Monday, February 25, 2013

Seasonal Affective Disorder (SAD)

Many people experience feeling down when the weather is cold and overcast but some people experience more significant symptoms when the winter months arrive. This condition is a form of depression called Seasonal Affective Disorder or SAD. Most people with SAD have symptoms that begin in the fall and resolve in the spring. The exact months can vary with the individual.

Common symptoms of SAD include:
- Sleeping more than usual
- Eating more than usual especially craving starchy foods
- Irritability
- Difficulty with relationships, especially feeling like they are being rejected
- Feeling sluggish, as though their arms and legs are weighted down

While everyone may experience some of these symptoms occasionally, people with SAD will experience them most days of the week for many weeks in a row. If you feel you may be experiencing these symptoms most days of the week you should make an appointment with your primary care provider to discuss the problem.

The good news is that Seasonal Affective Disorder is very treatable. Many people will respond well to treatment with antidepressant medication. Often the medication is started in the fall and discontinued in the spring but some people will take medication year round. There are many types of antidepressants that work in different ways. If you try a medication and experience problems or it doesn’t work, there are others to try.  Your primary care provider will make recommendations based on your individual circumstances.

Another treatment option for SAD is light therapy. This is the use of exposure to bright light of a specific intensity for a prescribed period of time each day. Normal light fixtures are not able to produce the intensity of light needed for this treatment so a special light must be purchased. Often this type of light fixture is not covered by insurance so if your provider has recommended this type of treatment you should check with your insurance regarding coverage. Light therapy is attractive to many people because it doesn’t involve a drug; however it is important to realize this therapy will involve a commitment of time each day. Most people using light therapy require 30-60 minutes of treatment every day. You should talk with your primary care provider about whether this type of time commitment will be realistic for you.  Side effects of light therapy can include headache, irritability, insomnia, and fatigue. These can often be managed by changing the length of time or time of day of the light therapy.

A small number of people experience seasonal changes in mood that begin in the spring and go away in the fall and some people being treated for Major Depression will experience some seasonal variation in their symptoms. These are special circumstances that you should discuss with your primary care provider.

Dillsburg FamilyCare, a member of PinnacleHealth Medical Group

Monday, February 18, 2013

Relieve Dry Skin

Dry, itchy skin is a common complaint during the winter months. Dry winter air and most types of indoor heating increase our chances of experiencing symptoms of dry skin. Symptoms of dry skin can include itching, mild soreness, flaking and cracks or fissures in the skin. Having cracks in the skin or scratching your skin open increases the risk of getting a skin infection.  So It’s best to actively treat dry skin as soon as you are aware of it.

Some people struggle with dry skin all their lives however it is more common for it to become a problem for people as they get older. The thinning of skin as we age causes our skin to become dry more easily.  The most common areas for people to have symptoms of dry skin are the hands and shins but any area of skin can suffer from dryness.  A few simple actions can help you get control of your dry skin.

First, minimize your skin’s exposure to water, especially hot water. Long hot showers or baths are not friendly for dry skin.  This means shorter, cooler showers or baths and consider showering only every other day. If you wash dishes or have a job that keeps your hands in water frequently wear  rubber gloves if possible.  When you dry your skin try to pat dry rather than rub. These things help to preserve your skin’s natural oils.

Next get a good moisturizer and use it often.  The most effective moisturizers are going to come in a jar or need to be squeezed out of a tube.  A lotion that is poured or comes out of a pump is usually not very effective for dry skin that is causing symptoms. Avoid heavily scented moisturizers as these frequently contain alcohols which are drying. Use your moisturizer at least twice a day. If you are a person who must wash their hands frequently during the day you may need to reapply your moisturizer much more often. Hand sanitizers are also drying so moisturize more often if you are using these products frequently.

If possible get some moisture back into the air in your home by using a humidifier, cool mist vaporizer  or even a pan of water on a radiator or wood stove.  It can be difficult and expensive to humidify an entire home so consider focusing on the room you spend the  greatest number of hours  in. For many people this room is their bedroom.

Lastly, get some moisture into yourself. Make sure you are staying well hydrated by drinking adequate amounts of water and non caffeinated beverages every day.

If you experience symptoms of dry skin that are not responding to your efforts to treat it or you have  significant soreness and/or redness especially if these symptoms are worsening you should see your primary care provider. They will be able to rule out other causes of your symptoms and if needed provide prescription creams which can help

Dillsburg FamilyCare, a member of PinnacleHealth Medical Group

Monday, February 11, 2013

Aisle full of cold medicine choices, but which is the right one?

Achoo!  Gesundheit!  If you are coughing, sneezing and sniffling right about now, you’re not alone. The vast majority of people we’re seeing at the office at this time of year for same-day sick visits have an upper respiratory infection…aka, a cold. Now, colds come in different varieties; there’s the garden variety “Rhinovirus” which gives the old tried and true cold symptoms. There’s also the more powerful RSV (Respiratory Syncitial Virus) which packs a punch to all who get in it’s way but even more to our littlest babies (more to come on this, keep reading). The flu is also still out there too (yes, still time to call the office to get your flu shot). So if you’re in battle with any of these right now, you’re not alone. I was in a visit with a patient last week and we got into a lengthy discussion about cold medicines; I joked with him at the time that I should blog about this topic then thought about it some and thought it would be worth sharing…so now I am!

I’ve read estimates of Americans getting 4 billion colds every year. This is why the US spends in the neighborhood of 4.2 billion dollars (yes, that reads billion) every year in cold remedies. By the USA Today report I read, that is only the “traditional” medicines, not the alternative ones (think Vitamin C, Echinacea and Zinc…so that number could double!). So now you realize why the cold/cough/flu remedy aisle in your local pharmacy or grocery store is SOOOO long and full of options. Simply stated, we buy them. I hope to help clear up which options to consider in your quest to feel better.

The thing about any and all cold medicines is this: they don’t make you better. They help you feel better sometimes. I hear all the time that the cold medicines help, but as soon as they wear off, the love is gone and symptoms return. They mostly exist as 4 hour formulations, which is not really that great. By the time you find improvement in your symptoms, the medicine is just about to wear off. Taking it every 4 hours is so time consuming. I don’t think there is anything I can manage to do every 4 hours during a busy day as a mom and at work. So I can practically recommend the 12 hour extended release formulations of any drug you take. Take one in the mornings when you wake up to help you with those daytime symptoms and another sometime 12 hours later—this second dose will help you manage symptoms overnight while you’re sleeping. Getting rest can be the difference in getting better or lingering sick. It won’t magically make you better but when you’re rested, you’ll FEEL better…and isn’t that really what you’re looking to do?

Let me start with the one I wish didn’t really have such a big place on the shelves. Dextromethorphan. It is billed as a cough suppressant. This makes sense at first. Yes, stop the cough. But think about it a little more carefully and you’ll see that the cough is actually protecting you. Let’s consider two scenarios. One - the cough is from lung/heart/stomach disease; so suppressing it allows you to go undiagnosed and that could be life-threatening…so, suppressing that cough is not a great idea. Two - the cough is from your upper respiratory area; the mucous is coming from your nose and sinuses and is caused by the mucous as it drips and drains into the upper part of your throat. The body tries to avoid that mucous from getting into the lungs to cause a pneumonia/lung the cough is actually a good thing there. The other thing about dextromethorphan is that it actually could be DANGEROUS! Yes, dangerous. It can interact with many depression/anxiety medicines causing a serious interaction. Since you can buy dextromethorphan without a prescription or even a talk with your pharmacist, this frightens me. So look for this drug and think three times before you buy it. Look for any drug that has a DM after it (DextroMethorphan) and, in my opinion, avoid it.

The one I really DO like is pseudoephedrine. This drug is not for everyone. Some people don’t tolerate it. I’d say, in my experience, 1 in 10 people tell me they cannot take it because it makes them jittery or have a fast heart beat. The other consideration is people with high blood pressure. For most patients who have controlled, treated high blood pressure, it’s OK to take this drug FOR A FEW DAYS while you’re sick and not worry it will cause serious damage (if your blood pressure is uncontrolled or it’s used beyond a few days, your doctor or provider should be involved). If you’re one of those people, this drug is not for you. If you’re not, this may be something that helps open up your nasal passages and keep you moving air…which is a good thing! In addition to causing nasal passages to clear, this can dry up some mucous secretion (more of a side effect than anything) making you feel better too, reducing that pesky cough. Phenylephrine is an alternative to the pseudoephedrine;  it is less stimulating and doesn’t raise the blood pressure. To buy pseudoephedrine, you must show a photo ID to the pharmacy staff. Phenylephrine is available grab-and-go off the shelf. Be warned, it doesn’t have the same power pack the pseudoephedrine punches.

The next among the big-three of cold medications is guaifenesin. This functions to loosen the mucous and help make it slippery and ready to cough/blow/spit out. This keeps down the likelihood that the mucous will be a breeding ground for bacteria to come in and infect later. This is a particularly good one to consider if you’re prone to sinus and ear infections after a cold. All in all, it’s not a bad choice.

One word of advice: READ!  Read the label of the drug you are about to buy and put into your body. This is important. If you decide to get a multi-symptom drug it has multiple drugs in it. Often, one of those drugs is a fever reducer/pain medication. If you don’t have pain or a fever, that may be unnecessary. Also, you may not need a cough suppressant AND decongestant AND mucous thinner AND fever reducer. I’m a minimalist. If you are not experiencing a particular symptom, don’t take a drug to fix it. There are side effects and interactions for every drug so choose them carefully and only when necessary. Many of them interact with prescription drugs—fever reducers can interact with blood thinners and contain the same active ingredient as some pain medicines. If you’re taking a prescription drug and see the same ingredient on the cold medicine label, think again and consider asking the pharmacist or your healthcare provider if it’s OK. Also, it’s helpful to us if you know what you’re taking if you come to see us. It helps us know what to avoid giving you to avoid further interaction if a prescription drug is provided at your visit. So please, read labels.

I mentioned RSV and babies. This is yet ANOTHER reminder that there are NO SAFE COLD MEDICINES FOR BABIES and children under age 5. Never give a child with a fever aspirin. Also, remember that doses of medicines are weight based. If you don’t know what dose of acetaminophen or ibuprofen to give your child/baby, don’t guess…please ask your doctor or pharmacist for some help.

Now, I’m a mom of 3 little boys. So I understand that weakness you feel at 3 a.m. with a coughing child (or more) wanting to get them to feel better and get everyone back to sleep. The problem is, the cough and cold medicines not only don’t work for them, but they also cause HARM to them. Many thousands of children under age 5 were taken to emergency rooms yearly when the FDA allowed the sale of those medicines. They removed them from shelves after it was clear they were causing more harm than good.

So what can you do for those little ones? There are a few old-school remedies that can help. At any age, the menthol/eucalyptus/rosemary rubs can be wonderful. They make reduced strength formulations for the little babies. It’s been shown to reduce symptoms in trials but this mom can tell you that it works. There’s no placebo effect (improvement/positive change in symptoms caused by the person’s desire to improve rather than the medication) when you’re dealing with a baby. So rub away! The other thing that helps lots of kid viruses (RSV, Croup) is humidified air. The humidity is helpful in decreasing the irritation of the lining of the respiratory tract. Finally, in children OVER AGE ONE; taking two teaspoons of honey before bed can help reduce cough symptoms.

Many will say these methods lack serious scientific clinical trials. I agree but challenge…is a safety trial needed for honey in a 3 year old? Dr. Andrew Weil spoke at the American Academy of Family Physicians’ educational meeting in Philadelphia this past fall. I was in the audience and was struck by something he said - I’ll paraphrase:  the more harm that can be done, the more studies that should be done. The harm factor of honey in a child OVER THE AGE OF ONE is minimal and so should be the trials. In my house, we mix in a little lemon juice and we call it honey-syrup (my kids don’t like the sweetness of honey straight-up).

I didn’t get into the alternative options much for adults but can say the honey trick would be something worth trying. I also read adding Cinnamon to that mixture in adults helps decrease the sugar-shock factor in people with blood sugar problems—so be sure to track your home blood sugars with your monitor to be sure your sugars are not bouncing high with this treatment. Remember, a sudden spike in your blood sugars could be a sign a serious infection is lurking.

I hope you all feel better soon. I keep hoping for an early spring but fear we are destined to another 5-6 weeks of winter. Well, mostly because that’s when it ends….March 21st! So keep hoping and marking off your calendar and before you know it, we’ll be right back here talking about seasonal allergy treatments!

Heritage Family Medicine

Wednesday, February 6, 2013

The Heart Healthy Life

Welcome to February, American Heart Month!

Regrettably, many of us know individuals that have been affected by heart disease or stroke. Cardiovascular disease remains the leading cause of death in the United States. According to the CDC, 1 in every 3 deaths is caused by heart disease and stroke which equals approximately 2,200 deaths per day. American Heart Month focuses on awareness and promoting healthy lifestyles for the prevention of cardiovascular disease. A heart healthy diet, regular exercise, weight management, stress management, and quitting smoking are all lifestyle changes that reduce the risk of heart disease and stroke. The focus of today’s blog is diet and exercise for a healthy heart.

What is a heart healthy diet? 
A heart healthy diet is a well-balanced diet that promotes a healthy weight, good blood pressure, and lower cholesterol levels. Changing your eating habits can be tough, but small changes can make a big difference.

Diet tips to jump start your way to a healthy heart:

Portion Control – The amount of food that you eat is as important as the type of food you eat. Many individuals eat much more than the recommended portion sizes, especially when eating out at restaurants. Eating large portions or eating until you feel “stuffed” leads to consuming increased calories, fats, and cholesterol. Knowing the recommended portion sizes for different types of food is the first step to eating healthier. A portion of vegetables, such as broccoli, is 1 cup which is about the size of a baseball. A portion of meat is 2 to 3 ounces is about the size of a deck of cards. For more information on portion sizes and daily servings of particular food groups, visit the American Heart Association Nutrition Center.

Eat Your Fruits and Veggies – Fruits and vegetables are low in calories and full of nutrients and fiber. Featuring more fruits and vegetables also helps you to avoid eating foods that are high in fats. Choose fruits and vegetables that are fresh or frozen, if buying canned products you should choose low-sodium vegetables and fruits that are pack in juice, not syrup. Deep fried vegetables are not a healthy choice.

Choose Whole Grain - Whole grains are high in fiber and nutrients that support good health. The American Heart Association suggests that at least half of your daily grain servings be whole grains. When you go grocery shopping look at your whole grain options; there are a variety of bread, rice, and pasta products to meet your whole grain needs.

Limit Saturated Fats and Cholesterol - High levels of cholesterol in an individual are linked to an increased risk of heart disease. Limiting how much saturated fats, trans fats, and cholesterol you eat will help improve your cholesterol levels and decrease your risk of heart disease. Avoiding butter, creamer, and shortening is an easy method of decreasing unhealthy fats in your diet. Check the nutrition labels of your food, you would be surprised by the foods that have unhealthy fats and cholesterol in them. The American Heart Association recommends that less than 7% of a healthy adult’s daily calorie intake be from saturated fats. It is also recommended that a healthy adult consume less than 300mg of cholesterol per day. Your healthcare provider may recommend your daily intake of saturated fats and cholesterol be further reduced based on your blood cholesterol levels.      

When cooking try to choose healthy fats (monounsaturated fats) such as those in olive or canola oil to promote better heart health. Make low-fat choices a part of your everyday life. Choose low-fat dairy products and lean meats whenever possible. Fish is a great substitute for high-fat meat, especially cold-water fish that are high in omega-3 fatty acids which help lower your triglycerides (blood fats).

Reduce Sodium in Your Diet – A diet that is high in sodium is linked to high blood pressure which is a risk factor for cardiovascular disease. The American Heart Association recommends that healthy adults have less than 2,300mg of sodium per day. In adults over age 50 and those with high blood pressure, diabetes, or kidney disease the daily sodium recommendation is further reduced to 1,500mg per day. One way to reduce the sodium in your diet is to limit the amount of salt that you add to your food. When buying groceries, choose low or reduced sodium foods and check the nutrition labels. Some examples of foods that are high in sodium are canned soups, breads, rolls, and deli meats.

For more information on eating and shopping heart healthy, register for the PinnacleHealth Heart Healthy Eating Programs - Grocery Tour. Learn how to choose healthy food options and read nutrition labels. Even better, it’s free! Call 717-231-8900 to register. Upcoming dates include February 6th at Giant on Simpson Ferry Road, March 6th at Giant on Union Deposit Road, and March 13th at Giant in Kline Village.

Why is exercise so important?
In America, 65% of adults are considered overweight and obese. Our growing waistbands and lack of physical activity is directly related to the development of heart disease. Regular physical activity is good for much more than just weight loss; exercise strengthens your immune system, improves your mood, decreases your blood pressure, and decreases your cholesterol levels.

The American Heart Association recommends 30 minutes of moderate to vigorous exercise 5 days per week. Anything that increases your heart rate is considered physical activity, such as going for a walk, climbing stairs, riding bike, or playing a sport. Moderate physical activity 30 minutes per day has been found to reduce the risk of stroke by 20% and the risk of coronary heart disease in women by 30 - 40%.

Tips on getting active:

  • Exercising for 10 minutes three times per day is comparable to exercising for 30 minutes once a day. So if you have trouble finding 30 minutes to exercise, exercising for a smaller amount of time in multiple sessions is still beneficial.
  • Walking is an easy way to start exercising regularly and it’s free.
  • Making small efforts on a daily basis to increase physical activity makes a big difference. For example, when you go shopping park farther from the door. The extra steps you take lead you closer to a healthier heart. 
  • Workout with a buddy; having someone to workout with is fun and is a great motivator.  
  • Joining a gym offers a variety of workout options as well as classes to keep your interest.

Thoughts to leave you with.
Making lifestyle changes is difficult; don’t get upset if you fall off the wagon occasionally, just make sure you get back on. Try your best and continually work to improve your diet and physical activity to promote a healthier heart. Talk to your healthcare provider about your risks for heart disease and their recommendations.

Jamie Weeder, MSN, CRNP