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Radon

Radon is an odorless, colorless, radioactive gas found in the earth’s crust throughout the world. It is formed from the breakdown of radioactive elements, such as uranium. Radon gas can move upward into the air and into underground and surface water. It dissipates in outside air where it causes no problems, but can be quite problematic if it seeps up into the house.

Any home can have an elevated radon level. New homes, old homes, well sealed or drafty, with or without basements or crawl spaces. People who spend  much of their time in basement rooms at home or at work have a greater risk for being exposed. Nearly one in fifteen homes has an elevated radon level. Radon levels cannot be predicted. They must be measured. The average radon level is 1.3 picocuries which is safe. A level above 4 picocuries is above the acceptable limit and needs to be dealt with.

Radon is the second leading cause of lung cancer in the U.S. , causing an estimated 21,000 lung cancer deaths per year. Only smoking causes a greater percentage of lung cancer. Stop smoking and reduce your radon exposure to significantly lower your odds for lung cancer.

Radon gas decays into radioactive particles which can get trapped in your lungs when breathing. These particles release small bursts of energy causing the damage to the lung tissue leading to cancer over a period of time. Not everyone exposed to such levels of radon will  develop cancer, but many will without any idea it’s happening.

As far as is known, radon exposure by itself, causes no obvious short term symptoms unless it turns into symptoms of cancer with shortness of breath, pain or tightness in the chest, a worsening cough, trouble breathing or swallowing.

You can check radon levels in your home. Do it yourself measuring kits can be bought, relatively inexpensively, at most hardware stores or online. The kits are placed in the home for several days then mailed to a lab for analysis.

A variety of methods can be used to decrease radon levels in the house if necessary. I recommend that a qualified contractor be contacted to get the job  done correctly.

In summary, test your home for radon levels. If necessary, work with a professional  contractor to decrease the radon exposure, quit smoking, and see your doctor if you have any of the previously mentioned signs of lung cancer.

Hives

Hives are an outbreak of red blotches on the skin. They can be less than an inch in diameter to greater than twelve inches size and can be found anywhere on the body. You may not feel them or they may be intensely itchy. They can often move around or come and go right in front of your eyes. Unlike most other rashes, pressing on an area of a red hive may cause it to blanch white.

Hives are often due to an allergic reaction to foods such as nuts, chocolate, eggs, fresh berries, and milk to name a few. Medications such as penicillin and sulfa also commonly cause hives. Physical stimulation of the skin from rubbing, scratching, pressure, cold, heat, and even exercise can cause a hive reaction.

Another condition called angioedema is similar to hives but involves swelling just beneath the skin, most commonly around the eyes and lips but can sometimes involve the hands and feet.

Hives and angioedema are both caused by a release of a chemical called histamine which can leak out of small blood vessels in the skin as a response to an allergic or physical stimulus.

In the short term, hives and angioedema are treated with over the counter antihistamine drugs such as Benadryl, Chlortrimeton, or one of the newer non drowsy drugs such as Claritin and Allegra. If either hives or angioedema persist (chronic urticaria), then a cortisone drug such as prednisone could be prescribed by your doctor.

In rare cases, hives can be the precursor to a condition called anaphylaxis, a severe allergic reaction that can cause immediate death such as seen in a person who dies from a bee sting. A person undergoing such a reaction needs an immediate shot of a drug called adrenaline, which can be either self injected by use of an Epi-Pen, or treatment by emergency personnel. The same urgency and treatment goes for severe angioedema which can cause life threatening swelling around the lips, mouth and throat.

One of the best ways of dealing with hives or urticaria is to avoid known triggering factors such as certain foods, drugs, or physical stimuli.

For anyone affected by either of these conditions, a referral to an allergist will be necessary for proper diagnosis and treatment options.

Vaccinations

I recently tuned in to a local radio station talk show where the host and a “non medical doctor” were criticizing vaccinations by citing false information and providing their personal bias.  I would like to offer my view of vaccinations.

Most vaccines contain parts of a germ or toxin that have been made so weak that they can no longer cause illness, but will stimulate one’s immune system to make antibodies against that specific disease.  Therefore in the future when they are exposed to that particular germ, the antibodies should prevent one from getting sick.

Since vaccines were first developed in the late 1700’s, millions of lives have been saved. Smallpox which wiped out entire civilizations has actually been totally eliminated from the face of the earth because of the smallpox vaccine.  I watched friends come down with polio in the 1950’s and become permanently paralyzed. This was a fearful disease until the polio vaccine banished it from the U.S.

We have effectively controlled outbreaks of common diseases such as measles, mumps, diphtheria and chicken pox. Before the chicken pox vaccine became available, over 11,000 Americans were hospitalized and over 100 died each year from chicken pox. It is estimated that measles, one of the most contagious diseases in the world, could cause almost 3 million deaths worldwide, if vaccinations were stopped.

Commonly asked questions: Are vaccines safe? I believe they are. Thousands of people take part in clinical trials before a vaccine is approved. Millions of people are vaccinated every year. Some people may get local reactions of pain, swelling and redness at the vaccination site, but this lasts only a few days.

• Can vaccines cause autism? I know this is an extremely controversial issue but there is no scientific evidence to directly link vaccine and autism. Common pediatric vaccines with the exception of some flu shots, no longer contain mercury or thimerosal, chemicals often implicated with vaccine side effects.
• Are infants getting too many shots at once? In general, infants tolerate these vaccines very well. Every day infants come into contact with millions of bacteria, viruses and pollen which impact their immune systems. Delaying shots can leave a child unprotected against certain diseases, many of which can have dangerous complications such as seizures, brain damage, blindness and even death.
• If everyone gets vaccinated will my child still need them? It is true that an unimmunized child has less of a chance of catching a disease if everyone else is immunized, but if a larger number of children are not immunized then there will be a greater chance of highly contagious diseases spreading through the population.
• How long does immunity last after getting a vaccine? Many vaccines such as measles and hepatitis B cause lifetime immunity.  Others such as tetanus, last for many years but require booster shots.

The bottom line is that vaccinations have saved millions of lives, significantly lessened, and in cases, eliminated certain killer diseases, and have played a very significant role in the increased life span of humans over the past several generations.  There are many well intentioned individuals and groups who advocate against vaccinations.  I hear what they are saying but scientific evidence and multiple studies have demonstrated the safety and effectiveness of vaccinations. Talk to your doctor about the vaccinations that you or your child may need.

Influenza

Influenza is transmitted by direct and indirect contact via respiratory droplets from coughing, sneezing or from just shaking hands.  The incubation period is several days and contagiousness can last as long as a week after the symptoms begin.  The best way to limit its spread is by frequent hand washing with soap and water for 15 to 20 seconds and by limiting close face to face contact with others when symptoms are present.  It is very important to know the difference between the common winter cold and influenza.  As opposed to a common cold, influenza has these distinguishing characteristics:

• Very sudden onset
• Fever
• Aches
• Sore throat

At the onset of influenza symptoms people often say they feel as if they had been “run over by a truck.”

The treatment for influenza is mostly symptomatic care:  plenty of rest, Tylenol or Advil (ibuprofen) for fever and aches, and maintaining adequate liquid intake.  There are drugs such as Tamiflu, available from a doctor which if taken within the first 48 hours of influenza symptoms may shorten the course of the illness by several days.  These are recommended for the elderly or chronically ill patients with influenza symptoms.

Being immunized by a flu shot significantly lessens one’s chance of getting the flu.  But as with any treatment there is no guarantee of 100% success.  One can still get a bad viral upper respiratory infection during the winter months even after the flu vaccine. Most people who receive the flu shot have no bad reaction to it.  Some people may experience redness and swelling at the injection site lasting a few days.  One cannot get the flu from a flu shot because it is made from a deactivated dead virus.  The benefit of the flu shot far outweighs the minimal risks.  Although the ideal time for a flu shot is from mid-October through November, the flu season can extend through May.

Atrial Fibrillation

Atrial fibrillation is an irregular often rapid heart rate, causing the heart’s two upper chambers to quiver instead of beating regularly. Fortunately, the lower two chambers still work normally and are able to pump the blood out of the heart, although not as efficiently. It is this inefficient pumping that can cause the frequent symptoms of palpitations, shortness of breath, weakness, and lightheadedness.

Atrial fibrillation is the most common heart arrhythmia. It is found in over 6 million Americans and accounts for some 90,000 deaths annually. It occurs in about 1% of individuals in their 60s increasing to up to 12%of adults in their 80s. Some 30% of people with atrial fibrillation are unaware of their condition.

Atrial fibrillation can be brought on by increasing age, prior coexisting heart disease, high blood pressure, thyroid disease, and drinking alcohol.  It can come and go or it can be chronic and permanent. It is usually not life threatening but it is a serious condition and needs to be treated.

There are two main goals in the treatment of atrial fibrillation. First is to attempt to control the rhythm, that is, get the rhythm back to the normal beating pattern. If a normal rhythm cannot be obtained then the second goal is to control the heart rate. Ideally one would want to have the rate 80 beats per minute or below.  Both of these goals can be accomplished with medication.

If one is very symptomatic or has relatively new onset atrial fibrillation, the heart can be electrically treated with a small electrical shock while under  brief anesthesia. This however is rarely a permanent solution.

One of the  main problems with atrial fibrillation is the chance of having a stroke. Blood clots can form in the quivering upper chambers. If a clot breaks loose it can go to the brain causing a stoke.  This can be prevented by taking a blood thinning medication. Another complication is heart failure due to a weakening of the heart muscle.

There is a new advanced procedure called ablation. In this case a catheter is inserted in a large blood vessel in the groin and threaded up into the heart. Through highly technical computerized imaging, the trigger area for the fibrillation in the upper chamber is identified and lightly treated with high frequency radio waves. This destroys the area where the abnormal impulses of atrial fibrillation are generated. The success rate for this procedure is around 70% initially and up to 90% if a second procedure is necessary.

Many people with atrial fibrillation are living relatively normal lives today when properly managed. It is a condition not to be feared but to be monitored closely and treated appropriately by your doctor.

Seasonal Allergies

Seasonal allergies are commonly referred to as allergic rhinitis a.k.a. “hay fever” if the nose is mostly affected and allergic conjunctivitis if the eyes are involved.

Allergic rhinitis affects up to 40 percent of children and 10 to 30 percent of adults in the United States. It is referred to as “seasonal” if symptoms occur at particular times of the year or “perennial” if it occurs year round.

Common symptoms of seasonal allergies include sneezing, itchy eyes, nasal congestion, headache, and fatigue.  These symptoms can have a tremendous negative impact on the quality of life and on productivity. American workers lose an estimated 6 million work days yearly to this disorder, as well as incurring costs of several billion dollars in medical care.

Seasonal allergies usually occur from spring to early fall, and are due to pollens from trees, grass and weeds.    Interestingly, in this neck of the woods people associate the now beautiful yellow blooming acacia trees as the main source of allergies at this time. However, the fact is that the acacia pollen is quite heavy and usually just falls to the ground. Coincidentally at this same time, Birch, oak and a number of grasses are the real allergy producing culprits.

Perennial allergies, occurring throughout most of the year, are 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 lead to a sinus infection.

There is a strong association between allergic rhinitis and asthma.  Up to 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 Chlortrimeton,  however, they are often associated with the bothersome side effect  of drowsiness.  They should be avoided in children below 2 years of age and in the elderly.    Newer  oral antihistamines such as Claritin, Allegra and Zyrtec, are now available without a prescription and cause significantly less side effects and are more conveniently dosed at once or twice a day.  Steroid nasal sprays such as Nasacort and Flonase are very effective and are now sold over the counter.

Seasonal allergies can also affect the eyes causing redness, tearing, itching, and swelling of the lids. This can be treated with cold compresses and with one of the newer oral antihistamines mentioned above. It would also be worth trying over the counter allergy eye drops such as Zaditor,  Alaway  or Naphcon A.  If these treatments aren’t working sufficiently, see your doctor who can help you decide what treatment is best for your symptoms.

 

Poison Oak

Having treated thousands of cases of poison oak in my career, I’d like to share with you what I’ve learned about this miserable affliction.

The poison oak plant which is so prevalent in our locale, contains an oil in its sap called urushiol. This oil is found in all parts of the plant; leaves, stems, and roots. Even in extremely minute quantities, like a billionth of a gram, it can cause a very severe allergic reaction to our skin. This usually occurs within 24-36 hours after exposure.

Eighty five percent of our population is susceptible to this rash and a lucky fifteen percent have a natural resistance to it.

You can be exposed to the oil by direct contact with any part of the plant, or by indirect contact with an object such as your own hands, clothing, tools, or anything that may have the urushiol oil on it. There have also been reported cases of smoke from burning poison oak, causing either a skin rash or a reaction in the lungs, although I have never seen this in any patient I’ve treated.

Once you have contact with the oil you have only a matter of minutes to wash it off before it will bind to the skin and begin the allergic rash. The best way to remove the oil from the skin is to rinse with lots of water and then wash with soap and water. Most any kind of soap will do. Also, wash any object which may have come in contact with the oil with soap and water, including the clothes you were wearing. And don’t forget to do the same to your shoes, tools and pets. Urushiol oil can remain active on inanimate objects for over a year.

There are a number of over the counter products including Technu and Zanfel, which are to be used on the skin after exposure to poison oak, to remove the oil. I have heard mixed reviews on their effectiveness. For now, I’ll stick with water and soap.

Poison oak rash never becomes systemic. It is medically called a “contact dermatitis,” and the only place where a rash can develop is where the urushiol oil has contacted the skin. Poison oak rash can affect almost any part of the body. The rash does not spread by touching it even if it is oozing a liquid, although it may seem to when it breaks out on new areas over a number of days. This may happen because the oil absorbs more slowly on thicker skin, such as the forearms, legs or trunk and faster on thinner kin such as the face and genitals.

Can poison oak rash be prevented before contact with the oil? Some allergy pills or shots have been used with limited success, but in general, they are no longer used, because of potentially serious side effects

A poison oak rash will always eventually clear up on its own if one is willing to wait it out. There are an abundance of home remedies to cure poison oak, none of which have been proven to be effective. However there is effective, proven, and safe medical treatment for those who wish not to suffer for several weeks. Your doctor may prescribe some form of a steroid cream which is stronger and much more effective than over-the-counter cortisone cream. If the rash is more serious and especially involving the face, systemic treatment may be necessary. This involves the use of cortisone pills called prednisone, which is my preferred treatment, or as a steroid shot. Either of these treatments is safe and very effective for most patients. Your doctor will help to determine the best treatment for your particular condition.

The bottom line is that you should avoid contact with poison oak, wash your skin and clothing as soon as possible if you do come in contact, and see your doctor for effective medical treatment if symptoms persist or worsen.

Bee Stings

Our most common local stinging insects are yellow jackets and bees. Yellow jackets are attracted to our delicious picnic food and are more aggressive than bees. They sting defensively when they feel that their nests are threatened. They also sting when stepped on, sat upon, or have in some way been provoked.  If one is being attacked by many bees or yellow jackets, it is best to vacate the area and run away as fast as possible.  These insects are capable of flying up to 15 miles per hour and pursuing for distances of 50 to 100 yards.  So don’t run too slow or stop too soon!

Wasps, including yellow jackets, can sting multiple times and leave no stingers in its victim. The  honey bee  sacrifices its life with its sting because it leaves the stinger and part of its abdomen with the venom sack attached to the skin of the victim.  This stinging apparatus continues injecting venom into its victim for up to one minute after the sting.  This is why the new accepted method to remove the stinger is just to pull it out with your finger tips as fast as possible.  Trying to take the time to find something to scrape off the stinger as was previously recommended just wastes time and allows more venom to be injected at the sting site.  Tests have proven that pinching out a stinger doesn’t force out more venom.

Stings are exceptionally painful. The best local treatment is to immediately place an ice pack on the sting site for up to several hours.  Home remedies such as applying pastes of meat tenderizer, clay, toothpaste, aspirin and baking soda, have no proven benefit.  Taking an antihistamine such as Benadryl by mouth, may help with itching.

A local toxic reaction to the venom occurring within hours to days after the sting may involve redness and swelling of just a small area around the sting or a much larger reaction often involving an entire arm or leg. As bad as this may seem, it is not serious and not life threatening and will resolve on its own in a matter of days.  These reactions are sometimes mistaken for a secondary infection but this is very rarely the case and antibiotics are hardly ever necessary.  A sting on the face may cause worrisome swelling but is not dangerous. A sting inside the mouth or throat however can be quite serious and needs emergency treatment promptly.

Almost every person who is stung will have at least a mild reaction around the sting site.  Less than one percent of the population will have a severe allergic reaction.

Serious allergic reactions may occur within minutes or up to several hours after the sting. Usually the more serious the reaction, the sooner the symptoms begin. For those who have suffered a serious reaction to a sting I would recommend a consultation with your doctor who may recommend allergy shots to make one less sensitive. An injectable adrenaline kit such as an “Epipen” may be prescribed to those who have had a very serious prior sting.

What to do when stung:

• Pull stinger out as fast as possible by any method using fingers is now allowable.
• Remove self from vicinity of stinging insects as fast and far as possible.
• Apply ice compresses to sting.
• Take Benadryl by mouth as soon as possible
• Call 911 if you experience:
• swollen tongue or throat.
• difficulty swallowing.
• tight breathing.
• feeling faint.
• severe hives.