Friday, August 31, 2007
Asthma attack like 'breathing through a straw'
A friend has suffered from asthma since he was a little boy. So when I asked him what it was like to have an asthma attack, he had lots of different responses. "It's like drowning without water... like you're breathing through a straw," he said matter-of-factly. Breathing through a straw? "Yeah", he said. "Try it sometime." So I did. I hiked down to the cafeteria, grabbed a straw and started walking back to my office, breathing through the plastic tube. By the time I got to the elevator, I was winded, and when I made it to my desk, I had to sit down. It wasn't easy. In fact, if I had to breathe like that for a long period of time, it would be debilitating.
Twenty-two million people suffer from asthma in the United States, and that number according is growing, according to the American Lung Association. Even though it's treatable, severe asthma attacks can destroy patients' lungs, put them in the hospital, or even in the morgue. The CDC estimates that more than 4,000 people died of complications from asthma in the U.S. last year. And according to pulmonary experts, that doesn't have to happen. They say no one should die from asthma.
In an effort to make sure asthma patients live active, full lives while minimizing the risk of their condition, the National Heart, Lung and Blood Institute of the NIH is recommending new guidelines for doctors and patients on how best to treat asthma. The recommendations are pretty lengthy, but there are a couple of key points. The NHLB wants to make sure doctors stay in touch with their asthma patients, because asthma symptoms can change as people get older. It also is asking patients to make sure they always take their medication, no matter if their symptoms have diminished. And the NHLB wants patients to recognize what triggers their asthma and to keep in touch with their doctors on a yearly basis, to make sure the medications they are using are working to full potential.
So why, you ask, would an asthmatic stop medication? Because the symptoms don't always linger. Sometimes asthma patients can go for years without having an attack. They get a false sense of security; they drop their meds, pitch their inhalers and go on with life. The problem is, asthma is chronic and it does return and when it does, it can be fatal.
Asthma can also be triggered by environmental factors and physical problems. Recent studies have shown that chronic conditions including reflux, obesity, sleep apnea, depression and even stress can cause frequent asthma attacks. And there are lots of things around us that can affect an asthmatic. Allergens are a biggie, because they cause allergic reactions that can set off an attack. Some common allergens are dust mites, mold, pollen and pet dander. And pollutants in the air are also major triggers. Chalk dust, smoke (especially secondhand smoke), even scented candles and perfumes can make asthma patients, especially asthmatic children, miserable. Asthmatics also have to watch how vigorously they exercise, because they become winded easily. Even the weather, especially cold and dry air, can cause asthma symptoms in certain people.
For my friend, asthma is part of his everyday life. He carries an inhaler. His family can handle the situation should he have an attack. The NHLB would like to see more families like my friend's, because they're aware of what the condition can do to their loved one. And according to physicians, knowing more about asthma is the best way to fight it.
Are you an asthmatic? Do you have a loved one who has asthma? Are there any recommendations you can make to help asthmatics live healthier lives? Let us know.
Thursday, August 30, 2007
Are you suffering from brain mold?
Whether you're one of those hot, exhausted people cleaning up after a flood or just fighting the good fight to keep that dark, dank film off the grout in the shower -- mold could affect your mood.
In what's being hailed as a first, a public health study led by Brown University finds a link between regular old household mold and depression.
The study included data from the World Health Organization of nearly 6,000 people in Europe.
Some of the science is intuitive - sure, if you have a moldy home, you're likely to feel out of control - and perceptions of control are linked to depression.
And yes, if you're depressed, you might not be the best housekeeper.
Exposure to mold can produce physical symptoms that are well-documented: For those with allergies, asthma or suppressed immune systems, mold can make you sick- and if you're sick from mold, that could certainly affect your mental state.
But researchers hypothesize there may be another possible pathway: mold on the brain. Molds are toxins - and researchers suspect (but haven't proven) these toxins may impede the function of the frontal cortex, that touchy-feely part of our brain that rules emotion.
As someone slightly household-chore-challenged, I wondered - just how much mold might it take to affect my mood?
It's hard to quantify, says lead researcher and Brown University epidemiologist Ed Shenassa, adding that while a little mold in the bath won't do it, the more mold your have, the more likely it is to impact emotion.
Let's be clear: What we have here is an association between mold and mood-- more research is needed to see whether mold does indeed directly cause depression.
But Shenassa says there is a clear takeaway from this study: "Healthy homes promote healthy lives." That means not letting carpets, wallpaper or ceiling tiles to get wet, and stay wet for more than 48 hours, and giving leaks in the roof, walls and plumbing the immediate attention they deserve, because they're all sources of mold.
The study appears in the October edition of the American Journal of Public Health.
Do you have mold - and has it affected your mind, and body? Tell us your story.
Wednesday, August 29, 2007
Rebuilding a storm-ravaged healthcare system
It is hard to believe that it has been two years since Katrina. I was at Charity hospital immediately after the storm and saw firsthand what happened to patients who had been forgotten. (Watch my 2005 report) Charity hospital was a New Orleans institution, not only training generations of doctors, but also taking care of the poor and indigent. I watched as these patients waited for days on top of a parking deck in the August sun, while doctors tried to keep them alive by pushing air into their lungs for hours on end. Many times, they lost that battle, and I saw patients die - while waiting to be rescued.
Over the last two years, I have been to New Orleans several times, focusing on the medical and health recovery. Truth is, I thought things would be better by now. I learned that Charity would never open again, reportedly too damaged by the floodwaters. I watched as a few hospitals re-opened, three out of seven, with only one near full capacity. I watched as so many mentally ill patients compete for remarkably few resources and still go untreated. Most shockingly, I watched as the death rates continued to go up, not down.
In fact, according to a new study published in an American Medical Association journal, the death rates went up 47 percent for months after Katrina hit. Doctors on the ground attribute it to untreated disease, few resources and absent physicians. Patients, who should have lived died premature deaths. They are still dying. I have spoken to patients, doctors working in the emergency rooms, and the man charged with rebuilding the health care system. While there is a cautious optimism, there is a real sense that too little has been done two years later. What do you think? Will New Orleans be able to rebuild their health care system? Any suggestion how to do that?
For more on the death rate in New Orleans since Hurricane Katrina, watch Dr. Sanjay Gupta's report on Anderson Cooper 360 tonight at 10 p.m. ET
Tuesday, August 28, 2007
Another benefit of statins? Not so fast...
This morning, you may read or hear about statin medications (cholesterol-lowering drugs) being shown to ward off Alzheimer's disease. While this could be welcome news for the millions who are at risk of developing the disease, I am urging caution. True, there is some older research that shows people who take statins may be less likely to develop Alzheimer's dementia. But when we investigated, we found that other touted studies like ACT, the Adult Changes in Thought study, found no apparent real benefit of statin medications on Alzheimer's dementia.
So, why all the fuss? A new study, which was supported by the National Institute on Aging, looked at the brains of people who had received statin medications and those who did not. More specifically, the researchers examined the brains of 110 people aged 65 to 79 after they died. They did find fewer of the tangles and plaques that are so often thought to be a sign of the memory-robbing Alzheimer's disease.
Still, no doctor is likely to be ready to prescribe statin simply for the purpose of preventing dementia. There are a few reasons. First of all, this study was rather small and it also wasn't randomized, meaning a population of people on statins wasn't directly compared with a group not on the medications. It is also important to remember that statin medications, like any drug, could have side effects. Some of the ones to watch out for are muscle pain, liver problems and nausea.
Statin medications are a multibillion dollar business. It seems the makers of these drugs are constantly coming up with new uses for them. What are your experiences with these medications? Did they work and did you experience any side effects? Would you take them to try to prevent Alzheimer's dementia?
Monday, August 27, 2007
Self-censoring linked to higher death risk
When I was in college, I volunteered at a shelter for abused women and children. Over the years, the faces would change, but the stories were similar. A disagreement with a husband or boyfriend often ended with a smack across the face, a shove into a wall or stinging words of hate. To survive, many of these women just took it and kept their mouths shut until they figured out a way to escape. Often women would tell me they didn't feel they had a "voice" in their relationships.
I thought about those ladies while reading about a new study on marriage, communication and death. The study, which appears in the July/August edition of the Journal of Psychosomatic Medicine, found that women who don't express themselves during disagreements with their husbands are FOUR times more likely to die compared with women who express themselves freely. The study's author, Dr. Elaine Eaker, says the 10-year study is the first to look at the effect of marital strain in relationship to the development of heart disease and death. The study also confirmed that marriage is good for men's health, but that unmarried men were twice as likely to die as married men.
So why is it so hard for some women to speak up? "We don't really know why women self-silence," says Dr. Eaker. "It may be some type of protection mechanism." Experts say most girls are taught not deal directly with their feelings. "Girls learn more 'relational forms' of aggression," says psychologist Dana Jack. She teaches at the Fairhaven College of Interdisciplinary Studies at Western Washington University and has written extensively about self-silencing. "Girls tell other girls, 'I won't play with you if you play with her." Boys on the other hand are taught to express their anger openly.
As a result, Jack says, some women are afraid of the consequences of showing anger during quarrels with their husbands. For some women, it's because of the threat of physical violence, but for others, there is a fear that if they speak up, their husbands will leave and their financial security will go out the door with them. So anger builds up and, like stress, it can damage the heart. Jack tells the story of a woman she once counseled in group therapy. "Lisa's" husband left her for a younger woman. One day, the husband showed up and took all the family albums. The new wife wanted them. Members of the group were incredulous when Lisa said she didn't put up a fight. She never did. Lisa told the group her kids knew she was angry only if she raised an eyebrow. After "self-censoring" for so long, Lisa lost the ability to express anger. She died from heart disease.
The bottom line, says Dr. Eaker, is that "self-silencing" women need to learn how to express themselves more constructively and put themselves in an environment where they feel safe to do so.
The Chinese philosopher Lao Tzu said "If there is to be peace in the home, there must be peace in the heart."
I want to know what you think. Do you self-silence in your relationships? Has marriage helped or hurt your health?
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