May is Skin Cancer Awareness Month as 5 million cases of skin cancer are diagnosed each year in the United States. This week, Consumer Reports released its 2018 Annual Sunscreen Guide on the best sunscreens to offer protection against UV (ultraviolet) rays. They looked at 73 various sunscreen lotions, sprays and sticks, which touted 80 minutes water resistance and an SPF of 30.
The top 5 sunscreens reported are:
La Roche-Posay Anthelios 60 Melt-In Sunscreen Milk, $36 (lotion)
Equate (Walmart) Sport Lotion SPF 50, $5.00 (lotion)
BullFrog Land Sport Quik Gel SPF 50, $8.50 (lotion)
Coppertone WaterBabies SPF 50 Lotion, $9 (lotion)
Trader Joe’s SPF 50+, $6 (spray)
Sunscreens use chemicals to disperse or absorb UV rays. Inorganic compounds in sunscreen such a titanium dioxide or zinc oxide attempt to scatter the UV rays. Organic compounds such as PABA and oxybenzone attempt to absorb UV rays so they can’t damage the skin.
UVA rays penetrate deeply into both the epidermis and dermis. They can cause premature aging of the skin, wrinkles, and skin cancer.
UVB rays are shorter and primarily affect the epidermis. They are responsible for causing sunburns as well as skin cancer.
SPF stands for Sun Protection Factor. The higher the SPF, the less sun photons enter the skin and cause damage. SPF primarily measures the protection against UVB rays. We multiply the SPF factor by how long it takes one’s skin to burn by the SPF number to determine the protection factor.
In theory, an SPF of 30 suggests your skin, if it burns within 10 minutes without protection, will not burn until 300 minutes has lapsed (30 times 10). However, we find this isn’t always the case. People sweat or swim and the sunscreen dissipates. Moreover many don’t put on the proper amounts (see below.)
So instead we use SPF as a grade to how much protection the product can offer.
An SPF of 15 blocks 93% of UVB rays
An SPF of 30 blocks 97% of UVB rays
An SPF of 50 blocks 98% of UVB rays
As we see, the relationship is not linear, however the higher the SPF, the more protection we have against UV rays.
Although the SPF alludes to protection against burning, hence UVB rays, a sunscreen may still protect against both UVA rays and UVB rays if it’s a broad spectrum sunscreen.
At least one in three adults has high blood pressure and strokes are the 5th leading cause of death in the United States.
In May we raise awareness of both these conditions during American Stroke Monthand National High Blood Pressure Education Month.
Every 40 seconds, someone in the United States suffers a stroke. And high blood pressure puts one at risk of a stroke, as well as heart disease.
Here are your questions answered.
The top number, or systolic pressure, is the pressure the heart exudes during a beat or pumping of the blood.
Diastolic pressure is the pressure in your arteries between beats while the heart is “filling.”
Both numbers are equally important as elevation of either can increase one’s risk of cardiovascular disease.
High blood pressure has now been redefined as being greater than 130/80 mmHg, down from 140/90 mmHg. Last year it was guestimated that 42% of Americans would soon be considered “hypertensive.”
Chronic high blood pressure can be dangerous. It may cause:
The stages of blood pressure are defined in the chart above. At the elevated or early stages of high blood pressure the following lifestyle changes will be recommended:
As a family physician I would also screen for diabetes, high cholesterol, low thyroid, kidney disease and sleep apnea.
If blood pressure cannot be controlled and continues to rise, medications may be prescribed to decrease blood volume, or lower the heart rate, or relax the blood vessels.
A stroke occurs when an area of the brain does not get the proper oxygen and blood flow it needs. There are two major types of stroke: ischemic and hemorrhagic.
Ischemic strokes are more common than the latter and occur when a clot prevents blood flow to part of the brain. 80% of all strokes fall under ischemic. It is a likened to a heart attack, except the brain tissue is being deprived of blood and nutrients. Plaques commonly arise from arteriosclerosis that break off travel to the smaller vessels of the brain.
Hemorrhagic strokes are less common and occur when there is a bleed of one of the brain vessels. The bleed prevents blood flow into the brain since it is seeping outside the brain tissue, causing damage to nearby cells. The bleeds could occur from high blood pressure or aneurysms that rupture.
What are the signs of a stroke?
Since a clot or bleed usually affect one area of the brain, we see symptoms on one side of the body, many times its contralateral (opposite) side. We can also see central effects. The symptoms of stroke include the following:
If the stroke was caused by a clot (ischemic) immediate treatment includes dissolving/removing the clot. Aspirin is used initially and if within the proper time frame, tissue plasminogen activator (TPA). These clots can also be surgically removed and arteries widened to bring blood flow to the brain.
With a hemorrhagic stroke, we need to stop the bleed and improve flow to the brain. Controlling the bleed, bypassing the vessel, “clogging” the aneurysm with techniques such as “coiling” (endovascular embolization) are sometimes utilized.
Time is of the essence, so it's crucial to identify the warning signs and call 911 immediately. The American Stroke Association uses the acronym “FAST” (Facial drooping, Arm weakness, Speech difficulty, and Time to call 911). The sooner a stroke victim receives medical attention the better the prognosis.
The following put us at risk of having a stroke.
Avoid the following:
Experts report allergy season will worsen each year due to environmental changes.
Allergy season usually begins in March with the start of Spring and can extend to the Fall even leading to new Fall allergies.
Each year we find allergy season starting a few weeks earlier as temperature changes prompt early blooms.
Tree pollens start first in January and then taper off in April. Grass pollen starts to rise in February and March. Finally weed pollens join the party by the Spring and extends through the Summer and Fall.
Dr. Jeffrey Demain, Board Certified Allergist and Immunologist reported at the March meeting of the American Academy of Allergy, Asthma and Immunology the following, “We have higher temperatures and expanding levels of carbon dioxide.
“When you look at a pollen grain, there are certain proteins that cause the allergy, they are the allergenic peptides,” he said. “It’s been shown that in rising carbon dioxide, the allergenic peptide of each pollen grain goes up.”
Plants utilize carbon dioxide for respiration as humans use oxygen. The higher carbon dioxide levels, the higher the pollen counts and proteins in pollens that contribute to allergies.
The increase in storms may contribute to allergy season as well as moisture in the air causes pollen to swell and “explode” into multiple little pollen particles, smaller and easier to breathe in.
Moreover stagnant flood water may cause fungi, mold and spores to grow, also leading to allergies.
The Allergy Capitals Spring 2018 report found many cities are worse off this year than they were in previous seasons. McAllen, TX , Louisville, KY, Jackson, MS, Memphis, TN and San Antonio, TX ranked in the top 5 in “Most Challenging Places to Live With Spring Allergies.” The copy of the report is below:
Let’s review allergies…..
Allergies are the result of the immune response to a foreign particulate that our body senses. One could be allergic to pollen, dust, dander, food, insects, mold, metals, transfused blood, grafts, medicine and anything the body senses as a foreign intruder. Even though these may be individually harmless, a hypersensitivity reaction occurs as a result of their intrusion into the body. IgE antibodies find the allergen (intruder) and activate mast cells in the tissue and basophils in the blood. When these cells get activated, they release substances to help protect the body, including histamines, leukotrienes, and cytokines. These help the body attempt to sneeze and cough the allergen out, wall off the antigen, signal more antibodies, or produce tears and nasal secretions to flush it out.
Symptoms of allergies could include any or a combination of the following:
Colds may have very similar symptoms to allergies. However they are different. The common cold is caused by a virus. When one gets infected by the virus they may feel malaise, fever, and achy. This does not occur with allergies. Moreover, nasal secretions from allergies are usually clear. In a cold, the mucous could be thicker and with color. The same holds true with sputum. During an allergy the cough may have little to no mucous and if so, be light colored. Thick mucus could be a sign of an infection. An allergic sore throat will seem more dry and scratchy. A sore throat from a cold is more uncomfortable and less easy to soothe. Allergies may persist or be cyclical. Cold symptoms will usually subside after a few days and rarely persist longer than 10 days.
Yes and no. Allergies should not in and of themselves cause an infection. However they may make one more vulnerable for a virus or bacteria to take over. Hence a bronchitis, sinus infection, or pneumonia could uncommonly follow an asthma attack.
As stated previously, if one is susceptible to colds, an allergic attack could make them vulnerable. Moreover if one suffers from asthma, an allergy attack could incite an asthma attack. Very rarely would we see a life threatening anaphylaxis to an allergen such as pollen.
Avoiding, or decreasing exposure to the allergen is key. We suggest the following:
Local tree, ragweed and grass pollen counts can be obtained here.
A study out of Harvard’s TH Chan School of Public Health finds 5 simple lifestyle changes that can add 1-2 decades onto one’s life.
Researchers looked at lifestyle and diet of over 100,000 men and women apart of the Nurses’ Health Study and the Health Professionals Follow-up Study. They found sticking to these lifestyle changes at the age of 50 could give the average woman 14 extra years of life and the average man, 12.
Since cancer and heart disease contribute to hundreds of thousands of deaths a year, study authors suggest the following:
Since smoking has been long linked to early death, due to increase risk of arteriosclerosis and multiple types of cancer, avoiding tobacco products have been found to increase life expectancy.
Researchers encourage a healthy body weight, more specifically a BMI of 18.5 to 24.9 kg/m2.
Obesity has been linked to diabetes, heart disease and multiple cancers, so a healthy diet is paramount.
Diets rich in vegetables, low sugar fruits, whole grains, fish and healthy fish oils have been found to decrease risk of diabetes, obesity, heart issues and various cancers.
Avoiding excess salt, sugar, and saturated fats are key.
30 minutes a day of moderate to vigorous activity daily has been recommended by multiple medical associations. I would encourage making sure one’s medical provider evaluates heart health before engaging in vigorous activity. But walking, swimming, household chores, dancing, and many other activities fall under “moderate activity” that can be safe and provide multiple health benefits.
Moderate drinking is defined as no more than one drink a day for women, two drinks a day for men.
Image above from CDC
However, the health benefits of alcohol consumption are controversial, as many studies have linked alcohol consumption to cancer. Moreover, the sugar levels in alcohol can contribute to diabetes and obesity.
Another study suggests artificial sweeteners can increase one’s susceptibility to getting diabetes.
Research led by Dr. Brian Hoffman from the Medical College of Wisconsin and Marquette University, looked at rats who were fed artificial sweeteners and found they had changes in their fat and energy metabolism such that fat levels increased and protein was instead broken down to provide much-needed fuel. Diabetes occurs when people cannot break down and utilize sugar correctly (more discussed below).
This isn’t the first time artificial sweeteners have been linked to a glucose metabolism disorder. In October 2016, researchers at Karolinska Institute found two diet drinks a day DOUBLES one’s risk of diabetes.
These studies are concerning as many people prone to high blood sugar opt for the “sugar-free” beverages, thinking they are protecting their health, when in fact they could be hurting it.
Why would artificial sweeteners have such an effect? One theory is our mouths and hence minds think something very sugary is coming down the pike. Artificial sweeteners can be anywhere from 150-500 times sweeter than actual sugar. So the pancreas and other organs may ready the body for this huge anticipated “sugar load.” When no sugar actually comes down the gullet and into the intestine to be absorbed, the body may eventually take a “boy who cried wolf” stance and not mount appropriate responses later. Diet soda has been associated with weight gain, maybe due to the body’s metabolism slowing down as a result it feels it is “starving” when real food is not coming down the gut.
Another theory suggests sweeteners may alter the gut microbiome which has been discovered to be instrumental in a variety of physiological processes, including metabolism. Another suggestion has been that sweeteners may interfere with the pancreas doing its optimal job by enhancing resistance to its main hormone in glucose metabolism, insulin.
Diabetes is a disease in which the body doesn’t utilize and metabolize sugar properly. When we consume food, its broken down into proteins, nutrients, fats, water, and sugar. These components are necessary for cell growth and function. They get absorbed in the small intestine and make it to the bloodstream. In order for a cell to utilize sugar, it needs the hormone insulin to help guide it in. It’s similar to a key that fits in the keyhole of the “door” of the cell, opening it up so sugar can enter. Insulin is produced in the pancreas, an organ that receives signals when one eats to release insulin in preparation of the sugar load coming down the pike.
So I imagine our mouth like a waiting room, the blood stream like a hallway, and the cells of the body the rooms along the hallway. Insulin is the key to open the cells’ “doors” allowing sugar to enter. If the sugar does not get in, it stays in the bloodstream “hallway” and doesn’t feed the cell. Weight loss occurs, and individuals may become more thirsty as the sugar in the blood makes it fairly osmotic, something the body wants to neutralize, reduce. The kidneys are going to want dump the excess sugar, so to do so, one would urinate more, again causing thirst. So when a diabetic loses weight, urinates more frequently and becomes thirsty, you now understand why.
Type I Diabetes, previously called insulin dependent or Juvenile diabetes, occurs when the pancreas doesn’t produce insulin, possibly from the immune system destroying the cells that produce the hormone. When this occurs there is rapid weight loss and death could occur if the cells don’t get the sugar they need. Insulin has to be administered regularly.
Type II Diabetes, previously called non-insulin dependent or adult-onset diabetes, occurs in those who began with a fully functioning pancreas but as they age the pancreas produces less insulin, called insulin deficiency, or the insulin produced meets resistance. This is the fastest growing type of diabetes in both children and adults.
Type IIIc diabetes may occur in individuals who suffered damage to their pancreas. Inflammation/infection of the pancreas (pancreatitis), a pancreatic tumor, or surgery affecting the pancreas may destroy the beta cells that produce insulin.
Cardiovascular disease – Sugar is sticky, so it can easily add to atherosclerotic plaques.
Blindness – high sugar content draws in water to neutralize and small blood vessels in the eye can only take so much fluid before they burst. Moreover, high blood sugar weakens blood vessels.
Kidney disease – the kidneys work overtime to eliminate the excess sugar. Moreover, sugar laden blood isn’t the healthiest when they themselves need nourishment.
Infections – pathogens love sugar. Its food for them. Moreover blood laden with sugar doesn’t allow immune cells to work in the most opportune environment.
Neuropathy – nerves don’t receive adequate blood supply due to the diabetes-damaged blood flow and vessels, hence they become dull or hypersensitive causing diabetics to have numbness or pain.
Dementia – as with the heart and other organs, the brain needs healthy blood and flow. Diabetes has been found to increase risk of Alzheimer’s as well.
Insulin resistance, if using our hallway and door analogy, is as if someone is pushing against the door the insulin is trying to unlock. As we know, those with obesity are at higher risk for diabetes, hence fat can increase insulin resistance. It’s also been associated with an increase in heart disease.
If your fasting blood sugar (glucose) is greater than 126 mg/dl, or your non fasting blood sugar is greater than 200 mg/dl, you may be considered diabetic. Pre-diabetes occurs when the fasting blood sugar is between 100 and 125 mg/dl. If ignored, and the sugar rises, pre-diabetics may go on to develop diabetes.
1/3 of American adults are currently pre-diabetic. Experts predict 1/3 of US Adults will be diabetic by the year 2050. Although genetics plays a big role, decreasing ones sugar intake and maintaining an active lifestyle can help ward of diabetes.
Foods high in sugar and carbohydrates increase one’s risk, so a diet rich in vegetables and lean meats is preferred.
Cannabis plants produce cannabinoids, or chemicals that can induce an effect on the body. When cannabinoids are produced by a plant they are called phytocannabinoids. Humans produce their own cannabinoids, called endogenous cannabinoids. Laboratory or synthetically produced cannabinoids are called synthetic cannabinoids.
The human body has a very intricate endocannabinoid (endogenous cannabinoid) system, with receptors throughout our brain, organs, glands, and immune system. Hence a wide variety of physiological responses, occur when these receptors are stimulated by cannabinoids. These include responses to sleep, memory, appetite, pain, immune response, mood, and cell damage repair and death, Research is currently investigating what endogenous chemicals the human body produces, but the majority of medical discussions surrounding cannabinoids includes the phytocannabinoids.
Cannabis plants produce many phytocannabinoids, but the most well known and studied include CBD (cannabidiol) and THC (Tetrahydrocannabinol). The latter is psychoactive, meaning it can give the user a feeling of euphoria. The former, CBD, in non-psychoactive and researched more than others for its medicinal benefits.
Now plants, just like animals, are classified from Kingdom (Plantae) down to Genus and species. Cannabis comes in a variety of species, including the major ones: C. sativa, C. indica and C. ruderalis.
C. ruderalis is less popular as it has a lower THC content. However it has “autoflowering” qualities, making them useful to cultivators, and if bred with C. sativa or C. indica could enhance the new hybrid in its reproduction.
C. sativa has a higher THC/CBD ratio, hence can provide more euphoria. It reportedly helps decrease anxiety, treat depression and increase appetite. It’s been touted to increase energy and boost creativity. It's also used to help manage attention deficit disorder. Although not approved yet in the US, an oral spray, nabiximol, has been developed and sold in multiple countries to treat neuropathic cancer pain. Its brand name is sold, by prescription, as Sativex® .
C. indica has a higher CBD content and has been used for its sedative properties. It's also used to help anxiety and induce appetite, but will additionally be used to treat pain and muscle spasms.
Epidiolex has received FDA approval to treat some seizures. Its high CBD component is credited for its anti-seizure activity.
There are multiple other strains, each touted to have their own unique properties. 420medbook.com provides the below table.
The challenge, however, is the lack of medical research in each of the different strains. And when a study does come out discussing the medical advantages or disadvantages to using cannabis medicinally, the specific strain may not be mentioned or easily found in the report.
I believe that various strains do have unique properties and there is an art to the field of medical marijuana but more research needs to be done and quickly to avoid random use of cannabis products for treatment of medical conditions.
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.