Carbon monoxide is a silent winter killer

Carbon monoxide is a very sneaky killer. The poisonous gas has no odor, no color, no smell, and no taste.

Carbon monoxide is a gas given off by everyday fuel-burning items that we regularly use. Usually, using appliances is not a problem, but if there is improper ventilation in an area where an engine or other devices are burning carbon monoxide-producing fuels, carbon monoxide can build up to dangerous levels. Humans in the area can breathe it in and become poisoned.

Breathing in smoke from a house fire can also cause carbon monoxide poisoning. Because carbon monoxide is odorless, colorless and tasteless, a person can be exposed to it and not even know it.

This situation is especially dangerous for people who are sleeping or intoxicated. Carbon monoxide poisoning can more easily affect unborn babies, children, elderly adults, and persons with heart conditions.

The way carbon monoxide poisons a person is that the carbon monoxide molecule binds to hemoglobin in our blood, preventing the usual binding of oxygen to hemoglobin. Our blood typically carries oxygen to all the cells in our body. Without oxygen, our tissues and organs can become damaged and even die. A fresh and constant supply of oxygen is essential for life.

Every year, 16,000 people are rushed to the emergency room with carbon monoxide poisoning. Over 500 people die from it every year in the U.S. Most deaths from carbon monoxide occur in the winter, especially December and January.

The experts suspect that the numbers of deaths from carbon monoxide poisoning are much higher due to under-reporting. Less than 15 states require the reporting of carbon monoxide deaths, there are no good autopsy tests for carbon monoxide poisoning, and coroners rarely suspect it as a cause of death.

When certain fuels are burned, they will produce carbon monoxide. Common fuels that can produce carbon monoxide when burned include:

  • Gasoline
  • Wood
  • Propane
  • Charcoal

Common producers of carbon monoxide include:

  • Gas furnaces
  • Charcoal grills
  • Automobiles
  • Propane stoves
  • Portable generators

The symptoms of carbon monoxide poisoning are common and non-specific. They include:

  • Headaches
  • Nausea and vomiting
  • Weakness
  • Lightheadedness
  • Fatigue
  • Dizziness
  • Blurry vision
  • Shortness of breath
  • Confusion
  • Loss of consciousness

Depending on how much carbon monoxide one is exposed to, the results of carbon monoxide poisoning can cause:

  • Severe illness
  • Irreversible brain damage
  • Heart damage that can be life-threatening
  • Death of an unborn baby in pregnant mothers
  • Death

To prevent carbon monoxide poisoning, the Centers for Disease Control and Prevention suggests:

  • Annually, have a certified technician check your furnace/heating systems, water heaters, and other gas-burning appliances. Your utility company can help you with this.
  • Install carbon monoxide detectors on all levels of your home and outside of sleeping areas. Change the batteries with daylight saving time changes, twice per year. If the alarm goes off, leave the area immediately and call 9-1-1.
  • Seek immediate medical attention if you suspect your ill-feeling, dizziness or nausea is the result of being near a fuel-burning engine or appliance.
  • Never use a generator, a camp stove, charcoal grill, or any other fuel-burning device inside a home.
  • Never use fuel-burning devices near a window even if they are running outside.
  • Never run an automobile inside a garage, even if the garage door is open.
  • Never use solvents inside. Many can produce fumes that can break down into carbon monoxide, especially solvents used to thin and clean varnish and paint. Use only in a well-ventilated area.
  • Never burn anything in a fireplace if it is not properly open or vented to the outside.
  • Never use a gas oven to heat your home.

The treatment of anyone with carbon monoxide poisoning includes getting into fresh air and getting medical help immediately. At the hospital, treatment may require breathing pure oxygen or even placement into a special pressurized oxygen treatment chamber.

Carbon monoxide poisoning is a life-threatening medical emergency. It is a silent, poisonous killer that is common in the winter or anytime one is around burning fuels. If you think you or someone you’re with may have carbon monoxide poisoning, get into fresh air and seek emergency medical care immediately by calling 9-1-1.

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Experts agree: More activity, exercise mean better health

Last week, the federal government came out with new recommendations for exercise and health. It is the first update issued by the government on exercise in 10 years.

A unique new position of the proposal by the U.S. Department of Health and Human Services (HHS) is that exercise, even in small amounts, can make a big difference. “Sit less and move more. Whatever you do, it all matters,” said Brett P. Giroir, assistant secretary for the HHS, in a recent interview.

The new guidelines are much more flexible. Previously, they said exercise should take place in blocks of at least 10 minutes. Not anymore. Even brief periods of activity, including housework, can count toward the overall daily total.

The report, published in the Journal of the American Medical Association, also states ongoing concern that the minimum goals of exercise are not being met by 80 percent of Americans, and almost 40 percent of Americans are obese.

The new exercise guidelines (for adults) cite 150 to 300 minutes of moderate-to-intense activity per week or 75 to 150 minutes of vigorous-to-intense activity per week. Additionally, two days per week should include muscle and bone strengthening activities. For older adults, balance-improving work should occur weekly, too. These are goals consistent with the 2008 recommendations.

Moderate-to-intense activities include:

  • Brisk walking
  • Raking leaves
  • Vacuuming
  • Playing volleyball
  • Casual swimming
  • Casual biking
  • Dancing
  • Softball

Vigorous activities include:

  • Jogging
  • Running
  • Intense fitness class
  • Intense biking
  • Intense swimming
  • Basketball
  • Intense dancing
  • Carrying heavy groceries
  • Active soccer

Recommendations for kids and teens (ages 6-17) call for at least 60 minutes of intense or vigorous activity daily, combined with three days per week of muscle-strengthening exercises. New to the guidelines are exercise recommendations for preschoolers, ages three to five. The report calls for three hours of daily activity for this group too. Activity means active play.

One parent reports a successful way to pull children away from screen time is to structure active play with other children and in groups settings. Have their friends over and let them play without devices/screens.

Experts state that overweight preschoolers often continue to be overweight children, and the continued obesity becomes harder and harder to correct over a lifetime. The health status and activity level of small children, unchecked, can chart a course for decades.

The report also has exercise guidelines for pregnancy, for the post-partum period, and with disabilities as detailed in the reference provided below.

Doctors say that since the 2008 report, we have come to confirm and understand more than ever how vitally important movement and exercise are for our overall health benefits. Increased movement and exercise show improvements in:

  • Sleep
  • Cancer prevention (especially bladder, colon, esophagus, stomach, breast, endometrium, kidney and lung)
  • Anxiety
  • Depression and post-partum depression
  • Emotional health
  • Bone health
  • Cognitive function and academic success
  • Balance and fall prevention in older adults
  • Diabetes
  • Weight control and healthy weight maintenance

Researchers report that every year in the United States alone, we spend over one billion dollars in healthcare costs related to the problems of inactive lifestyles. Experts say that even exercising one day a week can have profound health effects.

“Being physically active,” the guidelines reports, “is one of the most important things people of all ages can do to improve their overall health.”

Remember, a journey of 100 miles begins with a single step. Talk to your doctor or a physical fitness expert to get started on an exercise program today. Think about including the whole family. Starting at just a few minutes a day and building on that foundation can have fantastic quality-of-life and health benefits for you and your family.

 

Reference: The Physical Activity Guidelines for Americans, bit.ly/2P2HlRz

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Everything you need to know about acute flaccid myelitis

This rare but very serious condition can cause paralysis in children

Dr. Crutchfield, I saw on the news that many Minnesota children are developing polio-like symptoms. What is this about?

The condition is called acute flaccid myelitis (AFM). It is a rare,
but very serious condition that affects a person’s nervous system via
the spinal cord. The results are a weakening of one or more of the arms
or legs or other muscles of the body. The weakening of the legs can
cause extreme difficulty walking and even paralysis. As a result, the
condition is very similar, clinically, to polio.

Some patients make a rapid recovery and others may have a lengthy,
perhaps even permanent paralysis. The prognosis can vary depending on
the patient. If a person does have AFM, it is essential to use all
treatment and rehabilitation options available.

We currently are uncertain of what causes AFM. There may be one
singular cause, or the condition may be a result of many causes that can
produce the same effects. Scientists postulate that it could be a
yet-to-be-identified virus or even environmental toxin. I would also
submit for consideration infectious proteins called “prions” that can
cause disease. Additionally, doctors are not sure of any factors that
would increase one’s risk of developing AFM.

What we do know

  • The condition is very rare, affecting less than one in a million persons in the United States.
  • There have been six documented cases of AFM in Minnesota, with over 20 suspected cases.
  • From August 2014 through September 2018, there have been about 390
    reported cases of AFM in the United States. (Reporting is voluntary, so
    this number is probably lower than the actual number of cases that have
    actually occurred.)
  • Most cases are of children. The average age is four, and 90 percent of cases occur in those younger than 18.
  • In no cases have doctors discovered a causative agent, including the polio virus.

Symptoms

  • Sudden weakness in the arms or legs
  • Facial droop
  • Facial weakness
  • Slurred speech
  • Drooping eyelids
  • Difficulty moving the eyes
  • Difficulty swallowing
  • Difficulty breathing. This is the most severe complication of AFM
    because a weakening of the muscle that controls breathing is a medical
    emergency that, without immediate support, can lead to death.

What the Centers for Disease Control (CDC) is doing

The CDC is actively investigating all reported cases of AFM and
working closely with doctors and other healthcare providers and health
departments to increase awareness of AFM.

CDC activities include:

  • Encouraging healthcare providers to be watchful and report suspected cases of AFM
  • Actively looking for risk factors for developing AFM
  • Testing specimens, including stool, blood, and cerebrospinal fluid, from alleged AFM cases
  • Working with researchers across the country and world to determine the cause of AFM
  • Disseminating all new information on AFM to doctors, healthcare providers, and health departments as it becomes available

What you can do

Because the condition mimics the result of a viral infection, it is essential to:

  • Practice good hand-washing techniques
  • Use appropriate mosquito repellants and protection
  • Ensure all vaccinations are up to date

If your child develops weakness of any limb, especially if they have
cold-like symptoms or other viral symptoms, take them to the doctor
immediately. The prognosis now depends on getting prompt medical care as
soon as possible.

Eventually, we will understand the cause of AFM. Until then, these
action steps are our best hope for prevention and a good recovery.

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Cutting one’s skin is a cry for attention and help

Many things happen behind closed doors and in private, sometimes
going completely unnoticed or unimaginable. One of those things is
self-harm, such as cutting, which occurs much more often than people
would expect.

Every year, one in five females and one in seven males engage in
self-injurious behavior. About 90 percent of those who participate in
self-harm began during their pre-teen or teenage years.

Approximately two million cases are reported annually in the U.S.
Imagine how many cases there actually are, since a majority of the cases
go unreported.

When cutting occurs, it usually manifests as horizontal scars across
the lower arms (as in the picture) and upper thighs. These are both
areas that can easily be covered with clothing.

Cutting isn’t the only form of self-harm that can be done. Other
types of harm that can be self-inflicted and warning signs to look out
for include:

  • Burning
  • Picking at or reopening wounds
  • Punching or hitting oneself
  • Inserting objects into the skin
  • Purposely bruising or breaking one’s bones
  • Pulling out one’s hair

There are several myths about cutting and other forms of self-harm,
which are important to recognize, understand, and even debunk.

First, cutting isn’t considered an attempt at suicide. According to the Diagnostic Manual of Mental Disorders (DSM-5), the authoritative guide for doctors, cutting is considered a non-suicidal self-injury disorder.

Second, it is not a mental illness. Cutting is a behavior indicating a
lack of coping skills for emotional pain, intense anger and
frustration. Even though self-injury brings a brief feeling of calm, it
is usually followed by guilt, shame, and the return of painful emotions.
This destructive cycle can become addictive to the point that it
becomes a compulsive behavior and difficult to stop.

There are a great many reasons why people engage in cutting. It can
be triggered by someone’s social environment. An overwhelming amount of
stress can lead someone to feel like there’s no way out or to feel so
empty that the only emotional release is through inflicting pain.

What you can do:

In order to help prevent someone from harming themselves, it helps to
understand the risk factors and to be aware of red flags of secretive
behavior. Risk factors include, but are not limited to:

  • Age (teenagers and young adults most common, although it can happen at any age)
  • Having friends who self-injure
  • Abuse (sexual, physical or emotional)
  • Social isolation/ loneliness
  • Mental health issues (i.e., borderline personality disorder, eating
    disorders, depression, anxiety disorders, substance abuse, conduct, and
    oppositional defiant disorders)

Common signs and symptoms might include:

  • Parallel linear scars on the arms
  • Fresh cuts, scratches, bruises or other wounds
  • Possession of sharp objects, like a razor
  • Difficulties with relationships
  • Persistent questions about personal identity, such as “Who am I?” and “What am I doing here?”
  • Emotional and behavioral instability, impulsivity and unpredictability
  • Statements of helplessness, hopelessness or worthlessness

Each of us has a responsibility to look out for friends, family and
acquaintances for any signs or suspicions of self-harm and to offer help
and support during whatever is compelling someone to hurt themselves.
If you have a friend, loved one or acquaintance who is self-injuring or
has revealed thoughts about self- harm, you must take it seriously.

You may feel shocked, scared, or even feel you’re betraying their
privacy. However, this is too big of a problem to ignore, and their
safety and well-being are the most important considerations.

If you know anyone injuring themselves, suggest they reach out to
someone they trust, such as their parents, friends, teachers, a
counselor, a physician or spiritual leader. Furthermore, always keep the
suicide hotline number close by: 1-800-273-TALK (1-800-273-8255). If
you find yourself in an emergency situation, this requires a quicker
but, most importantly, calm response by calling 911 or other local
emergency numbers.

Do not condemn or criticize anyone who has cut themselves for their
behavior. What they need most is support and healthy coping skills
rather than added negativity.

Preventing self-harm should be the utmost goal. There’s no fool-proof
way to do so, but there are various avenues that can be taken to
curtail it, including many seemingly small things anybody can do to look
out for others and make a real difference.

Help is available

If you have ever harmed or currently harm yourself in any way, or if
you’ve had suicidal thoughts, remember one thing: You can overcome
almost any challenge. If you have injured yourself and believe your
injury is life-threatening in any way, immediately call 911 or the
suicide hotline.

Most importantly, reach out to somebody, anybody. If you can’t talk
to your family members, talk to your doctor. If the doctor is not
available, there is always help available at the hospital’s emergency
room. Be it family, friend, minister or doctor, there is always someone
there to help you. Please reach out.

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Five principles for closing the learning gap in babies

When it comes to improving learning and increasing brain development in children, the earlier we involve infants, the better.

Sociologists are talking a lot about something called “the learning
gap.” This is a gap in knowledge and ability seen between different
groups of children. These groups can vary based on race or socioeconomic
status.

The key is identifying ways to close, or even eliminate, this
learning gap in children. Closing the learning gap is a passion for
Harvard professor Dr. Ron Ferguson. He was stunned to be able to
identify a learning gap in children as early as age two. As he has
stated, “Kids aren’t halfway to kindergarten, and they’re already well
behind their peers.”

Brain development techniques can be implemented by caregivers well
before any formal learning programs, like preschool, begin. Even more
encouraging is that these techniques are mainly low cost or free.

In a recent interview with NPR, Dr. Ferguson said, “Things that we
need to do with infants and toddlers are not things that cost a lot of
money. It’s really about interacting with them, being responsive to
them.”

So he developed a plan to help eliminate the learning gap in kids. It
is a series of five principles that all caregivers can implement to
increase early childhood development significantly. He calls these
principles “The Boston Five.”

His goal is to introduce “the Five” to the Boston area and then
across the country. According to a recent report on NPR.com, the “Boston
Five” principles are:

  1. Maximize love, manage stress. Babies pick up on
    stress, which means moms and dads have to take care of themselves, too.
    It’s also not possible to over-love or be too affectionate with young
    children. Research shows feeling safe can have a lasting influence on
    development.
  2. Talk, sing and point. “When you point at
    something, that helps the baby start to associate words with objects,”
    Ferguson explains. Some babies will point before they can even talk.
  3. Count, group and compare. This one is about
    numeracy. Babies love numbers and counting, and there’s research to show
    they’re actually born with math ability. Ferguson says caregivers can
    introduce their children to math vocabulary by using sentences that
    compare things: “Oh, look! Grandpa is tall, but grandma is short,” or
    “There are two oranges, but only three apples.”
  4. Explore through movement and play. “The idea is to have parents be aware that their children are learning when they play,” Ferguson said.
  5. Read and discuss stories. It’s never too early to
    start reading aloud—even with babies. Hearing words increases
    vocabulary, and relating objects to sounds starts to create connections
    in the brain. The Basics also put a big emphasis on discussing stories:
    If there’s a cat in the story and a cat in your home, point that out.
    That’s a piece lots of parents miss when just reading aloud.

Maximize love and manage stress, principle number one, is related to a
previous article I wrote on minimizing insecurities and maximizing
success (“A good childhood can prepare us for a good life,” March 21,
2018 MN Spokesman-Recorder). Evident and crucial situations
involving food, housing, and family insecurities can have devastatingly
adverse predictive effects on children.

For many people, this new understanding can open doorways to
addressing and overcoming obstacles that can be life-changing. In a
recent CBS news segment related to the issue of adverse traumatic
childhood events and the way they affect subsequent human behavior, the
correspondent, Oprah Winfrey, commented that this new way of looking at
and understanding human behavior was “absolutely life-changing and will
influence all of her future relationships.”

Principle number four must include music and art. These are essential
for the developing brains of infants, too. Studies have evaluated the
social, intellectual and emotional outcomes of young children who
participated in art forms such as music, art, dance, theatre/acting,
drawing and painting. Emerging research supports the intimate
involvement in these activities and a positive influence on brain and
intellectual development in children.

Dr. Ferguson has decided that the best way to spread the word on
these early learning techniques is to teach them where the babies and
parents are. This teaching includes hospitals, community centers, social
service organizations, pediatric clinics, barbershops and hair salons,
and churches.

When it comes to closing the learning gap in babies, they need love
and attention. The more interactions we have with little ones, the
better. Their brains are like super-sponges. They soak up everything
that comes their way.

Learn and use Dr. Ferguson’s Boston Five principles. Use them as soon
as your baby is born. By doing so, you will put your child in the best
position to enjoy a happy, successful life.

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Breast reduction surgery: For some, it’s a good option with exceptional results

Question: Dear Dr. Crutchfield, my sister recently had
breast reduction surgery. She said she is delighted with the
results. What is breast reduction surgery and why would anyone have it
done?

Breast reduction surgery is the process of having skin, tissue and
fat surgically removed from the breasts to reduce their size physically.
The medical name of the procedure is “reduction mammaplasty.”

Breast reduction surgery is often considered to reduce the stress and
pain on the shoulders, neck and back caused by having abnormally large
breasts. It can be done to decrease one’s breast size so they look more
proportional to their body.

Reduction mammaplasty can also improve a person’s self-esteem and
self-image and allow them to comfortably engage in many physical
activities, including various sports.

Breast reduction surgery is a serious surgery and should be
considered with a skilled physician and board-certified plastic surgeon.
The surgery has benefits, as well as possible complications and
risks. It is essential to come to a sound understanding with your
surgeon about realistic expectations and outcomes of the procedure.

Breast reduction surgery can be done at any age, including teen
years. It is preferable to do so when the breasts are fully developed,
but if there is enough reason to have the procedure done as a teen, a
second surgery can be done later in life when the breasts are fully
developed.

Men can also have breast reduction surgery, but for different
reasons. The rest of this discussion will focus on breast reduction
surgery for women.

Reasons to consider surgery

Reduction mammaplasty may be considered if a woman has large breasts and they are causing:

  • Back pain
  • Neck pain
  • Shoulder pain
  • Inability to participate in certain physical activities and sports
  • Chronic skin problems under the breasts
  • Difficulty in getting bras that fit
  • Poor self-esteem

In certain circumstances, reduction mammaplasty may not be appropriate. These include:

  • Persons with significant health problems such as heart disease or diabetes
  • If one is extremely overweight
  • If one wishes to avoid scars or has a history of keloid formation
  • If one smokes heavily (this is a relative contraindication)

Reduction mammaplasty may be postponed if one is considering
childbirth with subsequent nursing. Nursing after mammaplasty can be
difficult and challenging. There are special surgical techniques to
increase the possibility of nursing, but they are not 100 percent
successful. Many who consider mammaplasty will wait until after they are
done having children.

Also, reduction mammaplasty may be postponed if you are considering a
significant weight-loss program. Sometimes the weight-loss program may
cause enough of a reduction that surgery is easier; or, more commonly,
the operation will be most effective when breasts are at a stable,
smaller size.

Risks include:

  • Bruising
  • Bleeding
  • Swelling
  • Infection
  • Discoloration
  • Scarring
  • Inability to breastfeed or difficulty doing so
  • Loss of sensation in the area around the nipples

The procedure

Before the surgery, your doctor will perform a complete physical
examination with bloodwork. Additionally, they may take photos of the
breasts and order an imaging study (mammogram). You should stop
medications that will cause increased bleeding (such as aspirin or
similar NSAIDs).

Your doctor will review with you the risks, goals and expectations of
the surgery, including scarring and numbness. The procedure is done
under general anesthesia. The exact location of the tissue removal will
vary depending on how much tissue needs to be removed and the preference
of the surgeon.

The surgeon will use a particular pattern that allows the breasts to
maintain a natural shape and keep an optimal positioning of the nipples.
The surgeon will also recommend how long you will be in the hospital.
Sometimes one can go home the day of surgery, and sometimes it is better
to stay in the hospital for a short while (one or two days) after the
procedure. You will also be started on pain medications and antibiotics
to reduce the chance of infection.

After reduction mammaplasty, your breasts will be swollen and tender.
Your doctor may recommend special dressings and compression garments.
Plan on plenty of ice and loose, comfortable shirts.

You should plan on taking at least a week off of work or school. You
should also plan on no strenuous activities for at last one month after
reduction mammaplasty.

You can see results of reduction surgery right away, but keep in mind
that full healing, including swelling and maximum scar resolution, can
take many months, even up to one and a half years.

Breast reduction surgery can successfully relieve pain, stress and
discomfort; allow one to engage in previously prohibited activities and
sports; and offer one a higher degree of self-esteem. If a
physician deems it medically necessary, the cost of the procedure is
usually covered by health insurance.

If you think you are a candidate for breast reduction surgery, talk
to your doctor. Many of my patients have told me it was one of their
best decisions.

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Diverticulitis: challenging but manageable

Dear Doctor: A friend recently told me he was feeling under the
weather due to a flare of his diverticulitis. What is diverticulitis?

Diverticulitis is the process of inflammation of small areas in the
intestines. Occasionally, our intestines can develop small out-pouches
along the length. If one or more of the pouches become inflamed, the
condition is called diverticulitis.

Diverticulosis can occur anywhere along the length of the intestines,
but it is most commonly observed in the intestines that reside in the
left side of the abdomen. There are several reasons for diverticulosis
and, without any additional complications, the condition is considered
benign.

The inflammation can be relatively mild, involving only one or two
areas, to the involvement of extensive areas that can lead to abscesses
and breakdown and rupture of the intestines, a life-threatening
emergency.

Most people with diverticulosis are unaware of it. Diverticulitis, on
the other hand, can have very pronounced symptoms. In some cases,
diverticulosis may cause left-sided abdominal pain and cramping that is
relieved with passing gas or moving one’s bowels. The abdominal cramping
pain can be extreme and severe. Also, one may experience flu-like
symptoms and can even run a fever. Diverticulosis can also produce red
blood in the stool.

Diverticulitis can present as a few isolated attacks, or be
longstanding and chronic, without ever becoming entirely free of
inflammation. With chronic diverticulitis, a blockage of the intestines
can occur.

When this happens, stools can become thin, one can experience
constipation or diarrhea, and stomach cramping and bloating. With
extreme cases of intestinal blockage, one may also experience
excruciating abdominal pain and nausea and vomiting.

Without treatment, diverticulitis can cause pockets of infection that
can rupture into the abdomen and require immediate surgery, scarring
that can lead to intestinal blockage, severe bleeding (that may require a
blood transfusion), and a strange condition called a fistula.

A fistula occurs when an inflamed portion of the intestine
(diverticulitis) touches a neighboring organ and actually forms a
connection to that area. Most commonly, the connection can occur with
the bladder, and when that happens, the kidneys can get infected. Other
less common areas of fistula formation include connections to the vagina
and the skin.

Risk factors

  • Age over 40
  • Overweight
  • Consuming a diet high in red meat
  • Taking NSAIDS or steroids on a regular basis
  • Eating a diet high in saturated fats
  • Low water intake
  • Family history
  • Personal history of polycystic kidney disease

Diagnosis

It is essential to make sure the diagnosis is correct before
embarking on a treatment plan. Many conditions can cause abdominal pain.
Acute appendicitis, fibroids, other intestinal infections, and cancers
of the abdomen (colon and ovarian) are good examples of conditions that
need to be ruled out.

If a patient has a well-documented history of diverticulosis, the diagnosis of diverticulitis may be more straightforward.

Imaging studies can be quite helpful. The imaging study of choice is a
CT scan. If the patient is pregnant, a CT scan is not appropriate due
to the radiation exposure, so an MRI is an acceptable alternative.

Colonoscopy can also aid in the diagnosis of diverticulosis, but in
an acute flare of diverticulitis, colonoscopy should not be used because
the inflamed tissue can easily damage the scope as it travels along the
intestines. Colonoscopy should be done six weeks or longer after the
flare of diverticulitis has subsided. Rarely, exploratory surgery may be
needed to make the correct diagnosis of diverticulitis.

Treatment

The treatment of diverticulitis will depend on the severity of the flare-up.

For mild flare-ups, the treatment may be as simple as staying at home
for a while with bed rest, antibiotics by mouth to address any
infection, a liquid diet while inflammation and healing occur, and a
mild over-the-counter pain reliever, if needed.

If the flare-up of diverticulitis is severe, the affected person may
have to be hospitalized. At that time, IV antibiotics may be
administered with stronger, prescription pain control medications. If
there is an infected pocket, such as an abscess, it may have to be
surgically drained.

If there is a consideration of a perforation of the bowel contents
into the abdomen (peritonitis) or fistula formation, or even a blockage
of the bowels, surgery will be required. In some cases, the diseased
portion of the intestines can be removed and the intestines can be
re-joined without the bad segment. This rejoining of the sections will
allow patients to have regular bowel movements.

In another case, if there are large areas of involvement, the
intestines may be re-routed to empty outside of the body through a
colostomy, and intestinal waste drains into a bag next to the
stomach. In some of these cases, if the inflammation subsides, the
colostomy can be reversed, and the normal intestinal function can be
restored.

If one does have diverticulitis, several lifestyle modifications can be made to minimize episodes. These include:

  • Exercise regularly
  • Maintain a healthy weight
  • Minimize red meat consumption
  • Eat plenty of high-fiber fruits and vegetables
  • Drink plenty of water
  • Minimize saturated fat intake
  • Minimize steroid and NSAID use

Diverticulitis can be a challenging disease. Fortunately, it can be
managed. If you have diverticulitis, talk to your doctor about a regular
visit schedule, what to do with episodes of exacerbation, and ask for
advice on minimizing flare-ups.

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FDA approves first new sickle cell medication in 20 years

Endari™ (L-glutamine oral powder) recently (July 7, 2017) received
FDA approval as the first new medicine to treat sickle cell disease
(SCD) in 20 years. Endari has been shown to decrease the number of
sickle cell crises and hospitalizations in patients with sickle cell
disease. Doctors expect it to be available for patients in the late fall
of 2017.

Sickle cell disease affects millions of people worldwide. People with
African, Spanish, Mediterranean and Indian ancestry are at increased
risk. Approximately 120,000 infants are born with sickle cell disease
every year.

In the U.S., approximately one in 500 African Americans and one in
1,200 Hispanic Americans are born with sickle cell disease.
Approximately two million Americans — including about eight-to-12
percent of the African American population — are carriers of the
disease. Carriers of the disease are said to have the “sickle cell
trait.”

What exactly is SCD and what causes it?

“Sickle” red blood cells are curved like the farm tool of the same name.

SCD is an inherited condition where the proteins that carry oxygen
(hemoglobin) are defective. These defective proteins change the shape of
red blood cells from the normal round shape to an odd “sickle” shape.

The job of red blood cells is to carry oxygen throughout the body so
that the body can function at its best. Normally, red blood cells flow
smoothly through blood vessels. Without oxygen, the red blood cells form
the odd sickle shape and clump and block blood vessels and the tissues
downstream are damaged.

Signs of blockage, known as a “sickle cell crisis,” include
excruciating pain, anemia, skin ulcers, excruciating organ damage,
stroke, lung complications, and a syndrome known as “acute chest
syndrome” (ACS), which may be potentially fatal and is the leading cause
of death among people with SCD.

Because sickle cell disease is inherited (given from parent to
child), an affected person has to get one defective sickle cell gene
from each of their parents. If a person only has one sickle cell gene,
they are said to be a “carrier” and do not have the disease or effects
of the disease, except in very rare, extreme cases. As a carrier, you
can pass the gene on to your children.

When both parents possess the sickle cell trait, each pregnancy has
the following odds: a 25 percent chance of producing a child with sickle
cell disease; a 25 percent chance of producing a child with neither
sickle cell trait nor sickle cell disease; and a 50 percent chance of
producing a child with sickle cell trait.

When only one parent has SCD, and the other has the sickle cell
trait, each pregnancy has a 50 percent chance of producing a child who
has either the sickle cell trait or sickle cell disease.

How is SCD diagnosed?

A simple blood test can show whether a person has sickle cell
disease. Most states test for sickle cell disease before infants go home
from the hospital. Doctors cannot predict which symptoms a child born
with sickle cell disease will have, when they will start, or how serious
they will be. There are three sub-types of sickle cell disease with
similar clinical pictures.

Can SCD be prevented?

One can avoid or minimize the effects of the disease by avoiding
situations that can exacerbate the disease such as high altitude,
increased atmospheric pressure, low oxygen situations, cigarette smoke
exposure, severe dehydration and extreme exercise.

How is SCD treated?

Patients with sickle cell disease will have a lifelong struggle
fighting many associated health problems such as pain, skin ulcers,
infections, anemia, organ problems and stroke. Nevertheless, many
patients can have an excellent quality of life by learning to
appropriately care for themselves and effectively manage the disease.

The best treatment is to prevent the attacks associated with the
disease as outlined above. Early treatment includes daily antibiotics
from ages two months to five years to prevent infections. Immunizations
are also very important.

Many doctors will develop a pain management plan for their patients
with the disease. Sometimes, periodic blood transfusions are helpful to
reduce the risk of stroke and treat the symptoms of anemia (feeling weak
and tired). A bone marrow transplant may also be an effective treatment
in certain patients.

The most important thing a person with sickle cell disease can do is
make sure they are receiving regular medical examinations with a
physician who is an expert in treating the disease.

The good news

As mentioned above, the drug Endari has recently received FDA
approval as the first new medicine to treat SCD in 20 years.  Endari has
demonstrated its ability to reduce the most severe complications of
sickle cell disease (SCD) in both adults and children age five and
older. The FDA notes that some common side effects of Endari include
nausea, constipation, headache, stomach pain, cough and body pain.

Endari works by reducing stress damage to red blood cells, which also
reduces the formation of sickled blood cell shapes. Significantly, it
is only the second FDA-approved drug to treat SCD, a serious and
debilitating disease, and is now the first treatment available for the
pediatric population.

Action steps for anyone with SCD

Talk to your doctor about the new medication, Endari™ (L-glutamine oral powder). Ask if it is appropriate for you.Learn
what sets off painful events, such as dehydration, extreme exercise,
cold exposure, long plane flights, high altitudes, and cigarettes.

Take antibiotics as instructed. Maintain a complete immunization schedule.

If you have a child with sickle cell disease, make sure caregivers
and teachers know of their special requirements, including frequent
drinks and bathroom trips and avoiding overexertion and cold
temperatures.

Locate a good support group near you or via the internet to reduce the familial stress the disease may cause.

Develop a good working relationship with a physician who is
comfortable and good at managing the condition. Develop a pain
management plan with your doctor.

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Want to prevent illness and disease? Wash your hands!

The numbers are in, and the Great Minnesota Get-Together, also known
as the Minnesota State Fair, had a record number of attendees this year –
just over two million people! In fact, I was one of them; I attended
the fair this last weekend.

While there, I noticed how many surfaces we constantly touch:
handles, railings, knobs and, of course, money. I also noticed how few
people bothered to wash their hands when I used one of the
restrooms. This got me thinking: How do we best protect ourselves from
all the germs and illness around us? The answer is simple – good,
old-fashioned handwashing. I thought it would be good to re-visit a
“Doctor’s Advice” column from last year on the subject.

We have all seen it. At a public restroom a person bolts out without
washing their hands, or just as bad, splashes water on their hands for
three seconds and barely grabs a paper towel before bolting out the
door. Both of these are woefully inadequate.

Of all the things you can do to prevent illness and the spread of
disease, proper handwashing may be the easiest and most effective.
Repeated handwashing is the best way to prevent getting sick and to
prevent spreading disease. Hand cleansing can be done with soap and
water or with an alcohol-containing hand sanitizer.

Here are simple guidelines to properly wash your hands. Talk to your
children, friends and family members and make sure they get into the
good hand-washing habit, too.

When and why should we wash our hands?

Throughout the day our hands come into contact with a variety of
things such as people, phones, handrails, door handles, toys, keyboards,
steering wheels, pets and other dirty surfaces that can harbor germs
such as bacteria, viruses and other microbes.

Handwashing is especially important after going to the bathroom. By
then touching our eyes, nose and mouth, as we all do dozens of times
during the day, we can infect ourselves with the germs on our hands. It
is not possible nor realistic to keep our hands completely
sanitized. The goal is to wash our hands properly and frequently to
minimize the spread of germs and disease.

The most important factor in proper handwashing is washing the hands with lathered soap for a minimum of a full 20 seconds.

Always wash your hands before:

  • Preparing food
  • Eating food
  • Touching contact lenses
  • Caring for a sick person
  • Caring for the wounds of an injured person
  • Taking or giving medicine
  • Touching or putting your hands or fingers in your mouth, eyes or nose

Always wash your hands after:

  • Handling any raw food, especially meats
  • Going to the bathroom
  • Changing diapers
  • Nose blowing
  • Coughing or sneezing, especially into hands
  • Petting animals
  • Handling pet toys or pet waste
  • Changing the dressing on wounds
  • Caring for a sick person
  • Handling waste or garbage
  • Handling garden or household chemicals
  • Touching dirty shoes
  • Shaking hands with people
  • Touching anything that could be contaminated with germs
  • Whenever your hands look or are dirty

Handwashing best practices

It is generally best to wash your hands with soap and water. Follow these simple steps:

  • Use running water, not a basin filled with water.
  • Either cold or warm water will work.
  • First, thoroughly wet your hands.
  • Apply a liberal amount of soap to wet hands. All soaps work well.
  • Rub hands together vigorously and well to produce a good lather.
  • Be sure to completely wash your palms, wrists, back of hands, between fingers, and under fingernails if needed.
  • Rub your hands aggressively for at least 20 seconds, or the time it
    takes to count silently to 20-banana (i.e. one-banana, two-banana,
    three-banana… to 20-banana). The length of handwashing is the most
    important factor in proper handwashing and cannot be shortened.
  • Rinse well for at least a seven-banana count.
  • Use a clean paper towel, clean cloth towel or air dryer to dry your hands completely.
  • Turn the faucet off with a paper towel or elbow. Do not touch the faucet to avoid re-contaminating your clean hands.
  • As you are leaving a lavatory, do not touch the door knob. Once
    again, use a paper towel to open the door to avoid contaminating your
    clean hands by touching the knob.
  • In the winter, consider applying a good moisturizer to keep the hands from becoming irritated and chapped.

Alcohol hand sanitizers can be used

Alcohol-based hand sanitizers can work acceptably when soap and water
are not available. It is important to make sure the sanitizer has an
alcohol content of at least 60 percent. Be sure to cover your hands
completely with the sanitizer. Rub well until hands are dry.

Teach children good handwashing habits, too

It is so important to teach children the proper way to wash hands to
maintain good health. Encourage them to wash their hands frequently and
especially before all meals, after all toilet use, and whenever their
hands appear dirty.

Show them exactly how to wash their hands and review their
hand-washing performance on a regular basis to make sure they are not
“backsliding.” If they are too short to reach a sink, make sure to have a
children’s step-stool available for them.

Remember to have them count to 20-banana to make sure they are
investing enough time to clean their hands properly. Hand sanitizers, as
mentioned above, can be used when water is not available. There is also
an excellent hand-washing instructional video listed at the end of this
article to review personally and with family members.

A great way to stay healthy

Proper handwashing is the best way to prevent illness and disease.
The key is to wash hands correctly. That means using soap and water when
possible, lathering well, and doing it at least for 20 seconds.

Watch the hand-washing video, teach your children proper techniques,
and insist they always wash their hands. Proper handwashing may be the
very best thing you do for their good health and your own.

For an excellent video on proper handwashing techniques produced by the Centers for Disease Control, go to www.youtube.com/watch?v=lhmYLwDdPuE.

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Endometriosis: A painful yet treatable condition for women

Dr. Crutchfield, my cousin was recently diagnosed with endometriosis. What is endometriosis?

Endometriosis (en-doe-me-tree-OH-sis) is a painful condition that
occurs in women when cells that normally reside inside the uterus grow
outside the uterus in the pelvis. Normally, these cells reside in the
inner lining of the uterus called the endometrium.

During a regular menstrual cycle, under the influence of hormones,
especially estrogen, the endometrial tissue swells and prepares to
accept a fertilized egg. If a fertilized egg does not arrive, the
endometrial tissue is shed (the bleeding associated with a woman’s
period) and the monthly cycle begins over with new endometrial tissue in
the uterus developing for a possible pregnancy in the future.

With endometriosis, endometrial cells can become attached to ovaries,
fallopian tubes, and the lining of the pelvis (see picture above).
During the regular menstrual cycle, the tissue thickens, swells, and
sheds, but the ectopic (normal cells in an abnormal location)
endometrial tissue does not get shed during menstruation as it normally
would as a part of the inner lining of the uterus.

As a result, the tissue is trapped in place and can cause pain, scarring, and even adhesions in the pelvis.

Endometriosis is a common cause of pelvic pain and infertility.
Rarely, endometriosis can be the cause of a rare form of pelvic cancer.
It affects an estimated 12 percent of women (almost six million) in the
U.S. and is most common in women in their 30’s and 40’s, but can occur
any time after menstruation begins.

Symptoms

The primary symptom of endometriosis is significant discomfort and
pain. Frequently, women can experience discomfort and cramping during
menses. In endometriosis, patients report a much more intense pain and
discomfort than usual. The pain of endometriosis tends to worsen over
time and can be quite severe.

  • Painful periods (dysmenorrhea). The pain can also seem like it is coming from your lower back and abdomen.
  • Infertility. Endometriosis is a common cause of infertility.
  • Heavy menstrual bleeding.
  • Pain with urination and/or bowel movements. This presents most commonly during menses.
  • Pain with intercourse. This is common with endometriosis.

The severity of pain is not necessarily an indication of how severe
endometriosis is. Although endometriosis is associated with pelvic pain,
there are other medical conditions like ovarian cysts, inflammatory
bowel disease, and pelvic inflammatory disease that can cause pelvic
pain. A doctor must determine the correct diagnosis as sometimes a
patient can have more than one condition causing pelvic pain.

Cause of endometriosis

Doctors are not sure what causes endometriosis. Theories include a
backward flow of blood during a period to deposit endometrial tissue in
the pelvis, an abnormal response to hormones causing pelvic tissue to
become endometrial tissue, and endometrial tissue being present in the
pelvis since birth. There are several other hypotheses, also, but no one
is certain of the exact cause.

Endometriosis risk factors

  • Not ever giving birth
  • A family history of endometriosis
  • Starting menses at an early age
  • Short menstrual cycles
  • Having high levels of estrogen
  • Having an abnormally shaped uterus
  • Experiencing menopause at an older age

Diagnosis

A doctor will take a careful medical history and perform a pelvic
exam. Additionally, imaging studies like ultrasound or an MRI may be
obtained to assist in the diagnosis of endometriosis.

Also, a surgical procedure called laparoscopy can be performed. This
is where a very small incision is made in the abdomen and a special
viewing tool is inserted to inspect the areas for endometriosis
directly. During this procedure a sample of tissue can be obtained and,
sometimes, the area of endometriosis can be removed.

Treatment

Fortunately, many effective treatments are available. Initially, only
mild pain medications may be required. Because the endometrial tissue
is affected and activated by hormonal activity, especially estrogen,
other treatments may include hormonal modulation and hormonal therapy.

In severe cases (including some cases of infertility), surgery may
remove or reduce the affected tissue. In other instances in which
pregnancy is not an issue, a hysterectomy with removal of the ovaries
may be an option.

Endometriosis can be a challenging medical condition to diagnose and
treat. Fortunately, endometriosis can be managed with success. If you
have pelvic pain, see your doctor for appropriate evaluation, diagnosis,
and treatment plan.

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