Category Archives: Health

Sleep Tight, Breathe Right

Frederick Jaccarino, M.D.

In a previous column we discussed the healthy diet. Diet is a frequent topic because it is a serious player in the pursuit of health and wellness, and it is a “modifiable” factor. Certainly diet is directly linked to most obesity. So today let’s discuss one good reason to avoid obesity – it can ruin a good night’s rest! Even folks lucky enough to usually report restful sleeping look forward to enjoying the next opportunity for a good refreshing sleep.

In reality, few Americans can say they usually sleep well. Among the common culprits ruining a good sleep are stress, certain medications, daytime inactivity, shift work, and excessive alcohol use. But, there is also a large group of poor sleepers who suffer from sleep apnea. If sleep apnea is causing your daily fatigue, it would make sense to deal with it.

Sleep apnea means that at times while you are asleep you stop breathing. Many patients are unaware that apnea has been happening. Often associated with sonorous snoring, the victim also has daytime sleepiness and the brain functioning issues associated with lethargy. A partner may note the absence of breathing for 5 to 10 seconds. If unrecognized and untreated, health consequences can be dire, and emphysema-like lung disease can result.

The diagnosis of sleep apnea is made in patients who have suggestive symptoms, and confirmed in a sleep lab. Symptoms to raise a concern for the disorder include fatigue, lethargy, snoring, or an observer’s report of breath stoppages during sleep. In the sleep lab a specialist will measure your brain, heart and lung functions while you sleep.

So, say your spouse has been sleeping in a separate room because of snoring, and you have a shortage of get-up-and-go when you should be most alert and energetic. A trip to the family M.D. may lead to a sleep study, and then… treatment options. Because most (not all) patients with sleep apnea are overweight, the first treatment suggestion is weight loss. There are surgical options if oral structures like tonsils, loose collapsable tissues, or the uvula, etc. are causing blockages in the upper airway. Also, because weight loss is so helpful, bariatric surgery (i.e. gastric banding) may be an option. There is a device, called CPAP, worn while sleeping which can support the loose collapsing oral tissues, easing air flow. The equipment is bulky and most patients find using it a disagreeable device. Besides, bed and equipment hardly belong in the same sentence!

My argument seems solid: eat wholesome food and lose weight. The alternative may lead you to the business end of a scalpel for a tonsillectomy or gastric bypass, or worse you can stumble through your days in a sleep deprived daze while your breathing steadily worsens. Convinced?

Let’s Get Together

Dr Frederrik

Back to school time is, for most parents, a sacred rite. Not that having the kids around 24/7 is without its own entertainment value, but there is “a time for freedom” too.

Now it is the time for school teachers to try to harness all that youthful energy and promise of our future citizens, engaging and guiding the maturation of a new generation.

Social engineers can argue about the advantages of gathering our children into group settings as an efficient manner of educating and civilizing our world. However, epidemiologists have compelling evidence that bringing large numbers of humans into close proximity has serious health consequences. It is the reason schools hire nurses, social workers, and police officers. The most obvious health consequence is the improved transmission of viruses and other germs. Sneeze or cough in a class full of kids, and several of them will later share their germs with the rest of their families and friends.

These infections include the common cold, flu, mono, strep throat, and even meningitis. And with America’s welcoming of globalization, classrooms often have students from countries where diseases such as TB and hepatitis are more common. Parents and health professionals should understand back-to-school implications. If a child has a fever, infection is likely the cause.

Symptoms such as cough or runny nose narrow down the possible causes. Most illnesses in children are easily managed by a calm parent.Ill children may need to stay home and rest, drink fluids, and be taught to blow their noses and cover their mouths when coughing. Medical assessment is called for if the symptoms are persistent and worsening, fluid intake is not able to stave off dehydration, or if there is severe pain or changes in the child’s brain function.

The infection risks of herding our young into classrooms and auditoriums are serious enough, but consider too the effect on the psychosocial development of our children.

Friendships, relationships, and sharing get redefined and refined, which are positives. Being bullied, coerced, and subjected to pack mentality are not welcome, but hard to prevent. A home environment with a positive, loving, and safe family structure will arm the child with the tools needed to cope with the negative aspects of our large group education format.

So parents, go ahead and rejoice that it is back to school time. Just stock up on Kleenex, acetaminophen, and make sure the lines of communication remain open so the path forward will stay clear.

What a Pain!

by Frederick Jaccarino, MD

Pain is an important part of staying alive, and we all must learn to cope with this unpleasant sensation. Pain is real even if you can’t touch it, weigh it, or objectively measure it. To describe a painful condition we usually compare it to other pains more commonly known and experienced, such as hitting your finger with a hammer or the pain of natural childbirth.

Two moms may have seemingly very similar childbirth experiences; ask one about it and she’ll say “no big deal,” while the second vows “never again!” Neither is wrong about their perception of the pain. Doctors have no test to predict or measure a patient’s level of discomfort, so they rely on the sufferer’s own assessment of how badly it hurts.

As a child painful events are learning experiences. Consider a toddler who touches a hot iron. The painful blister is a far more effective teacher than mom’s repeated warnings. If that same toddler flunks the blister lesson, he will be unlikely to survive to adulthood.

Short term (acute) pain is an alarm; something is awry, and a remedy needed. Doctors tend to be good at relieving acute pain. Ear infections, broken bones, and kidney stones are examples. Remove the stone, set the bone, and the pain will soon be gone. Pains due to infections usually fade when the invading bacteria are killed.

Imagine an ear infection without any pain. You wouldn’t recognize that the bacteria are multiplying and spreading. Minus pain, the infecting bacteria could spread into your skull and brain and eventually overwhelm your body’s defenses. But if pain alerts you to the infection, you will know to fight back, and can call in your ally, the doctor. Acute pains are necessary for the survival of the individual and the success of our species.

The rational response to pain is to identify the cause and to repair the malady. The process can be less uncomfortable if one can use pain relievers while awaiting the cure. Medications for pain relief include anti-inflammatories such as ibuprofen, aspirin, and naproxen. Prednisone and other cortisone relatives are also inflammation fighters. Analgesics such as acetaminophen, narcotics, and anesthetics also treat pain.

Analgesics blunt our perception of pain but do not fix the problem. These medicines may cause serious side effects such as damage to liver, or kidneys, as well as mental dulling and addiction. Nonpharmacologic pain relief by meditation, biofeedback, and other techniques help to divert or deceive the sufferer’s brain so that less pain is felt. Acute pain is not nearly as thorny a problem as is long-lasting, or chronic, pain. Think of the constant pain of joints swollen by arthritis, stiff lower backs, or bones pressured by growing clumps of cancer cells. Painful conditions like these can last for months or years. Soon we will discuss treatment options for chronic pain sufferers. It is estimated that there are 100 million Americans afflicted with chronic pain; surely you know some.