Influenza

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By Raj Hullon, M.D., J.D.

The flu is a contagious infection that affects the nose, throat, and lungs.  Onset is more abrupt compared to the common cold.  Symptoms can range from mild to severe, even leading to life-threatening complications.  Nausea, vomiting, and diarrhea are more common in children than in adults.  Other flu symptoms include:

  • fever (usually high).
  • extreme fatigue.
  • dry cough.
  • sore throat.
  • nasal congestion or runny nose.
  • muscle aches.
  • impaired sense of taste and smell.
  • loss of appetite.

Although flu-related morbidity and mortality vary from year to year, the CDC estimates that between five and 20 percent of Americans contract flu in a given year and that 200,000 people are hospitalized for treatment of flu-related complications.  Approximately 36,000 deaths a year result from flu-related causes in the United States (cdc.gov).

Seasonal flu refers to any of the combinations of influenza viruses that circulate throughout the world each year.  The flu season in the United States can begin as early as October and run through March.  The Center for Disease Control (CDC) tracks circulating flu viruses and related disease activity all year and, between October and May, provides weekly influenza updates at http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.   Pandemic flu refers to a global outbreak of flu that can overwhelm the health care system.  The cause is most likely a strain of influenza virus that is new or that has not circulated recently enough for large portions of affected populations to have built up gradual immunity to it.  Therefore, healthy individuals are at risk for complications following infection during a pandemic flu outbreak.  Seasonal flu, however, usually leads to fewer complications in healthy adults.  During the 1918 pandemic, for example, the estimated deaths from the disease and disease-related complications reached 20 to 40 million individuals globally. Fortunately, pandemic flu outbreaks are rare.  There were only three pandemic outbreaks in the 20th century while seasonal flu is annual and peaks in January or February.

Neck Pain: An Introduction

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

Rear view of a young man holding her neck in pain, isolated on white background, monochrome photo with red as a symbol for the hardening

By Raj Hullon, MD

Almost everyone has experienced neck pain of some sort during his or her lifetime — and for good reason.  One of the most common causes of such pain is poor posture.  Simple activities such as reading, especially in bed — or sleeping on a pillow that may either be too low or too high — can cause neck pain.  Other activities that can cause neck pain include bending over a desk for hours, maintaining poor posture while watching TV, and positioning a computer monitor either too high or too low.  The key is always to maintain the neck as close to a neutral position as possible.

The best medical care, however, begins with a crucial question:  What is the most serious problem this could be?  Neck pain can be referred from multiple anatomical structures as a result of developmental processes in the embryonic stage.  Serious cardiovascular, neurologic, infectious, or neoplastic etiologies must be considered before attention is focused on common musculoskeletal disorders.

Chronic neck pain is prevalent in Western societies, with about 15 percent of women and 10 percent of men suffering from it at any given time.  People with physically demanding jobs requiring neck flexion and awkward lifting are at high risk of developing chronic neck pain.  It is also common among health care professionals, particularly affecting nurses who are constantly involved in handling tasks that involve reaching, lifting, and pulling.  Dental professionals who work long hours bending over their patients also suffer from neck pain because of postural demands.

The pain is often muscular or ligamentous in origin and is usually self-limited although the pain can be persistent.  Pain is transmitted through nerve endings in the various ligaments and muscles of the neck, vertebral joints, and the outer layer of the intervertebral discs.  When these structures are irritated, strained, or inflamed, pain is felt in the back of the neck, may spread toward the shoulders, and is commonly felt between the shoulder blades.

The natural healing processes result in improvement in almost all cases.  In fact, the pain from serious neck injuries such as fractures, dislocations, and most cervical spine surgeries often resolves after a few weeks or months.  There is usually little if any correlation between neck pain and the degenerative changes that are commonly seen on X-rays.

Neck strain or sprain is the most common type of injury to motor vehicle occupants treated in U.S. hospital emergency departments.  Whiplash injuries can be serious in certain situations.  Severe damage to the spinal cord can be fatal.

Sports and athletics are also common sources of injury to the neck region and should be a particular concern for the younger adult population.

Another common offender is carrying unbalanced loads, such as a heavy briefcase, luggage, or a shopping bag. A careful history is often required to identify such factors as playing a role in neck and shoulder pain.

 

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Dust Mites and Allergies

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mite-67638_640By Rajinder S. Hullon, M.D., J.D.

Distantly related to spiders, dust mites are tiny organisms that cannot be seen with the naked eye. They feed on dust containing human skin flakes and primarily live in places that tend to collect dust:  such as carpets  and upholstered furniture —  and even sheets, pillows, blankets, and mattresses. As many as 90% of people who have allergic asthma are allergic to dust mites. Some people are allergic to live dust mites as well as the decayed bodies of dust mites and their fecal material, often found in household dust.

Symptoms of dust mite allergy typically include: repeated and prolonged sneezing, an itchy, stuffed-up nose, a watery nose, and watery eyes. The eyes, throat, mouth, and even the ears may itch.

Reducing household dust and humid environments, where dust mites thrive, can alleviate or eliminate allergic symptoms.

It can be nearly impossible to eliminate dust mites entirely, but here are some ways to decrease dust allergens in your home:

  • Keep humidity as low as possible, preferably less than 50%. Eliminating any water leaks or sources of moisture around the house, particularly in the basement, will also help make your home more inhospitable to mold.
  • Use air-conditioning properly. Air-conditioning can effectively lower the humidity level; filters should be changed and cleaned on a regular basis.
  • Replace surfaces where dust mites can proliferate, such as carpeting as well as upholstered furniture  that has smooth surfaces. In particular, avoid using wall-to-wall carpeting.
  • Remove stacks of paper, blankets, and similar dust catchers. Store blankets in sealed plastic bins or bags in a closet or a room apart from living areas.
  • Use dust-mite impermeable covers for pillows, mattresses, and bed covers.
  • Wash bedding in water hotter than 130˚F at least once a week. This kills mites.
  • Vacuum and dust often, especially in bedrooms.

DO AIR FILTERS HELP?

Because most dust mites are concentrated in surface dust, not airborne dust, air cleaners and filters are not very effective in reducing these allergens. Ion and ozone generators can remove dust particles from the air, but not from surfaces, where dust mites are most apt to be found. Ozone generators, which produce ozone at levels 10 times above what the U.S. Code of Federal Regulations specifies as safe, should be avoided.

DOES VACUUMING CARPETS HELP REDUCE DUST?

Vacuum cleaners stir up dust, so wearing a dust mask when vacuuming can reduce allergen exposure. Newer Higher Efficiency Particle Arresting (HEPA) vacuums may not actually reduce the number of dust mite allergens, but the vacuum cleaners can reduce the amount of small-particle dust that vacuuming generates. This, in turn, reduces the amount of inhaled dust containing dust mites and their droppings.

GETTING MEDICAL HELP FOR DUST MITE ALLERGIES

An allergist-immunologist will ask about your:

  • medical history.
  • eating habits.
  • home and work environments.
  • pets.

A blood test may be ordered to confirm dust mite allergy diagnosed on the basis of a scratch test. The doctor performs this test by painting a small patch of diluted dust mite allergen onto the patient’s back or forearm and then uses a needle to scratch the skin beneath the allergen. Swelling or redness that develops within 15 to 30 minutes indicates that the patient’s immune system has responded to the allergen.

Allergy shots and prescription medicines may provide relief for patients with persistent symptoms.

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Knee Pain

Posted on Posted in Continuing Education, Homestudy, Pain

Knee PainBy Rajinder Hullon, MD, JD

Knee pain is one of the most common complaints seen in outpatient medical-treatment centers. This disorder affects 20 percent of our population and is the fifth most common health complaint, accounting for millions of doctor visits each year.

Physicians treat knee pain more frequently these days for a number of reasons. Better health care options and availability have resulted in people living longer. Because the knee joint is one of the key weight-bearing joints in the body, it is subject to more wear and tear with age. Older people are more likely to suffer from some degree of knee pain.

The nationwide problem with obesity has also contributed to the increasing frequency of knee complaints. More stress is placed upon the knee joint the heavier a person is. At some point, the knee joint will be unable to support this stress, and surgical intervention may be required.

Preventing Knee Injuries

As everyone knows, an ounce of prevention is worth a pound of cure. In the case of the knee joint, the American Academy of Orthopedic Surgeons and the American Orthopedic Society for Sports Medicine offer these suggestions to avoid pain or injury:

  • Stay in shape. Good general conditioning helps control or prevent knee pain, particularly patello-femoral pain. Overweight individuals may need to lose weight to prevent excessive stress on the knees. Doctors recommend a 5-minute warm-up before running or beginning any other exercise.
  • Stretch. Stretching is a good warm-up technique before and after any exercise. When performed in the prone (face down) position, it helps maintain the flexibility of the ligaments, muscles, and tendons within the knee joint.
  • Increase training gradually. Work up gradually and avoid sudden changes in the intensity of exercise.
  • Use proper running gear. Running shoes should have good shock absorption and quality construction. Be sure shoes fit properly and are in good condition. If you have flat feet, you may need shoe inserts. Running shoes should be replaced every 3-4 months if used consistently.
  • Use proper running form. Lean forward and keep the knees bent. Also, try to run on a clear, smooth, and reasonably soft surface. Never run straight down a steep hill. Walk down it, or run in a zig-zag pattern.

Since there can be many different causes for such pain, the clinician must take great care to make an accurate diagnosis in order to ensure proper medical and/or surgical treatment.

Many knee pain cases also involve overuse or injury from sporting activities. In these situations, individuals should be aware of the importance of warm-up exercises and, and if pain arises, the need to seek early treatment to avoid permanent or disabling knee injury.

Of course, if you experience knee pain, the best thing you can do is see a doctor, and remember that if you’ve been diligent about exercise for a long time, a week off for rest and recovery might be the best thing you can do, whether you’ve come down with an injury or not.

INR (Institute for Natural Resources) offers continuing educations courses that cover many medical conditions including knee pain.

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Tea: From Social to Medicinal Beverage

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teaBy Rajinder Hullon, MD, JD

Tea is the most popular beverage in the world as well as one of the healthiest.

The history of tea is fascinating and offers great insight into the history of our world.

Ever since tea was first discovered in China, it has traveled the world, conquering the thirsts of virtually every country on the planet.

According to Chinese mythology, the origins of tea date back to a day in 2737 BC. Emperor Shen Nung was sitting beneath a tree while his servant boiled drinking water. When a leaf dropped into the water, Shen Nung, a scholar and herbalist, decided to taste the brew. The tree was the Camellia sinensis.

For several hundred years, people drank tea because of its herbal medicinal qualities. By the time of the Western Zhou Dynasty, tea was used as a religious offering. During the Han Dynasty (202 BC – 220 AD), tea plants were quite limited and only royalty and the rich drank tea not only for their health but also for the taste. As more tea plants were discovered during the Tang Dynasty (618 – 907), tea drinking became more common among lower classes and the Chinese government supported planting of tea plants and even the building of tea shops so everyone could enjoy tea.

Also during the Tang Dynasty, tea spread to Japan by Japanese priests studying in China. Similar to the Chinese adoption of tea, tea was first consumed by priests and the rich for its medicinal properties. Tea is often associated with Zen Buddhism in Japan because priests drank tea to stay awake and meditate. Soon, the Buddhists developed the Japanese Tea Ceremony for sharing tea in a sacred, spiritual manner. The Emperor of Japan enjoyed tea very much and imported tea seeds from China to be planted in Japan, making tea available to more people.

After obtaining coffee seedlings, Holland, England, and France were able to trade coffee and broke the monopoly exercised by the Arabs. Soon coffee trees were growing in the colonies of India, Java, and the West Indies. Coffee became one of the world’s most profitable export crops in the 18thcentury. Since then, coffee has been cultivated in many tropical locales and has especially prospered in South America. Today 50 percent of the world’s coffee is from Brazil, 25 percent from other Latin American countries, and nearly 20 percent from Africa.

Tea finally arrived in England during the 17th century when King Charles II married a Portuguese princess, Catherine of Braganza. The Queen made tea the drink of royalty and soon tea became a popular import to Britain via the East India Company. Afternoon tea or tea parties became a common way for aristocratic society to drink tea. Though tea was regularly imported to Britain, the taxes were so high that smugglers would get and sell tea illegally for those that could not afford it. In attempts to turn profits during the tea smuggling period, the East India Company began exporting the tea to America. The American tea was also taxed heavily and contributed to the cause of the Boston Tea Party.

Our Homestudy Course , The Mysteries of Coffee and Tea, explores the origins of coffee and tea and both the positive and negative effects that it can have on the human body. Some research also suggests that caffeine may impact cholesterol levels, the menstrual cycle and even dental health. Caffeine may also lower risk for some cancers. Some people are more sensitive to caffeine than others. Even one cup of coffee may affect their sleep duration and quality, while others can get plenty of shut-eye even after downing several lattés. So whatever is your choice, grab a cup and get ready to study!

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