage in your nose from becoming so thick it won't come out, keep the sinuses and nose passage clean and open by using a saline nasal wash, and if you develop a fever or worsening symptoms then be sure to see a medical provider.
What usually happens is someone starts with either a cold or allergy type symptoms, (stuffy/runny nose, dripping down the throat and headache) so they take their allergy/cold medication and/or sudafed every day for a few days. Each day the stuff coming out of their nose or down their throat gets thicker and thicker and changes color, leading them to believe they have an infection. The color of the drainage is not always indicative of an infection - in some cases it is - but for the most part it is not. What happens when you take too much antihistamine (Zyrtec, Claritin, Allegra, OTC cold products) or decongestants (Sudafed, Sudafed PE) it starts to dry up the secretions (snot) making them thicker and thicker. When you have a cold (Upper respiratory Illness ) your body is busy trying to fight the virus by sending tons of white blood cells to do the battle causing the drainage in your nose or throat to change colors. Many times when children have those green ugly boogers, it is because their immune system is so good at fighting the cold their boogers become full of the white blood cells making them thick and colorful! This doesn't mean they need an antibiotic.
The best way to help ease the sinus pressure and thick congestion is to use a saline nasal wash! - Ask any Ear, Nose & Throat practitioner or Allergist and most will agree - these nose washes are really good at keeping all the bad stuff out of there allowing you to feel much better. There are many brands of nasal washes, often called a Neti Pot - it just depends on which type of dispenser you prefer. Personally I perfer the squeeze bottle, though I have used the genie shaped pot before and it worked fine. Here is some information from "Up to Date for patients" - http://www.uptodate.com/patients/content/topic.do?topicKey=~WWw0K5jHohInh1 They have a great section about nasal washes. You can even find examples of how to use the saline nose wash on http://www.youtube.com/.
Next, don't over do it with the allergy/cold medications or Sudafed products. If you are taking these and notice the secretions in your nose or throat are getting thicker, then back off and start drinking more fluids and try using a saline nose wash. Last, but not least, do not use any nose sprays that contain oxymetazoline (there is a whole section of these products - aka Afrin) for more than 2-3 days as this will only increase the nasal stuffiness. The body can become quickly addicted to the effects of this kind of spray making it very hard to stop using it. I promise the saline nose wash will help - plus good old patience since the worst part of most colds only last 3-5 days.
If you are using a saline nose wash for the first time then be sure to fully read the directions and warnings so you don't cause any other problems such as an ear infection. I can't tell you how important it is to NOT blow your nose really hard after using the rinse - ouch! I only gently blow it and do not pinch one side closed like normal - this increases the pressure in your ears and can cause the water and snot to back up into your ears. Not a good thing.
Here is some more good information I found on Google Health about sinus infections https://www.google.com/health/ref/Sinusitis It mentions a really good point - most sinus infections do not require antibiotics - really, they don't. If you follow all the above steps, do not have any kind of deformity in your nose/sinus passages, and you keep well hydrated then you can usually get over the sinus pressure, stuffiness and drainage in about 7-10 days. Now this does not apply to anyone with recent history of sinus/nasal surgery, foreign body up their nose, other deformity that puts them at a higher risk of infections. What I'm talking about here is the common cold/ allergy stuffiness with sinus pain/ pressure, nasal drainage-both out the nose and down the throat type symptoms........
I hope this helps - the main thing to remember is try to keep the drainage in your nose from becoming so thick it won't come out, keep the sinuses and nose passage clean and open by using a saline nasal wash, and if you develop a fever or worsening symptoms then be sure to see a medical provider.
Thursday, August 13, 2009
Why do females tinkle on toilet seats?
I spent last week in Florida with several of those days at Disney World in Orlando – what a great place. Of course I had the need to go to the ladies room on numerous occasions and I have one question!: What are females doing that causes them to leave urine on the toilet seat? I swear over a 2 day period I went into many restrooms and at three different ones there was urine on the toilet seat in the stall I was lucky enough to go into. Each time I was not only disgusted, but also intrigued as to how someone could do this – AND leave it there for the next person to deal with. UGH! Ok, I am an intelligent person, or so I like to believe, and I understand physics enough to know if a female sits on the top of the toilet seat and urinates, it will not – no matter how hard you pee – get onto the top of the seat. Just won’t happen. Now, if someone was weird enough to stand over the commode and pee then it may very well get on the seat, and all over the floor – besides, why would you do that anyway, someone would see your feet and wonder what you were doing. Next theory I came up with is it was a small male – again why leave it there, don’t parents teach the little boys to wipe the seat. I always told my kids the famous saying “If you sprinkle when you tinkle please be neat and wipe the seat” – words to live by. Lastly I had a vision of a female hovering over the seat (not sure how) and going tinkle – this surely would get some on the seat. But again, WHY NOT wipe it up? Ok, with all that said let me tell you some information about public toilet seats.
Here is a great quote I have heard from many physicians - "To my knowledge, no one has ever acquired an STD on the toilet seat -- unless they were having sex on the toilet seat!" says Abigail Salyers, PhD, president of the American Society for Microbiology (ASM). This is a great article about what could be found in a restroom. WebMD article "What can you catch in restrooms" Here is another interesting fact posted by ABC news and it was on the BBC news as well - Your Keyboard - dirtier than a toilet!
*This was found on MSN diseases & Conditions/health topics. "You’re the only one who uses it, so how dirty can it be? In a word: filthy. A study by researchers at the University of North Carolina Health Care System found that keyboards were loaded with germs.
Even more disgusting, the average public toilet bowl contains 41 germs per square inch. The average personal keyboard? Some 21,000 germs per square inch. “Toilet bowls get cleaned,” says Philip M. Tierno Jr., Ph.D., director of clinical microbiology and immunology at New York University Langone Medical Center, “but keyboards rarely do.”'
I found an interesting link on Yahoo Answers regarding the question “Is there research that shows that using a paper toilet seat makes a difference? It seems like paper would not do much to stop the spread of germs or disease.” - one answer was “Liz W. is right! They protect you from hypothetical germs. The seat covers are provided to make people feel better. They don't help, but they don't do any harm either. If the toilet seat is soaked with body fluid (I know, yuck), then the body fluid will soak right through the paper seat cover. The toilet seat may be, as other posters suggest, cleaner than other surfaces like the stall door lock or the hot-water faucet. My students did an experiment where they swabbed various surfaces and grew bacteria in agar dishes. The dirtiest surface? A doorknob! The next dirtiest? A fellow student's unwashed hands! The toilet-seat swab grew no bacteria.” Source(s): I am a healthcare teaching assistant.
Personally if I find some drops of urine on the seat I take a wad of toilet paper and clean it up – if it is really disgusting I go to another stall. I have heard in some studies done in public restrooms show the first stall is the cleanest. Seems many people want more privacy and go to the back stalls and skip the first one – I have been doing this for years since hearing it and I have to say most of the time it is true. (Not that I take a Petri dish in there and test it!) Here is another article by ABC I found quite funny and interesting Myth: Toilet Seats Are the Dirtiest Thing in the Bathroom.
So please stop hovering the seats making it gross for the rest of us, just sit on it – and wash your hands afterwards!!!
Disney was a truly magical place – even if the guests can’t urinate in the toilets.
Here is a great quote I have heard from many physicians - "To my knowledge, no one has ever acquired an STD on the toilet seat -- unless they were having sex on the toilet seat!" says Abigail Salyers, PhD, president of the American Society for Microbiology (ASM). This is a great article about what could be found in a restroom. WebMD article "What can you catch in restrooms" Here is another interesting fact posted by ABC news and it was on the BBC news as well - Your Keyboard - dirtier than a toilet!
*This was found on MSN diseases & Conditions/health topics. "You’re the only one who uses it, so how dirty can it be? In a word: filthy. A study by researchers at the University of North Carolina Health Care System found that keyboards were loaded with germs.
Even more disgusting, the average public toilet bowl contains 41 germs per square inch. The average personal keyboard? Some 21,000 germs per square inch. “Toilet bowls get cleaned,” says Philip M. Tierno Jr., Ph.D., director of clinical microbiology and immunology at New York University Langone Medical Center, “but keyboards rarely do.”'
I found an interesting link on Yahoo Answers regarding the question “Is there research that shows that using a paper toilet seat makes a difference? It seems like paper would not do much to stop the spread of germs or disease.” - one answer was “Liz W. is right! They protect you from hypothetical germs. The seat covers are provided to make people feel better. They don't help, but they don't do any harm either. If the toilet seat is soaked with body fluid (I know, yuck), then the body fluid will soak right through the paper seat cover. The toilet seat may be, as other posters suggest, cleaner than other surfaces like the stall door lock or the hot-water faucet. My students did an experiment where they swabbed various surfaces and grew bacteria in agar dishes. The dirtiest surface? A doorknob! The next dirtiest? A fellow student's unwashed hands! The toilet-seat swab grew no bacteria.” Source(s): I am a healthcare teaching assistant.
Personally if I find some drops of urine on the seat I take a wad of toilet paper and clean it up – if it is really disgusting I go to another stall. I have heard in some studies done in public restrooms show the first stall is the cleanest. Seems many people want more privacy and go to the back stalls and skip the first one – I have been doing this for years since hearing it and I have to say most of the time it is true. (Not that I take a Petri dish in there and test it!) Here is another article by ABC I found quite funny and interesting Myth: Toilet Seats Are the Dirtiest Thing in the Bathroom.
So please stop hovering the seats making it gross for the rest of us, just sit on it – and wash your hands afterwards!!!
Disney was a truly magical place – even if the guests can’t urinate in the toilets.
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