Asthma Education Programs In School

You know, air is one of those things you just have to have. Asthma interferes with airflow, causing air trapping in the lungs, wheezing, cough and shortness of breath. It is estimated that one in 12 children has asthma, and it is the single most common reason for missed days of school.

Asthma attacks are common. Almost 50% of children with asthma report having at least one attack in any given year. Attacks are very frightening, with sudden onset of symptoms, and are a common reason for ER visits. It is the third leading cause of hospitalization for children under 15. Thousands of Americans die every year from asthma. Black people are three times more likely to die from asthma than Caucasians.

Credit: Healthdirect.gov.au

There was a study published that explored using school-based education programs about asthma. They found that teaching children about asthma in school decreased trips to the ER and hospitalizations.

There is a big problem with asthma management in this country. Many children and parents don’t know how to use inhalers properly. Children aren’t comfortable reporting symptoms at school because they’re embarrassed to ask to go to the nurse to use their medication. And access to primary care is inconsistent, leading parents to overuse the ER.

Asthma education programs in school raise awareness among students and teachers so children with asthma are less likely to be stigmatized. The more people who are able to recognize early signs of an asthma attack, the more likely a child will get treatment quickly when it is most effective.

Asthma claims the lives of thousands of people yearly. There is unfortunately limited primary care access in many parts of the country. With higher illness burden in African American children, more ways to educate patients and parents about asthma management are needed. Asthma education programs in schools are a natural and (now) proven option to decrease ER visits and hospital stays.

QUESTION: Do you think teaching children about asthma in school will help raise awareness and improve health outcomes?

Share

Is Measles Making A Comeback?

Lately measles has been in the news a lot  Five years we had a big outbreak of measles here in Ohio.  Currently Europe is seeing the highest numbers of measles cases they have had in 20 years.  The Pacific Northwest,  Texas and New York (among others) are seeing cases and it’s estimated that the US may see more measles cases in 2019 than we have seen in 30 years.

It is ironic that the success of childhood vaccination is the reason we’re seeing the resurgence of this disease.

Most people have never seen measles and don’t know how to recognize it.  I have never seen measles either.  Before you go questioning my training, you should know the reason WHY I’ve never seen measles.  For a very long time, measles has been extraordinarily rare in the United States.  The reason for this is universal childhood vaccination.

The live measles vaccine was introduced in 1963.  Before that time, according to the CDC it is estimated that 3-4 million people in the US got measles every year.  About 48,000 people were hospitalized, over 400 people died and 1000 people were left permanently disabled from measles encephalitis (brain infection).  That’s EVERY YEAR.

In the 1990s over 500,000 children still died worldwide ever year from measles.  That’s like 3 Boeing 747 jumbo jets crashing EVERY DAY, all year long.  From 2000-2013 there were 37-220 cases of measles in the US per year.  All of these cases were related to international travel, or exposure to an infected international traveler.  Measles was common in other parts of the world, you see.  It is much less common now, but by no means gone.

Ten states in the USA are reporting measles outbreaks right now.  What is interesting is that researchers predicted this last year, by looking at the rates of non-medical exemptions for vaccination.  The areas that have the highest rates of non-medical exemptions are the hot spots for the current outbreaks.

Why?

If vaccination resulted in the near-eradication of measles in this country, it doesn’t take a genius to see that falling vaccination rates will result in a resurgence of the disease.

Well-intentioned parents who love their children are frightened by all the reports of vaccine injury in the news media and on bloggers’ websites.  So they refuse to vaccinate and therefore put their families at risk from a dangerous, highly contagious disease that has no specific treatment.

If you or a family member get measles it is critically important to recognize it as soon as possible.  So let’s review the symptoms of measles.

  1. Fever:  sudden onset of high fever, sometimes up to 105F
  2. Cough, runny nose (coryza) and conjunctivitis:  These are sometimes called the “3 C’s” of measles.  Measles is a respiratory illness so the cough and sneezing is how the virus is spread.  Anyone with a fever, cough and runny nose should stay at home until the fever is gone.  If they get red, watery eyes they should ESPECIALLY be isolated until the fever is gone.
  3. Koplik’s spots:  These are little gray-white spots (like grains of sand or salt) surrounded by a red ring on the insides of the cheeks.  Those who have these spots are VERY contagious.  You can see a picture of them here.
  4. Rash:  The rash is what most people associate with measles.  It starts at the hairline and spreads down to the feet, and disappears slowly the same way.  This picture is from the CDC website.

measles-22-lg

If you are planning to travel to a country where measles is common, make sure your immunizations are up-to-date.  Large outbreaks have been reported in England, France, Germany, India, and the Philippines, to name a few.  The outbreak here in Ohio five years ago was related to unvaccinated travelers to the Philippines who then came back and exposed people in Ohio’s unvaccinated Amish population.

These measles cases are a good illustration of why universal vaccination doesn’t work as well if it’s NOT universal.  As vaccination rates fall because parents refuse to allow their children to be immunized, outbreaks of vaccine-preventable diseases will become more and more common.

Measles is highly contagious.  Approximately 90% of non-immune people exposed to a sick patient will get sick with the disease.  This is compared to an estimated 33-45% for influenza.

There are people who CANNOT be immunized.  The immunocompromised, those who are allergic to vaccine components, and the very young are unable to be fully vaccinated.  They depend on us to limit our ability to spread these vaccine preventable illnesses to them.

QUESTION: Have you ever seen measles?

Share

Healthy Skin Care

Believe it or not, summer is coming. Eventually.

Today I found myself dreaming about slathering on sunscreen and heading out to ride roller coasters at my favorite amusement park. I put sunscreen on my face every morning all year around. It occurred to me how many people don’t know how to tell the difference between dangerous and healthy skin care products.

This week I wanted to round up a list of the most dangerous skin care ingredients so you can check your products and make sure your skin is safe. Your skin is your largest organ and it’s the first thing people see so you should take good care of it and keep it healthy!

Parabens

Parabens are chemicals that are used as preservatives in skin care products. They mimic estrogen and disrupt endocrine signaling. Researchers have found parabens in breast tissue and have shown that they increase breast cancer cell growth. Parabens can even block the activity of tamoxifen, a drug that inhibits the growth of estrogen-sensitive breast cancer cells.

Parabens in breast tissue are intact, meaning they did not go through the liver. These parabens were not in food, but instead were absorbed directly across the skin. Parabens are used in a lot of very expensive skin care products, but it is becoming better understood that these preservatives are not safe. Check your skin care product ingredient labels to make sure parabens are nowhere to be found!

Artificial Colors

If there is something in your skin care that has a color followed by a number, it doesn’t belong in or on your body. These coloring agents are derived from petroleum. In general products derived from petroleum are considered human carcinogens and artificial colors are associated with ADHD in children. The EU has banned them. They shouldn’t be in your skin care products.

“Fragrance”

What does THIS mean? No one knows, actually. The word “fragrance” on a skin care label is deliberately vague and may include a number of dangerous ingredients like phthalates, solvents and other toxic chemicals.

Fragrances are associated with skin problems like rashes and eczema and they can trigger allergies and asthma attacks in sensitive people. It’s safest to use products that don’t have added fragrance.

Phthalates

These chemicals are used to soften plastics and are also found in lotions, creams, perfumes, nail polish and hair spray. They are often part of the “fragrance” in scented products (see above). Like parabens they mimic hormones and can affect cancer risk and fertility in both men and women.

Bottom Line

There are a number of dangerous chemicals that have no place in our diet, our water supply and our health and beauty products. This is by no means an exhaustive list. Since I’m focusing today on healthy skin care today I wanted to briefly touch on some of the most prevalent.

Please go grab your skin care products and check the ingredient lists. If you find parabens, phthalates, “fragrance” or artificial coloring agents please consider switching to skin care products which don’t use these ingredients.

Want to know what skin care I use? Bet you can guess 😉 Click here to see the products I trust for myself and my family, and click here to see the list of 2500 harmful ingredients NEVER present in the products I use.

Share

Reduce Colds And Flu With Vitamin D

How many colds and bouts of bronchitis do you have in any given winter?  Two?  Three?  Or are you one of those people who gets over one cold just to come down with the next?

Are you envious of those who don’t ever seem to get sick?  What if I told you the difference could be in your blood?  AND that it’s something EASY to change?

Turns out taking a vitamin D supplement reduces the risk of acute respiratory infections!  I’ve written about vitamin D before.  This nutrient has a lot of health benefits that we’re just starting to understand.  It helps keep bones strong.  It has mental health benefits.  Vitamin D levels are linked to the risk for multiple sclerosis.  We really don’t understand everything about how vitamin D works.

Credit: https://www.humnutrition.com/

Researchers in the UK wanted to know if there was a link between vitamin D levels and risk of colds and flu.  Specifically, they wanted to know if vitamin D supplements helped prevent respiratory infections.

Last year their study was published in the British Medical Journal.  They analyzed 25 other papers involving over 11,000 people to see if there was evidence that vitamin D supplements protect against respiratory infection.

They found that people who took vitamin D supplements did have a lower risk of acute respiratory infection, but the effect was pretty modest.  Overall, those who took vitamin D supplements had a 40.3% risk of acute respiratory infection, while those who didn’t had a 42.2% risk.  That means you have to treat 53 people to keep one person URI-free.  (The rest either would have been URI free without the supplement, or would have still gotten respiratory infections in spite of the supplement.)

Not a big effect, right?  Well let’s look deeper, OK?  The authors looked at those who were deficient to begin with, having a blood level less than 25 nmol/L, and found that with supplementation the risk dropped from 55% to 40.5%.  Your number needed to treat dropped from 53 to 7!

The authors also wanted to know if it mattered how you took your vitamin D.  In Europe apparently it’s common to give a huge dose (>30,000 IU) every once in awhile, called bolus dosing.  In the US we usually dose daily or weekly instead.

The study found that bolus dosing was NOT effective, and if you just looked at the studies that gave the vitamin D supplements on a daily or weekly schedule the effect was quite dramatic.

Those who started with low vitamin D levels saw their risk of upper respiratory infections drop from 59.8% to 31.5%.  (NNT=3.5)  That is a huge impact!  The fact that correcting deficiency had such a big effect is good evidence that this is real and not just statistical fancy footwork or a coincidence.

They also found a big drop, 46.2% to 33.6%, in children aged 1-16 years who were supplemented with vitamin D.  (NNT=8)  Since kids in school are exposed to germs all the time, this reduction is very important.

How can we use this information?  If you live in northern Ohio (or anywhere north of 40 degrees north latitude) you ARE vitamin D deficient unless you are taking a supplement.  So everyone in Cleveland needs to take a supplement all year ’round.  You also should have your levels checked periodically by your doctor or health practitioner to make sure you’re taking enough of a supplement, because some people need more than others.

I prefer to have my patients take their vitamin D every day rather than once per week.  It is easier to remember to take something every day, just make it part of your morning routine.  The best dose I’ve found is 2000-3000 units daily.  What is in your multivitamin is NOT enough.

While taking a vitamin D supplement is helpful, there’s more to staying healthy and warding off colds and flu than taking vitamins.  Make sure you’re washing your hands regularly.  Drink plenty of fresh clean water, get enough sleep, and watch your stress levels.  Stress depresses the immune system so if you’re feeling overwhelmed make sure to beef up your self-care routine!

If you’re wondering how to get enough vitamin D, please check out Shaklee’s Vita D3.  It’s an inexpensive way to add insurance for heart, bone AND immune health!  If you’re not already a Shaklee family member, why not click this link to get your personalized health assessment?  There’s no cost and no commitment, just individual recommendations for diet and lifestyle changes (and smart supplementation of course) to meet your health goals.

I have so many friends and patients suffering cold after cold this winter.  Now you have one more tool in the toolbox to keep you well!

QUESTION: Do you take vitamin D every day?

Share

Preventing Falls And Fractures

With the Snowpocalypse on its way this weekend I’ve been thinking about the rash of injuries that result from snow and ice every winter. Wrist fractures, back injuries, and the dreaded hip fracture happen when older adults slip and fall on snow and ice. What are some ways we have of preventing falls?

It’s obvious that preventing falls is much better than treating injuries when they happen. About 20% of hip fracture patients won’t leave the nursing home afterwards. Prevention strategies can be broadly divided into two categories: environmental measures and personal factors.

Environmental Measures

What can we do to make the environment safer and prevent falls? Snow removal and preventing the formation of ice (where possible) are obvious steps to take. Less obvious are installing railings on stairs, improving lighting, and placing awnings to prevent accumulation of snow and ice on landings and access points.

Personal Factors

Let’s face it, we live in northern Ohio. Snow and ice happen for about half the year. We can’t avoid it altogether and we can’t remove it all. So improving each person’s ability to avoid falls and avoid injury if they DO fall is critically important.

If you’re faced with ice and more snow than you’re comfortable with, stay home if possible. If you must go out, keeping one hand on something stable like a railing is smart when navigating stairs or other risky places. Using a cane if you have one can help.

Exercise, particularly Tai Chi, has been shown to reduce the risk of falls in senior adults. Better body awareness, better muscle strength and tone, and better balance are some of the benefits offered by regular exercise and Tai Chi in particular.

For the more adventurous, martial arts like jiu jitsu teach the student how to fall safely and reduce the risk of injuries in a fall. I myself have avoided serious injury in a fall not long ago, due to my training.

If you’re a woman over 60, make sure you’ve had a bone density (DEXA) test. This is a simple Xray that measures the strength of your bones. Using your bone density and other risk factors like age, gender and medical history, your doctor can estimate your fracture risk. If your fracture risk is high, you should discuss with your doctor what you can do to reduce your risk.

One important thing to do to keep your bones strong is to take vitamin D and a bone health supplement daily. Here in northern Ohio adults need 2000-3000 units of vitamin D every day, all year around. A lot of doctors tell patients to take calcium but bones need calcium, magnesium and vitamin D to be healthy. I recommend Shaklee’s OsteoMatrix which provides SMALL coated caplets proven to be well absorbed to support bone health.

Avoiding falls and avoiding injury from falls is very important. First, you have to stay on your feet. If a fall does happen, being able to fall safely and having strong bones to prevent fractures is critical.

QUESTION: Are you afraid of falls? What do you do to avoid them and stay safe?

Share

Dietary Fiber Decreases Health Risks

Do you eat plant-based? Vegetarian? Paleo? Keto? The Standard American Diet (appropriately abbreviated as SAD)? If you are interested in avoiding heart disease, stroke, cancer and diabetes, new research suggests you need to take a good look at your dietary fiber intake.

A huge meta-analysis of over 200 studies examining almost 135 million person-years of data was done. That’s an enormous amount of data! Both observational studies and clinical trials showed that eating higher amounts of dietary fiber resulted in lower body weight, blood pressure and cholesterol. Also, eating more fiber was associated with lower risk of heart attacks, stroke, diabetes and colon cancer.

How much lower was the risk? 15-30% decreased risk, which is huge! Statistical analysis suggests that the risk reduction really is from the fiber intake. First of all, there is a dose response curve, meaning that small increases in fiber result in smaller benefit, and larger intakes of fiber result in larger benefit.

How much fiber do you need to eat to get the benefits? This research suggests the most benefit is seen at intakes of 25-29 grams per day. The average American eats less than 15 grams of fiber per day. There is evidence that even more daily dietary fiber may give even more benefits!

What is the best way to figure out how much fiber you’re getting? I always recommend folks use MyFitnessPal, a free nutrition tracking program. Track for a week and see what your average fiber intake is. The best way to gradually add fiber is with FOOD, not supplements (although fiber supplements like Metamucil are better than nothing).

Fresh and dried fruits, veggies, beans, nuts, seeds and whole grains are your best sources of dietary fiber. WebMD has a nice article listing some high fiber foods to choose.

The higher fiber content of plant foods is likely the main reason plant-based diets are so healthy and result in such positive health benefits. Not able to give up meat, eggs and dairy altogether? Take positive steps for your health and start adding more plant foods (and therefore more fiber) to your diet today!

Share

Online Patient Portal Use

Does your doctor offer an online patient portal for you to communicate with her? Have you decided not to take advantage of this important opportunity? You might be making a mistake.

More and more patients have the opportunity to access a growing portion of their electronic medical record directly through a patient portal. They can request medication refills and appointments, send emails to their care team, and even read the office visit notes generated by their doctors.

My employer does offer a patient portal but a number of my patients won’t take advantage of it. Sometimes they say that they don’t want to provide their email address. Elderly patients sometimes don’t have a computer at all. Sometimes they won’t say why they don’t want to enroll.

I do know that I like when that little box on my EMR dashboard is green, showing my patient uses the portal. I can email her directly about her test results and make sure all her questions are answered. She can see what medications and supplements WE think she’s taking and let us know if our records aren’t correct.

There was a report published recently that looked at online patient portal use. They found that over 60% of respondents said they did NOT use a patient portal. Most of those people also said they had never been offered one.

What I found interesting in this study was WHY people said they didn’t want to use an online patient portal. Patients wanted to talk to someone in person. Well, yeah! If I have something concerning or confusing going on I want to talk to a real person. But if all my labs are normal, shoot me an email. Oh, and also let me SEE my results (and download and print them too). That’s the bonus!

Clear and easy two-way communication between patients and their care team is very important. An online patient portal is one of many tools patients and physicians can use to facilitate communication. If you have the opportunity to sign up for an online patient portal please consider doing so!

QUESTION: Do you use an online patient portal? What has been your experience? If not, why not?

Share

Is It Pertussis, Or Just A Cough?

My husband and I got a notification from the county health department this week. A student at my son’s high school was diagnosed with pertussis.

My first thought was that s/he must have not been vaccinated. But then I looked into the data and found that isn’t necessarily so.

What is Pertussis?

Pertussis, or whooping cough, is a childhood illness that starts with typical cold symptoms and progresses to a horrible spastic cough. It is very dangerous for small children and can be fatal. 13 children in the US died from pertussis in 2017.

As a bacterial infection, pertussis does respond to antibiotics but only if they are started BEFORE the typical whooping cough begins. Unfortunately, before the typical cough starts it looks just like a cold. This is one of the reasons we vaccinate against it – there is no other way to prevent the awful, potentially fatal cough.

In case you are thinking “Oh, it’s just a cough,” here’s a video of a baby girl in the ICU with pertussis. And here’s a video of a 64-year-old man hospitalized with pertussis.

What about the vaccine?

I know you’re going to say “But Dr. Jen, if there’s a good vaccine available how does this happen?” The problem with the vaccine is that the immunity decreases over time. (The immunity you get from having whooping cough itself also appears to decrease over time, which is a scary thought.)

No vaccine is 100% effective, but the current vaccine is pretty good. Immunity is estimated at 80-90% over the first year and starting to wane about 4 years after vaccination. The pertussis vaccine was changed from whole-cell to acellular (no cells) in the 1990s because the whole cell vaccine had a lot of side effects. However, the new acellular vaccine is not as effective.

It is recommended that TDaP (tetanus, diphtheria and acellular pertussis) vaccine booster doses be given every 5-10 years. Unfortunately it is not indicated for adults over 65. Pregnant women and those who spend time with babies and small children should be particularly careful to get booster doses regularly.

Bottom Line

Even though the pertussis vaccine isn’t perfect it still does a nice job of reducing the risk of whooping cough in the US. According to the CDC, in 2015 there were about 20,000 cases of pertussis in the US and 6 deaths between 2014 and 2015. Worldwide it is estimated that there were 24 million cases of whooping cough and over 160,000 deaths in 2015. Most of these cases occurred in developing countries where vaccination coverage is low.

Community vaccination decreases the risk that someone will be exposed to pertussis. Personal vaccination decreases the risk that, if exposed, an individual will get sick. Because the most vulnerable individuals are babies under the age of 1 year (too young to be fully vaccinated) it is important that all of us get regular boosters.

We live in a country that vaccinates, and we all benefit from that. We all should roll up our sleeves and get vaccinated to protect our precious, vulnerable babies from pertussis.

Share

Merry Christmas!

My family and I are traveling this Christmas, but I wanted to take a moment to write to you. I’m hoping you have a wonderful, peaceful holiday with your loved ones!

I’ve been reminded of a few things today:

  • Traveling makes you crabby sometimes
  • People do crazy things when driving in construction traffic
  • North Carolina has even more orange barrels than Ohio
  • When you’re 6’4″ you don’t fit on a pull-out couch anymore
  • Eating sushi while driving is not recommended

However, I also was reminded that traveling with my favorite people in the world to see my OTHER favorite people in the world is really a lot of fun 🙂

God bless you and bring you a bring you plenty of joy this holiday season <3

Share

Menopause Symptoms And Quality of Life

Women who have reached menopause often feel as though they’ve traded one problem for another.  Sure, you don’t have to deal with the hassle of menstrual periods and worry about pregnancy anymore.  The hot flushes, night sweats, sleep problems, mood swings and vaginal dryness are not much improvement though.

Ask women who have menopause symptoms what their least favorite part is.  They will say the hot flushes and sweats at random times of the day and night.  They will tell you about the poor sleep and emotional roller-coaster.  They often WON’T tell you they have vaginal dryness and intolerable itching and loss of urinary control.  They usually won’t tell you they can’t tolerate intercourse with their partner anymore.

A lot of times they don’t tell ME that either.  I ask every woman at her physical about these symptoms if she is heading into menopause.  Women are embarrassed to discuss those parts of their bodies, even with their doctor.

There was a research study published recently in Menopause that asked women with menopause symptoms specifically about vaginal, vulvar and urinary symptoms.  Women who had had no menstrual period for at least a year were asked to fill out a questionnaire, and then had a gynecological exam.

Over 90% of the women were found to have vulvovaginal atrophy.  After the ovaries stop making estrogen at menopause, the skin and other tissues around the vagina and urethra become thinner, dryer and more fragile.  This is called atrophy and is often responsible for the itching, irritation and pain with sex that many women experience.

Many women know about hormone replacement therapy for menopausal symptoms and often refuse to take it.  Not as many women know that there are safer alternatives for vulvovaginal atrophy.  I usually recommend women try over-the-counter DHEA cream which they can get at the health food store or online.  One of my patients told me she tried Julva cream which she bought online and it helped a lot.  (Not an affiliate and I have no personal experience with it, just passing along a report from a happy patient.)

Topical estrogen cream is also very effective and is safe to use even in women who have had estrogen-sensitive breast cancer.  This is a prescription and usually requires an exam to make sure the diagnosis is right.  Many things other than vulvovaginal atrophy cause itching in pain (including infections and some skin conditions).

If you or a woman you love is suffering with itching, pain and/or urinary symptoms after menopause please don’t suffer in silence.  See the doctor and discuss your symptoms so you can get treatment.  Treatment works!

QUESTION:  Have you had problems with menopausal vaginal symptoms?  How has it affected your life?

Share