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What’s the best mask to protect against variants?

We know now the main way the novel coronavirus that causes COVID-19 spreads is through the air in droplets an infected person breathes out. And we know that clouds of the tiniest of these droplets, called an aerosol, can linger in the air for up to an hour. This is why, until everyone is vaccinated everywhere in the world, masks are our best defense against the pandemic along with physical distancing and washing our hands.

So, sure, we’re all tired of wearing masks, just like we’re tired of staying home and wish we could visit friends and relatives on the other side of those closed borders. But images of ICUs and descriptions of “long COVID” help us to be patient… and reports of how contagious some of the variants can be are convincing of the danger that is still out there. We all want to avoid that.

So what’s the best mask available to us?

3 basic types of masks

There are 3 main types of masks: the N-95, disposable medical masks, and cloth masks. Keep in mind that any mask is better than none, but they are only as effective as the fit around your face. All air must be breathed through the mask in order to be filtered. Any air that escapes around the mask because of gaps in the fit can carry virus into the person’s airway or, in the case of someone who is infected, out into the air for someone else to breathe in.

I discovered that the Centers for Disease Control and Prevention (CDC) in the USA did some research on masks in January of this year. They found that there’s more than one way to get a high level of protection from the masks that are available to us.

The N95 mask

N95 masks, also referred to as respirators, are the gold standard and are strongly recommended for healthcare workers who are working closely with patients who have (or are suspected of having) the novel coronavirus. At the beginning of the pandemic, there was such concern that the public would buy up all available masks, along with no studies to prove they helped (since the virus was so new), that authorities told the public not to use masks at all.

However, it’s been over a year now… enough time to learn that the virus travels through the air and to manufacture all the masks the public might want to buy. I see N95s at my local Costco, always in stock, these days. But is it the best mask to wear when you go shopping or enter a public place?

It might not be. But you should be aware that an N95 mask is harder to breathe through because of its higher filtration. It also only works to filter 95% of particles you breathe in if it is fitted tightly to the face. When fitted properly, it will leave a reddened line or dent in the face where it seals after just a few hours of wear. You may need to adjust the ear loops by tying a knot in them to make sure the mask is pressed securely against your face. Many of us would be uncomfortable wearing one for any length of time unless we were required to do so for our work. You do get used to them after a while…

Medical procedure (surgical) masks

The flat, pleated medical procedure masks, also called surgical masks, are made with 3 layers of good quality filtering material but, because of their design, they typically don’t create a good seal around the face. This allows air to leak around the mask, reducing its filtering ability. The CDC’s study showed we could expect about 56% blockage of particles from a medical mask alone that is worn properly.

Knotting ear loops

Another method of improving the fit of a medical mask they tested, was to tie a knot in the ear loop close to the fabric then tuck in the sides. This pulls the medical mask more into the shape of the N95 mask, greatly reducing gaps on the sides and around the nose. One study found this alone improved filtration to at least 77% of particles.

Cloth masks

Homemade cloth masks were the first alternative suggested to medical masks that were difficult to find a year ago. The initial recommendation was to make one from 2 layers of tightly woven cotton fabric or heavy t-shirt material but, with research, that was upgraded to recommending 3 layers of different fabrics, ideally one of them being non-woven material. There are lots of patterns for sewn or folded masks (that don’t require sewing) on the internet and, of course, you can buy cloth masks anywhere now. I wish I’d known that I could have cut up a t-shirt for some protection on our trip home from Spain in March 2020! The CDC study found approximately 51% reduction in inhaled particles using a 3-layer cotton cloth mask, and this would very with the materials used.

One advantage of cloth masks is that they are washable, so you don’t have to worry about supply. Plus you can individualize them, adjusting the loops and shape if needed, so they fit your face snugly. You can even have fun with designs and colours—I love the “matching” look 🙂 and comical ones. However, the filtering capacity varies widely depending on the fabric used. When I sewed masks, I put a pocket for a filter on the inside so users could increase the filtration according to changing recommendations. Blue shop towels were one recommendation for a non-woven filter, and I used these in my masks until the most recent recommendation – double masking.

Double masking

I started noticing people on TV wearing two masks in late January. It turns out that this technique is based on the research by the CDC mentioned above. The fabric medical masks are made from filters well – the problem is leakage around the edges of the mask where gaps often occur because of the curves of the face. Woven cotton, especially when cut on the bias (diagonal), and knitted fabrics have some stretch and can mold to the face better than medical mask material.

As well, when a mask is sewn, it can be sized and shaped to fit over the nose and chin and tucks can be added wherever they are needed to fit the shape of the individual’s face. When I was sewing masks for family and friends last year, I was surprised that a mask that fit most faces would gap badly on others or just be so large it would slide off and not filter at all. Faces come in all sizes and shapes! I ended up making 3 different sizes for adults and added extra tucks for my hubby’s masks.

So the CDC looked at 2 options: placing a well-fitting cloth mask over a medical procedure mask and tying the ear loops to improve the fit. Both approaches significantly improved the filtration ability of the medical mask.

Combining 2 methods

They tested combinations of either 2 masks used together, or a medical mask tied and tucked as described (and shown in the photo above). Here are some numbers from their studies:

  • Doubled or tied mask with a simulated cough (exhalation) and unmasked reciever – 85.4% reduction in particles exhaled
  • Inhaling with doubled or tied mask, with an unmasked source – 82.2% reduction in particles inhaled
  • With both the source and receiver with doubled mask – cumulative reduction in exposure of 96.4%
  • With both the source and receiver using a tied mask – cumulative reduction of 95.9%

The study also commented on mask fitters (small, shaped devices worn over a medical mask to seal it to the face), and covering a medical mask with a stretchy, close-fitting fabric, like a length of pantyhose fabric or a “gator” necesita scarf. Both these techniques were found in two other studies to give similar results to double masking. Mask fitters are also referred to as a mask seal or brace, and are worn on top of a face covering to improve fit. You can buy these already made or make your own. Here are some videos and instructions. The last example, on slide 35, is the simplest to make and, if making for yourself, you can just knot the elastic to fit rather than using slide clamps, if you don’t have access to these.

Can you just layer 2 medical masks?

No. The CDC notes that layering 2 medical procedure masks does not give similar results, as this does not improve the fit. They also recommend choosing cloth masks with a nose wire to ensure a good fit over the nose.

So, you might want to consider using an N95 mask, now that they are more readily available, if someone in your household has COVID or if you are in some other higher-risk situation. However, using a medical mask with either a well-fitting cloth mask over it, tying the ear loops to improve the fit, or using a mask fitter will work very well in most situations you will encounter in public. Now that variants are spreading, it’s worthwhile to take that extra step to ensure good filtration and good fit for whatever mask you choose to use.

One last bit of COVID news…

As you know, I’m always reading quirky heath news. Here’s an interesting one for you. Flushing a toilet or urinal creates aerosols… and we know that those with COVID excrete the virus (they can actually detect whether anyone using the “facilities” in a building has it by doing a single test of its wastewater). So, the advice, if you need to use a public restroom, is to flush then get the heck out of there quickly. I’ll probably wear a mask in public washrooms from now on, even when COVID is long over with…

References:

More scientists now believe COVID-19 spreads primarily through the air — CTV News

Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021 – Centers for Disease Control and Prevention (CDC)

Double masking can block 92% of infectious particles, CDC says – CNN Health

What you need to know about face masks as protection against coronavirus – CNN

How to make a Badger Seal – University of Wisconsin-Madison

Don’t linger after you flush — CTV News

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How to criticize…

I’ve been a reviewer of educational programs for pharmacists for over 20 years and, somewhere along the way, I learned tips on how to critique a person’s writing. I think this advice can apply to any time we want to share an opinion on work someone has done or even on an opinion they’ve expressed, so I thought I’d pass it along. Too often, conflicting opinions are expressed rudely, especially on the internet where people feel anonymous. It makes me cringe, knowing there’s a human somewhere on the other side of the screen…

Expressing opinions

The way you express your opinion can either begin a stimulating discussion where both parties can learn something (even if it’s only what others think) or it can shut down the conversation and belittle the other person. And isn’t it conversation, learning and new ideas that make life interesting?

In conversation, it helps to acknowledge the other person’s opinion before expressing your own—perhaps by saying something like: “That’s an interesting take on the situation” or ” Now, that seems different from my experience”. You get the idea. We all have different points of view and experiences, and these colour how we judge events. We believe what we do for a reason. Acknowledging and trying to understand others’ opinions broadens our understanding of the experience, event or whatever is being discussed.

Churchill famously often used to begin with “I may be wrong, but…”, allowing him to more easily change his mind when he learned additional facts that warranted it. None of us can claim to know everything. We form our opinions on what we know, and it’s just smart to keep the door open to changing your mind after you’ve learned more.

On the internet, it’s much easier for some to become the bully when they don’t know the person who wrote the post. These are the ones we call trolls, although I expect they don’t see themselves that way. We need to remember there is a real person, a human with feelings, behind that text.

Helpful tips

So, the tips I was taught to follow, when doing a formal review of an educational program, besides following these thoughts, were to start the critique by pointing out what was good about the program, offer constructive criticism of what I felt could be improved, and to finish with something positive. You can almost always find something complimentary to say about a piece of writing or a passionate opinion (if only the commitment to an idea).

It was also recommended to make positive suggestions for improvement, rather than just criticize what was said. Offering an additional credible source of information to support your suggestion carries more weight than just you saying it. I often add a link to a recognized website with authority on the subject to support my suggestions.

In conversation with a person who believes facts we know are incorrect according to current science, for example, in the debates over vaccines and masks, pointing out that they are incorrect won’t help change their mind. First, it is recommended to try to understand why they believe what they do. People who are fearful, may want to deny that the pandemic is real to reduce their fear; someone whose child has had a bad reaction could understandably believe that all vaccines are dangerous. Simply commanding a person to “Take your medicine” without understanding why they are hesitant, answering their questions and gaining their trust, rarely results in increased compliance to taking medication. I learned this and more in a 10-hour program on how to counsel patients effectively.

Sadly, on the internet where it’s difficult to build real relationships and many feel they are almost anonymous, there are too many people who feel justified in creaming someone because they have a different opinion. I see this all too often on a Pharmacy website I follow. It surprises me that nice polite Canadians can sometimes be so mean to their colleagues. Fortunately, they’ve not done it to me yet (I write articles for the site from time to time), but I have experienced this on FaceBook. I just keep being nice and point out where my facts came from (I don’t just make stuff up!!).

And after you’ve been trolled?

So, here’s a suggestion for when you run into someone who hasn’t learned to be kind when they have a critique of your work or have a different opinion than you. Keep a little file, folder or book with complementary comments and praise you’ve received, cards you’ve received that say what a great friend you’ve been, thank you’s for something kind you’ve done.

Either ignore or respond to the critique in a calm, polite way, depending on the comment and venue then, later, browse through the wonderful feedback you’ve received in the past to remind yourself that not everyone is a troll.

Over the years, I’ve received many cards and thank-you notes from happy clients and I still have them—they’re shown in the photos above and below. It raises my spirits to look through them from time to time…

Thank-you’s for some pet medicines I made over the years…

#VaccineDebate #InternetTrolls

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Why do we get “addicted” to coffee?

Have you ever wondered why we crave caffeine or nicotine when we consume them regularly? Or why, after a while, all we’re doing is satisfying the craving? And why we don’t feel so good without our drug of choice after we’ve adapted to it? It’s all about what happens when these substances attach to receptors on the surfaces of cells in our bodies…

Many drugs work by attaching to a receptor on the surface of a cell—we can think of receptors as tiny “locks” throughout our bodies, each one with its specific shape, waiting for the substance (its “key”) to come along, attach, and turn the receptor on. This creates an action inside the cell, like caffeine giving us energy, or nicotine relaxing us. When the effect is pleasant, or helps us feel better, sometimes we keep consuming these “keys”, like caffeine, nicotine, alcohol or even narcotics, trying to keep the effect going.

However, your body always tries to keep things on an even keel. We call this “homeostasis”. So, if you keep lots of your drug of choice in your system, eventually your cells make more receptors for the drug. This results in you just feeling your ordinary self when the substance is in your system. This is known as “developing tolerance” to the drug.

Of course, it’s a bit more complicated than this, with other substances often attaching to the same receptor, creating competition and sometimes providing different actions, but you get the idea. It depends on which key gets into the lock and whether it turns it on.

But if you don’t consume a favourite drug you use daily, after a little while you’ll have lots of empty receptors looking for the “keys” they’re used to having. This can cause you to feel not-so-great. With caffeine, you may have a headache and feel sluggish; with nicotine you may become irritable, feel anxious, or have insomnia.

You start to crave the drug because you know it will make you feel better but, really, once you’ve developed tolerance to the drug, all it will do is make you feel like your regular self. That’s why people will sometimes gradually increase the amount of drug they use, as they try to get the same drug effect that they used to experience.

This lock-and-key concept applies to many substances, from hormones to some medications you take. Even drugs like Tylenol and Advil can eventually cause headaches if taken daily, then suddenly stopped. We call this “medication induced headache” and it happens because your body has adapted to having the medication there all the time.

Without the substance around for a period of time, cells gradually return to making fewer receptors again and the cravings will stop. Some receptors, like those for opiates and nicotine, take longer to return to normal numbers, making these drugs harder to quit. Caffeine receptors seem to return to normal amounts in 3 or 4 days when you quit coffee, and cravings and withdrawal are much less of a problem if you taper your coffee intake gradually.

This week I came across the cutest explanation of how all this works by David B. Clear (a scientist/blogger/cartoonist who lives an idyllic life on an island in the Mediterranean). He uses caffeine as an example. Since I’ve had an extra-busy week, I’m just going to share it with you. He’s also much funnier than I am and even uses cartoons to explain how caffeine works and why we crave it so much. I don’t know about you, but making coffee is the first thing I do when my feet hit the floor in the morning! I’ve always thought it was the taste I was craving… but I very likely have lots of extra caffeine receptors waving around in my brain!

Anyway, here’s the link… hope you enjoy this fun science-y explanation of how caffeine works and why we crave it!

https://medium.com/i-wanna-know/how-caffeine-works-26f7bf813b94

#caffeine #coffeeaddiction #caffeinewithdrawal

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Can Adults Have ADHD?

ADHD or Attention Deficit/Hyperactivity Disorder, is a neurodevelopmental (or brain development) condition that is quite common in children. Five to ten percent of school-aged children in the US (depending on the source you read) are reported to have been diagnosed with it. But can adults have the condition too?

What is ADHD?

There is no single laboratory test to diagnose ADHD. It’s diagnosed by analyzing symptoms and problems the person has, such as:

  • Lack of attention and focus, daydreaming
  • Hyperactivity, always fidgeting or moving
  • Being impulsive
  • Difficulty controlling emotions
  • Self-focused behaviour: interrupting others, trouble waiting their turn
  • Poor organization and time management skills
  • Forgetfulness
  • Problems finishing a task
  • Difficulty following instructions

While all children show these traits at times, children with ADHD do this more regularly and the behaviours can affect success in school and interactions with other children. The diagnosis of ADHD is a process with several steps. The doctor will want to make sure it isn’t another problem with similar symptoms, like a sleep disorder, anxiety, depression, or a learning disability. They may want to talk to teachers, parents and others who care for the child to assess behaviour in different situations. Sometimes, if it is felt that medication would be beneficial, a trial will be done to assess how well a particular medication works before starting a regular prescription. Regular drug holidays are recommended to ensure it is still needed.

There are 3 types of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and a combination of the two. Symptoms can change over time, as the person ages and, while males are more often active, females tend to be the inattentive type that is less often diagnosed.

And, yes, the condition can continue into adulthood. However, adults are less likely to be diagnosed and the symptoms can be different.

Symptoms in adults

While many of the symptoms of ADHD in adults are similar to those in children, adults often exhibit restlessness and inattention, rather than overt hyperactivity. Fidgeting can continue for adults, as well as impulsivity.

As adults, those with ADHD can still tend to get distracted easily and misplace things. They might lose their temper quickly, be more irritable and impatient than others, and interrupt other people who are speaking. They may also have more difficulty than most in following instructions. Adults with ADHD could find dealing with stress to be a challenge. At work, they may miss deadlines and have difficulty staying seated, succeeding better at a job where they can move around.

But many adults have learned adaptations to control their symptoms and to turn what can be a problem in childhood into an advantage as an adult. A job that requires lots of energy might be perfect for someone with ADHD. Having an ADHD mind that likes to think “out of the box” can be an advantage for work that requires innovation and creativity. Smartphones are an ideal tool to keep on schedule and ensure important tasks are not forgotten.

Some years ago, my husband and I were watching a program on TV about adult ADHD. At the end of the documentary, we looked at each other with the same thought: my hubby had ADHD. But he has turned it into an advantage. He’s always had plenty of energy to keep up with the middle school students he taught and innovative ideas to make their curriculum interesting. Understandably, his most disliked part of the job was sitting in staff meetings. I think his favourite invention is the sticky note and he’s used them well for years to keep organized and remember tasks that needed to be done—a great adaptation strategy.

My friends have always been jealous of me with my “hyperactive hubby”… He always been energetic and looking for projects to do around the house. I’d come up with an idea for a home improvement and, next thing I’d know, it was done!

What’s the cause?

The cause of ADHD is generally thought to be genetic—it tends to run in families—or a result of how the brain developed, perhaps influenced by something like nutrition or smoking/alcohol use during pregnancy. But there has been some suggestion it could be due to (or worsened) by pesticides or food additives and colouring agents—chemicals in our food. Some parents report improvement in their child’s symptoms by changing to whole, unprocessed food in the diet. As this is a healthy change, it’s worth trying.

Research has not shown ADHD to be caused by too much sugar in the diet, watching TV or playing video games excessively, poverty or poor parenting. However, these factors could potentially worsen ADHD symptoms.

But there are medications to control symptoms and increase the person’s ability to succeed in a setting that requires sitting still and paying attention, like school. Unfortunately, most schools are not geared to teaching children who don’t fit “in the box” of sitting at desks in rows in a classroom, making it more difficult for a very active child to be successful and harder for the teacher to cope.

However, learning coping strategies to compensate for negative symptoms, while choosing activities and careers that take advantage of the positive aspects of ADHD can help a person succeed and thrive because of their differences. Coping strategies should be part of any treatment that is considered necessary.

One positive characteristic of some with ADHD is the ability to change. My hubby actually loves new situations and thrives in new challenges. In these days of rapid change, this can be a distinct advantage. Albert Einstein is quoted as saying: “The measure of intelligence is the ability to change” and, although politicians are often criticized for changing their minds, Churchill is reported to have said “Those who never change their minds, never change anything.”

We all need to use whatever traits we have to our best advantage. And we need to work to develop schools and workplaces that compensate for behaviours that can be less successful while developing each person’s strengths. It’s important to recognize ADHD, in adults as well as children, to help them achieve the success they deserve in today’s world.

#ADHD #AttentionDeficit

References:

Attention-Deficit/Hyperactivity Disorder (ADHD) – Centers for Disease Control and Prevention (CDC)

What to know about untreated ADHD in adults – Medical News Today

14 Signs of Attention Deficit Hyperactivity Disorder (ADHD) – Healthline

Causes of and Risk Factors for ADHD—Healthline

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Ecotherapy: the Park Prescription

When you were a kid, did your Mom just tell you to “Go outside and play” like mine did? Turns out, she wasn’t just getting you out of her hair. She was doing something that was good for your health, something more than encouraging you to get some exercise. And now, doctors are doing the same, even for us grownups. Some are now writing prescriptions instructing their patients to spend a specific amount of time outdoors, in nature, each week.

Ecotherapy

It turns out that there are many heath benefits to spending time, not just outdoors, but in a natural setting. Ecotherapy is a newer scientific field that studies the effects of natural settings on our health. Studies comparing brain activity of healthy people after a 90 minute walk in nature, as compared to a similar walk in an urban setting, have shown reduced stress, anxiety and depression. They also found decreased repetitive thoughts, lower blood pressure and decreased levels of the stress hormone, cortisol, that raises blood pressure and cholesterol, causes inflammation and has other detrimental effects when it is elevated too long.

Benefits were noted after about 20 minutes, so each session in natural surroundings is recommended to be at least this long.

What are the benefits?

Exercise

First, there’s the most obvious: exercise. Many of us do something active while we’re outside and away from our entertaining screens. I’m sure you already know the benefits of exercise in improving health and reducing risk of many diseases from heart disease and cancer to the risk of falling, with a long list between these two, not to mention maintaining healthy bones and muscles.

Exercise is important for all ages and levels of fitness. I remember seeing an elderly woman in Spain, walking on the Paseo Maritimo with her walker, enjoying the sunshine and view of the Mediterranean in spite of her level of disability. Even a small amount of movement can maintain or improve your capacity for exercise and ability to function.

Mental health

You might be less aware of the mental health benefits of being outdoors, even if you’re just relaxing on a park bench. Appreciating nature’s beauty distracts us from our worries and even improves depression and anxiety. It’s just plain good for your mental health. I’ve found that a walk on the beach near my home, regardless of the weather, always makes me feel better when I’m upset about something. It even helps make a good mood better than ever!

Interestingly, even bringing the sounds of outdoors to those who cannot get outside is reported to make a difference in brain activity, directing attention outward, distracting focus from worrying about problems. Looking at pictures of nature, especially a favourite spot or a place you’d like to visit, is also helpful in distracting from inward-directed focus that occurs during anxiety, post-traumatic stress disorder and depression.

Immune system

But you may not realize that, when you’re outside in a natural setting, you also expose yourself to a variety of healthy microbes that are different from what are in your home, just by breathing. Some call this “forest bathing” but healthy microbiota exist in any park or garden with plants and trees, not just in large forests. Perhaps a better term is “nature bathing”, immersing yourself in nature.

Spending time outside in various natural settings increases the variety of microbes in our bodies, along with the exposure we choose when eating various fermented foods that contain microbes, like certain cheeses (cheddar, gouda, and mozzarella), yoghurt, kefir, miso, and fermented vegetables or pickles made without vinegar. Microbes we inhale eventually are swallowed and added to the mix. Scientists now recognize that the digestive system is much more than just a way to get nutrients into our bodies. The types and balance of bacteria, fungi and viruses living there (collectively called the microbiome) produce nutrients for us, influence our immune systems and even communicate with our brains.

And we can’t forget about COVID…

These days we have even more reason to spend time outdoors. We’ve learned that improved ventilation and maintaining space from others are important factors in reducing spread of viruses and being outside in fresh air provides ideal ventilation and plenty of space to spread out while still enjoying the company of others. Of course, it will still be a while until crowded venues, like outdoor concerts, are recommended but we’re seeing higher numbers allowed for outdoor activities than for indoor ones because of the infinite “air exchange” nature provides, the natural movement of air that carries away those nasty viruses, if any happen to be present.

So, don’t be surprised if the first prescription your doctor gives for a milder health complaint is a “Park Prescription” with instructions to spend a couple of hours a week at your local park or even just 20 minutes 3 times a week. In fact, the benefits of a Park Prescription could be expected to add to any other treatment you may need to use. If you have other health conditions, your doctor may also have additional advice or cautions as you start your “prescription”.

This is a world-wide movement inspired by Healthy Parks Healthy People, an initiative of the National Park Service in the UK and being promoted in Canada by Park Prescriptions, A Prescription for Nature.

You can read more about it below, but why wait for your doctor to tell you to get outside and enjoy nature? After over a year of COVID restrictions we all have at least a little COVID fatigue… the “COVID-osis” I wrote about a couple of weeks ago. Isn’t it great to know that just going outside and absorbing a little nature can get us on the road to a cure!

Note: The above photo is of a little creek flowing into the Saint John River (in the background), on a walking trail near the Princess Margaret Bridge in Fredericton.

#mentalhealth #forestbathing #NaturePrescription

References:

Health benefits of nature—Healthy by nature

PaRX– A Prescription for Nature

11 Probiotic Foods That Are Super Healthy—Healthline

Healthy Parks Healthy People—National Park Service

Sour mood getting you down? Get back to nature—Harvard Health Publishing

Spending time in nature helps mental health—CBC News

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Seasonal time change-Love it or hate it?

This year I voted for the first time ever in a TV News poll. The question was: should we continue to change clocks in this spring and fall? I voted no!

Why vote no?

Changing our clocks often creates confusion. Not all countries change at the same time and some areas don’t change at all now. It doesn’t take much imagination to understand the confusion this must create for travellers, airlines, distance meetings on the Internet, and showing up for church on time on that first Sunday.

For example, I always assumed that all countries changed their clocks at the same time. How else could international travellers and transportation systems manage during that week? We jokingly chastised a friend for arriving an hour late at our meeting place while staying in France, presuming she’d forgotten to change her clock. Later we realized Canada changes a week before Europe does and, of course, we were following Canadian news. I had wondered why my phone hadn’t changed the hour automatically… turns out it was smarter than we were!

But time change can also affect health and how well you sleep while your body adjusts its daily cycles by that hour. Animals, plants, and even microbes have these daily cycles as well as humans. They are part of the biological clock which controls cycles of various lengths, some of which are longer than a day, like women’s menstrual cycles. The daily cycles are called circadian rhythms, from the Latin term “cerca diem” which means “around a day”.

Each of us has our own ”chronotype”, or individualized daily rhythm. Some of us are “early birds”, others are “night owls”, and these tendencies often run in families. But our rhythms are also affected by factors outside the body, especially light, including artificial light from our home lighting and devices. Getting more or less sleep than usual, changing time zones, and working a night shift can affect circadian rhythms. Hormone changes like menopause and the menstrual cycle can also have an influence. And aging can change your circadian rhythms too—our chronotype is often different in later life than it was when we were teenagers, sliding us more toward the “early bird” type, quite different from the teenage “night owls” who love to sleep in.

Your body has its own clock… located in the brain

Biological rhythms are controlled by a cluster of neurons (nerve cells) called the SCN (superchiasmatic nucleus) located in the hypothalamus section of the brain. It’s located behind the eyes, it’s very sensitive to light, and it receives direct nerve input from the eyes.

The SCN sends signals throughout the body to regulate many activities. It cues systems like digestion to produce digestive enzymes at mealtimes, and the endocrine system to produce hormones that wake us and help us go to sleep. The sleep/wake cycle is one of the most well-known circadian rhythms. Those who are completely blind and keep their eyes closed during the day, can reduce the amount of light falling on the back of the eyes enough to disrupt their day/night cycle. I had a young client who was blind that used a drowsy-causing antihistamine to help correct his sleep/wake cycle because of this many years ago.

Circadian rhythms can also affect metabolism and weight gain by regulating blood sugar and cholesterol production. They can control how sharply your brain focuses and can affect risk of mental health problems like depression, bipolar disorder, and dementia. The immune system is also influenced, impacting DNA repair and our natural systems of cancer prevention.

What can time change do?

Arbitrarily changing the time with the season means all these automatic functions need to shift by an hour. We know that travel across several time zones requires a major shift of circadian rhythm, with the well-known fatigue we call “jet lag”. But even 1 hour can leave us tired and not functioning our best for a few days while we adjust to the sudden change, rather than experiencing the gradual change of the seasons.

Circadian disruptions, even of only 1 hour, have been shown to result in serious sleeping problems – struggling to fall asleep, waking during the night, and being unable to sleep as long as you want in the morning. Disruptions are also suggested as potentially contributing to obstructive sleep apnea, where breathing stops briefly, disrupting sleep and decreasing oxygen levels.

Timing of drug administration in relation to circadian rhythms may influence drug effectiveness too. Chronobiology, the study of the effect of the circadian rhythm on our biology, is part of a current area of research into personalization of medicine along with other factors that affect an individual’s response to medication.

What can you do to help stabilize your circadian rhythm?

Going to bed and getting up at the same time each day helps to keep the circadian rhythm on an even keel. Using less bright lighting after sundown, and especially reducing blue light that the SCN is most sensitive to, can reduce the effect on your circadian rhythm and your sleep. Most devices have a dimmer for the screen and some now have built-in filters for blue light, the colour of light that seems to affect the SCN most.

Why do we change the clocks anyway?

Originally clocks were changed to provide more daylight hours for farmers and the “war effort”, while keeping sunrise earlier during shorter winter days. But is this still needed with mechanization of farming and the peace time we now enjoy? Or is it just a habit or tradition? Several jurisdictions have already fixed their clocks and more are considering it.

Why did I vote to freeze clocks?

I voted we should stay permanently with Daylight Savings Time in that CTV opinion poll, mainly because of the unnecessary confusion created by the shift and the lack of a good reason to continue the tradition. But this year I noticed it took me longer to adapt to the change. It’s Thursday as I write this and last night was my first good night’s sleep this week. It’s taken me four days to adapt my internal clock to the 1 hour shift last Sunday. So negative health effects are another reason to stop seasonal time adjustments. I was happy to see that the majority in the poll voted to stay in Daylight Savings Time permanently too!

So, how did you make out this week? Did you find yourself a little draggy in the morning? Any trouble falling or staying asleep? I’m curious… Shall we do our own little poll? Are you in favour of eliminating the twice yearly time change? Vote below!

References:

What to know about circadian rhythm—Medical News Today https://www.medicalnewstoday.com/articles/circadian-rhythms?utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=MNT%20Daily%20News&utm_content=2021-01-12&utm_country=&utm_hcp=&apid=30707099

Circadian Rhythm—Sleep Foundation https://www.sleepfoundation.org/circadian-rhythm

Circadian Rhythms—NIH National Institute of General Medical Sciences https://www.nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx

Get in Touch With Your CircadianRhythm—WebMD https://www.webmd.com/sleep-disorders/find-circadian-rhythm#1

#sleepbetter #circadianrhythm #seasonaltimechange

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Neti pots: salt, steroids, baby shampoo?

People have used saline rinses for the nose and mouth for centuries, and doctors still recommend them for minor infections and pain. Rinsing helps to wash away bacteria and viruses and inactivates some of them, giving our immune system a better chance to overcome the invaders. But what’s the best solution to use?

Chronic sinus problems…

When I first went to my doctor with a sinus problem that wouldn’t go away, she suggested trying a neti pot rinse with saline 3 times a day as a first treatment. While it helped clear away some of the excess mucous that was clogging my breathing, the relief was very temporary. I progressed to steroid nasal sprays that, again, gave only short-lived improvement and subsequently to an Ear, Nose and Throat specialist who gave me more steroids in a higher dose, this time in a form designed for inhalation but mixed with saline and used with a neti pot. You may remember the blog I wrote about the vertigo and tinnitus that developed after just three weeks on that regimen. On hindsight, it may have been because I used it at bedtime, thinking I would sleep better if I could breathe through my nose. Some of the solution probably stayed in my sinuses longer that it should have because I was laying down, increasing my exposure to the drug and worsening the side effects.

Through all this, I couldn’t help thinking that there must be bacteria or yeast that were the underlying problem but weren’t being addressed. My sinus problems had started right after a nasty chest infection–why would parents bring their terribly sick, coughing child into the pharmacy, infecting others, while waiting for his prescription to be filled?? We know now that masks are an excellent tool for preventing spread of infections–we should continue using them when we are ill even after the pandemic is under control. Sorry for the rant…

It took 2 courses of different antibiotics to clear my chest infection and I suspected it was a resistant organism that was at the root of my chronic sinusitis. However, I was told that we couldn’t do a culture of the sinuses to see what was going on. It was frustrating to be treating only symptoms and not the cause. Especially after my reaction to high dose nasal steroids, I didn’t relish using them for the rest of my life and worried I might eventually lose my hearing (a year later, I still have tinnitus in one ear…)

Adding baby shampoo…

So, it goes without saying that I read everything I come across about the nose and sinuses. And, a few weeks ago, I found an article about using baby shampoo in a neti pot for chronic sinusitis. Baby shampoo? Yes, but well diluted, of course, down to 1%, or one ml in 100 ml of saline. Normal saline, a solution of salt in water that is the same saltiness as tears and other body solutions, is used rather than plain water, as it is much less irritating to the sensitive lining of the nose. The writer described getting significant relief from his chronic sinusitis of many years, when nothing else had helped, by using soapy water as a nasal rinse.

Of course, I dug further into the science. Shampoos and other soaps contain surfactants, chemicals that break up surface tension, allowing oil and water to mix, and (as we all know in these days of COVID) they actually kill many infectious organisms. Some bacteria produce a “biofilm”, a film that protects them against our immune systems’ advances, making them more resistant. The surfactants in shampoo help to break up these films, allowing the immune system to do its thing more effectively. Baby shampoo is gentler than many other soaps, being designed for babies, so is chosen because it will cause less irritation in the sensitive lining of the nose.

I couldn’t wait to try it… in fact, I tried some liquid hand soap I had on hand but it was quite irritating. I don’t recommend this! But the baby shampoo didn’t irritate my nose, although I read some people do complain of this. Reducing to 0.5% might solve the problem if you experience irritation, but it might not work as well.

However, this has been a game-changer for me! I no longer have to take decongestants or steroid spray every day. In fact, I can’t remember the last time I used either. And, once the congestion was under control, I found I didn’t need to use the 1% shampoo in saline rinse every day. However, it’s safe to use daily if needed. I find that using a nasal rinse with 1% baby shampoo 2 or 3 times a week keeps everything under control for me.

So, here’s how I do it:

  • I use 2 measuring cups (1 cup and ½ cup), measuring spoons (1/2 and 1/4 tsp), non-iodized salt, baking soda, and baby shampoo (preferably unscented). I find the shampoo bottle with pump attached is really convenient.
  • I boil tap water and let it cool, but you can also use distilled water. Boiling kills any organisms that might be in the water and evaporates chlorine that is usually added to city water supplies. I do a kettle full, pour it into a glass jar while still hot, and store it in in my washroom with the rest of my equipment.
  • Mix up some salt and baking soda–I mix 1 tablespoonful of baking soda with 1 cup of sea salt. They recommend avoiding iodized salt, as the iodine can be irritating. Note that proportions of salt and baking soda vary in different recipes, up to half and half, but I find the mixture above works fine.
  • To prepare the solution, I use 2.5ml (1/2 tsp) of the salt mixture in 250ml (1 cup) of water and stir well until dissolved. Some recommend warming the water to body temperature, but I find room temperature is fine (and simpler!)
  • I pour half the solution into a 125 ml (1/2 cup) measuring cup, then add 1.25 ml (1/4 tsp) of baby shampoo to the remaining ½ cup and stir well. It takes a couple of minutes of stirring for the shampoo to mix in thoroughly.
  • I do a rinse with the soap solution first, then usually do a few other things, like rinsing off the equipment I’ve used and brushing my teeth (letting my sinuses “soak”, so to speak), then I rinse the soapy solution out of my nose with the remaining non-soapy saline solution.
  • Make sure your equipment is thoroughly cleaned after each use. I rinse everything with hot tap water immediately after using then let air dry, and I spray with alcohol then let dry after every 2 or 3 uses. You can also just put the equipment in the dishwasher to clean everything well.
  • And here is a video of how to actually do the neti pot rinse.

What about COVID-19? Can nasal rinses help?

Of course, in these days of the coronavirus pandemic, many are wondering whether nasal rinses can prevent or treat COVID-19. While it is unlikely that it could be a cure, studies have shown that saline rinses can reduce viral shedding in ordinary coronavirus infections like the common cold, making the infection less likely to spread to others. Adding a surfactant, like baby shampoo, would be expected to have a better chance to neutralize the coronavirus as it is an enveloped virus (surfactants can disrupt virus coatings, as they do when we wash our hands properly). Studies on the effects of nasal rinses on COVID-19 are ongoing (so no conclusions yet), but it’s interesting that we do know the spread of influenza and common colds could be reduced somewhat, along with congestion symptoms, by using a nasal rinse with baby shampoo when infected. So, while it’s not likely to be a cure, using nasal rinses when infected may be able to reduce the risk of spreading the novel coronavirus.

Of course, wearing a mask is almost certainly far superior at preventing infection than trying to rinse the virus away could be. Once the virus has entered the nasal passages, rinsing could only be expected to temporarily reduce the virus count, even if effective, so we want to prevent it from getting into our bodies through proper use of masks and physical distancing from others.

Sore throats and minor mouth infections

Saline solution (without shampoo!) can also be used as a gargle for minor sore throat or sore mouth (such as a canker sore). It is less important to use purified water and normal saline, as the lining of the mouth is not as sensitive as the nose. I like to use lots of salt and warm tap water so it will dissolve faster when using as a gargle or mouth rinse.

My hubby swears by using salt for a sore throat or mouth sores (something he’s done since he was a child), and he’s right—it really works quite well to relieve soreness and speed healing. Of course, if the pain is severe or you don’t get relief from milder pain within a couple of days, see your doctor. You may have a more serious infection. Although the solution is safe, it is recommended not to swallow it, especially if you have high blood pressure, as salt can increase pressure in some people.

So, have you tried saline rinses or gargles? Is it a family tradition? I’m wondering how many know about and use this simple at-home treatment…

References:

Impact of Nasal Saline Irrigations on Viral Load in Patients With COVID-19—U.S. National Library of Medicine https://clinicaltrials.gov/ct2/show/NCT04347538

No, Mouthwashes and Nasal Rinses Aren’t Cures for COVID-19—Healthline https://www.healthline.com/health-news/no-mouthwash-and-nasal-rinses-arent-cures-for-covid-19?c=197157373360

Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient—American Journal of Rhinology http://www.neilmed.com/articles/babyshampoo.pdf

What to know about gargling with salt water—Medical News Today A guide to salt water gargles: Sore throat, other conditions, and recipe (medicalnewstoday.com)

#netipot #sinusrinse

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Neuropathic pain… oh my nerves!

Neuropathic pain is pain caused by nerves that aren’t working as they should. Put simply, nerves are long thin cells that carry messages of body sensations to the brain, and commands for movement back to the body. The brain is made up of a complex network of nerves that interpret messages and communicate with each other, allowing us to think and feel. When nerves become damaged, messages can become disrupted or nerves can simply start firing on their own, creating false messages such as pain when there isn’t a problem. We call this neuropathic pain, pain that is caused by the nerves themselves malfunctioning.

In contrast, “nociceptive” pain is caused by an injury, physical pressure or inflammation in some part of the body. The nerves are working properly when they send pain messages to the brain telling you there is something wrong. Your nerves can also trigger a sub-conscious reflex movement that reduces damage, like pulling your hand back from a hot surface even before you realize you’ve burned your finger.

What does it feel like?

Neuropathic pain, pain caused by the nerves themselves, can be mild or severe, permanent or temporary. It can feel like burning, throbbing, electrical-like sensations, tingling “pins and needles”, increased sensitivity, itching or just numbness. Basically, whatever the nerve is supposed to do can either be blocked or “overdone”, depending on whether the damaged nerve stops transmitting signals or starts firing randomly because of damage or pressure. Sensations can be changed when sensory nerves are damaged or squeezed and, when motor nerves are affected, the ability to move can be blocked (for example, paralysis with a stroke) or uncontrolled (as when muscles twitch).

What causes it?

Neuropathies can often be hard to diagnose and treat, and there is a wide range of causes for damage to nerves. Some of these include:

  • Diabetes—High sugar in the blood causes damage to tiny nerves in the hand, feet and eyes, leading to numbness and loss of vision over time, especially when blood sugar levels are not well controlled.
  • Cancer and cancer treatments—A growing tumour can press on nearby nerves inhibiting their function or causing pain. Cancer drugs, with their toxicity spilling over onto our own cells, can cause damage to nerve cells too. Numb fingers are common with some chemo treatments, but these nerves usually repair themselves after treatments are finished when dosages are carefully monitored.
  • Neurological diseases—Some diseases cause symptoms by having an effect on nerves, like multiple sclerosis, a disease where the myelin “insulation” around nerves becomes damaged, resulting in nerves firing randomly or signals being unable to travel through the nerve.
  • Stroke—A stroke results from blood not reaching part of the brain, either because of a blood clot or because a blood vessel has burst. Without blood and the oxygen and nutrients it carries, nerve cells in the brain die and cease their function. Interestingly, sometimes other nerves can take over the function, allowing a significant amount of recovery. This is called “plasticity”… the ability of tissues to grow and change (somewhat like molding plastic!)
  • Shingles—After you have chicken pox, the herpes zoster virus doesn’t totally disappear. It stays dormant in nerve cells, waiting for its chance to come back as shingles, a nasty painful/itchy rash with fluid-filled bubbles on the surface of the skin. While it’s reactivated, the virus can cause damage to the nerve it’s growing in, sometimes resulting in ongoing pain signals being generated even after the virus infection is subdued and the rash is healed. This is known as “post herpetic neuralgia”, and can last weeks, months or even years. Treating the virus infection quickly with an anti-viral medication will reduce the nerve damage and chance of developing long-term problems. It is recommended to start treatment within 72 hours but the sooner, the better.
  • Phantom limb pain—It’s hard to imagine, but almost 80% of people with amputations can have pain or itching that their brain is telling them is occurring in the limb that is no longer there. These sensations are likely initiated in a nerve that has been cut or damaged in the surgery sending signals that the brain interprets as coming from the absent limb. It must be so frustrating to have an itch that you can’t scratch!
  • Nutrient deficiencies—Lack of a nutrient essential for nerve health, for example vitamin B12, can also be a cause of malfunction of peripheral nerves, those in the extremities. Interestingly, metformin, a commonly used medication for diabetes, can reduce absorption of B12, leading to a deficiency in significant numbers of patients, and increasing risk of numbness in the hands and feet that is often blamed on the diabetes itself.

And there are many other diseases that can cause misfiring of nerves. I occasionally get a burning sensation on the outside of one foot—it took me quite a while to figure out it was a compression neuropathy, caused by a muscle spasm in my calf pressing on the nerve to my foot. I get quick relief from this foot pain by massaging my calf. Who would have thought! Unfortunately, in some people the source and exact location of the problem are never identified.

Focal neuropathies are those focused in one spot of a single nerve, making them easier to treat once diagnosed. Peripheral neuropathies, for example diabetic neuropathy, can be widespread since the cause (high sugar in the blood) originates in the blood that circulates throughout the body.

Treatment

Of course, addressing the cause (like taking an anti-viral for shingles, keeping diabetes under control, or using massage as I do for my foot pain) is an ideal treatment if this is possible. Otherwise, using medication that modifies how nerves fire, like anticonvulsants, antidepressants or drugs that block certain pain receptors within the body, can be helpful to reduce discomfort. There are also drugs that can activate calming pain-blocking pathways, like the GABA pathway and alpha adrenergic pathway in the body.

Commonly used neuropathic pain medications include anticonvulsants like gabapentin/pregabalin, and carbamazepine (Tegretol), and tricyclic antidepressants like amitriptyline or desipramine. Magnesium supplements (especially if the diet is lacking in magnesium) are sometimes helpful, as well as substance P blockers like capsaicin (a non-prescription cream) or loperamide (an antidiarrheal medication that can also be made into a cream by a pharmacist). In difficult to treat neuropathies, pain receptor blocking drugs like ketamine (yes, the date-rape drug!) may be tried.

As a compounding pharmacist, I have often made some of these into a penetrating gel when the location of the damage was known and this avoids side effects commonly noted when taking it by mouth. Because the medication is delivered directly to where the problem is, much less is needed and side effects like drowsiness and stomach upset are essentially eliminated. This allows us to combine several drugs that work to block pain in different ways into one product. One favourite that often works well is a combination of ketamine (an NMDA blocker), gabapentin (an anticonvulsant AMPA blocker) and clonidine (an alpha-adrenergic blocker).

Sometimes the pain and sensitivity were so great, the person couldn’t tolerate rubbing a pain cream onto the skin. In these cases, we would supply a lidocaine spray in a water base (avoiding alcohol that could cause painful coolness as it evaporated) to numb the skin before using the pain gel.

It has been very gratifying, as a compounding pharmacist, to be able to help people who were not getting pain relief from the standard medication. It was at a pain conference that I learned how muscle spasms, where muscles become thickened and shortened, could cause pain in a different part of the body by pressing on nerves or pulling on tendons that attach muscles to bone. This results in pain being sensed in a different location than the origin of the problem, making it more difficult to diagnose the source.

If you suffer from neuropathic pain in spite of treatment with standard medication, I highly recommend asking a local compounding pharmacist trained in pain management to work with your doctor. Together the 3 of you can work to find alternative solutions to calm your pain.

#NeuropathicPain

References:

Types and causes of neuropathic pain—Medical News Today

Algorithm for Chronic Neuropathy—Professional Compounding Centers of America (PCCA)

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Fibromyalgia

Fibromyalgia is a long-term condition that causes pain and tenderness all over the body. It’s not caused by damage or inflammation (like arthritis) but is believed to be caused by the nervous system becoming more sensitive to pressure and pain. Most patients also have fatigue that affects normal activities and is often worse after exercise. They also commonly report poor sleep, feeling unrested on wakening, poor memory and clouded thinking (also called or “fibro fog”).

Some people also have other nerve related problems along with fibromyalgia, such as restless leg syndrome, bowel or bladder problems, numbness or tingling, or sensitivity to noise, light or temperature.

Fibromyalgia used to be diagnosed by pain or tenderness in at least 11 of 18 specific points on the body. But now the requirement for diagnosis simply includes widespread pain on both sides of the body and above and below the waist for at least three months. Some have referred to the condition as “Central sensitivity syndrome”. It’s often reported to start after a stressful event, accident or infection, suggesting a possible involvement of stress hormones in its development.

Diagnosis

There is no specific test to tell you that you have fibromyalgia. It’s diagnosed by its symptoms along with the elimination of other potential causes for the pain. Fibromyalgia is often misdiagnosed and can take many years to be identified because the symptoms are similar to many other conditions.

Some of the illnesses doctors need to eliminate when they suspect fibromyalgia include low thyroid, rheumatoid arthritis, Systemic Lupus Erythematosis (SLE), polymyalgia rheumatica, other inflammatory/immune disorders, chronic fatigue syndrome, and multiple chemical sensitivity. If you have any chest pain/shortness of breath/palpitations your doctor would also screen for heart problems.

Fibromyalgia is not arthritis but somehow it falls under the umbrella of rheumatic diseases, perhaps due to the pain and fatigue sufferers experience being similar to arthritis. It is thought to involve effects on peripheral and central (in the brain) pain receptors, as well as spine inflammation and affective (mood) brain systems.

Doctors usually do blood tests to eliminate other causes of symptoms:

· TSH (thyroid test) – Low thyroid symptoms are similar to fibromyalgia, especially diffuse muscle pain and fatigue.

· Vitamin D (25-hydroxy vitamin D) – Low levels of vitamin D can result in muscle pain/tenderness. Very low levels can also cause fatigue.

· Iron – Deficiency can cause or worsen fatigue, sleep, depression symptoms, and restless leg syndrome. Transferrin and ferritin are molecules that transport iron, and blood levels of these may be tested to check for hemochromatosis (a genetic disease of excess iron in people of Mediterranean descent).

· Magnesium—Low levels can lead to muscle spasms.

· Erythrocyte sedimentation rate (ESR) – This is a test of how quickly red blood cells settle. An increased rate indicates arthritis-type inflammation. This is done to rule out inflammatory disorders that can mimic fibromyalgia symptoms and the value should be normal, indicating no inflammation.

Treatment

So far, no cure exists but management strategies can help greatly to relieve symptoms. Look for education about the disease to learn about lifestyle changes, physical activity, and medications that can help. Support groups, online and in person (once the pandemic is under control!), can be helpful. Be sure to ask your doctor for suggestions. Non-drug treatments can also give benefits and using several strategies together is ideal.

Stress management

Since there appears to be a stress component to fibromyalgia, learning how to reduce stress can be very helpful. Self management practices like relaxation training, activity pacing, visual imagery, and distraction strategies can add together to relieve fibromyalgia symptoms. Self-efficacy is the belief in one’s ability to control or succeed in specific situations, or to accomplish a task. Learning to increase self-efficacy give a sense of control and can improve the result of other treatments for any type of chronic pain.

Exercise

In spite of the fatigue and increase in pain that can be the result of too much exercise, it’s important to continue to do aerobic and resistance exercise. Low impact aerobics, walking, water aerobics, stationary bicycle, and Tai Chi are recommended exercises. Start gently and gradually increase as your tolerance improves.

Heat, massage, and other treatments like trigger point therapy for muscle spasms can be useful. Saunas, hot baths/showers, and self massage techniques help achieve self-efficacy for pain control.

Medications

It is strongly recommended to avoid narcotics, sleeping pills, and tranquillizers unless nothing else works, due to risk of addiction. These drugs can also increase fatigue and memory problems. Because people with fibromyalgia tend to be sensitive to medications and often experience adverse affects, it is recommended to start with low doses of all medications and gradually increase as necessary. Always combine medication with non-drug treatments, especially stress management, exercise, and psychological counseling if it’s needed.

Beware of medication duplication if seeing specialists for specific problems, for example, a dentist for temperomandibular joint pain (TMJ). I once did a medication review for a woman with chronic pain problems, and I discovered she was getting the same class of medicine from four different doctors!

Anticonvulsant drugs (such as pregabalin and gabapentin) and anti-depressants (like duloxetine [Cymbalta] and milnacipran/levomilnacipran [Savilla/Fetzima]), are used for their pain-relieving properties. However, they are given in much lower doses than when used for convulsions or depression. They also cause drowsiness but can help sleep if taken at bedtime or 1 to 2 hours before (giving time for the effect to kick in, plus wearing off earlier resulting in less morning drowsiness). If they bother your stomach, it’s recommended to take them with food. Non-prescription anti-inflammatories, like ibuprofen and naproxen, and acetaminophen (Tylenol) are usually of limited benefit.

Dextromethorphan (DM), found in nonprescription cough syrups or compounded by a pharmacist into capsules, has been successfully used for fibromyalgia and other chronic pain but does not have large studies to support its use. However, you could ask your doctor about it if what you’re using is not working well enough. It works by blocking NMDA pain receptors in the body.

Low dose naltrexone, also referred to as LDN, is a low dose of a prescription drug used to block opioid drugs (Naltrexone is a drug used to prevent drug abuse, similar to naloxone that rescues drug users in overdose, but slower and longer acting). It comes in tablets of 50mg but for fibromyalgia, the dose is 0.5mg daily, gradually increasing to as high as 4.5mg daily. Anecdotally patients report good results, but proper studies are currently lacking. However, since opioid receptors are believed to be involved in fibromyalgia, there is a logical mechanism behind use of this type of medication.

Medical cannabis has small studies to support effectiveness in fibromyalgia with few to no side effects. The synthetic cannabinoid, nabilone (Cesamet), was also found to improve pain and anxiety in fibromyalgia.

Beta-blockers, such pindolol or propranolol, taken in low doses at bedtime can improve pain and agitation.

Alternative therapies

· Alpha lipoic acid is a potent antioxidant that has been found to relieve pain in some with fibromyalgia. It has been studied for relief of diabetic nerve pain at doses of 600-1200mg daily, but for fibromyalgia some sources recommend starting with only 50-100mg daily, likely due to increased sensitivity to medications.

· Topical capsaicin cream, available without a prescription, can be a useful add-on. It has no side effects except possibly mild burning where it is applied (it’s made from hot peppers) but not everyone experiences this side effect.

· Magnesium and malic acid are 2 nutrients are involved in the production of energy within cells and a deficiency theoretically would cause some symptoms of fibromyalgia. However, research is still lacking to say these are supplements all fibro patients should take. A trial of 1 to 2 months should be long enough show a difference if you plan to try one or both of these.

· Progesterone replacement with natural progesterone (not a synthetic analog) has been reported to help reduce pain and improve sleep. Using it as a cream is more efficient as a large percent of swallowed progesterone is removed by the liver as soon as it’s swallowed. Users say that rubbing the cream on the painful area gives quick additional pain relief, suggesting that it works on local pain receptors as well as systemically. It is recommended to measure the cream for a consistent daily dose (usually 20 to 60mg daily but can vary from 10 to 200mg). Small studies suggest that fibromyalgia pain is increased in women with lower production of progesterone and testosterone. AS well, some women report their fibromyalgia began after menopause or other hormone changes, such as stopping hormone therapy, and this also supports the possibility of a hormonal connection. It could also explain why fewer men (who naturally have higher levels of testosterone) suffer from fibromyalgia. Progesterone cream is available in health food stores without prescription in the US but requires a prescription in Canada and must be compounded by a pharmacist. Note that many oils reduce absorption of progesterone through the skin. It must be prepared in an oil-free base to be effective.

· SAM-e (S-adenosylmethionine) has been studied for joint pain for many years. It has been found to relieve pain as effectively as anti-inflammatory drugs like ibuprofen, celecoxib (Celebrex) and naproxen (although these are reported elsewhere to have only a small effect in fibromyalgia). Newer studies suggest it may also improve symptoms of depression. But be sure to talk to your doctor before trying it.

· St. John’s wort is a herbal medicine that is well known to relieve symptoms of mild to moderate depression whether the result of living with chronic pain or other causes. However, as it works in a similar mechanism to standard antidepressants, it should not be combined with other antidepressants, like duloxetine (Cymbalta) or milnaciparin (Savilla/Fetzima) that are commonly prescribed for fibromyalgia as this would be a duplication leading to increased risk of side effects.

· Valerian is sometimes referred to as the “Valium” of the plant world and it has been proven to improve sleep in most people who use it. The good part is that it is not addicting like the benzodiazepine (Valium) family of drugs. It is available as capsules or tea…just a warning: hold your nose if using the tea as it’s described as smelling like “dirty socks”!

It is always recommended to talk to your doctor about alternative options and you certainly don’t want to try all of these options at once! Depending on their area of practice, your pharmacist may also be able to advise you about doses and possible interactions with your current medications. Most have access to good information sources on herbal and alternative medicines available to them. Keep in mind you may need to allow time for them to do the appropriate research.

Flare-ups

Identifying triggers for flare-ups can help you avoid them. Doctors recommend avoiding sudden changes in routine, for example, diet, exercise, and major life changes, if possible. Keep your activity level constant and know your limits.

Start medications at the lowest possible dose and increase gradually to reduce risk of flares.

Prepare ahead for situations that caused flares in the past. For example, arrange for help with housework or childcare if you suspect your fibromyalgia may flare up.

Behavioural therapy

Behavioural therapy, also called cognitive behavioural therapy or CBT, is a type of “talk” therapy that can help you look at your situation in a different way. Talking about anxiety, stress, depression, sleep disturbances, beliefs about pain, and coping strategies can improve the outcome of chronic pain treatments. Depression can be a contributor to pain or a result of chronic pain. If these “psychosocial” variables are not also recognized and addressed, results of medication treatment may be reduced in one third to one half of patients with fibromyalgia.

Diet

Modifying diet and practicing good sleep hygiene are crucial. A high sugar diet can worsen pain. Sensitivity to food additives is a problem for some with fibromyalgia, especially if they also have irritable bowel syndrome (IBS) which is a fairly common combination. Some people find alcohol can cause a flare up of symptoms. Caffeine beverages late in the day or a large meal eaten late can interfere with sleep.

Generally, a poor diet worsens symptoms of fibromyalgia. Doctors recommend a nutritionally balanced diet of whole foods, following a nutrition guideline, like Canada’s Food Guide. Adding individual nutrients as supplements may be useful if your diet is deficient. For example, you might experience muscle spasms due to low magnesium, or increased pain because of low of vitamin D.

But rather than take a lot of supplements “just in case”, it would be ideal to base supplement use on a blood test, if possible. You don’t want to take unnecessary medication, especially if you are already on a specific treatment for your fibromyalgia. Keep a food journal for 2 weeks before asking about recommended diet changes so they will know what you are currently eating.

Here are some specific diet recommendations I found:

· Slowly wean off caffeine (stopping abruptly may increase fatigue and pain, headaches, anxiety and worsen sleep).

· If you smoke or vape tobacco products, stop. Cigarettes and vape fluids contain many toxic chemicals that can worsen fibromyalgia symptoms.

· Eliminate food chemicals, especially MSG and aspartame. In some cases, just eliminating these 2 ingredients has resulted in improvement in symptoms. However, avoiding preservatives and other food additives can also be helpful.

· Eating large amounts of carbohydrate-rich foods (those high in sugar and white flour) may contribute to symptoms. Combining these foods with fiber or fatty food slows the absorption of the carbohydrate.

· Fruits are healthy foods that are generally high in carbohydrates, but some are higher than others. Citrus fruits, apples, berries, cantaloupe, and peaches may be preferred, and try to combine them with fiber- or fat-containing food.

· Avoid junk foods and packaged snacks as these usually contain large amounts of sugar/carbohydrates.

· Foods containing antioxidants, such as Vitamins C and E, minerals (selenium and zinc, and phytochemicals (natural chemicals found in whole plant foods) are important to include, as patients with fibromyalgia produce more damaging free radicals than do healthy people. Antioxidants neutralize these, preventing cell damage (presumably also damage to nerve cells).

· Low vitamin D is very common in people with chronic pain. Supplementing when blood levels are low has been shown to improve fibromyalgia symptoms. Note that vitamin D is produced in the skin in response to exposure to sunlight, and those in the northern hemisphere do not receive enough sunlight in the winter months to produce this vitamin. Supplements (up to 200iu per day) are highly recommended from October to April, and year round for those who spend little time outdoors or always wear sunscreen.

The photo above, by the way, is of the moon setting at 7am today, Friday February 26th… taken from inside, of course! It was -14c and very windy out there in east coast NB, Canada this morning!

References:

Fibromyalgia Differential Diagnoses—Medscape https://emedicine.medscape.com/article/329838-differential

Alternative Therapies for Fibromyalgia—WebMD https://www.webmd.com/fibromyalgia/alternative-therapies-fibromyalgia

How Alpha Lipoic Acid Helps Fibromyalgia Pain—Healing Fibro How Alpha Lipoic Acid Helps Fibromyalgia Pain – Healing Fibro

Daily Fluctuations of Progesterone and Testosterone Are Associated With Fibromyalgia Pain Severity—The Journal of Pain Daily Fluctuations of Progesterone and Testosterone Are Associated With Fibromyalgia Pain Severity – ScienceDirect

Progesterone information: Can I Speak to the Hormone Lady? –Jeannie Collins Beaudin https://jeanniebeaudin.wixsite.com/author/books

#fibromyalgia #chronicpain #FibromyalgiaProgesterone

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COVID-osis

Well, I just realized it’s a good thing we’re back to “orange” here in southern New Brunswick… I think I was starting to catch “COVID-osis”, that mental state that comes over you when you’ve been in COVID isolation just a little too long.

You know what I mean… you start lots of projects to keep yourself busy since you have so much time on your hands with no socializing and so many places off-limits. You know you have to be careful, especially with the new, highly contagious variants invisibly finding their way into our communities so you’re mostly just staying home. And since no-one is coming to visit, why not leave everything out so you can just hop from one activity to another when you get bored? Plus, nobody will see the dust, so just leave the cleaning until next week and have some fun.

Lots of projects…

I’ve developed little work stations all over the house. I have my art desk set up in the sun room, with all my tools, supplies and works in progress. And I have my tablet set up there so I can pop in and do another section of the online painting lessons I signed up for whenever the mood strikes me. My spare bedroom is converted into a sewing and knitting room (I have a knitting machine). I’m still making a few masks—my daughter needed some spares when she finally was rehired to her old job she lost during the first wave. And the family room has my hand knitting corner where I like to knit while watching TV. Inspired by all the “Bernie” memes, I’ve been knitting patterned mittens… about a dozen pairs done! Just for fun, I’ve even added thumb openings for those who like to take photos with their phones outdoors!

But the house gradually got messier, I hung out in my PJs longer, and I needed an invitation from my hubby to inspire me to go for a walk outside. I had set up my computer on the dining room table for some reason that I don’t remember any more, and there it stayed. Too convenient. I wouldn’t call it depression, but there certainly was a level of not caring about the various messes all over the house while the “red zone” restrictions dragged on and visiting wasn’t allowed.

Back to “Orange”

Thank goodness we’re back to “orange”… nothing like a little contact with other humans to perk you up. With the current level of restrictions, we are allowed to socialize with 10 other people who don’t live in our home. So we enjoyed a wonderful dinner with 4 friends and invited 2 family members over for dinner this week. Four more positions to fill… That will be my sisters and their hubbies this Sunday! We’re going to celebrate all the 4 birthdays we missed during the restrictions, all at once!!

Of course, visitors coming for the first time in a long time made me look at my living areas through new eyes. Good grief… I couldn’t let anyone see all my mess! I spent a full day cleaning and putting things away, and another day preparing for our “grand visite”. And guess what? I love how everything looks now. I just look around and feel good about my home. Wish I’d done it sooner!

My computer is back on my desk where I can do some serious work. If I’m planning to get more writing done this winter than just my blog, I’d better get at it. In fact, I have a book written that just needs to be uploaded, and I just got a beautiful, finished cover for it. Nothing holding me back now except myself!

How about you?

So, how are you doing with COVID restrictions? Have you been doing anything special to keep busy during all your extra “spare time”? Is it helping your state of mind and energy level? It’s all too easy to just lounge around feeling sorry for yourself, missing the good times usually spent with family and friends (as I can attest!). But it can feel good to accomplish something, at least for me, and clearing away the clutter made me feel even better. It’s good to find an activity that makes you feel relaxed and contented, whether it’s meditation, art, exercise or something else.

What’s your favourite feel-good thing to do to fight off “COVID-osis”? Please share in the comments… maybe your ideas will help inspire the rest of us!