Millions of Americans have, at some point in their life, experienced shortness of breath, or dyspnea. Sometimes it’s a sign of being out of shape, sometimes it’s from being overly excited, but sometimes it’s due to a severe medical condition.
A study performed by the British Lung Foundation, found the following surprising statistics:
3 in 10 adults gasp for air after climbing a flight of stairs
4 in 10 gasp for air when trying to run to catch a bus
2 in 10 suffer from shortness of breath at some point during the day
25% have difficulty breathing during sex
Most adults experience shortness of breath at least 6 times a week
Study participants were given a survey asking about their activity and stamina, and 25% admitted to exercising less than once a week.
So are we out of shape? Or is shortness of breath a sign of significant disease?
Being “short of breath” is a response by both the heart and lungs to not enough oxygen getting circulated throughout the body. This could be due to a variety of factors:
Lung disease prevents blood from becoming oxygenated such as:
All of these may give the sensation of being “short of breath.” The body then detects the lungs can’t do their job so signals are sent to dilate bronchioles to increase oxygenation, increase respiratory rate and increase heart rate to rush more blood into the lungs.
Heart conditions that can cause shortness of breath include:
These above conditions could prevent the heart from doing its job, pumping blood, so if the body detects lack of oxygenated blood, signals get sent to increase heart rate and respiratory rate as well.
Anemia is a condition where the body lacks enough healthy red blood cells and/or hemoglobin responsible for bringing oxygen to organs and tissues. Suffering from anemia may result in shortness of breath.
If one is out of shape, as soon as the exercise, or climbing the flight of stairs, ceases, the respiratory rate will normalize within minutes. If it doesn’t or if other symptoms present with the shortness of breath, an underlying medical condition could be the cause.
Concerning co-symptoms include:
Although current guidelines recommend exercising with moderate intensity 150 minutes a week, any activity that induces shortness of breath or any of the above symptoms should be evaluated by a medical provider. If one has been inactive for years and wants to start becoming physically fit, its best to discuss a conditioning plan and current heart health with one’s medical provider with protocols on how to address shortness of breath during workouts.
Once hailed as a hero to curbing our deadly tobacco epidemic, vaping has now become more popular than smoking cigarettes among middle and high school students.
Last month the CDC reported that 4.3 percent of middle school students and 11.3 percent of high school students vape e-cigarettes. This week, results from a 2016 National Youth Tobacco Survey cite a 900% jump in use among teens from the years 2011-2015, with half a million middle school students and 1.7 million high schoolers having vaped within the last 30 days.
As more studies finalize, we’re anticipating these numbers to rise even higher.
Although electronic cigarette products are not to be purchased or used by those under 18, teen use of Juul and other vaping products have gone viral.
“RJ,” who asked to remain anonymous, is a senior at a local Las Vegas high school and states, “Almost everyone vapes. No one smokes anymore due to the health risks. They think vaping is safer and cooler. Smoking’s out, vaping - definitely in.”
Students who were never destined to pick up a stick of tobacco have become new recruits to the inhaling industry, being duped by the flavors and image of a “safe way to look cool.”
The Juul casing is particularly attractive. It looks like a flash drive so it/s sleek, smooth and easy to hide.
The flavored nicotine & e-juices, are a huge draw to those who would never tolerate the smoky taste of tobacco. These can include almost any taste preference such as chocolate, vanilla custard, strawberry, bananas foster and even margarita flavor.
At the start of the year a landmark study found teens who start vaping were 2.5 times likely to become tobacco smokers within a year, suggesting vaping is a gateway drug to later smoking cigarettes. The nicotine introduced in the e-cig can get children hooked fairly quickly such that they may be drawn to unfiltered cigarettes when vaping isn’t enough.
Vaping is not without its risks. Last month a study from Johns Hopkins Bloomberg School of Public Health revealed toxic levels of lead from the heating coil element leak into the vaporized fluid that is inhaled. The month before, a study from New York University found vaping to increase risk of heart disease and cancer. In 2015 a University of Minnesota study found e-cig vapor to include chemicals such as formaldehyde and various metals that are linked to bladder cancer. For more on these studies read here.
Even handling the e-juice has its risks. In March, John Conway, Assistant Principal of Jamestown High School in North Dakota, fell ill after confiscating a device and it’s juice from two high school students. He became nauseous, dizzy, had huge emotional swings and suffered from an intense headache, highlighting the danger e-juice could pose to young kids and pets.
As parents and schools try to combat the growing vaping epidemic, care needs to be taken with the handling and disposing of the concentrated nicotine liquid.
June 1st marks the official start of Hurricane season and runs until November 30th. September is usually the most active month. Hurricanes are categorized by their wind speed as designated as the following:
Category I have sustained winds of 74 to 95 mph
Category II have sustained winds of 96 to 110 mph
Category III have sustained winds of 111 to 130 mph
Category IV have sustained winds of 131 to 155 mph
Category V have sustained winds of over 155 mph.
In a given year, the Atlantic Ocean averages 12 hurricanes with 2 becoming “major” meaning a Category III or greater. Hurricane Katrina in 2005 was at one point a Category V and when it hit landfall it was a Category 3-4 (depending on the source), tragically killing over 1800 people and causing $108 billion in damage. The deadliest hurricane to ever hit US soil was the Great Galveston Hurricane of 1900 in which over 10,000 people died.
According to the National Oceanic Atmospheric Administration, The Weather Company and Colorado State University, the 2018 Hurricane season will be above average in activity, with possibly 14 named storms, 7 of which are expected to become hurricanes, 3 of which could become major hurricanes.
2017 was a particularly active hurricane season with three major hurricanes hitting the US. Dr. Phil Klotzbach, of the Colorado State University Tropical Meteorological Project, stated in 2017, “While the tropical Atlantic is warmer than normal, the far North Atlantic remains colder than normal, potentially indicative of a negative phase of the Atlantic Multidecadal Oscillation (AMO). Negative phases of the AMO tend to be associated with overall less conducive conditions for Atlantic hurricane activity due to higher tropical Atlantic surface pressures, drier middle levels of the atmosphere and increased levels of sinking motion.”
This year he states, “Last season had near-record warm sea surface temperatures in the tropical Atlantic.” He continues, “If El Niño were to suddenly develop, that would certainly knock down our forecast.”
El Nino is refers to a ocean-atmospheric interaction where sea surface temperatures rise near the equatorial Pacific, causing increase wind shear in the Atlantic equatorial region and has been linked to highly active hurricane seasons.
This year’s names for the 2018 Hurricane Season are the following
If I was going to predict on names alone, I’d forecast Helene, Isaac and Kirk to be doozies.
Preparation means starting early.
Make sure you keep informed of the latest alerts and official recommendations.
Evacuate when told to do so by city officials.
Many people will try to tough it out and unfortunately get walled up in their homes. So make sure you have adequate water (1 gallon per day/person for at least three days) and 1/4 – 1/2 gallon/water/ per pet, except the fish obviously.
Canned foods, flashlights, medical supply kit, batteries, blankets, cash, medications in water proof containers should be set aside for disasters, and put important papers in waterproof/fireproof casings.
According to ready.gov, its recommended to do the following:
Always have an emergency plan, practice it with family members, discuss with distantly located relatives how you will notify each other of your safety, and stay tuned to your radio, TV, wireless emergency alerts encase evacuations are ordered.
The EpiPen® auto-injector contains epinephrine, used during an emergency to treat severe allergic reactions, or anaphylaxis.
If one is allergic to an insect or food, a severe allergic reaction may ensue upon exposure, in which the immune system releases a flood of chemicals that can cause throat tightness, hives, lip and facial swelling, difficulty breathing, nausea, vomiting, low blood pressure, rapid heart rate, cardiac arrest and possibly death.
Epinephrine stimulates the heart to increase cardiac muscle contractility, cardiac output, subsequently raising the blood pressure. Additionally it relaxes the muscles surrounding the airways, allowing one to breathe easier and take in more oxygen. Moreover it helps to stop the release of additional immune chemicals.
The EpiPen® is manufactured by Mylan. Its cost made headlines when the EpiPen two-pack recently stickered for close to $600. Now generic forms are available costing anywhere from $109-$300 for a dual pack.
The disposable auto-injector, for an adult, delivers 0.3 mg of epinephrine, while the EpiPen Jr., used in pediatric populations, delivers 0.15mg of the medication. It can be self-administered, through clothing if necessary, into the thigh muscle in one smooth movement once the safety release is removed.
After 0.3 ml is administered during the single adult dose, the EpiPen® unit is discarded.
However many are not aware that 1.7 ml of solution remains within the cartridge. This could, in theory, be used for an additional 5 doses if in a remote, “wilderness” setting.
Dr. Arthur (Tony) Islas, Fellow of the Academy of Wilderness Medicine, and professor at the University of Nevada, Reno School of Medicine’s Department of Family Medicine, demonstrated how to extract the remaining doses from the autoinjector at the January Nevada Academy of Family Physicians meeting in Lake Tahoe.
Although it's recommended that all users follow the manufacturer’s labels, those trained in emergency and wilderness medicine may take the used cartridge, cut off the top plastic, and extract the syringe with the remaining fluid.
Dr. Islas states the initial 0.3 mg dose of epinephrine lasts for 20 minutes. For most people this allows plenty of time for emergency responders to come to the site of the victim. However, in a “wilderness” or remote setting, another dose may need to be administered during a very severe case of anaphylaxis.
Canadian neuroscientists suggest taking Ibuprofen daily may prevent the onset of Alzheimer’s.
IMAGE FROM ALZHEIMER’S ASSOCIATION
Researchers from the University of British Columbia believe those who take daily ibuprofen, a non-steroidal anti-inflammatory (NSAID), can decrease inflammation of the brain caused by the abnormal proteins that cause Alzheimer’s.
In 2004, Dokmeci et al suggested ibuprofen could delay Alzheimer’s onset as it protects neurons (nerve cells) and decreases inflammation of the brain.
In this study, Dr. Patrick McGreer and his team believe they can identify those early on who could benefit from the inexpensive, over the counter treatment.
McGreer is President and CEO of Vancouver-based Aurin Biotech. He and his team developed a saliva test that measures the protein Abeta42 (amyloid beta protein 42). In patients at risk of Alzheimer’s, they found levels of Abeta42 to be two to three times higher than normal. Abeta42 accumulates in the brain, causing inflammation and destroying nerve cells. Though previously believed Abeta42 is made exclusively in the brain, the saliva test suggests Abeta42 is made elsewhere in the body and can be detected years earlier. If the protein/peptide is found earlier and known to cause inflammation, McGreer and his team believe preventing the inflammation with ibuprofen could essentially prevent Alzheimer’s onset.
He states, “What we’ve learned through our research is that people who are at risk of developing Alzheimer’s exhibit the same elevated Abeta42 levels as people who already have it; moreover, they exhibit those elevated levels throughout their lifetime so, theoretically, they could get tested anytime. Knowing that the prevalence of clinical Alzheimer’s Disease commences at age 65, we recommend that people get tested ten years before, at age 55, when the onset of Alzheimer’s would typically begin. If they exhibit elevated Abeta42 levels then, that is the time to begin taking daily ibuprofen to ward off the disease.”
Daily ibuprofen would not, however, be without its risks. Gastric upset, ulcers, kidney disease and heart disease could occur with excessive NSAID use. The authors suggest a “low dose” but did not specify an exact milligram quantity.
Advances in Alzheimer’s treatment have met multiple obstacles as the neurodegenerative disease is difficult to detect early and the few treatments we do have are not very effective at slowing and reversing pathology. If protein deposition in the brain can be prevented early, we could potentially save the millions of people destined to get the disease. Currently 5.5 million people in the US have Alzheimer’s, and 44 million people are affected worldwide.
For more on the study read here.
Although flu cases have started to decrease since its peak early this winter, flu season may continue well into late Spring. The CDC warns a second wave of flu may be upon us as Influenza B is making the rounds.
Although first bombarded with H3N2 “A” strain influenza, Americans appear to be reporting more “B” flu cases this time of year, comprising more than 58% of cases lab-identified.
And young children are especially susceptible to B strain viruses.
5 pediatric flu-related deaths have been reported this week. The CDC cites 133 influenza-related pediatric deaths for the current 2017-2018 season.
According to the CDC:
Overall, influenza A(H3) viruses have predominated this season. However, in recent weeks the proportion of influenza A viruses has declined, and during week 11, influenza B viruses were more frequently reported than influenza A viruses.
Week 11 (March 11-17, 2018) has seen the following:
The proportion of outpatient visits for influenza-like illness (ILI) was 2.7%, which is above the national baseline of 2.2%. Nine of 10 regions reported ILI at or above region-specific baseline levels. Six states experienced high ILI activity; nine states experienced moderate ILI activity; New York City, Puerto Rico, the District of Columbia, and 17 states experienced low ILI activity; and 18 states experienced minimal ILI activity.
The trivalent and quadrivalent flu vaccines both protected against Influenza B as well as the A strains of H1N1 and H3N2 this year. However, flu shot efficacy proved poor for the 2017-18 season, being approximately 30% effective. Moreover, flu viruses can mutate as the season progresses.
It is not uncommon for one to be infected with the flu twice by two different strains circulating during the season.
What’s concerning is allergy season is beginning to overlap with flu season. Those with allergies may have a temporary weakness in their immune system, making them more susceptible to catching a cold or flu.
One of the most embarrassing, untalked about faux pas that occurs in families is the accidental witness of two parent figures having sex.
Our children see us make dinner, watch TV, argue about the in-laws, blame each other for the last cookie being eaten, drop each other’s toothbrush in the toilet (Ok I did that once!), so seeing, and hearing, two adults be intimate could potentially leave a mental scar for life.
And the moment the child is being visually and audibly traumatized, what do we do? We scream…..”GET OUT,” or “YOU’RE NOT SUPPOSED TO BE HERE!”
Then once dressed, or finished, we hunt down the child, who’s probably hiding in their room, to try to urgently rectify the situation. My guess is many of us fail at this as well.
Telling them “Mommy and Daddy were just having a conversation,” adulterates any competency in communication skills they might have developed over the past few years.
“Mommy and Daddy were having sex” might work, but the average child who just witnessed it may choose a life of celibacy that instant.
So what should we do?
I don’t care if you told them a million times not to enter your room, it’s YOUR fault the door was unlocked. Blaming the child makes the situation worse and traumatizes them more. Let them know you’re not mad and want to discuss what happened.
Children of all ages learn by mimicry. Watching parents have sex may startle not so much because of the sexual nature, but because it’s an act they don’t want to mimic.
In a child’s mind they think that the act they just witnessed is one they need to engage in later if they want to be a grown up like you…..and it scares them. Reassure them that they do not have to do “everything Mommy and Daddy do.”
If the child thinks “all adults” do what they just witnessed (position, sounds, tools, etc.) they will extrapolate and think their teachers, clergy, and grandparents do the exact same thing. This could be traumatizing as well. Let them know that you and your partner were experimenting and having fun and sex is different for everybody. Which brings us to….
Rather than labeling it sex, calling it Mommy and Daddy time is fine. Let them know that adults need private time and some things or acts may feel good and make them happy.
The child may be more concerned about being yelled at or caught doing something they shouldn’t than actually seeing you have sex. So their first priority is making sure this doesn’t happen again. Set boundaries such as, “When our door is closed, knock first,” will give them a concrete instruction to follow. They may then ask, “But, what happens if there is a fire?” - so let them know in an emergency, getting your attention is OK.
If your child says “I got it, I got it, yeah I understand,” that doesn’t necessarily mean he/she understands. It means they want to leave the conversation. That’s fine. You can always revisit it later. Sometimes during a drive in the car, topics such as this may be easier to discuss than at home with baby brother/sister giggling nearby. They’re a captive audience (unless they choose to jump out of the car), and you can smoothly transition to the subject by asking for permission to have a “big boy/big girl” talk.
Kids like two things, being asked permission by a parent and not being talked to like a little kid. Capturing their attention this way may allow you to then discuss what needs to be discussed.
One more bit of advice …..when the kids are home and you can’t control yourselves, keep it down, avoid loud machinery, and keep it under the covers……
The US Centers for Disease Control and Prevention advisory committee voted this week to return the FluMist, nasal spray flu vaccine, to the recommended options for the 2018-2019 flu season.
In 2016 it was not recommended and discouraged as they found its effectiveness against seasonal flu to be approximately 46%, when 65% efficacy was touted by the injectable flu shot. However this flu season, the current flu vaccine was found to be only 35% effective with one of the worst flu seasons in years taking the lives of healthy young adults and children.
Why was this season so severe? The H3N2 strain was the predominant one, notorious for bad flu seasons, and is crafty, able to mutate before the vaccine is finalized. Hence our flu vaccine was not able to be as close a match as desired.
The panel voted 12-2 this week to include FluMist as an option for medical providers to recommend against the upcoming 2018-2019 flu season.
Why was FluMist removed? Experts found it to be ineffective against one of the influenza A H1N1 strains. With its overall efficacy found to be lower than the flu shot it was deemed a less ideal option than the shot.
FluMist is a live attenuated vaccine that is not recommended in infants and pregnant women. It’s indicated for those between the ages of 2-49 and introduces a live, weakened version of the flu virus to incite an immune response. This differs from the injectable flu vaccine which uses killed versions of the flu strains to induce a flu response.
Children prefer the FluMist as the nasal spray offers a less painful option than an injection.
The FluMist Quadrivalent nasal spray, manufactured by MedImmune of AstraZeneca PLC, offers protection against 4 strains of flu including H1N1, H3N2 and two influenza B strains. According to FluMist’s prescribing information, the FluMist proved 90% effective against H3N2 as opposed to influenza B where it scored 44.3% effectiveness. Another review found its efficacy against H3N2 to be 79%.
Now that’s not to say the FluMist would have been immune to the vaccine issues experienced with this year’s flu shot as H3N2 is a highly virulent and mutable virus, and could have snowed the FluMist vaccine makers as well.
Yet we may need to consider that the FluMist may be more efficacious for some strains of the flu whereas the flu shot may better protect us against others. More research needs to be done in this area. As of now choosing which flu shot to get for the next flu season may be a crap shoot.
The World Health Organization (WHO) has issued a list of diseases that could potentially become worldwide deadly epidemics, and “Disease X” is included in this list.
The list includes the following:
Disease X represents a pathogen, not yet identified, that could turn and become one of the worst threats yet.
Citing biochemical warfare, gene editing, or Mother Nature’s ability to induce mutations, the WHO believes a benign pathogen that’s currently circulating could jump from animal hosts to humans, or evolve to become a highly virulent, infectious bug.
So the next “Disease X” could be:
This warning helps remind the globe of the unpredictability and speed at which new epidemics arise.
WHO stated, “Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.”
Moreover, diseases such as Zika and Ebola were discovered decades ago, but only recently did they cause fast-moving epidemics, despite smaller sporadic outbreaks in the past. So a currently deadly virus or bacteria that causes isolated cases, if the conditions are right, can ignite a cluster, expand locally in an outbreak, or increase further and become an epidemic.
And humans lack natural immunity to chemical agents and man-made pathogens, hence can be easily overpowered when exposed for the first time.
The formal designation of Disease X will hopefully incite researchers to prepare for what could be a surprise ambush by something that’s been either under our radar for some time or about to be created.
A coyote who attacked several people in Westchester County, NY this week has been captured and killed, testing positive for rabies.
Authorities believe another coyote is on the loose presumed to be rabid as well.
A police officer, a postal worker, two bicyclists and two dog walkers, with their pets, were attacked within a 24 hour period. Three sheep may have been mauled as well.
One dog and a sheep have died as a result of the attacks.
The two coyotes may have been travelling together, with one still being at large.
The attacks occurred in Yonkers, Hastings-on-Hudson, and possibly Somers, NY. Residents have been asked to avoid any wooded areas and keep their pets inside.
An animal with rabies may be very aggressive, more prone to attacks as opposed to one that is not infected.
Rabies is a disease caused by a virus and transmitted through a bite. Although dogs are the most common animal to transmit the virus to humans, it more commonly infects bats, coyotes, raccoons, skunks, jackals, mongooses and foxes.
The animal will be agitated and many times foaming at the mouth due to hypersalivation.
The virus affects the central nervous system, including the brain, and can therefore be fatal. Once symptoms appear it may be too late to save the affected animal or patient.
Once exposed to infected saliva the virus enters the peripheral nervous system (nerves in the limbs, outside of brain and spinal cord.) Then it travels to nerves in the muscle, replicates there and eventually works itself up to the brain. Stages occur as the following:
An incubation period is the time it takes from exposure until symptoms show. With rabies the average incubation period can range anywhere from a few days to years with the average lasting a few weeks. During the incubation period the patient may not know they are infected and the pathogen is multiplying and spreading.
The prodrome causes the patient to feel flu-like with symptoms including:
These symptoms may last anywhere from 2-10 days.
As the central nervous system (brain and spinal cord) become affected symptoms include:
A deep state of unconsciousness can occur within 2-7 days.
Despite ventilatory support for breathing, most die of cardiac and or respiratory arrest.
Although most infections prove fatal, some may survive with an injection of rabies immune globulin that binds to and prevents the virus from replicating. Then four – five vaccines are given over the next two weeks to help stimulate the immune system.
Wild animals suspected of having rabies during an attack will be euthanized and their brain tissue examined for rabies. For domesticated animals, whose suspicion is less, they will be observed for 10 days, and if they do not elicit symptoms, most likely do not have rabies.
If one has been bit by a wild animal who has not been caught, the medical provider may wish to treat empirically with post exposure prophylaxis.
Pet owners can start by vaccinating their pets. Avoiding wild animals, especially bats, preventing them from entering the house. Vaccinations are also available for those who work frequently with animals or travel to areas where rabies is more common.