Health Care and Throat Nodules (Nodes)

Do you know anyone who has suffered from nodes or nodules on their vocal chords? Typically it comes from overuse of the throat and vocal chords by singers, public speakers and others who do a lot of talking or singing for a living. Many performers deal with it as part of their hazardous vocal needs. Sometimes it is called "Screamer's Voice."

According to the American Academy of Otolaryngology (AAO), the term vocal cord lesion refers to a group of noncancerous (benign), abnormal growths (lesions) within or along the covering of the vocal cord. Vocal cord lesions are one of the most common causes of voice problems and are generally seen in three forms; nodules (nodes), polyps, and cysts.

The AAO says that vocal cord nodules are also known as “calluses of the vocal fold.” They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped. More details are found at their site: http://www.entnet.org/content/nodules-polyps-and-cysts .

Nodules and polyps, according to the American Speech-Language-Hearing Association, cause similar symptoms:

·         Hoarseness

·         Breathiness

·         A "rough" voice

·         A "scratchy" voice

·         Harshness

·         Shooting pain from ear to ear

·         A "lump in the throat" sensation

·         Neck pain

·         Decreased pitch range

·         Voice and body fatigue

If you have experienced a hoarse voice for more than 2 to 3 weeks, you should see a physician. A thorough voice evaluation should include:

·         a physician's examination, preferably by an otolaryngologist (ear, nose, and throat doctor) who specializes in voice,

·         a voice evaluation by a speech-language pathologist (SLP), and

possibly a neurological examination.

The team will evaluate vocal quality, pitch, loudness, ability to sustain voicing, and other voice characteristics. An instrumental examination may take place that involves inserting an endoscope into the mouth or nose to look at the vocal cords and larynx in general. A stroboscope (flashing light) may be used to watch the vocal cords as they move. Much more detail on vocal nodes is located at this site: http://www.asha.org/public/speech/disorders/NodulesPolyps/ .

A doctor makes the diagnosis by examining the vocal cords with a mirror or a thin, flexible viewing tube (laryngoscopy), according to Merck Manuals. Sometimes the doctor removes a small piece of tissue for examination under a microscope (biopsy) to make sure the growth is not cancerous (malignant).

Treatment is to avoid whatever is irritating the voice box (larynx) and rest the voice. If abuse of the voice is the cause, voice therapy conducted by a speech therapist may be needed to teach the person how to speak or sing without straining the vocal cords. Most nodules and granulomas go away with this treatment.

Granulomas that do not go away can be removed surgically but tend to come back. Most polyps must be surgically removed to restore the person's normal voice. More info can be found at this website: https://www.merckmanuals.com/home/ear,-nose,-and-throat-disorders/mouth-and-throat-disorders/vocal-cord-polyps,-nodules,-and-granulomas .

According to the British Voice Association, if you have symptoms that suggest you may have vocal nodules:

·         Seek a medical opinion from a Laryngologist experienced with voice problems. The best solution is to ask your primary care doctor for a referral to a multidisciplinary voice clinic.

·         Whenever possible rest your voice and avoid speaking against noise, shouting or coughing violently.

·         Inhale steam to soothe irritated and swollen vocal folds.

·         Keep well hydrated and avoid inhaled irritants, such as smoke.

·         If you are a singer discuss suitable warm up exercises with your singing teacher and do not try to sing high and quiet – you will be doomed to disappointment until the nodules have resolved.

·         If your Laryngologist refers you to a speech and language therapist take up the option and work hard on the exercises you are given. Voice therapy is like physiotherapy or Pilates for the voice and may well be all you need to resolve the nodules.

·         If your Laryngologist suggests surgery, do not panic! It may well be the quickest and most effective way to deal with the problem. Ask your Laryngologist to explain exactly what they will do at surgery and why they feel it is the best treatment option. Discuss any worries you have openly.

·         Don't beat yourself up about it! Vocal nodules are not a crime or even necessarily the result of "bad technique". They are an injury, much as a marathon runner might sustain during training or a race.

Although vocal nodules remain a problem for professional voice users and may cause some cancelled shows, delays in training, a lot of hard work and inevitably some anxiety, they are very unlikely to herald the end of a career. More details are located at this site: http://www.britishvoiceassociation.org.uk/voice-information_vocal-nodules.htm .

Having nodules or nodes on your throat should not be taken lightly. Seek professional medical advice to help your situation. Your doctor can prescribe treatment or suggest more advanced options for care. Don’t continue to ignore the symptoms, and do what the doctor says!

Until next time.

Health Care and Diabetes

One of the most difficult health care management issues today is controlling the rise in cases of diabetes. Chronic disease management costs and care have increased substantially with the disease over the past decade.  The medical community has declared diabetes to be an epidemic within current society, and it appears to be getting worse each year.

However, in a sign that Americans may finally be turning the corner in the fight against diabetes -- and possibly obesity -- federal health statistics released this month show that the number of new cases of diabetes has dropped for the first time in decades and reported by HealthDay News. The decline wasn't sudden or dramatic. But, the number of new diabetes cases went from 1.7 million in 2009 to 1.4 million in 2014, according to the U.S. Centers for Disease Control and Prevention.

The CDC report offers some encouraging indications that Americans may finally be adopting healthier lifestyles. For example, fewer whites are now being diagnosed with diabetes -- typically type 2 diabetes, by far the most common form of the disease. But, blacks and Hispanics haven't seen significant declines in diagnoses even though a downward trend is starting to emerge, the CDC report showed. Educated Americans also have seen improvements in diabetes diagnoses, while the less educated have only seen a flattening in the number of new cases, the report found.

Today, diabetes takes more lives than AIDS and breast cancer combined -- claiming the life of 1 American every 3 minutes. It is a leading cause of blindness, kidney failure, amputations, heart failure and stroke. Living with diabetes places an enormous emotional, physical and financial burden on the entire family. Annually, diabetes costs the American public more than $245 billion, according to the Diabetes Research Institute Foundation.

Just what is diabetes? To answer that, you first need to understand the role of insulin in your body. When you eat, your body turns food into sugars, or glucose. At that point, your pancreas is supposed to release insulin. Insulin serves as a “key” to open your cells, to allow the glucose to enter -- and allow you to use the glucose for energy.

But with diabetes, this system does not work. Several major things can go wrong – causing the onset of diabetes. Type 1 and type 2 diabetes are the most common forms of the disease, but there are also other kinds, such as gestational diabetes, which occurs during pregnancy, as well as other forms. Much more information about this disease is located at this site: http://www.diabetesresearch.org/what-is-diabetes .

According to the American Diabetes Association, the following symptoms of diabetes are typical. However, some people with type 2 diabetes have symptoms so mild that they go unnoticed. Common symptoms of diabetes include the following:

·         Urinating often

·         Feeling very thirsty

·         Feeling very hungry - even though you are eating

·         Extreme fatigue

·         Blurry vision

·         Cuts/bruises that are slow to heal

·         Weight loss - even though you are eating more (type 1)

·         Tingling, pain, or numbness in the hands/feet (type 2)

Early detection and treatment of diabetes can decrease the risk of developing the complications of diabetes. Significant material about this health care problem is found at this website: http://www.diabetes.org/ .

Metformin is the standby drug for millions of people with type 2 diabetes, but a new study finds that adding it to insulin therapy won't boost blood sugar control for overweight teens with type 1 diabetes, according to HealthDay News.

In type 1 diabetes, which comprises about 5 percent of diabetes cases, the body is unable to produce the insulin it needs. So, supplemental insulin is a must for people with the disease. The new study was led by Kellee Miller of the Jaeb Center for Health Research in Tampa, Fla. As her team explained, young people with type 1 diabetes are at even higher metabolic risk if they become overweight or obese, especially in adolescence.

That's because both obesity and puberty may cause the patient to require higher levels of supplemental insulin, complicating blood sugar control, the researchers said. However, prior studies of how Metformin might affect blood sugar control in teens with type 1 diabetes have been inconclusive, Miller's team noted. More details on this news is located at this website: https://www.nlm.nih.gov/medlineplus/news/fullstory_155990.html

Managing diabetes is a challenge every day. There are so many variables to keep in mind -- food, exercise, stress, general health, etc. -- that keeping blood sugar levels in the desired range is a constant balancing act.

Men and women whose underlying biological clock does not match the sleep hours imposed by modern work schedules have metabolic risk factors that may predispose them to a higher risk for type 2 diabetes and heart disease, according to a new study published online in November in the Journal of Clinical Endocrinology and Metabolism. 

The work is the first to link so-called "social jet lag" with increased metabolic risk in middle-aged adults. Social jet lag refers to the disconnect between a person's natural circadian rhythm and the restrictions placed on it by social and work obligations. So, even your work habits can affect the possibility of contracting diabetes.

According to eDocAmerica, recent statistics also indicate that people with type 2 diabetes mellitus have nearly twice the risk of developing Alzheimer's disease as people without diabetes. While the exact reason for this is still being investigated, several interesting findings connecting the two diseases have emerged.

The American Diabetes Association reports that in 2012, 29.1 million Americans, or 9.3% of the population had diabetes. Of these, 90 to 95% have Type 2 diabetes. While both Type 1 and Type 2 diabetes are characterized by high blood sugar, the mechanism for the development of each type is very different. Type 1 diabetes is considered to be an autoimmune disease in which the cells within the pancreas that produce insulin are destroyed, resulting in a deficiency of insulin.

Without insulin to move sugar from the bloodstream into the body's cells, blood sugar rises. Type 2 diabetes, on the other hand, is considered a disease of "lifestyle". Poor diet, inactivity, and obesity are major reasons for its development. In type 2 diabetes elevated blood sugar levels are initially due to the body's inability to use insulin effectively. This is known as "insulin resistance" and is associated with higher than normal insulin levels.

In addition to significantly increasing one's risk of heart attack and stroke, Type 2 diabetes mellitus is associated with a number of other medical complications including:

·         Blindness from diabetic retinopathy

·         Reduced blood flow in the feet and legs requiring amputations

·         Kidney failure

·         Nerve damage and ulcerations of the feet

If these problems weren't enough, add in the recent findings that Type 2 diabetes may also contribute to the development of Alzheimer's disease.  More details about this subject are located at this site: http://weeklyhealthtip.blogspot.com/2015/11/the-link-between-type-2-diabetes-and.html .

Diabetes is a disease that still is being researched on a daily basis, and new issues are discovered on a regular basis as to the cause and treatment of it. There are varying degrees of health care issues with the disease, and management of it is serious. If you or someone you know has diabetes or may be symptomatic, see your doctor for a medical protocol. Don’t ignore its affects on your life—it can be deadly if left untreated.

Until next time. 

Health Care and Thanksgiving in 2015

It’s that time of year that families gather together to celebrate and give thanks for all their blessings, and look forward to spending time around a table laden with bountiful food and drink. Thanksgiving is a uniquely American holiday, and it has been celebrated in one form or fashion since the Pilgrims made nice with the Native American Indians in the 1620’s. About 400 years of  togetherness sometimes has its benefits, and sometimes not.

According to the History Channel, in November 1621, after the Pilgrims’ first corn harvest proved successful, Governor William Bradford organized a celebratory feast and invited a group of the fledgling colony’s Native American allies, including the Wampanoag chief Massasoit. Now remembered as American’s “first Thanksgiving”—although the Pilgrims themselves may not have used the term at the time—the festival lasted for three days.

While no record exists of the historic banquet’s exact menu, the Pilgrim chronicler Edward Winslow wrote in his journal that Governor Bradford sent four men on a “fowling” mission in preparation for the event, and that the Wampanoag guests arrived bearing five deer. Historians have suggested that many of the dishes were likely prepared using traditional Native American spices and cooking methods.

Because the Pilgrims had no oven and the Mayflower’s sugar supply had dwindled by the fall of 1621, the meal did not feature pies, cakes or other desserts, which have become a hallmark of contemporary celebrations. For a lot of detail about the history of this holiday, go to this site: http://www.history.com/topics/thanksgiving/history-of-thanksgiving .

One major component that is part of Thanksgiving is the food. People get in a festive mood and begin preparing days in advance for the main feast of the holiday, and other meals leading up to it as well as afterwards—it is a major event. The Food Network has some incredible ways to you to make your guests feel as though they’ve dined and experienced Nirvana. Here is your path to gourmet victory: http://www.foodnetwork.com/thanksgiving.html .

Additionally, as if that’s not enough, the New York Times has a significant Thanksgiving food “How To” cooking guide that shows every neophyte baker or aspiring gourmand the best way to prepare about any dish you wish: http://cooking.nytimes.com/thanksgiving . And Southern Living Magazine displays every possible Thanksgiving side dish you could want: http://www.southernliving.com/food/holidays-occasions/thanksgiving-dinner-side-dishes .

As well, there are parades and football games to watch on the big screen television or on your electronic devices. Thanksgiving Day parades are held in some cities and towns on or around Thanksgiving Day. Some parades or festivities also mark the opening of the Christmas shopping season. Some people have a four-day weekend so it is a popular time for trips and to visit family and friends.

Most government offices, businesses, schools and other organizations are closed on Thanksgiving Day. Many offices and businesses allow staff to have a four-day weekend so these offices and businesses are also closed on the Friday after Thanksgiving Day. Public transit systems do not usually operate on their regular timetables. Thanksgiving Day it is one of the busiest periods for travel in the USA. This can cause congestion and overcrowding. Seasonal parades and busy football games can cause disruption to local traffic. More information about what goes on in America is found at this website: http://www.timeanddate.com/holidays/us/thanksgiving-day .

Thanksgiving is one of the busiest travel seasons of the year, with tens of millions of people flying, driving and headed out of town. For some the journey is short, and for others it’s a major travel event. The American Red Cross provides very helpful advice if you’re bustling the family off to Grandma’s house for the holiday: http://www.redcross.org/news/article/Travel-Safety-Tips-for-Thanksgiving-Travelers .

And, you’ll especially want to be careful about fire safety during this holiday, whether in the kitchen when preparing meals or in the home when having a fire in the family den fireplace. ABC News has some great advice: http://abcnews.go.com/blogs/lifestyle/2014/11/5-fire-safety-tips-to-keep-in-mind-this-thanksgiving/ .

Even though Thanksgiving is celebrated as a wonderful day and season of giving thanks for all your blessings, there are some safety precautions you should take to ensure that your celebration doesn’t get derailed.

Turkey safety— the turkey is the biggest star. Make sure he evokes a round of applause—not a round of visits to the bathroom or, worse, the hospital.

Buy carefully.

·         Avoid fresh, stuffed turkeys; buy your turkey at least 1-2 days before you cook it, and keep it in the fridge; keep it in the freezer if you’ve bought it earlier.

Defrost properly.

·         Thaw in the refrigerator (every 4-5 lbs. needs one day to thaw).

·         Submerge the turkey (wrapped in leak-proof packaging) in cold water (every 1 lb. needs 30 minutes to thaw) that should be changed every half hour.

·         Microwave in a microwave-safe pan, removing any packaging and following the manufacturer’s instructions.

Cook immediately after thawing.

·         Avoid slow cooking or partially cooking the turkey.

·         At 165 degrees F at least.

·         Opt to cook the stuffing separately.

Use a thermometer on the innermost part of the thigh and wing, as well as the thickest portion of the breast, to ensure that the turkey is well cooked.

·         Don’t carve at once; give the juices time (20 min.) to settle.

·         Keep Clean!

·         Wash your hands with soap and water before and after handling food.

·         Keep all surfaces and utensils clean.

·         Never handle cooked and raw food together, in order to avoid cross-contamination.

·         Keep raw meat away from vegetables or other uncooked food.

The Thanksgiving dinner should be fun and festive, not fearful and dangerous. A significant amount of safety information about all things Thanksgiving is found at this website: http://www.atlantictraining.com/safety-tips/thanksgiving-safety-tips.php . As well, the CDC has some safety tips for you to follow about food prep: http://www.cdc.gov/features/turkeytime/ .

Also, according to the ASPCA, Thanksgiving is a time for friends, family and holiday feasts—but also a time for possible distress for our animal companions. Pets won’t be so thankful if they munch on undercooked turkey or a pet-unfriendly floral arrangement, or if they stumble upon an unattended alcoholic drink. Check out the following tips for a fulfilling Thanksgiving that your pets can enjoy, too, at this website: https://www.aspca.org/pet-care/general-pet-care/thanksgiving-safety-tips .

Overall, Thanksgiving is a time to celebrate your blessings and be thankful for all you have. Take time to remember what and who are important, and say a simple prayer to Him for that which provides the real reason you can give thanks.

Until next time.

Health Care and Legionnaires Disease

Several years ago a strange illness was diagnosed after many attendees of a conference in 1976 became very sick. American Legionnaires returning from a state convention in Philadelphia began to fall ill with mysterious symptoms including pneumonia and fevers up to 107 degrees. Several of the conference attendees died, and no laboratory tests could determine the cause of their illness, which quickly became known as Legionnaires’ disease. Over 30 people died. Many more were hospitalized for several weeks.

It took researchers six months to determine that the illness had been caused by a bacterium, Legionella pneumophilia. Doctors now know this illness usually succumbs to the timely prescription of proper antibiotics, according to the New York Times. The bacterium, which in this case was apparently spread from the hotel’s air-conditioning system, is a cause of pneumonia and other illnesses worldwide. A more detailed background story of this illness is available at this site: http://www.nytimes.com/2006/08/01/health/01docs.html?pagewanted=all&_r=0 .

CDC researchers named the species of bacteria Legionella pneumophila because the second word means "lung-loving" in Latin. This bacteria is actually very common in the natural world and only causes trouble when it gets into people's respiratory systems. It finds your lungs to be an especially comfortable place because they have conditions the bacteria prefer—they are warm and moist, according to ScienceClarified.com.

Legionella are found to exist naturally in stagnant water, and in the Philadelphia case, the CDC traced the outbreak source to the hotel's air conditioning system whose condenser was vented very close to its air intake system. This meant that the large air conditioning system, which had not been cleaned for some time, had the common Legionella germ growing in it, which people then inhaled after the organism had gotten into the air intake pipes. Read more at this site: http://www.scienceclarified.com/Io-Ma/Legionnaires-Disease.html

However, while the disease can be treated with antibiotics, many times it is misdiagnosed and it is estimated that only 5-10% of cases are ultimately reported. The fatality rate of Legionnaires’ disease has ranged from 5% to 30% during various outbreaks and can approach 50% when treatment with antibiotics is delayed. More information about the history of Legionnaires’ Disease is available at this website: http://www.thelegionnaireslawyer.com/history-legionnaires-disease/ .

According to the Centers for Disease Control (CDC), Illness caused by Legionella continues to be detected, now more than ever. Each year, it is estimated that between 8,000 and 18,000 people in the United States need care in a hospital due to Legionnaires' disease. More illness is usually found in the summer and early fall, but it can happen any time of year.

Legionella is a type of bacterium found naturally in fresh water. When people are exposed to the bacterium, it can cause illness (Legionnaires’ disease and Pontiac fever). This bacterium grows best in warm water, like the kind found in:

·         Hot tubs

·         Cooling towers (air-conditioning units for large buildings)

·         Hot water tanks

·         Large plumbing systems

·         Decorative fountains

Cooling towers use water to remove heat from a process or building. They are often part of the air conditioning systems of large buildings. In contrast, home and car air conditioning units do not use water to cool, so they do not aerosolize water (spread small droplets of water in the air) and are not a risk for Legionella growth. More info is located online at this site: http://www.cdc.gov/legionella/about/history.html .

Patients with Legionnaires' disease have pneumonia and in addition may have clinical findings suggestive of a systemic disease, according to this website: Open-Access-Biology.com .The symptoms and signs of the disease are often quite variable. The majority of patients have fever, which is usually one of the earliest signs of the illness. Accompanying the fever may be anorexia, myalgia, rigors, and headache.

Clinical diagnosis also may indicate chest pain, shortness of breath and cough may or may not be prominent findings. The cough may or may not be productive, and when it is productive the sputum can be bloody, purulent, or scant and mucoid. In some patients the absence of purulent sputum production, chest pain and cough may fool clinicians into discarding pneumonia as a possibility. When chest pain and haemoptysis are prominent the patient may be suspected of having a pulmonary infarction.

Abdominal pain, diarrhea, nausea and vomiting may occur as well, symptoms that have led to consideration of intra-abdominal infections and inflammatory conditions such as appendicitis, peritonitis, abscesses, inflammatory bowel disease and diverticulitis.

Elderly and immune-compromised patients may not have fever or findings that localize to the lung. Confusion and memory loss are common presenting findings. Much less common are frank encephalopathy, focal neurological findings, seizures and meningitis. A deep dive into the clinical analysis of all aspects of Legionnaires’ Disease can be found at that same site: http://www.open-access-biology.com/legionella/edelstein.html.

According to OSHA, some people have lower resistance to disease and are more likely to develop Legionnaires' disease. Some of the factors that can increase the risk of getting the disease include:

·         Organ transplants (kidney, heart, etc.)

·         Age (older persons are more likely to get disease)

·         Heavy smoking

·         Weakened immune system (cancer patients, HIV-infected individuals)

·         Underlying medical problem (respiratory disease, diabetes, cancer, renal dialysis, etc.)

·         Certain drug therapies (corticosteroids)

·         Heavy consumption of alcoholic beverages

Early treatment reduces the severity and improves chances for recovery. The drugs of choice belong to a class of antibiotics called macrolides. They include azithromycin, erythromycin, and clarithromycin. In many instances physicians may prescribe antibiotics before determining that the illness is Legionnaires' disease because macrolides are effective in treating a number of types of pneumonia, according to OSHA.

Avoiding water conditions that allow the organism to grow to high levels is the best means of prevention, according to OSHA. Specific preventive steps include:

·         Regularly maintain and clean cooling towers and evaporative condensers to prevent growth of Legionella. This should include twice-yearly cleaning and periodic use of chlorine or other effective biocide.

·         Maintain domestic water heaters at 60°C (140°F). The temperature of the water should be 50°C (122°F) or higher at the faucet.

·         Avoid conditions that allow water to stagnate. Large water-storage tanks exposed to sunlight can produce warm conditions favorable to high levels of Legionella. Frequent flushing of unused water lines will help alleviate stagnation.

If you have people living with you who are at high risk of contracting the disease, then operating the water heater at a minimum temperature of 60°C (140°F) is probably a good idea. Consider installing a scald-prevention device. More detailed information is located at this website: https://www.osha.gov/dts/osta/otm/legionnaires/faq.html .

Legionnaires’s Disease can be deadly if not properly diagnosed. Any incident you experience of flu-like symptoms, especially if you’ve been traveling, should be reported to your doctor or a health care professional. Don’t take chances that it may be something minor like a cold or other type of nominal illness. Not many individuals contract this disease, but those who do should take immediate action to get prompt medical attention.

Until next time. 

Health Care and Dizziness

Being dizzy is symptomatic of several medical or underlying health issues. Dizziness can be caused by different reasons and should never really be taken lightly, especially if you are experiencing it on a regular or sustained basis.

According to HealthLine, dizziness is the feeling of being lightheaded, woozy, or unbalanced. It affects the sensory organs, specifically eyes and ears. It can cause fainting. Dizziness is not a disease but a symptom of other disorders.

Vertigo and disequilibrium may cause a feeling of dizziness, but those two terms describe different symptoms. Vertigo is characterized by a feeling of spinning. Disequilibrium is a loss of balance or equilibrium. True dizziness is the feeling of lightheadedness or nearly fainting.

Dizziness is common. The underlying cause of dizziness is usually not serious. Occasional dizziness is nothing to worry about. However, frequent or sustained dizziness is another problem.

Seek medical attention if you have recurring bouts of dizziness with no apparent cause. Also seek immediate help if you experience sudden dizziness along with a head injury, a headache, neck ache, blurred vision, hearing loss, a loss of motor ability, a loss of consciousness, or chest pain. These could indicate serious issues. More detailed info can be found at this website: http://www.healthline.com/symptom/dizziness .

According to the Mayo Clinic, dizziness has many possible causes, including inner ear disturbance, motion sickness and medication effects. Sometimes it's caused by an underlying health condition, such as poor circulation, infection or injury. The way dizziness makes you feel and your triggers provide clues for possible causes. How long the dizziness lasts and any other symptoms you have also help pinpoint the cause. Factors that may increase your risk of getting dizzy include:

Age: Older adults are more likely to have medical conditions that cause dizziness, especially a sense of imbalance. They're also more likely to take medications that can cause dizziness.

A past episode of dizziness: If you've experienced dizziness before, you're more likely to get dizzy in the future.

Dizziness can increase your risk of falling and injuring yourself. Experiencing dizziness while driving a car or operating heavy machinery can increase the likelihood of an accident. You may also experience long-term consequences if an existing health condition that may be causing your dizziness goes untreated. Much more detailed material is located at this website: http://www.mayoclinic.org/diseases-conditions/dizziness/basics/definition/con-20023004.

Occasional dizziness is very common in adults, but it may surprise you to learn that vertigo — a related but more serious condition that makes you feel like the room is spinning as you stand still — affects nearly 40 percent of people over 40 at least once, according to the University of San Francisco Medical Center.

While dizziness can make you feel momentarily unbalanced, and ranges in severity from merely annoying to seriously debilitating, vertigo may be a major symptom of a balance disorder. It can also cause nausea and vomiting.  Additional facts about dizziness are available at this site: http://www.everydayhealth.com/news/10-surprising-facts-about-dizziness-vertigo/ .

According to the Vestibular Disorders Association, the body maintains balance with sensory information from three systems: vision,  proprioception (touch sensors in the feet, trunk, and spine), and vestibular system (inner ear). Sensory input from these three systems is integrated and processed by the brainstem. In response, feedback messages are sent to the eyes to help maintain steady vision and to the muscles to help maintain posture and balance.

A healthy vestibular system supplies the most reliable information about spatial orientation. Mixed signals from vision or proprioception can usually be tolerated. When sitting in a car at a railroad crossing, seeing a passing train may cause the sensation of drifting or moving, and feeling a soft, thick carpet underfoot as opposed to a solid wood floor can produce a floating sensation.

However, compensating for vestibular system abnormalities is more problematic. Just as a courtroom judge must rule between two sides presenting competing evidence, the vestibular system serves as the tie-breaker between conflicting forms of sensory information. When the vestibular system malfunctions, it can no longer help resolve moments of sensory conflict, resulting in symptoms such as dizziness, vertigo, and disequilibrium. Dizziness can also be linked to a wide array of problems and is commonly linked to blood-flow irregularities from cardiovascular problems. A lot of detailed material on this subject is available at this website: http://vestibular.org/node/2 .

Dizziness accounts for about 5% to 6% of doctor visits, according to the Merck Manuals. Dizziness may be temporary or chronic. Dizziness is considered chronic if it lasts more than a month. Chronic dizziness is more common among older people. People who have warning signs, those whose symptoms are severe or have been continuous for over an hour, and those with vomiting should go to a hospital right away. Other people may see their doctor within several days. People who had a single, brief (less than 1 minute), mild episode with no other symptoms may choose to wait and see whether they have another episode.

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the dizziness or vertigo and the tests that may need to be done. In addition to warning signs, important features that doctors ask about include severity of the symptoms (has the person fallen or missed work), presence of vomiting and/or ringing in the ears, whether symptoms come and go or have been continuous, and possible triggers of the symptoms (for example, changing position of the head or taking a new drug).

Doctors then do a physical examination. The ear, eye, and neurologic examinations are particularly important. Hearing is tested, and the ears are examined for abnormalities of the ear canal and eardrum. The eyes are checked for abnormal movements. Additional details are available at this site: http://www.merckmanuals.com/home/ear-nose-and-throat-disorders/symptoms-of-ear-disorders/dizziness-and-vertigo .

Pregnant women also experience dizziness. It's not uncommon to feel lightheaded or dizzy occasionally. When you're pregnant, your cardiovascular system undergoes dramatic changes. Your heart rate goes up, your heart pumps more blood per minute, and the amount of blood in your body increases by 40 to 45 percent, according to BabyCenter.com.

What's more, during a normal pregnancy, your blood vessels dilate and your blood pressure gradually decreases, reaching its lowest point in mid-pregnancy. It then begins to go back up, returning to its regular level by the end of pregnancy. Most of the time, your cardiovascular and nervous systems are able to adjust to these changes, and there's adequate blood flow to your brain. But occasionally they don't adapt quickly enough, which can leave you feeling lightheaded or dizzy or cause you to faint.

The first thing to do is lie down so you won't fall and hurt yourself if you do faint. If you're in a place where it's impossible to lie down, sit down and try to put your head between your knees. And naturally, if you're doing anything that might put you or others at risk for injury, such as driving, pull over and stop right away. Lying on your side maximizes blood flow to your body and brain. It may keep you from fainting, and could relieve lightheadedness altogether. Lots of helpful information on pregnancy and dizziness is located at this site: http://www.babycenter.com/0_dizziness-and-fainting-during-pregnancy_228.bc .

Dizziness is typically not harmful, unless there is a more severe underlying cause. It’s definitely inconvenient and can be stressful. However, if you feel that symptoms are more severe than usual for any reason, see your doctor, or go to the nearest medical facility to get checked out. It may be nothing to worry about, or it might be a health situation that needs definite medical attention and diagnosis by a healthcare professional. Be careful.

Until next time. 

Health Care and Pseudobulbar Affect

Have you seen those TV commercials lately with actor Danny Glover talking about a neurological disorder that causes people to break out into uncontrollable laughter or crying? This health care issue is known as pseudobulbar affect or PBA, and its debilitating characteristics effects tens of thousands of newly diagnosed cases per year.

Pseudobulbar affect (PBA), emotional lability, labile affect, or emotional incontinence refers to a neurologic disorder characterized by involuntary crying or uncontrollable episodes of crying and/or laughing, or other emotional displays. PBA occurs secondary to a neurologic disease or brain injury. 

Patients may find themselves crying uncontrollably at something that is only moderately sad, being unable to stop themselves for several minutes. Episodes may also be mood-incongruent: a patient might laugh uncontrollably when angry or frustrated, for example.

PBA episodes can be described in two key ways, according to PBAinfo.com:

·         PBA outbursts can be inappropriate: The crying or laughing episodes are inappropriate to the situation in which they occur. Sometimes these are spontaneous crying or laughing eruptions that don’t reflect the way a person is actually feeling.

·         PBA outbursts can be exaggerated: Another characteristic of PBA episodes is that though the crying or laughing may be appropriate for a given situation, they’re exaggerated – they’re more intense or last longer than the situation calls for.

One of the jobs of the brain is to figure out how we feel in the moment. That information is then sent down to the brainstem, also known as the “bulb.” The brainstem then sends signals to the face and other parts of the body that show emotion.

PBA is believed to be the result of a disruption of these signals. When people have certain neurologic conditions or brain injuries, it can cause damage in the brain tissue that creates a disconnection between the parts of the brain that express emotion and those that control emotion.

The result is the frequent outbursts of involuntary crying or laughing known as pseudobulbar affect. If you break the term down literally, “pseudo” means false, “bulbar” refers to the brainstem and “affect,” describes how the body shows mood or emotion. More details can be found at this website: http://www.pbainfo.org/science .

The side-effects for PBA sufferers include feelings of emotional exhaustion and, frequently, social isolation, according to Psychology Today. Without realizing that they have a medical problem, people with PBA often adapt their lives to avoid things that trigger the response, including interacting with others unless they absolutely have to. With social isolation comes more negative emotion that can over time manifest as depression.  

While all of this may sound like new knowledge about a recently discovered disease, PBA has actually been well-documented in the medical literature for more than 100 years, though it has been labeled at least ten different things during that time. More detailed material is found at this site: https://www.psychologytoday.com/blog/neuronarrative/201110/not-all-crying-is-depression-understanding-pseudobulbar-affect .

According to the National Institutes of Health, although it is most commonly misidentified as a mood disorder, particularly depression or a bipolar disorder, there are characteristic features that can be recognized clinically or assessed by validated scales, resulting in accurate identification of PBA, and thus permitting proper management and treatment. Mechanistically, PBA is a disinhibition syndrome in which pathways involving serotonin and glutamate are disrupted.

This knowledge has permitted effective treatment for many years with antidepressants, particularly tricyclic antidepressants and selective serotonin reuptake inhibitors. A recent therapeutic breakthrough occurred with the approval by the Food and Drug Administration of a dextromethorphan/quinidine combination as being safe and effective for treatment of PBA.

Side effect profiles and contraindications differ for the various treatment options, and the clinician must be familiar with these when choosing the best therapy for an individual, particularly elderly patients and those with multiple comorbidities and concomitant medications. A much more detailed clinical explanation and overview is available at this site: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849173/ .

To distinguish PBA from depression or other causes, doctors may administer a questionnaire rating episode frequency, duration, voluntary control and appropriateness to context and inner feelings. Additional details can be found at this website: http://alsn.mda.org/article/pba-symptoms-no-laughing-matter .

According to the American Stroke Association, in January 2011, the FDA approved a new drug called Nuedexta™ (dextromethorphan quinidine) specifically for PBA. In clinical trials, it proved effective against placebo, but it has not been compared directly to antidepressants. Analyzing data across studies, it appears to be faster acting than the anti-depressants with few side effects. Nuedexta™ is not recommended for patients with certain arrhythmias: prolonged Q-T interval, complete heart block, history of torsades de point (a type of ventricular tachycardia) or heart failure.

As with any new drug, there is a considerable cost difference when compared to older, off-patent medications. Nuedexta™ is manufactured by Avanir Pharmaceuticals and costs $200–300 for a month’s supply. The SSRIs mentioned in the article are $10–$12/month. Though off-patent antidepressants are often used in treating PBA, Nuedexta™ is the only prescription drug currently indicated specifically for PBA by the FDA. Avanir, like many pharmaceutical companies, does have a Patient Assistance Program. More detail on this medication and PBA is available at this website: http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/EmotionalBehavioralChallenges/Pseudobulbar-Affect-PBA_UCM_467457_Article.jsp

One of the best ways to deal with PBA is to tell your friends, co-workers, and family that you have it. Explain what PBA is and what causes it. Let the people around you know that you may have uncontrolled emotional outbursts. That way, when you suddenly burst into tears or start laughing they won’t be surprised or shocked. And you won’t have to always worry about losing control at the wrong moments, according to HealthLine.com.

You can gain some control over your symptoms with a few simple tricks. When you start feeling the urge to laugh or cry, try to distract yourself. Think about something different. If you’re crying, try to focus on something upbeat or funny. For example, you could think about a funny movie you saw recently. Take slow, deep breaths. And relax the muscles that start to tense up whenever you have an episode. More info is located at this site: http://www.healthline.com/health/multiple-sclerosis/pseudobulbar-affect#Medicines8 .

PBA can have an enormous impact on a person's social life. Emotional episodes caused by the disease can be embarrassing and can damage interpersonal relationships. The Brain Injury Association of America study indicates that 60% of people with brain injuries feel that PBA and its accompanying outbursts make it hard for them to initiate and maintain friendships. The disease was also the cited culprit in being housebound for 40% of people in the survey.

For caregivers of people with PBA, it can be difficult trying to deal with a person who feels isolated and alone because of their disease.  PBAinfo.org offers a few tips for caregivers to help them interact positively with emotionally explosive loved ones:

·         Let them know that you support them and they are not alone. Reassure them that many people suffer from the symptoms of PBA.

·         Remind them that their outbursts are caused by a physical disease, not a mental condition.

·         Indicate your willingness to listen to their frustrations and concerns.

·         Keep an "episode diary." By recording PBA episodes, you can ensure better communication with your doctor and help him or her make an accurate diagnosis.

According to the American Stroke Association, these episodes can strike a person up to 100 times a day. They can be a few seconds to a few minutes long. More information about this topic for seniors and others is available at this website: https://www.agingcare.com/Articles/crying-is-not-always-depression-148580.htm .

Psuedobulbar Affect has been identified in several million patients, both men and women. It is a disease that can be managed, but not readily identified unless the doctor knows what to look for and how to treat it. More people suffer every day from PBA. The good news is that there are therapies to help overcome PBA and its impact on the lives of those who have it. If you think you may be symptomatic, or know someone whom you may suspect exhibits the symptoms, see your healthcare provider to get a proper diagnosis.

Until next time.