Coping With Seasonal Allergies

As a physician, I've seen a significant uptick in allergy-related complaints lately. It's that time of year again—the pollen is high, the air is thick, and many of you are battling the familiar symptoms of seasonal allergies. So, let's talk about how to manage these pesky symptoms and find some relief.

Understanding the Culprits

Seasonal allergies, also known as allergic rhinitis or hay fever, are triggered by airborne allergens like pollen from trees, grasses, and weeds. These allergens cause your immune system to overreact, releasing histamine and other chemicals that lead to those uncomfortable symptoms.

Common symptoms include:

• Sneezing
• Runny or congested nose
• Itchy eyes, nose, and throat
• Watery eyes
• Postnasal drip
• Fatigue

Practical Tips for Relief

Here's some practical advice to help you manage your allergies:

1. Monitor Pollen Counts: Stay informed about local pollen levels. Many weather apps and websites provide daily pollen forecasts. When pollen counts are high, try to limit your outdoor activities, especially during peak pollen times (usually mornings and evenings).
2. Create a Barrier:
   • Keep windows closed, especially at night.
   • Use air conditioning with a HEPA filter to trap allergens indoors.
   • Consider using a dehumidifier to reduce mold growth.
   • When you come indoors, change your clothes and shower to remove pollen.
3. Nasal Irrigation: Rinsing your nasal passages with a saline solution can help clear out allergens and mucus. You can use a neti pot or a saline nasal spray.
4. Over-the-Counter Medications:
   • Antihistamines: These medications block histamine, reducing symptoms like sneezing, itching, and runny nose. Look for second-generation antihistamines like cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra), as they are less likely to cause drowsiness.
   • Decongestants: These can help relieve nasal congestion, but they shouldn't be used for more than a few days, as they can lead to rebound congestion.
   • Nasal Corticosteroids: These nasal sprays, like fluticasone (Flonase, Veramyst) or mometasone (Nasonex), are very effective for reducing nasal inflammation. They are generally safe for long-term use, but it can take a few days to see their full effect.
   • Eye Drops: For itchy, watery eyes, over-the-counter antihistamine or lubricating eye drops can provide relief.
5. Consider Allergy Immunotherapy (Allergy Shots): If your allergies are severe and significantly impact your quality of life, talk to your doctor about allergy immunotherapy. This involves gradually exposing you to small amounts of allergens to desensitize your immune system.
6. Maintain a Clean Environment: Regularly clean your home to reduce dust and mold, which can exacerbate allergies.
7. Hydration and Diet: Staying well-hydrated can help thin mucus. A healthy diet rich in fruits and vegetables can support your immune system.

When to See a Doctor

While over-the-counter medications can be helpful, it's essential to see a doctor if:

• Your symptoms are severe or persistent.
• Over-the-counter medications aren't providing relief.
• You have asthma or other respiratory conditions that are worsened by allergies.
• You have concerns about possible side effects from medications.
• You are experiencing sinus infections or other complications.

A Caring Approach

Remember, you're not alone in this. Allergy season can be tough, but with the right strategies, you can manage your symptoms and enjoy the outdoors again. Don't hesitate to reach out to your healthcare provider for personalized advice and treatment options.

Coping With Stress During The Corona Virus Pandemic

With the corona virus pandemic, most of us have some degree of stress. This is a normal human response and we should learn to recognize its manifestations.  Stress has behavioral, physical, emotional, and cognitive aspects.  Below is a partial list you might recognize in yourself and others.

Behavioral

• Poor appetite or over-eating
• Excessive use of alcohol or smoking
• Irritability 
• Poor ability to concentration
• Blaming others
• Self-isolation
• Risk taking

Physical

• Headaches
• Stomach aches
• Shakiness or tremors
• Heart palpitations
• Feeling jumpy or easily startled
• Bowel problems
• Feeling nauseated
• Insomnia

Emotions

• Elevated anxiety or fearfulness
• Sadness or depression
• Anger/rage
• Guilt
• Euphoria

Thinking

• Confusion
• Poor memory
• Poor concentration
• Problems deciding what you should do
• Denial that anything bad is happening

Some Ways To Relieve Stress

Most of us have dealt with stress before.  We have learned tactics and techniques that have worked.  Your knowledge and experience can help in the present situation.  

Getting enough sleep, eating a healthy diet, taking breaks from the news media, and doing something relaxing can help. Activities such as reading a book, stretching, yoga, listening to music, walking or other exercise, meditation, and even taking a bath can all reduce stress.

You should stay informed with reliable sources of information like the Centers for Disease Control and Prevention or the World Health Organization.

Stay connected to friends and relatives by calling or using other social media.  It helps to share your feelings.

Recognize when normal stress becomes exaggerated to the point you are having difficulty functioning.  You should be open to asking for help.  Contact your  primary care provider or mental health services in your community.  If you feel suicidal, call 911 or your local mental health hotline.

Contact CDC.gov for more information on the pandemic.  Stay Safe, Stay Home!

Garcinia Cambogia for Weight Loss

Garcinia cambogia is a fruit that grows in Southeast Asia.  It has become popular in the U.S. for its reported weight loss properties.  The active ingredient is called hydroxycitric acid (HCA) found in the peel of this fruit.  It has been found to inhibit an enzyme called citrate lyase and cause interference with fatty acid metabolism and theoretically resulting in less fat accumulation in the body.

Several studies have shown this to be true in laboratory animals.  However, studies in humans using an experimental group that received the real substance and a control group receiving a placebo or inactive substance showed no significant difference in weight loss between the groups.

Conclusions so far are that garcinia cambogia is not an effective weight loss remedy.

A healthy weight loss program continues to be a reduced calorie diet, exercise and healthy changes in eating habits.  As always, you should consult your health care provider before engaging in diets or taking any supplements.

Vitamin D Supplementation

Vitamin D is a fat-soluble vitamin.  It is called the sunshine vitamin because it is made in the body when ultraviolet rays from the sun strike the skin and trigger the synthesis of vitamin D3.  Plants synthesize vitamin D2.  Both forms of the vitamin must be converted in the liver and kidneys to the active form, 1,25-dihydroxyvitamin D to be used in the body.

The main function of vitamin D is to facilitate the body’s absorption of calcium, a major ingredient in bone formation.  A shortage of vitamin D leads to weak, brittle bones in both children and adults; resulting in diseases known as rickets in children and osteomalacia in adults.

Promising uses of vitamin D have been noted in recent research involving reduction of heart attacks.  In one study, men deficient in vitamin D were twice as likely to have a heart attack as men who had adequate levels.

Studies have indicated that vitamin D status in the body can affect cancer risk.  It appears to play a role in the prevention of colon, prostate, and breast cancer. 

Vitamin D levels are lower in the fall and winter months, a time when colds and flu are more prevalent. Observational studies have shown that people with low vitamin D levels are more likely to get these infections or have had a cold or flu in the recent past.

Studies are mixed regarding whether vitamin D helps reduce weight.  A recent study with laboratory rats showed that rats given vitamin D directly to the brain had large decreases in food intake and weight when compared to rats not given the vitamin.

Recommended daily average vitamin D intake recommended by the Food and Nutrition Board is the following :

•       Birth to 12 months - 400 IU
•       1 to 13 years - 600 IU
•       14 to 18 years - 600 IU
•       19 to 70 years - 600 IU
•       71 years and older - 800 IU
•       Pregnant and nursing women - 600 IU

Optimal vitamin D intake is reported to be much higher, with 1,000 to 2.000 IU for adults.  There is a growing consensus that vitamin D intake should be at these higher levels with the widespread prevalence of vitamin D deficiency. 

Safe upper limits of vitamin D intake are reported to be 1,000 – 1,500 IU per day for infants, 2,500 – 3,000 IU for children 1- 8 years, and 4,000 IU for children 9  and older, adults, pregnant and breastfeeding women.

Taking too much vitamin D can cause weight loss, increased urination and abnormal heart rhythms.  It can also raise blood levels of calcium which can cause deposits in tissue and blood vessels and thus damage the heart, blood vessels, and organs.  Increased kidney stone occurrence has been reported.   

Getting too much vitamin D from food is highly unlikely.  Excessive sun exposure will not over produce vitamin D since the heated skin is thought to degrade previtamin D3 and vitamin D3 as it is formed.

Before taking vitamin D supplements, you should consult with your healthcare provider to determine if you require them and how to take them safely.

Nightime Leg Cramps

Nighttime leg cramping is a common ailment especially in people over the age of 50.  As many as half report cramps at least three times per week, and 5-10 percent have them nightly.  Cramping usually occurs suddenly in the calf muscle resulting in significant pain and sleep disturbance.  Cramps can last from a few seconds to more than fifteen minutes. 

The cause of leg cramps is mostly unknown, although imbalances in electrolytes like sodium, calcium, magnesium and potassium have been implicated.  Circulation problems, dehydration, sedentary lifestyle and certain medications like diuretics (water pills), angiotensin receptor blockers (blood pressure medication), benzodiazepines (anxiety medication), statins (for high cholesterol), certain cancer treatment drugs and oral contraceptives also may cause leg cramps. Diseases associated with nighttime leg cramping include diabetes, hypothyroidism, hypoglycemia, alcoholism, muscle disorders, Parkinson's disease and other neurologic disorders. 

Leg cramps can often be relieved by flexing the toes upward to stretch the calf muscle or by getting up and walking around.  Gentle massage of the tensed muscle and warm compresses can be helpful.  In one study, passively stretching the calf muscles three times a day for several days successfully prevented cramps.  Subjects stood three feet from a wall, leaning against it with arms outstretched and gently tilting forward with the heels kept firmly in contact with the floor until a non-painful stretch was felt in the calves.  This position was held for 10 seconds and repeated after five second intervals for 3-4 repetitions.

Staying well hydrated and exercising regularly is recommended not only to prevent cramps, but to help maintain overall health. 

Medications may be used when cramps are persistent and severe.  Quinine was commonly used in the past with varying degrees of success but has been discontinued more recently due to potential side effects involving blood and heart problems.  Muscle relaxers, antihistamines, calcium channel blockers, and anti-seizure medications are other common treatments.

Persistent, painful leg cramping should be evaluated by your health care provider to determine if a disease process is involved and to develop a treatment plan specifically for you.

Poison Ivy and Other Poison Plant Rashes

With spring and summer, you may come in contact with plants such as poison ivy, poison oak and poison sumac.  With contact, most people will develop an itchy red rash accompanied by blistering of varying degrees. 


Poison ivy is common in most areas of the U.S. with the exception of Hawaii and part of Alaska.  It appears in clusters of three leaves with red stems and often grows like a vine, climbing up trees.  Leaves range from light green to dark green and turn bright red in the fall.  Leaflets have a few to no teeth along the edge.

Poison oak is seen west of the Rockies and in the Southeast.  Its leaves are divided into three leaflets with scalloped, toothed, or lobed edges.  They can resemble the lobed leaves of a true oak.  Leaves are generally bronze when they first appear, but turn bright green in the spring, yellow-green to reddish in the summer and bright red or pink from late July to October.

 Poison sumac is seen in the Northeast, Midwest and parts of the Southeast.  It grows as a shrub or small tree in moist areas and has stems with 7-13 smooth-edged leaves in pairs.  The leaves are orange in spring, green in summer, and yellow, orange, or red in fall.

Poison plant rashes cannot be spread to others by fluid from blisters or skin to skin contact.   The plant oil can stick to clothing, tools and pets and cause a rash with contact.  Plant oil can last up to five years on inanimate objects.  Oil should be removed from your skin as soon as possible with soap and water.  Removal from objects can also be accomplished with soap and water or rubbing alcohol.

The rash can appear to be spreading to other parts of the body since it is absorbed at different rates.   Spreading can occur by scratching with oil trapped underneath fingernails.

Apply over-the-counter corticosteroid creams to ease the rash and itching.  Calamine lotion, wet compresses, soaking in cool water, and oral antihistamines can offer additional relief.  Avoid hot showers or baths.

See your doctor if the rash is extensive, pus or tenderness is present, the rash spreads to your eyes, mouth, or genital area or if it does not resolve in a few weeks.

Prevention is by avoidance and wearing long sleeves, pants and gloves when exposure is likely.  Wash exposed clothing separately in hot water and detergent.  Skin barriers such as lotion containing bentoquatum can be protective if applied before exposure.  Do not burn poison plants since the plant oil can attach to smoke particles and be inhaled causing serious respiratory problems. 

Creatine Supplement - Uses and Precautions

Creatine is a popular supplement often used by athletes to improve muscular performance.   It is classified as a nitrogenous organic acid that is naturally produced in the body primarily by the kidneys and liver.  It can also be consumed in the diet since it is present in meat and fish.  Creatine is produced as a food supplement in powder form or capsules.  More that 4 million kilograms are used by Americans each year.

Athletes and body builders use creatine supplementation to increase muscle mass and muscle performance in anaerobic type activities.  This would include brief, high-intensity exercise such as sprinting.  Data suggests that creatine may benefit athletes such as hockey players, football players, rowers, squash players, and wrestlers.  Creatine does not seem to improve performance in aerobic exercises.  It also has not been found to improve performance or body composition in people over 60.

Creatine has been used to treat health problems such as Parkinson's disease, muscular wasting, depression, bipolar disorder, high cholesterol, vision problems and ALS (amyotrophic lateral sclerosis or Lou Gehrig's disease).  Efficacy in these areas is variable.

Creatine is considered safe when used in recommended doses.  It can cause stomach pain, nausea, diarrhea and cramping in some people.  If taken in high doses, there is concern that it could cause kidney, liver and heart problems, but this has not been confirmed.  People with kidney disease, diabetes, pregnancy or breast feeding should not use creatine.  Combining creatine with caffeine and ephedra could cause serious side effects.  There is a report of a stroke in an athlete who used this combination for a number of weeks.

If you choose to use creatine, consult your doctor first to ensure your safety.