Category: Health

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Health

C. Difficile…so difficult!

Clostridium difficile is a bacterium that is resistant to many antibiotics – hence the name “difficile” since it’s difficult to treat! It is the most common cause of infectious diarrhea in hospitals and nursing homes in Canada and other industrialized countries.

Most cases occur in patients taking certain antibiotics that kill a wide range of bacteria (referred to as broad-spectrum antibiotics) in high doses or for a long period of time. The normal bacterial flora in the digestive system that keep c. difficile in check is destroyed by the antibiotic, allowing the resistant c. difficile to take over. These infectious bacteria produce toxins that damage the bowel, and cause diarrhea and inflammation in the lining of the bowel.

Some people can have c. difficile in their bowel and not show symptoms, likely because other bacteria are keeping its growth in check. There are different strains of c. difficile and some cause more serious illness.

Stomach acid helps to kill unfriendly bacteria like c. difficile if we happen to swallow some. Acid-suppressing drugs, especially proton pump inhibitors (like Losec®, Tecta®, and Nexium®) that strongly block acid production, can increase the risk of a symptomatic infection of c. difficile.

How is it passed from person to person?

C. difficile bacteria and their spores are found in feces. People can get infected if they touch surfaces contaminated with feces and then touch their mouth… (How gross!) This helps you understand how important it is to wash your hands regularly!

If you are healthy, generally there is actually little risk of developing an infection. But in the elderly and those with other illnesses whose immune system may be less healthy, there is a greater chance of infection.

It’s important to keep the normal gut bacteria healthy. When there are fewer normal healthy bacteria in the gut, c. difficile have a better chance to grow and cause infection. Include fermented foods that contain live bacteria in your diet, and take probiotics after a course of antibiotics. This will help to replace the good bacteria that are often destroyed along with the bad ones that caused the infection and maintain a healthy gut flora.

What are the symptoms?

C. difficile infection causes watery diarrhea, fever, decreased appetite, nausea, and abdominal pain or tenderness. The diarrhea usually does not respond to regular diarrhea medications and will last more than the 2 or 3 days of diarrhea from other causes. A stool sample is often tested to confirm that the cause of the diarrhea is c. difficile.

How can you prevent c. difficile?

Wash your hands often with soap and water. Healthcare workers should always wash their hands after touching every patient to prevent passing bacteria and other infectious organisms from one patient to another (or to themselves!). At home, always wash your hands after caring for an ill person, using or helping with toileting and before preparing or eating food.

Alcohol-based hand washes help but are not as effective as soap and water as they do not kill c. difficile spores. Wearing disposable gloves when caring for someone with c. difficile is recommended and hands should be washed with soap and water when the gloves are removed.

How is c. difficile infection treated?

The antibiotic that caused the infection should be stopped right away, and a new antibiotic that kills c. difficile will often be started. Very mild cases may clear on their own.

C. difficile is resistant to many antibiotics, hence the name “difficile – difficult to treat! Metronidizole (Flagyl®) is an antibiotic that may be effective for mild to moderate infections. Vancomycin (Vancocin®) is used for more severe infections and it is considerably more expensive than metronidazole. A new antibiotic, fidaxomicin (Dificid®) showed better results against c. difficile in studies, but it is very expensive.

Taking probiotics (good bacteria in capsule form) in large doses has been reported to help when all else has failed, or as an add-on to antibiotic treatment. It also helps to prevent reinfection, which occurs in 20% of cases.

In extreme cases, the diseased part of the bowel may be surgically removed. Fecal microbiota transplantation (also known as stool transplant) is another new therapy that may be tried in recurrent infection. Donors are screened for infections, parasites, viruses and other bacteria. Stool from the donor is then placed into the infected person’s bowel using a colonoscope or nasogastric tube.

References

https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

http://www.mayoclinic.org/diseases-conditions/c-difficile/diagnosis-treatment/treatment/txc-20202426

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Health

Artificial sweeteners may cause weight gain!

You could be gaining weight because you are using sugar substitutes… A new study suggests use of artificial sweeteners is linked to weight gain (not loss!) and increased risk of developing diabetes…

Considering the widespread use of sugar substitutes, it is surprising that there are comparatively few long-term studies that have been done. Most are “observational” studies rather than the higher level intentional type of study (randomized groups, placebo-controlled studies referred to as “randomized controlled trials” or RCT’s), so cannot prove a cause-and-effect relationship.

However, in the long term RCT’s averaging 6 months that the researchers found, regular users of artificial sweeteners had an increased risk of type 2 (adult onset) diabetes, higher blood pressure, and modest increases in weight and waist circumference.

The Canadian researchers could find no solid evidence for long-term benefit from artificial sweeteners, and there was some evidence of harm from long-term consumption.

But why would artificial sweeteners be linked to weight gain, not loss? Researches couldn’t explain, but had some thoughts:

  • Artificial sweeteners may disrupt healthy gut bacteria.

  • They may confuse metabolism. For example, the sweet taste may cause the body to be expecting sugar, stimulating a release of unneeded insulin. Increased blood insulin is the first stage in the development of type 2 diabetes. It also would cause a decrease in blood sugar that would stimulate appetite.

  • The appetite-stimulating mechanism may overcompensate for missing calories from sugar when eating other foods.

  • Artificially sweetened foods may simply be a common part of an overall unhealthy diet.

An Australian study suggests that artificial sweeteners may increase appetite for calories by up to 30%. When sweetness versus energy is out of balance for a period of time, researchers say, the brain re-calibrates and increases total calories consumed. They called this the “starvation response”.

They also learned that the brain produces 2 waves of “pleasure” producing dopamine – one with the taste of sweetness and a second wave when the blood sugar rises. If there is no blood sugar rise (because an artificial sweetener was used) the brain sends hunger signals.

A US study, published in the American Journal of Public Health in 2014, found that overweight and obese people ate more when they drank artificially sweetened drinks.

The Australian study also noted increased hyperactivity, insomnia and glucose intolerance as well as an increase in appetite and calories consumed in animals they studied.

Altogether, these studies suggest that we would be much better off to avoid sugar substitutes completely and use a small amount of sugar instead. Better yet, switching to water (flavoured with a herbal tea if you like) might be a good way to promote a healthier waistline!

References:

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Health

Waking up with a stiff one in the morning???

Of course, I’m talking about a stiff neck, back or, heaven forbid, a Charley-horse! What causes those awful muscle spasms and can you prevent them?

Skeletal muscles are the muscles attached to our bones that are generally under our conscious control. We use these muscles to move parts of our bodies and to make facial expressions, such as smiling.

A muscle spasm, or muscle cramp, is an involuntary contraction of a skeletal muscle. Spasms of the skeletal muscles are often caused by overuse and muscle fatigue, by electrolyte imbalances or can be associated with a previous injury. Usually they occur abruptly and don’t last long. If they are extremely painful and don’t resolve on their own, you should seek a medical assessment to look for possible underlying causes.

Causes

Although the precise cause of a muscle spasm is not always known, electrolyte imbalances are believed to contribute. Spasms occur more frequently when exercising or doing physical work in hot weather, when dehydration and electrolyte loss occurs due to sweating. Muscles require enough water, glucose, sodium, potassium, calcium and magnesium to allow the muscle proteins to develop an organized contraction. A lack of any of these elements can cause the muscle to become irritable and develop spasm. The muscle soreness and increased risk of spasm that occur after new or increased exercise is thought to be due to a lack of electrolytes. With continued exercise, blood flow capability increases, bringing increased electrolytes, nutrients and oxygen to the muscle, and soreness no longer occurs.

Other causes of muscle spasms include:

  • decreased blood supply to the muscle, due to narrowing or disease of the arteries,

  • arthritis or other injury of a joint (where muscles spasm to try to support the damaged joint),

  • obesity, where increased weight can cause stress and strain of the core muscles of the trunk, leading to spasms of the neck and upper or lower back

  • diseases like diabetes, anemia, kidney disease and thyroid or other hormone issues (can potentially disrupt electrolyte balance)

  • diseases of the nervous system, such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), or spinal cord injury

Treatment

If a skeletal muscle goes into spasm, the initial treatment is to gently stretch the muscle lengthwise to break the spasm and resolve the acute situation. A physiotherapist or massage therapist can teach you exercises to stretch less obvious muscles, relieving spasm and pain. Heat and anti-inflammatory medications, such as ibuprofen (Motrin, Advil) or diclofenac (Voltaren Gel) can also be helpful for short-term pain relief. Your doctor may prescribe stronger pain medication and/or a muscle relaxant in more severe situations when the spasm does not readily subside. In Canada, the muscle relaxant, methocarbamol (Robaxicet and generic versions) can be bought without a prescription.

Quinine, an anti-malaria drug, is a very effective medication for nocturnal leg spasms and was used for many years for prevention of the nighttime “Charley-horse”. However, quinine was found to have serious side effects (vision problems and abnormal bleeding) and is only used now in severe cases where other medications do not help.

Trigger Points

A “trigger point” is a small area of contraction in a muscle, that shortens and weakens it, creating pain where the muscle attaches. The trigger point is often not located where the muscle pain is perceived. In medical terms, this is described as “referred pain”, much like the way a heart attack (damage in the heart muscle) is often felt in the left shoulder or arm. A trigger point is defined as a “highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue” — so it’s an area that is painful when pressed and can be felt as a lump under the skin in the muscle. Drs. Travell and Simons wrote extensively about trigger points starting in the 1940s, mapping out common muscle trigger points and the areas where pain from each is commonly felt. Their work is the basis for today’s therapeutic massage and for some physiotherapy.

Massage, either by a professional or self-massage, can be helpful for muscle spasm. Massage can increase circulation to the muscle, bringing nutrients and removing breakdown products. Pressure on the trigger point of a muscle can also help to relax a spasm and trigger points are sometimes used as the site for acupuncture or accupressure. If you are interested in learning self-massage for relief of pain from chronic muscle spasms, I could suggest The Trigger Point Therapy Workbook, by Clair Davies, an excellent self-treatment guide that I have used with my clients (and myself!) for many years.

Conclusion…

So, if you are exercising or doing physical work, especially in a hot environment, be sure to drink extra water to replace fluids you are losing. If you are prone to muscle spasms, consider also replacing minerals, for example, by consuming a supplement or electrolyte containing foods or drink during activities on warm days. Ensure your diet contains adequate minerals: calcium, magnesium, sodium and potassium. If the spasm lasts more than a few days and is not due to an obvious overuse of the muscle or dehydration, see your doctor or physical/massage therapist and, together, look for an underlying cause.

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Health

Dance away your cares!

Saturday, July 1st, is Canada’s 150th birthday, and there will be music and celebration across the country… and, no doubt, lots of dancing, singing and just plain happiness! Celebrations are good for the spirit and dancing is one of the most fun types of exercise.

Dancing can actually be used as a therapy for many conditions, including anxiety, depression, feelings of isolation and chronic pain. It’s also used in patients with brain injury, AIDS, arthritis, autism, cancer and other conditions. It can be performed by those who are physically disabled, mentally handicapped and even elderly folks in nursing homes. Last week, I watched a video of a group of ladies dancing with their walkers to “Rock around the clock” – they were having a wonderful time! Click here to enjoy it too!

Dance therapy works for anxiety, depression and pain through the mind/body connection. In addition to the exercise component and exposure to music – both therapeutic in themselves – dance allows expression of feelings and thoughts through movement. And it’s fun!

A trained dance therapist can see dance movements as a source of information… an expression of the client’s subconscious thoughts and emotions, relationships to others, and symbolic movements that are personal to each individual. Feedback to the client from the therapist is used to promote increased self-awareness. Changing movements is claimed to initiate a change in the subconscious, and vice versa. So, trying out a new dance or changing up your moves can be even more uplifting. Dance is thought to express something that cannot be expressed in any other way.

Regardless of the interpretations a trained dance therapist can extract, there is no doubt dancing is therapeutic, even without anyone analyzing your movements! Moving to music you love is great exercise and lots of fun, and guaranteed to lift your spirits. It’s an exercise you can do while socializing with a group: formally at a class, informally at a club, or at a family wedding… or all by yourself with music blaring while cleaning the kitchen! Dancing with your kids or grandchildren is especially fun. A favourite activity in our house was dancing to the music of Dire Straits on a Saturday morning…some of their tunes still make me want to get up and dance!

So, turn up the music and dance like nobody’s watching… as often as you can… no matter who is around! It will improve your fitness level and lift your spirits, and might even help reduce anxiety, depression and pain.

Happy Canada Day!

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Health

Tick talk…

It’s tick time… and ticks, including those that carry Lyme disease, are in long grass and on bushes, waiting to grab onto you, your clothing or your pet as you pass by.

The numbers of cases of Lyme disease are increasing – the US Center for Disease Control (CDC) estimates over 300,000 cases occur each year, although only around 30,000 are reported. Lyme infected ticks are present in largest numbers in north eastern US but, with global warming and increases in deer population, deer and the ticks they carry, are migrating north and are now found in parts of Canada as well. They are even found as far south as Florida, but are less likely to contact humans in warmer climates, as they hide during the day to seek shelter from the heat.

Lyme disease is caused by bacteria in the Borrelia family – tests look specifically for the Borrelia bergdorferi – but some researchers suspect that all bacteria in the Borrelia class can cause similar disease. The bacteria are carried mainly by black-legged ticks, also called deer ticks or bear ticks, and these ticks in turn are carried by deer, mice, gray squirrels, opossums and chipmunks. Lyme disease is not something new – DNA from the bacteria that causes it was identified in the 5,300 year old bones of Ötzi the Iceman, a mummy found in the Eastern Alps in 1993.

Early symptoms of Lyme disease include fever, chills, headache, fatigue, muscle and joint pain, and swollen lymph nodes. 70 to 80% of people who are infected get a rash that gradually increases in diameter over several days, and about 30% of these have a distinctive “bulls eye” appearance. The rash can get as large as 30cm (12 inches) across, most often is uniformly red or bluish red, and is rarely itchy of painful. However, 20 to 30% of infected people have no rash as all so its presence is not necessary for a positive diagnosis.

Diagnosis of Lyme disease is usually made by symptoms plus a history of tick exposure. However, immature ticks are tiny and flesh coloured, and can be difficult to see on the skin. Blood tests look for antibodies to the bacteria, not for the bacteria itself, as Borrelia dislike oxygenated environments and leave the blood quickly for other less oxygenated tissues, such as joint fluid or bone. As antibodies take several weeks to develop, blood tests will often not show positive results in the first few weeks of an infection. All of this suggests that many cases are not readily diagnosed.

If diagnosed and treated early, however, a full recovery is likely. It is treated with antibiotics, usually amoxicillin, tetracycline, doxycycline or cefuroxime, generally for 10 to 21 days but sometimes longer.

Ticks are tiny – the size of a poppy seed – so you need to look carefully to see them. As they feed, they become engorged with blood, becoming larger and easier to see. But you want to remove ticks as soon as possible. The tick must attach to skin for 24 hours to transmit the disease, so early removal can reduce the chance of infection. Check skin carefully after walking in tall grass or gardening – ideally, remove all clothing first so you can check all areas of your body. Be aware that clothes and pets can carry ticks too, that can bite you later, so handle clothing carefully (best with rubber gloves if you suspect ticks are present). Place clothes in the dryer at high heat for at least 15 minutes – dry first to kill any ticks, then wash later! Ticks have been reported to survive washing of clothing.

There are two good techniques for tick removal, depending on what tool you are using:

  • Fine-tipped tweezers – grasp the tick close to the skin. You want to grip the head, not the body (squeezing the body can cause the tick to regurgitate infected fluids into the bite, increasing the risk of infection). Pull straight upwards (or in the direction opposite to the angle of entry of the mouth parts, if you can see this), and pull slowly and steadily. Don’t twist or jerk the tick out quickly as this can increase the chance of the head or mouth parts breaking off and staying in the skin. Any parts left in the skin will also cause irritation and can increase the risk of other infections and can be removed as you would remove a splinter, with tweezers or a needle. Don’t use flat-tipped tweezers to remove ticks, as these will squeeze the body, increasing the chance of fluid regurgitation.

  • Tick removal tool (O’Tom Tick Twister is one recommended brand I found) – slide the tool between the body of the tick and the skin, and rotate the tool 2 to 3 times until the tick detaches. Rotate in only one direction to decrease the risk of breaking off mouth parts. Follow included instructions carefully.

Ticks are also more likely to regurgitate fluids into the wound, increasing the risk of infection, if they are irritated. Tick removal techniques that involve burning, freezing or using harsh chemicals to make the tick let go are not recommended. A viral internet video showing a technique using liquid dish detergent and a cotton ball seems to be effective at removal, but the irritating soap may increase the chance of fluid regurgitation. This technique is not recommended in the sources I consulted, due to a lack of testing to ensure the risk of regurgitation is not increased.

Ticks can be crushed in a tissue then flushed, or encased in a piece of adhesive tape. Placing into a ziplock baggie is another option. Some sources suggest keeping the tick for confirmation testing, in case symptoms of Lyme disease develop in the future.

So, pop a pair of pointed tweezers or a tick removal tool into a baggie and add it to your hiking or gardening equipment this summer! If you have room, add a roll of adhesive tape to safely remove any unattached live ticks you see on your skin, clothing or pet. And check your skin carefully after enjoying an outing in long grass or bushes where ticks may be waiting for you, so you can remove them before any infection has a chance to take hold…

Have you had a tick bite? How did you handle it? Leave a comment below!

References: WebMD.com; PetMD.com; http://www.bada-uk.org/correct-tick-removal

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Health

How to fall well…

Falling when you’re a child is part of life but falling as an adult puts you at risk of an injury, whether you’re in you’re 20’s or your 80’s. There are strategies to prevent falling but, if you do fall, you can also fall “well”…

Here’s my story: while excitedly trying to book concert tickets on my phone and climbing the stairs, I took a step backwards to say something to my husband, missed the stair, and landed with full weight on a turned ankle. The bad sprain that resulted required several weeks recovery (including an air cast) plus weeks of physiotherapy… all from a moment of inattention.

Of course, much of what I want to discuss is common sense. However, many falls are due to not paying attention or neglecting to correct an obvious hazard. Taking a few moments now may mean you will avoid an injury that could take weeks to recover from.

If you do fall, of course you’ll only have a fraction of a second to react… but falling properly can decrease your chance of a serious injury. Here are some suggestions that may help you to react correctly:

  1. Protect your head – It’s the most important part of your body!

    1. If falling forward, turn your head to the side to protect your nose and mouth. Bring your arms up in front. Think of landing in a push-up, with arms flexed to absorb the impact.

    2. If falling backward, round your back and tuck your chin to your chest.

  2. When falling sideways, turn as you fall if possible. Try to land on the “meaty” area of your butt to cushion your fall rather than land directly on your hip.

  3. Keep arms and legs bent and stay loose to absorb impact.

    1. Try breathing out as you fall to keep relaxed.

    2. Try to break your fall using both the hand and forearm to avoid excess force on the wrist.

    3. Roll with the impact if you can to reduce the force on one area of the body.

Here is a site with more suggestions on falling “well”: http://www.wikihow.com/Fall-Safely

Of course, it’s always best to avoid a fall that could cause a painful injury. Most falls are preventable — being aware of the possibility and taking preventative action could prevent a lot of pain:

  • Exercising regularly to maintain flexibility and balance may help you to prevent a fall.

    • Physical activity builds strength, coordination and balance. Slow, gentle exercise like yoga or Tai Chi is very effective. For those who are less able to exercise, even exercise done while sitting in a chair can improve muscle strength, improving the ability to maintain balance when standing. There are lots of exercise programs on the internet – sparkpeople.com is a free one that includes a series done in your chair for elderly or those with a disability.

    • Stretching regularly can improve flexibility, giving increased range of movement and reducing chances of pulling a muscle if you do slip or fall. Stretches can easily be done in bed when you awaken or before going to sleep. Stretching can also be beneficial for muscle spasm related problems, like low back pain or heel pain. Consult a physiotherapist or massage therapist for personalized exercises if you have specific problems.

  • Around the home

    • Footwear – Floppy slippers, sock feet, high heels, or slick soles are best avoided. Choose footwear with non-slip soles whenever possible.

    • Stairs – Always use handrails, and pay attention to your footing when climbing or descending stairs. Ensure stairs have a slip resistant covering.

    • High traffic area – Keep clear of tables, lamps, etc.

    • Remove hazards – Ensure rugs are non-slip, carpet edges are secure, and electrical wires are securely wrapped up and tucked away. Clean spills of liquids, grease, powders or food right away.

    • Lighting – Have adequate lighting to ensure you can see potential hazards at night, especially on stairs. Have a lamp within reach of your bed in case you need to get up at night. Ensure a clear path to switches that are not near the door of the room. Keep a flashlight in an accessible area (that you will remember!) in case of a power outage.

  • Use proper safety equipment, indoors and out

    • If you need to use out-of-reach storage area, have a sturdy folding ladder available – never stand on furniture to reach high areas.

    • Ensure your bath tub has a properly installed non-slip surface. Elderly or disabled should consider installing safety hand rails, but and using a bath chair with handheld shower for increased safety.

  • If you’ve had a fall that is not easily explained, make an appointment with your doctor or pharmacist to discuss possible causes:

    • Check medications – some medications can increase the risk of falling. Check type, dosage and number of drugs being taken.

    • Check health conditions – some falls are caused by an undiagnosed health problem that can be corrected.

    • Review any history of falls to identify potential problems.

    • If you have a chronic disability, an occupational therapist may be able to provide you with solutions that will improve your lifestyle and reduce risk of injury.

Lastly, just paying attention to what you are doing can often prevent injuries. Certainly, my fall on the stairs was completely due to not paying attention to what I was doing. It’s easy to run on “autopilot” as we perform routine activities, but so important to always remain aware of our surroundings …All just common sense, of course, but worth some conscious thought!

Do you have other ways to prevent falls, or to prevent injury if you do fall? Leave a comment below!

Reference: Mayo Clinic website.

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Health

Dirty places

I believe it’s always better to prevent disease than treat it… An article forwarded by a reader prompted this blog about what you can do every day in your home to reduce exposure to disease-causing bacteria, viruses and fungi.

Here is a list of the dirtiest places in your home, and how to clean them up:

Kitchen

Sink – Food particles rinsed off dishes along with moisture create a breeding ground for bacteria like E. coli and salmonella. Your sink should be disinfected at least as well as your toilet bowl and a lot more often!

  • Rinse your sink at least once a day with bleach and water. A spray bottle with 1 part bleach and 9 parts water makes this easy. [Most spray bottles are 1 liter, so pour in 100ml bleach (measurements are usually indicated on the bottle) and fill up with tap water]. Spray generously, leave at least 5 minutes, then rinse.

Dish cloth – food particles also become lodged in your dish cloth and the cloth stays wet for hours (sometimes all day!), creating another ideal growth environment for bacteria that you then spread onto counters and dishes as you wash them.

  • Change to a clean cloth every day and consider spraying with your bleach solution when you clean your sink. I also keep a bucket of bleach and water in the laundry room and toss the dirty cloths in to soak until laundry day.

Dining room

Salt and pepper – Researchers at University of Virginia (2008) tested home surfaces touched by people in early stages of colds and found viruses on 41% of surfaces tested, including all sets of salt and pepper shakers.

  • When wiping the table after a meal (with your clean cloth!) be sure to include the salt and pepper.

  • Wash hands before eating, especially if you’re coming down with something, to prevent spread of germs to yourself and others.

Living room

Remote control – Just think about that one: it’s dropped on the floor, falls between sofa cushions, coughed on, sneezed at… and then you pick it up and use it, sometimes while having that finger-food snack in front of the TV. The study mentioned above showed the remote control was among the germiest household items they found.

  • Wipe regularly with a disinfecting wipe, or a bleach or alcohol solution to prevent spread of germs, especially when someone in the household is sick.

Office

Computer keyboard – Like the remote, keyboards are sneezed on and touched with hands that may be contaminated with bacteria and viruses, especially if shared. Some also eat at the computer, providing more food for bacteria in the form of crumbs. British researchers who swabbed keyboards found E. coli and staphylococcus bacteria. Four out of 33 keyboards tested were declared health hazards and one had 5 times more bacteria than found on the average toilet seat!

  • Wash hands before and after using your computer.

  • Avoid eating at the computer but, if you must, shake out crumbs regularly and/or vacuum with the brush attachment.

  • Wipe the keyboard with alcohol or bleach wipes but avoid anything too wet, which could short out your keyboard.

  • Don’t forget to wipe the mouse too!

Bathroom

Toothbrush – Just think: you use this brush to clean your mouth of excess bacteria and plaque that accumulates in your mouth overnight… I’ll say no more!

  • Replace your toothbrush regularly, especially after an illness.

  • Rinse your brush well and store it where it will dry well after each use.

  • Consider rinsing or spraying with peroxide after use. A small squirt bottle or sprayer works well for this – check the cosmetic department for a suitable empty container.

Toilet – Research found that flushing the toilet can send water droplets into the air as far as 6 feet, and bacteria from droplets can linger in the air for as much as 2 hours, and can be inhaled or land on nearby surfaces (including your toothbrush!).

  • Close the cover of the toilet before flushing.

  • Store toothbrushes where they can air out but away from the toilet.

Tub – Water from bathtubs, especially whirlpool tubs, has be found to contain bacteria and/or fungi. Whirlpools, because their pipes and motor tend to trap water, are especially prone.

  • Clean and disinfect tubs after every use with bleach (home made sprayer, described for kitchen use above, works well!) or bathroom cleaner.

  • Run whirlpool tubs for 30 minutes once a month with hot water containing ½ cup of powdered dishwasher detergent to clean the pipes.

Bedroom

Bed – House dust mites (tiny creatures too small to see with the naked eye) love the dead skin cells that slough off our skin at night and the moisture from our sweat. Millions can be found in older mattresses and pillows, and in our sheets and blankets too. Their feces (that looks like tiny pearls under a microscope) are especially irritating and allergenic when inhaled, and are the source of many chronic allergic reactions.

  • Change old mattresses and pillows, or cover with an allergen-proof cover. If highly allergic, a cover will reduce allergic symptoms even with a newer mattress.

  • If highly allergic, consider vacuuming the mattress when changing the bed.

  • Wash sheets and covers regularly in hot water to kill and remove dust mites.

  • Air out non-washable items like duvets regularly, ideally outdoors in sunshine.

  • Pillows can be washed too – use hot water, as with sheets.

  • Keep humidity low to discourage mite growth. Mites peak in April and October, when temperatures and humidity are ideal for their growth. Asthma and allergies also peak at these times of year!

  • Turn down your bed instead of making it, once or twice a week, or delay making it in the morning to let it dry thoroughly. I’ve always made my bed first thing in the morning – I plan to change this habit!

Of course, you don’t need your home to be sterile! But paying some attention to these potential problem areas may help to prevent the next cold or flu from spreading to everyone in the house… or prevent a minor illness from common bacteria or fungi!

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Do you take daily stomach medicine?

If you have been taking potent acid-suppressing drugs [Losec (Prilosec in USA), Nexxium, Prevacid, Tecta, Dexilant or others] regularly for more than 8 weeks, you should talk to your doctor about whether you should continue taking them. Although indicated long-term for some conditions, recent studies have found that 40 to 55% of people are taking them for no diagnosed reason.

One factor that keeps people on these drugs, known as PPI’s (Proton Pump Inhibitors), is that many experience “rebound hyperacidity”, or increased production of stomach acid, when the medication is stopped. New guidelines have been created to help your doctor advise you how to quit these medications if they are no longer needed.

Although this class of drug has been available for over 25 years and is generally regarded as safe, with some being sold now without prescription, some problems have been associated with long-term daily use:

  • Decreased absorption of some vitamins and minerals (calcium, magnesium, vitamin B12 and possibly iron, and vitamin C) that need stomach acid for absorption.

  • Decreased bone density (due to decreased absorption of calcium) with associated increase in fractures of the wrist, hip and spine.

  • Increased muscle spasms (due to decreased magnesium)

  • Interactions with some drugs (clopidogrel [Plavix, taken to prevent blood clots], high dose methotrexate [used to treat cancer].

  • Increased growth of certain unfavourable bacteria in the digestive system (C. difficile, Traveller’s Diarrhea, Small Intestine Bacterial Overgrowth).

  • Increase risk of developing pneumonia (likely associated with increased bacteria in the digestive system).

“Observational” studies suggest an association of use of PPI drugs with increased cancers of the esophagus and stomach, dementia, chronic kidney disease and heart attacks. Observational studies do not prove the drugs cause these conditions, but they have created some concerns. Although recommended for preventing acid reflux in patients with Barrett’s Esophagus (scar tissue in the esophagus caused by long-term acid reflux, believed to be a precursor for cancer of the esophagus), one study observed increased rates of cancer in patients who took PPI’s daily. Hopefully, future studies will be done to determine whether these drugs are truly a cause of the observed increased risk.

A newly reported study done at University of Southern California has suggested a mechanism for multiple organ damage from acid suppressing drugs. PPI drugs block the pumping mechanism that pumps acids into the stomach but they found these drugs also block similar acid pumps in the tiny enzymatic “garbage disposal” lysosome sacks within other cells in the body, reducing the acid they need to function. This, they propose, allows waste to build up inside cells in the kidney, brain and lining of blood vessels, causing cells to age more quickly and dysfunction. This could explain how drugs designed to dramatically reduce acid in the stomach, could affect other organs. However, more research is needed – so far, this is just a theory.

Meanwhile, many people are taking these drugs for no documented reason and others may do just as well on a lower level acid suppressing drug such as an H2RA or Histamine-2 Receptor Antagonist [the ranitidine (Zantac)/ famotidine (Pepcid) family of drugs] that don’t have these side effects. Non-drug approaches can also be used to reduce acid reflux. These include diet and lifestyle changes, such as:

  • Eat smaller meals and don’t eat late at night

  • Reduce weight (even 5-10% can make a difference)

  • Avoid tight clothing

  • Avoid “trigger” foods and drinks (keep a diary of which foods were eaten before episodes)

  • Ask your pharmacist or doctor to check your medications for any that might be aggravating reflux

The guidelines recommend lowering the daily dose, stopping, switching to “as needed” use, or changing to an H2RA to reduce acid, once a course of 4 to 8 weeks has been completed to heal an ulcer or esophagus damage from heartburn. Note that “rebound hypersecretion” of acid has been reported for up to 2 weeks when long-term PPI drugs are discontinued, that is difficult to distinguish from the original problem. Reducing the dose gradually and introducing non-drug strategies (diet/lifestyle changes) may help reduce symptoms on discontinuation of PPI’s. Click here for Mayo Clinic’s lifestyle recommendations for reflux (GERD or GastroEsophageal Reflux Disease).

The detailed deprescribing guideline recommendations are available here.

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Health

Considering injections for arthritis? Read this!

Injections of steroids into a joint to reduce pain and inflammation from arthritis is a relatively common practice. But this week, I read two studies that questioned this treatment…

The first study compared knee injections of the steroid, triamcinolone, with saline and the injections were given every 12 weeks for 2 years. Although both groups experienced some pain relief, the difference wasn’t significant. And, the group that received triamcinolone had significantly greater cartilage volume loss than those who were injected with saline. Cartilage forms the natural cushioning layer inside our joints.

This study was published in the Journal of the American Medical Association on May 16, 2017.

The second study was reported in Univadis, a health news service I read every week, and the study was posted on Pubmed, a service of the National Health Institutes in USA. This study compared injections of sodium bicarbonate (baking soda) plus calcium gluconate, with injections of the steroid, methylprednisolone, given into the knee joint monthly for 3 months.

Although both groups showed benefit, the sodium bicarbonate/calcium group showed significantly greater improvement than the group who received the steroid injection. These results build on earlier research showing that bicarbonate/calcium injections were helpful for inflammatory joint disease, published in 2015 in BMC Musculoskeletal Disorders.

Taken together, these studies suggest that steroid injections should no longer be used to treat osteoarthritis, at least in the knee joint. Sodium bicarbonate and calcium gluconate are readily available in injectable form, are relatively inexpensive, and the second study suggests they may offer a beneficial substitute.

Sodium bicarbonate neutralizes acid, producing a more alkaline environment, and calcium acts as a buffer, also reducing acidity. So, in my mind, this begs the question: can osteoarthritis patients benefit from adjusting their diets to provide a more alkaline system? And would this help to reduce joint inflammation? Lots of health sites promote this as fact, but hard science is lacking, perhaps due to lack of funding to run proper studies.

However, the alkaline diet is a healthy one, consisting of whole fruits and vegetables, green juices and salads, beans and nuts. It is a plant-based diet that avoids added sugars, processed foods, excess meat and animal protein, and alcohol, caffeine and artificial sweeteners. Might be worth a try along with your doctor-recommended treatment – it seems highly unlikely a diet such is this could do any harm.

In fact, a diet similar to this is recommended for avoiding other chronic diseases like heart disease and diabetes so, whether or not you have arthritis, I’d recommend shifting your diet to contain more plant-based foods and less added sugar, processed food and animal protein. This brings me back to Michael Pollan’s recommendations I wrote about in an earlier blog:

  • Eat real food

  • Mostly plants, and

  • Not too much!

Simple rules to live by, and easy to follow!

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Health

Other reasons to “have to go"…

Frequent sudden urges to urinate that are difficult to control could be caused by Overactive Bladder Syndrome (OAB), a common condition that occurs increasingly as we age. OAB is not a disease – it’s the name used to refer to a group of non-infectious conditions with different causes that cause a sudden urge to urinate.

Another common bladder problem, called Stress Urinary Incontinence (SUI), involves leakage of urine when sneezing, laughing or doing physical activities. It is a different condition than OAB and is treated differently, but a person can have both stress incontinence and overactive bladder. I’ll discuss both of these conditions in this article… so scroll down if “laughing so hard you peed your pants” is your main complaint!

OVERACTIVE BLADDER SYNDROME (OAB)

OAB is not just a normal part of getting older, part of “being a woman” or, for men, just part of having a prostate problem. If you need to urinate urgently 8 or more times during the day, or 2 or more times during the night, talk to your doctor to determine what may be the cause. Be aware that urinary tract infections and bladder cancer can cause symptoms similar to OAB, and these should be treated as soon as possible. There are effective treatments for OAB, both medicines and non-medical treatments, that can improve your quality of life.

Symptoms of OAB can have several different causes:

  • Excess caffeine or alcohol

  • Incomplete bladder emptying, leaving less room for storage of new urine

  • Nerve disorders, such as stroke or multiple sclerosis, that affect nerve signals to the bladder

  • Diabetes, which also can cause damage to nerves

  • Mobility disorders, that make it more difficult to get to the bathroom quickly enough

  • Medications that cause a rapid increase in urine production or require high fluid intake

  • Abnormalities in the bladder, such as tumors or bladder stones

  • The specific cause may be unknown

Diagnosis:

  • A bladder diary kept for a few days before your doctor’s appointment, with the number of times you need to urinate, any urine leakage, amount and timing of fluid intake and timing of any medications you take can be helpful

  • A scan may be done or a small tube called a catheter may be inserted to determine if any residual urine remains in the bladder after urinating.

  • A urine culture may be done to ensure your symptoms are not being caused by a treatable infection.

  • A scope may be performed to eliminate other causes.

TREATMENTS

Lifestyle changes (Behaviour therapy):

  • Limit intake of food and drinks that you find irritate the bladder

    • E.g. coffee, tea, artificial sweeteners, caffeine, alcohol, carbonated drinks, citrus fruit, tomatoes, chocolate, spicy foods

  • Keeping a bladder diary for a few days may help you determine contributing causes (foods, activities, etc)

  • Double voiding

    • After urinating, wait a few seconds, relax and try again. This may be helpful if you have trouble emptying your bladder completely.

  • Delayed voiding

    • This involves waiting a few minutes before urinating, and gradually increasing the time to train the bladder to delay emptying. Check with your healthcare provider before trying this strategy, as it may not be helpful with some types of OAB.

  • Scheduled voiding

    • This involves urinating on a schedule instead of waiting until you feel the urge.

  • Exercises to relax your bladder muscle

    • These are sometimes called “quick flicks” – quickly squeezing and releasing the pelvic floor muscles (the muscles you use to hold urine in) can send a message to your nervous system and back to your bladder to stop squeezing and relax. Keeping still, relaxing and concentrating on the “quick flicks” can help the relaxation of the bladder.

  • If you have urine leakage, specialized absorbent products are available that also control odor, allowing you to participate in activities that could cause problems for you.

  • If you are overweight, losing weight may reduce symptoms

  • Excessive fluid restriction may cause urine to become concentrated and irritating to the lining of the bladder, increasing the urge to urinate.

  • Strengthening the pelvic floor muscles by doing Kegel exercises may be helpful. Click here for a description of how to do this exercise.

Medical and surgical treatments:

There are several prescription drugs available to relax the bladder muscle, and prevent it from contracting when the bladder isn’t full. These may be considered when lifestyle changes do not control the problem adequately. Common side effects include dry mouth and eyes, constipation, drowsiness and blurred vision. They are available as tablets and capsules taken by mouth, or as a gel or patch to deliver medication through the skin.

If medications don’t help, injections to partially paralyze the bladder muscle or stimulation of the sacral nerve that controls the bladder may be tried. These treatments would be performed by a specialist.

STRESS URINARY INCONTINENCE (SUI)

Stress incontinence is loss of urine due to physical movement or activities – such as coughing, sneezing, running, or heavy lifting – that put pressure or stress on your bladder. It occurs when muscles and tissues that support the bladder and the muscles that regulate the release of urine (urinary sphincter) weaken.

Risk factors include:

  • Childbirth in women, particularly forceps delivery, and hysterectomy

  • Prostate surgery in men

  • Age – muscles generally weaken as you age, but SUI is not considered a normal part of aging. It can occur at any age.

  • Body weight – being significantly overweight can increase pressure on the abdominal organs, including the bladder

  • Illness or smoking can increase coughing, worsening stress incontinence

Treatment strategies:

  • Pelvic floor muscle (Kegel) exercises (click here for a description)

  • Fluid consumption – adjusting the amount and timing of fluid intake may help, but avoid dehydration. Avoiding alcohol and caffeine is of questionable benefit.

  • Healthy changes – quitting smoking, losing extra weight, or treating a chronic cough may improve symptoms

  • Bladder training or scheduled urinating may be helpful, especially before activity.

Medications:

There are no approved medications specifically for stress incontinence, but estrogen replacement (often given as a vaginal cream, suppository or ring when being used for urinary or vaginal problems) can help some post-menopausal women by improving the health of these estrogen-responsive tissues. The medication, desmopressin, given as a nasal spray, blocks the production of urine and is sometimes used to reduce the need to urinate at night.

Surgical treatments:

  • Sling procedure – a strip of tissue or tape is surgically placed under the urethra for support

  • Bladder neck suspension – designed to lift the bladder and support it. Can be performed laparoscopically, with instruments inserted through small incisions in the abdomen.

You can read more about these medications and procedures here.

References: