Feeling Breatheless?

Pneumonia is a pretty life impacting disease, and when you’ve got it you’ll know it’s serious.  It starts out with a dry cough and progresses to a wet cough, usually a productive, green-yellow, wet cough which can even have an odor to it.  Breathlessness is the big symptom.  Sometimes people don’t seek help until they’re short of breath.  They can’t get enough oxygen because the lung tissues are compromised.  They swell because of all the white blood cells moving in to combat the infection.  The membrane gets thicker in the lung and the oxygen can’t get across the membrane.  There’s one thin cell wall between the oxygen-laden air you breathe in and the red blood cells that pick it up which gets so broad that the oxygen can’t get across there to get picked up by the red blood cells.  The breathlessness is nothing mystical.  It’s just a physical distance that’s created by the swelling.

People lose their appetite during a pneumonia bout because when they don’t have enough oxygen their body knows that they don’t need to be doing anything extra like walking or doing this or that.  At the same time digesting food takes a lot of energy and a lot of blood flow to go down there and take all the enzymes and to carry the food away and to process the food in the liver.  Loss of appetite is a hallmark of pneumonia.

Then, of course, you can get aches and pains all over.  Frequently pleurisy can develop when you get pneumonia – a little fluid between the lung wall and chest wall.  That will be significant pain.  That’s not a little bit of pain, that’s sharp pain.  Usually every breath you take you know about it.  

Complications include pleurisy as well as breathing difficulties that can become so acute that you need to be hospitalized with oxygen.  Certainly if I could I’d want to do the oxygen at home.  Hey, we know that up to 18% of the people who die in the hospital die of pneumonia.  I don’t want to go there, right?  You might get another infection on top of it such as septicemia, where these bacteria wind up in the bloodstream.  The lungs are extremely thin.  They are one cell thick and a lot of times that’s a very thin cell that’s kind of spread out where there’s no nucleus or anything.  But the cell gets real thin there.  It’s fairly easy for bacteria to get into the bloodstream from the lungs.  When you’ve got bacteria circulating in the blood then you’ve got a serious life-threatening issue right then.  

Of course, I’m not advocating that someone not go to the hospital if they’re in need for medical attention.  But if all you’re doing at the hospital is sitting in a bed receiving oxygen, that could be something you can do at home and not worry about the increased risk of bacterial infections you might find at a hospital. 

We’ll talk about treatments for pneumonia next time.

Drowning Alive

As I normally do when I begin a talk about a particular health concern, I like to begin by talking about how relevant this concern is by listing a number of statistics that show the impact of the subject at hand. In this case I’m going to talk about pneumonia.  Many of us have had pneumonia in our lives.  Over 1% of the population every year has pneumonia.  That’s pretty big for a disease that can impact life pretty harshly.  That’s almost as common as getting a cold.  In the general population a little over one out of 100 people every year gets pneumonia.  It’s the fifth leading cause of death; 65,000 people a year die from pneumonia.  It’s the 8^th cause of death if you are in a hospital.  The economic cost is about $40 billion a year.  

It’s interesting to see how the medical community divides up pneumonia.  You would think they would divide it by bacteria, and viruses.  Instead they divided it up into hospital-acquired pneumonia and community-based pneumonia.  You’ve got to know there’s a problem in our hospitals if they are dividing diseases according to whether you got them in the hospital or you got it at home or out in the community.  That’s just a little reality check there.

There are different types of pneumonia according to the normal categories of bacterial, viral, fungal, and inflammatory pneumonias.  We talked a little last week about bronchitis.  That’s where that type of pneumonia would begin.  

In the viral category you have flu which we’re all familiar with.  There are two categories of people that pneumonia is really dangerous for: infants and folks over 65.  If you look at that, probably the danger for those over 65 is influenza.  If you’re talking about an infant it’s a whole different category.  Respiratory seneschal virus and other childhood viruses, even chickenpox, can become pneumonia and childhood diseases like measles.  But RSV  is certainly the biggest one among children.

Almost always, it’s a standard in medicine that we should not put people on antibiotics who get a viral infection.  However, pneumonia is probably the perennial disease that gets treated, day in and day out, with an antibiotic because if you’ve already got pneumonia your lungs are already significantly compromised.  Even if it did start with a virus, there are hundreds of different kinds of bacteria in our lungs already as part of the normal bacteria.  One of those is soon going to take over because your lungs are immuno-compromised from using up your immune system fighting the viral particles there.  Sooner or later if you have a viral pneumonia you’re probably going to come down with a subsequent bacterial pneumonia.  So it’s pretty standard operating procedure in medicine, certainly if you’re admitted or if you are out-patient, if you get the diagnosis of pneumonia to go ahead and start you on a antibiotic.  

Doctor’s are trying to back off of antibiotics because we’re getting all these MRS’s (methicillin resistant bacteria).  These bacteria are smart little rascals.  They can even transfer knowledge of immunity or resistance toward antibiotics between themselves.  You may have gotten an antibiotic and then you sneeze or kiss or share some of your bacteria with somebody else, and the bacteria you gave to someone else can transfer the knowledge of resistance to that bacteria to your bacteria.  So these are not just dumb little bugs multiplying out there that we’re dealing with.  There is certainly some intelligence and knowledge that they swap among themselves.  

Certainly there are atypical pneumonias like Legionnaires' disease.  Back in 1976 a bunch of people came down with an infection, pneumonia, at the head table right under an air-conditioning vent at a American Legion conference in Philadelphia.  That’s how the bacteria got its name.  Six out of 8 of those people at the head table died.  Other people died and a lot got really sick from pneumonia from that bacteria which was in an air-conditioning system.  Other people have died since that happened.

You probably heard on the news in 2003 about SARS, acute respiratory syndrome.  Again, that’s viral.  Then there are other bugs such as TB.  It is still out there and it’s making a comeback.  Certainly fungi can cause pneumonia.  Funguses are much more important if you consider a person who is getting drugs for cancer treatment or an AIDS patient, someone whose immune system is compromised.  Those are the people you really watch out for with fungal infection.

Then there are physical ways you can get pneumonia.  If you were to breathe in some caustic chemicals with a lot of alkali or acid in it that could burn your lungs. You might also aspirate some food and the bacteria that was in the food or the bacteria in your lungs could begin to grow. The immune system doesn’t just fight bacteria and infection.  It also takes care of damaged tissue and cleans up the debris and lays down new tissue and does repairs. While your immune system is mopping up all the damage from the aspirated food it has to be able to take care of any bacterial infection as well.  The immune system is a multi-tasking genius that our Creator designed in our bodies. 

Next time I’ll talk a little about what pneumonia looks like and then we’ll deal with the treatments. 

Get Rid of Your Allergies

Earlier this week I talked about allergies and their causes.  I wanted to add a note about bronchitis before we talk more about treatments. While allergies certainly cause a good deal of discomfort in the nasal passages, they can also be the cause of many cases of bronchitis.  Everything I said about the nose and nasal passages relates to the lining of the lungs and the bronchi, too.  Even though your nose filters out a lot of those particles of pollen, a lot of them still do get down into the bronchi and lungs and they land there.  The same response is going on in the lungs that is going on in the nose (which you can read about in the last post) except your lungs have all these little hair-like fibers that brush the mucous and pollen up toward the throat when you, for lack of a nicer way to describe it, hock it up and clear your throat to spit it out. 

What are some treatments for allergies? Standard medical treatment relates first of all to making a proper diagnosis of whether it’s an infection or whether it’s allergy.  The common practice is to treat bacterial infections with antibiotics even though that may not always be prudent or wise.  That’s frequently what’s done.  We probably need to reserve antibiotics for more severe conditions, longer-term bronchitis, or even pneumonia and let the body heal itself in most of the other instances.  If the white blood count does show that it is allergic or if the doctor’s clinical examination wisdom along with your history provide that information, that’s good. 

After that, the standard medical treatment are anti-histamines and steroids.  Steroids have gotten a pretty bad name because of the medical steroids that we use, the artificial steroids.  If I’m ever going to put a patient on steroids, I like to use what the human body makes and that is cortisol or hydrocortisone.  That can be used with relative safety and impunity especially for short periods of time as opposed to the artificial steroids.  As long as we can use a very, very identical thing to what the body is making usually we don’t get into a whole lot of trouble.  

There are some good homeopathics for allergies.  You may want to consult a good homeopath because there are some practical homeopathics.  Some beneficial supplements include Vitamin C, which has been known to help allergies and allergy-related issues, as well as bioflavonoids.  If you are having allergic reactions you should probably avoid aspirin and ibuprofen and drugs like that.  Of course you want to avoid cigarette smoke and things like that which are very irritating to the bronchi and sinuses.

You should consider the possibility of keeping your windows closed and using good air filtration.  If you don’t have a central furnace you might want to consider a room HEPA filter.  Frankly, the more you pay for those filters, or the finer particle it filters, probably the better you are.  Live plants in the house can help filter some things.  There is a caveat there.  Sometimes if you are watering them too much you can grow your own mold and mildew and create your own problems.  A word of caution there.

It is interesting to note, medically, that people with a bacteria in their stomach (helicobacter pylori) have a significant association with allergies.  In other words if you take 1000 patients with seasonal allergies (rhinitis, bronchitis, sinusitis) and test them for helicobacter pylori a dramatically more significant percentage of those will have that bacteria than if you just test a random population without any sinus problems.  That bacteria is associated with allergies for whatever reason.  We don’t know that connection.

Other natural things that can be used are echinacea, golden seal, and bromelain.  One very practical thing to do is good old saline nasal spray.  Just washing those allergens off of the membranes in your nasal passages can have a significant benefit.  If you’ve been outside a good thing to do is take a shower before going to bed.  Your hair is a great pollen magnet.  You lay that on your pillow and rub your nose in it as you go along in your sleep.  Those are just some practical things to do.

Finally, as I mentioned last post, stress reduction and stress avoidance is the most significant thing that we can do.  Any overflow of stress can exacerbate allergies and cause them to manifest. 

What Are You Allergic To?

In a few months the temperature will start warming up and Spring will be upon us. Spring is traditionally the season for allergies, when pollen and other foreign particles are in the air in huge quantities.  Rhinitis, sinusitis, bronchitis during this time of year can all be allergy related.  It’s not just a little problem.  It’s the fifth leading cause of chronic disease in North America.  It causes more than 15 million doctor visits each year.  An estimated $8 billion dollars is annually expended on costs related to allergies.  It’s just astronomical the numbers related to this.  It’s probably the leading cause of absenteeism in work.  I struggle with that because I also hear that back pain is the most common, but it’s right up there at the top.  It’s nothing to sneeze at!

A lot of people don’t even know that they have it.  I was with my mother in Athens, Georgia some time ago. We were talking about allergies and springtime allergies.  I said, “Don’t you have some?”  She said, “No.  I seem to finish every winter with a little cold right as spring arrives, but no, I don’t have allergies.”  Well, I hate to tell you, Mom, but if you have a seasonally recurring cold that seems to happen about the same time every year including stuffy, runny nose, sneezing, wheezing, it may well not be a cold at all.  It’s probably allergies.  

Why does it seem so much like a cold?  Because your body is responding to foreign invaders in your body, particularly in the sinus passages and in the lungs.  There is an altered immune response to the effect of your body attacking pollen just like it would a bacteria or a virus.  So for all intents and purposes it is almost impossible for you to tell the difference sometimes.  You may relate it to the yellow stuff landing on your car or when you see the ragweed floating through the air in little pollen pods in the fall.  If you take an anti-histamine and notice that it gets better, you’ll know it’s an allergy.  If no one else has a cold or it’s not cold season it is sometimes then related to allergies and we have an ah-ha moment.  “This may not be a cold.”

The very same process happens with pollen as it does with bacteria and viruses.  There are something called mast cells in your skin that when they come in contact with these foreign particles they release histamine.  That’s where the famed anti-histamine works as a treatment.  But your basophils, a type of white blood cell, also release histamine.  The purpose of basophils is to dilate small blood vessels so that more white blood cells can get out of the blood vessel and into the tissue to fight these foreign invaders.  The white blood cells come there and they attach these particles creating the stuffiness and the inflammation and drainage you get from allergies.  

A lot of people get a very inflamed nose.  I’ve had a lot of people when I did family practice who would come in and say “My throat is so dry and scratchy.”  I would look in the back of the throat and it was just slimy, red and wet, if I can be that descriptive.  It was because the drainage from their nose was very caustic.  The reason why drainage occurs is because the body is making this material to kill bacteria, fungi, and viruses, so of course it’s going to be caustic material.  It has hydrogen peroxide in it.  It has histamine in it.  It has all kinds of cytokines and chemokines that are really designed to kill cells.  No wonder it is irritating to the front of the nose when you blow your nose and to the back of the throat as it drips down.  

It’s interesting, the percentage of the population having significant allergies have doubled about every 15-20 years.  There is something going on out there.  We have so many new things in our environment, all the way from plastics to MTBE in your gasoline. There are hundreds of new toxic substances created every year and we don’t even realize a lot of times what they are or where they’re coming from.  We now literally have thousands and thousands of man-made chemicals that didn’t exist in organic chemistry.  Our bodies had never had a chance to look at or respond to them until just a short span of time relative to human history and bio-development, certainly in the last few decades in relationship to modern history. 

In the end, the rise of allergies in our population may have as simple an explanation as the good old “s” word, stress.  Every year the government produces a productivity index.  Since they’ve been keeping that, the productivity of Americans have gone up, (except for recently with the recession).  What does that mean?  That means that you’re doing more in less time.  That sounds like a good definition for stress to me.  As we do more in less time, certainly our stress level goes up.  So that in and of itself would be a valid cause for immune dysfunction.  

I'll talk more in my next post about one of the side effects of allergies: bronchitis. Stay tuned.

The Life and Times of Fibromyalgia

In my last post I joked that given the commonality of some of the symptoms of fibromyalgia, we all have it.  Actually it’s estimated that 1-2% of the population has it which would be millions and millions of Americans. 

The history of the disease is interesting.  Years ago, I can remember when I first started medicine, it was a huge question of whether this was just malingering or what this was.  That may have something to do with the fact that most of the primary doctors back then were male and most of the people who get this are female.  Women were widely told “This is all in your head.  Go home.  You’re just depressed.  Take an anti-depressant.”  We blew them off.  That was not a good period of time in the medical field.  We needed to recognize that there was an honest problem.  We may not know what to do about it, but giving people recognition that, yes, there’s an actual problem here has some benefit in and of itself.

It was ignored by medicine for a lot more years because we didn’t really have anything to do for it and still don’t have a lot to do for it today.  Doctors don’t like to admit they can’t help people with their problems.  Patients don’t like to be told there is no help.  Still, today, there is some denial or a lot of ignoring. Because of its insidious and slow onset, it is frequently not even recognized.  A person might be coming in complaining of TMJ (temporal mandibular joint) pain and not have read an article or put the rest of the pieces together.  The doctor is rushing from one patient to the next and he doesn’t ask questions.  It can go unrecognized for long periods of time.  It’s frequently under-diagnosed and misdiagnosed.  There are a lot of pitfalls there from the medical side of things.   

It’s also interesting that people in Africa or India or other places don’t seem to get fibromyalgia.  It’s kind of a European/American disease.  What is it? What causes it?  Is it stress?  Is it microwaves in the air?  Is it fluoride in the water?  We don’t really know what causes it or where it comes from.  We do know that there is disturbance of sleep patterns.  We do know that there are different alterations of neuro-hormones in the brain.  There is low growth hormone.  There is a derangement of things in the brain.  We know that some of those things can be diagnosed, but part of the diagnosis is that all of your blood tests and X-rays will be normal even if you do have fibromyalgia.  It’s important for us to have a diagnosis in case it’s something else medically that we can treat.  

But it’s very interesting to note that there is a continuum of fibromyalgia.  That continuum is directly related to the amount of stress the patient is in.  The more stress they have the worse their fibromyalgia is.  

The one thing that we can universally prescribe that we know that helps is not a drug.  It is not a pill that medicine knows to prescribe; it is simply exercise.  That’s a hard thing to get somebody to do who is stiff in the morning and hurts all over.  But that’s the one thing that we can consistently encourage patients to do is exercise.  

In the alternative medical field there are certain things we’ve tried:  alpha lipoic acid, B12, and magnesium certainly should be tried. Also acetylcysteine, glutathione, and Omega-3’s are always important and particularly important for fibromyalgia because of it’s anti-inflammatory needs.  It is an inflammation of sorts.  L-arginine can be beneficial because it increases nitrous-oxide and that helps control pain out there. 

Medically things that doctors try are P3, thyroid supplements; doxaphene as kind of an anti-depressant; and oxytocin shots can be beneficial.  Testosterone may be of some benefit.  There are some things to try medically. 

The huge thing, the real take-home note here is the continuum of stress and it’s relationship to fibromyalgia.  The more stress, categorically, the more pain and the more significant a problem this is going to be on a daily basis.  And that's the skinny on fibromyalgia.

Fibromyalgia: Pain With No Cause

Fibromyalgia is an interesting, intriguing problem which I have personally experienced.  My case is actually quite unusual because I’ve read articles that said that around 90% of the people who have this are women.  I guess that makes me fairly unique as a man having personally experienced fibromyalgia.

It’s kind of interesting what medicine does with it and where they place it and it’s treatment. It is included medically as an arthritis, in the arthralgias.  In fact, the most common one, only after osteoarthritis.  Yet it doesn’t have anything to do with joints.   It’s related to muscles and tendons and pain.  

Fibromyalgia defined, is pain bilateral all over the body that lasts greater than 3 months.  Doctors have 18 specific sites that they test and you have to have 11 of those 18 to qualify officially for having fibromyalgia.   It’s characterized by aching, by pain in these spots, and by disturbed sleep patterns.  People rarely get good stage 4 sleep and that causes some other problems.

Fatigue is a major symptom.  Morning stiffness and depression are other symptoms, but not primary depression, only secondary depression.  You don’t have depression and then get this as a result of it. The depression comes because you’re in pain and there doesn’t appear to be any hope because there aren’t any good medicines, because it is going on for a long period of time, and because it actually changes neuro-transmitter levels of good feeling things in the brain; oxytocin and dopamine and different brain chemicals that help us to feel good.

Recurrent headaches are another of the symptoms.  It’s not migraines, you can actually get worse headaches than that, muscle tension headaches, usually of the occipital nerves in the back of the head.  

Also, you can get tender lymph nodes.  There can be bowel and bladder disturbances, and in fact irritable bowel syndrome is one of the things that characterize fibromyalgia.  Finally, some lesser symptoms include sensitivity to heat and cold, anxiousness, dizziness, occasional palpitations of the heart and even decreased coordination.  Sounds like that wrapped all of us up in there together.  I guess we’ve all got fibromyalgia.  

In my next post I'll talk a little about the history of fibromyalgia in the medical community and the possible causes of fibromyalgia.