Asthma Action Plan Necessary

May is National Asthma Awareness Month. It is estimated that more than 8 percent of the U.S. population suffers from asthma, and the numbers are rising yearly.

This translates into 18 million adults and 7 million children with the disease.

Asthma causes more than 3,000 deaths yearly, along with 500,000 hospitalizations, 2 million emergency room visits and 9 million doctor’s office visits.

The disease costs the U.S. economy $56 billion per year. It has a tremendous financial impact on our families, our nation and our health care system.

Asthma occurs when the small airways deep in the lung tissue become swollen and narrowed. This makes it difficult for air to pass through, causing the usual symptoms of wheezing and shortness of breath. Asthma can be deadly if not treated promptly and properly.

It is unclear why asthma affects some people and not others. The difference is probably due to both environmental and genetic factors.

For some people, asthma symptoms flare up under certain circumstances.

Allergy-induced asthma is triggered by such things as pollen, grasses, pet dander, and dust. Exercise-induced asthma is triggered by exercise or exertion. Occupational asthma results from exposure to chemical fumes, dust or gases.

A number of factors have been identified as increasing one’s chance of developing asthma:

- Having a close relative — a parent or a sibling — with asthma.

- Having any other allergic condition, such as hay fever or eczema.

- Being overweight or a smoker.

- Experiencing exposure to secondhand smoke or other airborne pollution.

Treatment of asthma can be broken down into two categories.

First, for quick relief, a drug called albuterol is the mainstay of treating an acute attack — one that is happening now. The drug is breathed into the affected lung airways using either a handheld inhaler or a tabletop device called a nebulizer.

Second, for longer-term treatment, inhaled corticosteroids, such as Flovent, have revolutionized the treatment of asthma by helping prevent attacks and also helping in the treatment of an acute attack.

I can’t emphasize enough how important it is to have an asthma action plan worked out with a doctor. Asthma is an ongoing condition that needs constant monitoring and treatment.

In spite of reports of increasing rates of asthma in the population, I have been a witness to fewer patients coming into my practice for treatment of acute symptoms. This has been in large part due to the use of the inhaled corticosteroids, as well as patients working closely with their doctors.

Depression Doesn’t Need to be a Death Sentence

Depression is a true medical illness, just like having diabetes or high blood pressure. It’s not a weakness, having the blues or something one can just snap out of. Fortunately, like most illnesses, it is treatable through medication and psychotherapy.

Common symptoms of depression include feeling sad, unhappy, irritable or frustrated; a loss of interest in things that usually bring pleasure; feeling worthless; fatigue, excessive sleeping or insomnia; indecisiveness and decreased concentration; and in some cases, thoughts of death, dying or suicide.

Many of us may briefly experience any of the above symptoms, but the person with true depression lives with these symptoms day in and day out.

Some risk factors of depression are having biological relatives who have depression or who have committed suicide and experiencing stressful events, such as the death or loss of a loved one. Women are also at risk, especially after a pregnancy. Other risk factors are serious, chronic illness and abuse of alcohol, drugs or nicotine.

In general, the most effective treatment for depression is a combination of medication and psychotherapy.

There are many types of antidepressant drugs available, and finding the right one may take some trial and error. Antidepressant drugs may take several weeks to take effect.

A patient who experiences undesired side effects should not stop taking the medication without consulting the prescribing doctor. In many cases, one must taper off the drug to avoid withdrawal.

Psychotherapy is provided by a trained and licensed professional, who can help one to understand one’s thoughts and behaviors and guide one in making effective changes. Ideally, this treatment can also provide a regained feeling of hope, happiness and control.

If someone you know is having suicidal thoughts, help is needed immediately. Here’s what needs to be done:

- Contact a family member, friend or clergy member for help.

- Call a suicide hotline number. Our local number is 877-663-5433.

- Seek professional consultation from a doctor or a mental health provider.

If someone you know is on the verge of, or has attempted, suicide, call 911 immediately for professional and rapid help.

Depression is not a weakness; it is a treatable illness. A doctor can help.

Hay Fever Hits Hard

Allergic rhinitis, commonly called hay fever, affects as much as 40 percent of children and 10 to 30 percent of adults in the United States. It is “seasonal” if symptoms occur at particular times of the year and “perennial” if they remain year round.

Common symptoms include sneezing, itchy eyes, nasal congestion with a decreased sense of smell, headache and fatigue.

These symptoms can tremendously impair one’s quality of life, as well as productivity. American workers lose an estimated 6 million work days yearly to this disorder and incur costs of several billion dollars in evaluation and treatment.

Seasonal rhinitis usually occurs from spring to early fall and is due to pollens from trees, grass and weeds. Perennial rhinitis, lasting throughout most of the year, is caused by indoor factors, such as dust mites, animal dander and mold.

Nasal stuffiness from allergic rhinitis can cause swelling and obstruction of the sinuses which can cause a sinus infection.

There is a strong association between allergic rhinitis and asthma. As much as 50 percent of patients with asthma have allergic rhinitis. Sleep disorders in adults and a high proportion of ear infections in children are also associated with allergic rhinitis.

Treatment for people who think they have allergic rhinitis can begin with an over-the-counter antihistamine, such as Benadryl or Chlor-Trimeton. However, these are often associated with the bothersome side effects of drowsiness. They should be avoided in children younger than 2 years and in elderly patients.

Newer antihistamines, such as Claritin and Zyrtec, are now available without a prescription and cause significantly fewer side effects than the older antihistamines. They are also more conveniently dosed, at once or twice a day.

Intranasal steroids have been shown to be very effective in relieving the symptoms of allergic rhinitis with minimal side effects in recommended doses. These nasal sprays are available by prescription from a doctor.

n Terry Hollenbeck, M.D., is an urgent-care physician at Palo Alto Medical Foundation Santa Cruz in Scotts Valley. Readers can view previous columns on his website, http://valleydoctor.wordpress.com, or email him at valleydoctor@sbcglobal.net. Information in this column is not intended to replace advice from your own health care professional. For any medical concern, consult your own doctor.

Allergy treatment at a glance

- Avoid substances and situations that cause your reaction.

- If symptomatic, try over-the-counter, nondrowsy antihistamines, such as Claritin or Zyrtec.

- If still symptomatic, see your doctor for prescription intranasal steroid sprays.

- If none of the above is helpful, ask your doctor for a referral to an allergy specialist.

Sleep Apnea

Sleep apnea is a common disorder in which one’s breathing pauses while one is asleep. These pauses last from seconds to minutes and can occur five to 30 times per hour.

Sleep apnea is a common condition affecting 12 million to 18 million Americans. It robs people of a good night’s sleep, causing excessive daytime drowsiness and a feeling of constant tiredness.

Most people with sleep apnea aren’t aware of the condition and might think they are getting a decent sleep. Many are tipped off by a family member or bed partner who is aware of the sleeper’s nocturnal breathing difficulties.

Sleep apnea occurs when the muscles in the back of the throat relax, which can temporarily narrow and even close off the airway. The brain then senses the lack of oxygen and awakens the sleeper enough to take a normal breath, and so the cycle continues.

Symptoms of sleep apnea are:

-Loud snorting or choking sounds during sleep.

- Loud snoring. (But not everyone who snores has sleep apnea.)

- Excessive daytime sleeping or drowsiness.

- Observed episodes of not breathing during sleep.

- Awakening with dry mouth or sore throat.

- Abrupt awakening, feeling short of breath.

Sleep apnea is found more commonly among people who are obese; men; the elderly; users of sleeping medications, tranquilizers, alcohol or tobacco; and patients with hypertension or hypothyroidism.

The condition is diagnosed on the basis of family and medical histories, a physical exam and sleep studies done at specialized sleep clinics. These sleep studies, some of which can also be done at home, monitor the sleeper and can definitively determine if one has sleep apnea and how severe it is.

Treatments for sleep apnea include lifestyle changes, such as avoiding alcohol and tobacco use, losing weight, sleeping on one’s side instead of on the back, and keeping nasal passages clear.

Some patients wear mouthpieces to keep their airways open while they sleep, and others use breathing devices, such as the continuous positive airway pressure machine. This machine uses a mask that fits over the mouth and nose, or just over the nose. It gently blows air into the throat, keeping the airway open.

In some cases, surgery may be used to widen breathing passages.

Sleep apnea needs to be taken seriously. Studies in recent years have shown that people with untreated sleep apnea have a three times greater chance of death, mostly from heart attacks, than people without the condition.

If you show signs and symptoms of sleep apnea, or if someone you love does, a visit to a primary-care physician is essential for a routine health check and referral to a sleep specialist.

Many Plagued by Insomnia

It is estimated that about one-third of adults have difficulty sleeping and are thus sleep deprived.

Twenty percent of people get less than six hours of sleep. Adults need seven to nine hours of sleep a night. Any less than this can cause increased stress and a depressed immune system and can make one cranky and irritable. It also puts one at increased risk of obesity, diabetes and high blood pressure.

Insomnia becomes more prominent as we age, which is unfortunate, because older people still need as much sleep as younger people do. Aging causes a change of sleep patterns, leading to a lighter, less restful sleep. Decreasing physical and social activity and an increase in chronic health problems also contribute to less sleep.

These are some causes of insomnia:

- Stress

- Anxiety and depression

- Medications, such as heart and blood pressure drugs, steroids, decongestants and weight-loss products

- Caffeine, nicotine and alcohol

- Medical conditions, such as chronic pain, frequent urination and sleep apnea

- Changes in environment or work schedule

- Eating and drinking too much late in the evening

Nonprescription-medication remedies should be tried first.

Lifestyle changes

Be consistent with the time you go to bed and when you wake up. Don’t nap more than 30 minutes a day, and preferably do it before 3 p.m.

Make your bedroom conducive to sleep by keeping it dark, quiet and a comfortable temperature. Don’t linger in bed if you can’t sleep.

Limit or avoid caffeine, alcohol and nicotine. Avoid large late meals.

A recent study found that most adults who did aerobic exercise four times a week dramatically improved their sleep.

Behavioral therapies

Learn relaxation techniques.

Limit the time you spend in bed, and associate your bed and bedroom only with sleep.

See a therapist who specializes in insomnia, who may provide a cure for insomnia and not just treat the symptoms with medication.

Alternative medicine

Melatonin and valerian are over-the-counter supplements that are marketed as sleep aids. They may be worth a try; however, some studies have shown them to be no more effective than a placebo and their long-term safety record isn’t known.

Prescription medication

Prescription sleep aids can be very effective in many cases, but they should be used for as short a time as possible, because longer-term use is thought to contribute to other health problems.

Sleeping pills also have side effects, such as drowsiness, impaired judgment, depression, agitation and balance problems.

If you are not getting the good night’s rest you deserve, see a doctor who can help to treat and guide you to having a more restful and satisfying sleep.

Childhood Nutrition

March is National Nutrition Month. I would like to discuss the important topic of childhood nutrition. Whether you have a newborn or a teenager, what he or she eats is important to both physical and mental development.

The following are my recommendations supported by the American Academy of Pediatrics. 

Infants

From birth to 12 months, it’s all about milk, whether it’s breast milk, iron-fortified formula or a combination of the two. Whole milk is not to be given during this time. At four to six months babies can begin solid foods such as iron fortified baby cereal, strained fruits, vegetables and pureed meats. Fat restriction at this age is usually not necessary since fat helps to develop the brain and nerves.

Preschoolers, toddlers

At 12 months, children who have been weaned off breastfeeding may begin drinking whole milk. Low-fat milk would be better if there is a strong family history of obesity or heart disease. Calcium is necessary during this time to help build strong healthy bones and teeth. Milk is still one of the best calcium sources along with fortified cereals and juices. Fiber is also important to help fight obesity and promote digestion and prevent constipation.

Elementary school

Protein is important in this group. If a child won’t eat meat, plenty of protein can be found in beans, eggs and peanut butter. At this age, kids will start eating more not-so-healthy snacks and fast foods. It is important to monitor their intake of fats and salt and the ever-increasing consumption of sugar in all its many forms.

Teenagers

This is the time when junk food can become a bigger part of the diet. It’s also when some kids become very conscious of their weight and may develop eating disorders, such as bulimia and anorexia. Calorie requirements increase, as does the need for calcium. Low-fat milk and calcium-rich and -fortified foods are still very important. Girls who begin menstruating will need more iron-rich foods, such as meat and poultry, vegetables and beans, and fortified cereals and grains.

It is also now recommended that all children, beginning in the first two months of life, receive at least 400 IU of vitamin D daily. Discuss this with your doctor.

Getting our children to eat a healthy diet may not be an easy task. There’s too much childhood obesity (one in three children in America), diabetes and even heart disease. We need to monitor our children’s eating preferences and habits and be diligent about encouraging and explaining to them the benefits of a healthy, well-balanced diet.

For us parents, this may be a constant battle, but one well worth fighting to help ensure that our children will grow up to be healthy adults.

Anxiety a Common Ailment

We live in anxious times. Media reports bring us news of a poor economy, joblessness, people losing homes, international problems, high crime rates and more.

In addition, there are our own personal issues to deal with, such as poor health, relationship difficulties, financial problems and high-pressure jobs.

Even everyday annoyances stress us out, such as being stuck in traffic, computer problems and too many appointments and obligations.

More than 40 million people suffer from anxiety. Anxiety can begin in childhood, but it most commonly affects the middle-aged and even the elderly. Twice as many women as men have anxiety. Other similar disorders include social phobias, post-traumatic stress disorder, panic disorder, and obsessive-compulsive disorder.

Some of the more common manifestations of anxiety are:

- Constant worrying and obsessing over big or small problems.

- Feelings of impending doom or worthlessness.

- Fatigue or trouble sleeping.

- Restlessness and feeling uptight.

- Difficulty concentrating and irritability.

- Sweating, nausea, vomiting, shortness of breath and rapid heart rate.

When a patient is evaluated by a doctor for anxiety, physical causes — thyroid problems, heart or lung disease, even dietary problems — need to be ruled out. Once that is done, there are several options for treatment.

Psychotherapy

By working with a trained therapist, patients can focus on working out underlying life stresses and concerns and making behavior changes.

This may be done through cognitive behavioral therapy, which is one of the more common types of psychotherapy. It involves learning to identify unhealthy negative beliefs and behaviors that contribute to anxiety and then teaches how to replace them with positive, healthy beliefs.

These treatments can give a person the tools necessary to deal with responses to life’s many problems and can help one gain control, especially by changing the way one responds to situations.

Medications

For the short term, anxiety can be treated with benzodiazepines, such as Xanax and Ativan. These can work quickly and effectively, but they can be habit forming. For the longer term, antidepressants, such as Zoloft or Celexa, can be used.

Close medical supervision is important for drug therapy.

Lifestyle remedies

People who feel anxious can also treat themselves with exercise; healthy diet; avoidance of alcohol; relaxation techniques, such as yoga and meditation; and adequate sleep.

If you think you suffer from anxiety, see your doctor. With evaluation and a personalized treatment plan, your anxiety can be brought under control.