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QUOTE FOR WEDNESDAY:

“In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s.1  Data from 2015-2016 show that nearly 1 in 5 school age children and young people (6 to 19 years) in the United States has obesity.

CDC Centers for Disease Control and Prevention

Dupuytren’s Contracture

Dupuytren’s (du-pwe-TRANZ) contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm.  This is a condition that affects the fascia—the fibrous layer of tissue that lies underneath the skin in the palm and fingers. In patients with Dupuytren’s, the fascia thickens, then tightens over time. This causes the fingers to be pulled inward, towards the palm, resulting in what is known as a “Dupuytren’s contracture.” Knots of tissue form under the skin — eventually creating a thick cord that can pull one or more fingers into a bent position.  This is why, the fascia is a layer of tissue that helps to anchor and stabilize the skin on the palm side of the hand. Without the fascia, the skin on your palm would be as loose and moveable as the skin on the back of your hand. In patients with Dupuytren’s disease, this palmar fascia slowly begins to thicken, then tighten.  As Dupuytren’s progresses, bands of fascia in the palm develop into thick cords that can tether one or more fingers and the thumb into a bent position. This is called a “Dupuytren’s contracture.” Although the cords in the palm may look like tendons, the tendons are not involved in Dupuytren’s.

 The affected fingers can’t be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands.

This occurs most often in older men of Northern European descent.

The cause of Dupuytren’s disease is not completely known, but most evidence points towards genetics as having the most important role.

There are anecdotal reports of Dupuytren’s emerging or worsening after a patient experiences an injury or an open wound (including surgery) to his or her hand; however, there is no good evidence to support this. There is also no compelling evidence to suggest that it is caused by overuse of the hand.

Risk Factors:

This occurs most often in older men of Northern European descent.

The cause of Dupuytren’s disease is not completely known, but most evidence points towards genetics as having the most important role.

There are anecdotal reports of Dupuytren’s emerging or worsening after a patient experiences an injury or an open wound (including surgery) to his or her hand; however, there is no good evidence to support this. There is also no compelling evidence to suggest that it is caused by overuse of the hand.

There are a number of factors that are believed to contribute to the development or worsening of Dupuytren’s disease. These include:

  • Gender. Men are more likely to develop the condition than women.
  • Ancestry. People of northern European (English, Irish, Scottish, French, and Dutch) and Scandinavian (Swedish, Norwegian, and Finnish) ancestry are more likely to develop the condition.
  • Heredity. Dupuytren’s often runs in families.
  • Alcohol use. Drinking alcohol may be associated with Dupuytren’s.
  • Certain medical conditions. People with diabetes and seizure disorders are more likely to have Dupuytren’s.
  • Age. The incidence of the condition increases with age.

Symptoms:

Nodules. You may develop one or more small lumps, or nodules, the nodules may feel tender but, over time, this tenderness usually goes away.  There can be “pitting” or deep indentation of the skin near the nodules.

Cords. The nodules may thicken & contract=the formation of dense and tough cords of tissue under the skin. These cords can restrict or tether the fingers and thumb from straightening or from spreading apart.

Contractures. The tissue under the skin tightens, one or more of your fingers may be pulled toward your palm and may be restricted from spreading apart. The ring and little fingers are most commonly affected, but any or all of the fingers can be involved, even the thumb.

As the bend in your finger increases, it may be hard to straighten it fully. It may be difficult to grasp large objects, put your hand in your pocket, or perform other simple activities.

Diagnosing the condition:

In most cases, doctors can diagnose Dupuytren’s contracture by the look and feel of your hands. Other tests are rarely necessary.  Your doctor will compare your hands to each other and check for puckering on the skin of your palms. He or she will also press on parts of your hands and fingers to check for toughened knots or bands of tissue. Your doctor also might check to see if you can put your hand flat on a tabletop or other flat surface. Not being able to fully flatten your fingers indicates you have Dupuytren’s contracture. 

Treatment:

A number of treatments are available to slow the progression of Dupuytren’s contracture and relieve symptoms.

Know in most cases a Dupuytren’s contracture progresses very slowly, over a period of years, and may remain mild enough such that no treatment is needed. In moderate or severe cases, however, the condition makes it difficult to straighten the involved digits. When this happens, treatment may be needed to help reduce the contracture and improve motion in the affected fingers. Typically, as a contracture worsens, the involvement of the fascia becomes more severe and treatment is less likely to result in a full correction.

Currently, there is no cure for Dupuytren’s; however, the condition is not dangerous.

Although it varies from patient to patient, Dupuytren’s usually progresses very slowly and may not become troublesome for many years. In fact, for some patients, the condition may never progress beyond developing lumps in the palm.

If the condition progresses, your doctor may first recommend nonsurgical treatment to help slow the disease.

Nonsurgical Treatment

Steroid injection. Corticosteroids are powerful anti-inflammatory medications that can be injected into a painful nodule. In some cases, a corticosteroid injection may slow the progression of a contracture. The effectiveness of a steroid injection varies from patient to patient.

Splinting. Splinting is not known to prevent the progression of a finger contracture. Forceful stretching of the contracted finger may not be helpful and, in fact, could cause an injury to the finger or hand.

Splinting may be used after surgery for Dupuytren’s contracture to protect the surgical site; however, it is not known if it reduces the risk of recurrent contracture or tightening of the healing wound.

Surgical Treatment

If the contracture interferes with hand function, your doctor may recommend surgical treatment. The goal of surgery is to reduce the contracture and improve motion in the affected fingers.

There is no known cure for Dupuytren’s contracture; however, surgery is intended to “set back the clock” by reducing the restricting effect of the cords by either disrupting or removing them. Unfortunately, the healing tissues will form with the same potential to develop cords in the future—but the gains in hand function can still be substantial.

The surgical procedures most commonly performed for Dupuytren’s contracture are:

  • Fasciotomy-In this procedure, your doctor will make an incision in your palm and then divide the thickened cord(s) of tissue. Although the cord itself is not removed, dividing it helps to decrease the contracture and increase movement of the affected finger.Fasciotomy is performed using a local anesthetic that numbs just your hand without putting you to sleep. After the procedure, your wound will be left open and allowed to heal gradually. You will have to wear a splint during your recovery.
  • Subtotal palmar fasciectomy-Partial (also called limited, subtotal or selective) fasciectomy aims to remove the diseased tissue while leaving behind the normal fascia. The term ‘partial’ and related terms cover the whole range of degrees of excision between ‘segmental’ and ‘total’.

Your doctor will talk with you about which procedure is best in your case.

Fasciotomy. In this procedure, your doctor will make an incision in your palm and then divide the thickened cord(s) of tissue. Although the cord itself is not removed, dividing it helps to decrease the contracture and increase movement of the affected finger.

Fasciotomy is performed using a local anesthetic that numbs just your hand without putting you to sleep. After the procedure, your wound will be left open and allowed to heal gradually. You will have to wear a splint during your recovery.

QUOTE FOR MONDAY:

“Parents who delay or skip childhood vaccinations even when kids have no medical reasons are contributing to U.S. outbreaks of measles and whooping cough.”

Michigan Health Lab

Complications of not immunizing children!

The N.Y. State Health Department states the following:

There are many reasons parents give for delaying a vaccination, from “My baby cries when she gets the shot,” to “My child is too young to get so many vaccines.” More important than all of these excuses is one simple fact: A child’s immune system is more vulnerable without vaccinations. And if it weren’t for vaccinations, many children could become seriously ill or even die from diseases such as measles, mumps and whooping cough.

We live in an increasingly global world, with increased risks around every corner. Travelers entering into New York create an even greater risk of exposure. On a regular basis there is a new report regarding a disease outbreak somewhere in the world – including in the United States and New York State. The Centers for Disease Control and Prevention reports outbreaks around the world and provides health information for travel to more than 200 international destinations. (cdc.gov) From mumps, to pertussis to the measles, diseases once thought to be eradicated are coming back because people are not being vaccinated as they once were. If you think tears from a needle are hard to watch, imagine the suffering your child will experience if he or she contracts a serious disease that could have been prevented.

While misinformation in the media has led many parents to delay vaccinations as a result of either Dr. Andrew Wakefield’s false claims about autism or Dr. Bob’s Alternative Schedule (aap.org), many diseases have begun to reemerge among children around the world. Don’t let your child become a statistic — make sure they get all the recommended vaccinations. And if you’re worried about autism, visit “The Truth About Autism.”

Yes there are side effects to vaccinations but the odds are slim and the reason for the vaccinations in childhood including adulthood outweighs the possible risk for side effects.  I have been a RN 31 years and have received the MMR (measles, mumps, and rubella) every 10 years, flu every year, & pneumonia every 5 years and have never gotten a side effect from them.

The threat of death by disease isn’t the only medical consequence of skipping vaccinations. An unvaccinated child faces lifelong differences that could potentially put him or her at risk. Every time you call 911, ride in an ambulance, go to the doctor or visit the hospital emergency room, you must alert medical personnel of your child’s vaccination status so he or she receives distinctive treatment. Because unvaccinated children can require treatment that is out of the ordinary, medical staff may be less familiar, and less experienced, with the procedures required to appropriately treat your child.

Women who are pregnant but not vaccinated can be vulnerable to diseases that may complicate their pregnancy. A pregnant woman who contracts rubella in the first trimester may have a baby with congenital rubella syndrome (CRS), which can cause heart defects, developmental delays and deafness.

People who choose not to vaccinate their children also put others at risk if their child isn’t vaccinated and becomes ill. Special groups of people cannot be vaccinated, including those with compromised immune systems (e.g. those with leukemia or other cancers). These people rely on the general public being vaccinated so their risk of exposure is reduced.

There are also social implications of not vaccinating your child — from exclusion to quarantine. If sick or exposed to disease, your child may need to be isolated from others, including family. If there is an outbreak in your community, you may be asked to take your child out of school and other organized activities, causing your child to miss school and special events. Your child’s illness or inability to go about their daily activities also may impact your work and household income. For more information on vaccination requirements for schools in the state of New York, see New York State Immunization Requirements for School Entrance/Attendance (PDF, 71KB, 2pg.).

Everyone 6 months and older should get a seasonal flu vaccine every year. It’s important to reiterate that every year the flu remains a threat, and every year children still die as a result of having the flu. One of those children was Joseph Marotta. At 5 years old, Joseph contracted the flu. Less than 10 days after contracting the flu, Joseph died. His parents, along with other members of Families Fighting Flu (familiesfightingflu.org), are strong advocates for annual flu vaccines and encourage all families to get vaccinated. It’s important that everyone 6 months and older receives an annual flu vaccine. Every year a flu vaccine is skipped, your child is at risk.

The CDC states:

If you know your child is exposed to a vaccine-preventable disease for which he
or she has not been vaccinated:
• Learn the early signs and symptoms of the disease.
•Seek immediate medical help if your child or any family
members develop early signs or symptoms of the disease.
IMPORTANT:  Notify the doctor’s office, urgent care facility, ambulance personnel, or
emergency room staff that your child has not been fully vaccinated before medical staff have contact with your child or your family members. They need to know that your child may have a vaccine-preventable disease so that they can treat your child
correctly as quickly as possible. Medical staff also can take simple precautions to prevent diseases from spreading to others if they know ahead of time that their patient may have a contagious disease.
• Follow recommendations to isolate your child from others, including family members, and especially infants and people with weakened immune systems. Most vaccine-preventable diseases can be very dangerous to infants who are too young
to be fully vaccinated, or children who are not vaccinated due to certain medical conditions.
•Be aware that for some vaccine-preventable diseases, there are medicines to treat infected people and medicines to keep people they come in contact with from getting the disease.
•Ask your health care professional about other ways to protect your family members and anyone else who may come into contact with your child.
•Your family may be contacted by the state or local health department who track infectious disease outbreaks in the community.
­
If you travel with your child:
•Review the CDC travelers’ information website (http://www.cdc.gov/travel)
before traveling to learn about possible disease risks and vaccines that will protect
your family. Diseases that vaccines prevent remain common throughout the world, including Europe.
­
•Don’t spread disease to others. If an unimmunized person develops a vaccine-preventable disease while traveling, to prevent transmission to others, he or she should not travel by a plane, train, or bus until a doctor determines the person is no longer contagious.
If you or your family are not getting vaccinated please reconsider since it could prevent disease in you and your family, even prevent spreading a disease to others in your community for not getting vaccinated!

 

 

QUOTE FOR THE WEEKEND:

“As a result, many parents are inundated with horror stories of vaccine dangers, all designed to eat away at them emotionally while the medical and scientific communities have mounted their characteristic response by sharing the facts, the data, and all of the reliable peer-reviewed and well-cited research to show that vaccines are safe and effective. ”

U.S. National Library of Medicine/National Institutes of Health

National Immunization Awareness Month

National Immunization Awareness Month (NIAM) is an annual observance held in August to highlight the importance of vaccination for people of all ages. NIAM was established to encourage people of all ages to make sure they are up to date on the vaccines recommended for them. Communities have continued to use the month each year to raise awareness about the important role vaccines play in preventing serious, sometimes deadly, diseases.

Diseases that vaccines prevent can be dangerous, or even deadly if not prevented via a vaccine.  Understand ALL vaccines greatly reduce the risk of infection by working with
the body’s natural defenses to safely develop immunity to disease.
Also to understand how vaccines work, it is helpful to first look at how the body fights illness in more detail. When germs, such as bacteria or viruses, invade the body, they attack and multiply. This invasion is called an infection, and the infection is what causes the illness. The immune system uses several tools to fight infection. Blood contains red blood cells, for carrying oxygen to tissues and organs, and white blood cells or immune cells, for fighting infection. These white blood cells consist
primarily of B-lymphocytes, T-lymphocytes, and macrophages:
In simpler terminlology this means building antibodies to the diseases or eating up the disease or fighting the disease that spread in the body but getting it under control (meaning killing it off).  So vaccines fight off and prevent infection from growing in the human body including in our dog or cat (Ex. rabies vaccine for example).
How is this done, well let us explain:
Macrophages-  are white blood cells that swallow up and digest
germs, plus dead or dying cells. The macrophages leave behind
parts of the invading germs called antigens. The body identifies
antigens as dangerous and stimulates the body to attack them.
Antibodies- attack the antigens left behind by the macrophages.
Antibodies are produced by defensive white blood cells called
B-lymphocytes.
•T-lymphocytes- are another type of defensive white blood cell. They attack cells in the body that have already been infected.
The first time the body encounters a germ, it can take several days to make and use all the germ-fighting tools needed to get over the infection. After the infection, the immune system remembers what it learned about how to protect the body against that disease.
The body keeps a few T-lymphocytes, called memory cells that go
into action quickly if the body encounters the same germ again. When the familiar antigens are detected, B-lymphocytes produce antibodies to attack them.
Vaccines help develop immunity by imitating an infection. This type of infection, however, does not cause illness, but it does cause the immune system to produce T-lymphocytes and antibodies. Sometimes, after getting a vaccine, the imitation infection can cause minor symptoms, such as fever. Such minor symptoms are normal
and should be expected as the body builds immunity. Once the imitation infection goes away, the body is left with a supply of “memory” T-lymphocytes, as well as B-lymphocytes that will remember how to fight that disease in the future. However, it
typically takes a few weeks for the body to produce T-lymphocytes and B-lymphocytes after vaccination.
Therefore, it is possible that a person who was infected with a disease just before or just after vaccination could develop symptoms and get a disease, because the vaccine has not had enough time to provide protection.

Types of Vaccines:

Scientists take many approaches to designing vaccines. These approaches are based on information about the germs (viruses or bacteria) the vaccine will prevent, such as how it infects cells and how the immune system responds to it. Practical considerations, such as regions of the world where the vaccine would be used, are also important because the strain of a virus and environmental conditions, such as temperature and risk of exposure, may be different in various parts of the
world. The vaccine delivery options available may also differ geographically. Today there are five main types of vaccines that infants and young children commonly receive:
Live, attenuated vaccines fight viruses. These vaccines contain a version of the living virus that has been weakened so that it does not cause serious disease in people with healthy immune systems. Because live, attenuated vaccines are the closest thing to a natural infection, they are good teachers for the immune system.
Examples of live, attenuated vaccines include measles, mumps, and rubella vaccine (MMR) and varicella (chickenpox) vaccine. 
Inactivated vaccines also fight viruses. These vaccines are made by inactivating, or killing, the virus during the process of making the vaccine. The inactivated polio vaccine is an example of this type of vaccine. Inactivated vaccines produce immune responses in different ways than live, attenuated vaccines. Often, multiple doses are necessary to build up and/or maintain immunity.
•Toxoid vaccines prevent diseases caused by bacteria that produce
toxins (poisons) in the body. In the process of making these
vaccines, the toxins are weakened so they cannot cause illness.
Weakened toxins are called toxoids. When the immune system
receives a vaccine containing a toxoid, it learns how to fight off
the natural toxin. The DTaP vaccine contains diphtheria and
tetanus toxoids.
Subunit vaccines include only parts of the virus or bacteria, or subunits, instead of the entire germ. Because these vaccines contain only the essential antigens and not all the other molecules that make up the germ, side effects are less common. The pertussis (whooping cough) component of the DTaP vaccine is an example of a subunit vaccine.
Conjugate vaccines fight a different type of bacteria. These bacteria have antigens with an outer coating of sugar-like substances called polysaccharides. This type of coating disguises the antigen, making it hard for a young child’s immature immune system to recognize it and respond to it. Conjugate vaccines are effective for these types of bacteria because they connect (or conjugate) the polysaccharides to antigens that the immune system responds to very well. This linkage helps the immature immune system react to the coating and develop an immune response. An
example of this type of vaccine is the Haemophilus influenzae type B (Hib) vaccine.
Vaccines that require more than one dose.
There are four reasons that babies—and even teens or adults for that
matter—who receive a vaccine for the first time may need more
than one dose or every year like the flu shot or every 5 years like pneumonia shot:
•For some vaccines (primarily inactivated vaccines), the first dose does not provide as much immunity as possible. So, more than one dose is needed to build more complete immunity. The vaccine that protects against the bacteria Hib, which causes meningitis, is a good example.
•In other cases, such as the DTaP vaccine, which protects against diphtheria, tetanus, and pertussis, the initial series of four shots that children receive as part of their infant immunizations helps them build immunity. After a while, however, that immunity begins to wear off. At that point, a “booster ” dose is needed to bring immunity levels back up. This booster dose is needed at 4 years through 6 years old for DTaP. Another booster against these diseases is needed at 11 years or 12 years of age. This booster for older children—and teens and adults, too—is called Tdap.
•For some vaccines (primarily live vaccines), studies have shown that more than one dose is needed for everyone to develop the best immune response. For example, after one dose of the MMR vaccine, some people may not develop enough antibodies to
fight off infection. The second dose helps make sure that almost everyone is protected.
•Finally, in the case of the flu vaccine, adults and children (older than 6 months) need to get a dose every year. Children 6 months through 8 years old who have never gotten the flu vaccine in the past or have only gotten one dose in past years need two doses
the first year they are vaccinated against flu for best protection. Then, annual flu shots are needed because the disease-causing viruses may be different from year to year. Every year, the flu vaccine is designed to prevent the specific viruses that experts
predict will be circulating.
The Bottom Line Some people believe that naturally acquired immunity—immunity
from having the disease itself—is better than the immunity provided by vaccines. However, natural infections can cause severe complications and be deadly. This is true even for diseases that most people consider mild, like chickenpox. It is impossible to predict who will get serious infections that may lead to hospitalization. Vaccines, like any medication, can cause side effects. The most common side effects are mild. However, many vaccine-preventable disease symptoms can be serious, or even deadly. Although many of these diseases are rare in this country, they do circulate around the world and can be brought into the U.S., putting unvaccinated children at risk.

Even with advances in health care, the diseases that vaccines prevent can still be very serious – and vaccination is the best way to prevent them!

QUOTE FOR FRIDAY:

“Most cases of cough are temporary.  But even a short-term cough can be a sign of a bigger health issue that needs to be addressed by a doctor. Here’s how to narrow down the possible culprits—from asthma to pneumonia to whooping cough says Peter Dicpinigaitis, MD, director of the Montefiore Cough Center and professor of clinical medicine at Albert Einstein College of Medicine in New York City.”

Fox News.

A persistent cough don’t ignore and find out why.

Temporary Solution

 

The cough reflex is one of humans’ most vital defenses, highly effective in clearing secretions and preventing foreign materials from entering the lower respiratory tract. However, when a pathological cough persists without serving any useful purpose, it can be highly irritating and disruptive, causing significant sleep disturbance, chest pain, urinary incontinence, frustration, anger, and depression. “It’s easy to underestimate the tremendous quality of life issue that cough is, not only for the patient but for the family. Some of our patients have been coughing every single day for ten, twenty, even thirty years,” founded at the Montefiore Cough Center, one of the few specialty cough centers in the United States.

The Montifiore Cough Center found the following information via there research:

Despite the prevalence of cough, researchers have yet to fully understand its mechanism and relationship with the brain. Stimulation of the vagus—a cranial nerve with motor function in the larynx, esophagus, lower respiratory tract, and ear—can stimulate the cough reflex. The transient receptor potential vanilloid (TRPV1) receptor, a sensory nerve channel known as a “cough receptor,” induces the reflex when stimulated by irritants such as capsaicin (derived from red chili peppers), hydrogen, heat, low pH, certain enzymes, and anandamide (a naturally occurring, euphoria-inducing brain neurotransmitter).

The cough mystery presents a particular challenge to those who attempt to diagnose and treat it.  Physicians need to maintain the protective cough, an important barrier reflex that prevents complications like bronchitis, pneumonia, and lung collapse, but eliminate the maladaptive cough. To do this successfully, the cough’s underlying etiology must be identified and addressed.

Manypatients cough due to post-nasal drip, or upper airway cough syndrome (UACS). UACS is often treated with a combination of a first-generation decongestant /antihistamine and other nasal corticosteroids, nasal ipratropium bromide, or nasal cromolyn. Newer generation, non-sedating antihistamines such as Claritin, Zyrtec, and Allegra, which circumvent drowsiness because they don’t pass the blood-brain barrier, are ineffective for treating UACS-associated cough.

Asthma, whether “cough-variant” (where cough is the sole or predominant symptom) or “classic” (with symptoms including wheezing) is the second most common cause of chronic cough, found in 24-29% of patients at Montefiore. Coughing inflames the sensory afferent nerves (those that carry messages from receptors to the central nervous system). Leukotrienes, lipid mediators whose production also generates histamines, are thought to contribute to the inflammation. Asthma therapy (usually a combination of inhaled bronchodilators and steroids) can take up to eight weeks to show improvement. An oral leukotriene receptor antagonist known as zafirlukast has in some cases been more effective than steroids in reducing asthma-associated cough, possibly because it more effectively suppresses the interaction of eosinophils (white blood cells that fight concomitant infection during asthmatic reaction) with cough receptors. Non-asthmatic eosinophilic bronchitis, a condition characterized by chronic cough without the airway remodeling common to asthma, is often misdiagnosed as cough-variant asthma because it responds similarly to inhaled corticosteroids.

Gastroesophageal reflux disease (GERD) is among the most common etiologies of cough, and perhaps the most difficult to diagnose. Most patients with reflux-associated cough have no other symptoms of GERD, though the characteristic heartburn, nausea, and regurgitation may subsequently appear. The standard GI workup for GERD—endoscopy, barium esophagram, prolonged esophageal acid monitoring, and impedance monitoring—may not detect mild acid exposure, brief reflux events, rapid esophageal clearance, and distal or “high” reflux. “You might send your patient for a full GI workup and receive test results that are unremarkable, but that patient’s reflux still causes an incredibly life-jarring cough”.

Chronic cough can also result from laryngopharyngeal reflux (LPR), a subtype of GERD in which reflux reaches the upper airways. People with LPR often cough when eating, drinking, laughing, talking on the telephone, or getting up in the morning, and may experience hoarseness or other voice change.

The current GERD diagnostic options and treatment therapies may be inadequate, though better options are beginning to emerge. Twenty-four-hour catheter-based pH monitoring, for example, is invasive and often inconclusive as patients typically modify their activity and diet the day they wear the nasal catheter. Better but costlier options include the Bravo™ pH Monitoring System, in which a tubeless monitoring capsule is placed in the mucosal wall of the esophagus, transmitting pH data to a pager-sized receiver worn on patient’s belt over a 48-hour period; and Multichannel Intraluminal Impedance (MII) Testing, which assesses acid and non-acid reflux, adequacy of acid suppression, and symptom-reflux association. Treatment for GERD—usually aggressive acid suppression therapy, an approach that requires significant diet and lifestyle modification—may still be inadequate, and the addition of prokinetic therapy with additional medication may be necessary. Those who don’t respond sufficiently to acid suppression and prokinetic therapy may be candidates for laparoscopic Nissen fundoplication, or “antireflux surgery,” which, based on small published reports, has yielded quality of life improvements in up to 90% of patients who have undergone it.

Postinfectious or postviral cough, a harsh, dry, persistent hack remaining from an upper respiratory infection, has been historically difficult to treat. This cough creates persistent airway inflammation, which in turn causes enhanced cough sensitivity, creating a vicious cycle that inhibits healing. Postviral coughs can persist for weeks or even months and may respond to antiinflammatory agents, such as inhaled and oral steroids.

More effective cough treatment options are needed, yet no new antitussive drugs have been developed in the last half century. With the discovery of TRPV1, however, pharmaceutical companies’ interest in these medications has surged. Numerous potential novel antitussive agents are now being studied, including antagonists to eosinophil, tachykinin receptor, 5-HT receptor, and TRPV1 receptor; agonists to the delta-opioid receptor, NOP receptor, and GABA-B; endogenous cannabinoids, and large conductance Ca+2-activated K+-channel openers.

The idiopathic (unexplained) cough remains a mystery. Patients with this cough—predominantly peri-menopausal women with a lower capsaicin threshold, many of whom have had an upper respiratory infection preceding symptom onset—may have been inadequately diagnosed. However, even after aggressive, comprehensive testing and treatment, some continue to cough. A percentage of these patients are reported to have lymphocytic airway inflammation and autoimmune diseases, but the link is neither consistent nor definitive.

Chronic cough is the most common reason that patients seek medical care, yet only a fraction of people with UACS, asthma, non-asthmatic eosinophilic bronchitis, or GERD actually experience this symptom, a phenomenon yet to be understood. These individuals may possess an intrinsically hypersensitive cough reflex, more easily triggered by aggravating factors to produce the reaction.

Although cough has been historically under-researched relative to its importance as a medical problem, the last decade has witnessed a significant increase in scientific activity dedicated to understanding the mechanism of cough, and identifying more effective therapies.

QUOTE FOR THURSDAY:

“Crohn’s disease may affect as many as 780,000 Americans. Men and Women are equally likely to be affected, and while the disease can occur at any age, Crohn’s is more prevalent among adolescents and young adults between the ages of 15 and 35.”.

Crohn’s and Colitis Foundation

Treatments for ulcerative colitis versus chron’s disease!

Ulcerative colitis treatment usually involves either drug therapy or surgery.

Several categories of drugs may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.

 Anti-inflammatory drugs

Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis. They include:

  • 5-aminosalicylates. Examples of this type of medication include sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Which one you take, and whether it is taken by mouth or as an enema or suppository, depends on the area of your colon that’s affected.
  • Corticosteroids. These drugs, which include prednisone and hydrocortisone, are generally reserved for moderate to severe ulcerative colitis that doesn’t respond to other treatments. Due to the side effects, they are not usually given long term.

Immune system suppressors

These drugs also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these drugs works better than one drug alone.

Immunosuppressant drugs include:

  • Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, including effects on the liver and pancreas.
  • Cyclosporine (Gengraf, Neoral, Sandimmune). This drug is normally reserved for people who haven’t responded well to other medications. Cyclosporine has the potential for serious side effects and is not for long-term use.
  • Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These drugs, called tumor necrosis factor (TNF) inhibitors, or biologics, work by neutralizing a protein produced by your immune system. They are for people with severe ulcerative colitis who don’t respond to or can’t tolerate other treatments.
  • Vedolizumab (Entyvio). This medication was recently approved for treatment of ulcerative colitis for people who don’t respond to or can’t tolerate other treatments. It works by blocking inflammatory cells from getting to the site of inflammation.

Other medications

You may need additional medications to manage specific symptoms of ulcerative colitis. Always talk with your doctor before using over-the-counter medications. He or she may recommend one or more of the following.

  • Antibiotics. People with ulcerative colitis who run fevers will likely take antibiotics to help prevent or control infection.
  • Anti-diarrheal medications. For severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheal medications with great caution and after talking with your doctor, because they may increase the risk of toxic megacolon (enlarged colon).
  • Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others) — but not ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), and diclofenac sodium (Voltaren), which can worsen symptoms and increase the severity of disease.
  • Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia and be given iron supplements.

Surgery

Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy).

In most cases, this involves a procedure called ileal pouch anal anastomosis. This procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste relatively normally.

In some cases a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.

Cancer surveillance

You will need more-frequent screening for colon cancer because of your increased risk. The recommended schedule will depend on the location of your disease and how long you have had it.

If your disease involves more than your rectum, you will require a surveillance colonoscopy every one to two years. You will need a surveillance colonoscopy beginning as soon as eight years after diagnosis if the majority of your colon is involved, or 15 years if only the left side of your colon is involved.

Alternative medicine

Many people with digestive disorders have used some form of complementary and alternative (CAM) therapy.

Some commonly used therapies include:

  • Herbal and nutritional supplements. The majority of alternative therapies aren’t regulated by the FDA. Manufacturers can claim that their therapies are safe and effective but don’t need to prove it. What’s more, even natural herbs and supplements can have side effects and cause dangerous interactions. Tell your doctor if you decide to try any herbal supplement.
  • Probiotics. Researchers suspect that adding more of the beneficial bacteria (probiotics) that are normally found in the digestive tract might help combat the disease. Although research is limited.
  • Aloe vera. Aloe vera gel may have an anti-inflammatory effect for people with ulcerative colitis, but it can also cause diarrhea.
  • Acupuncture.
  • Turmeric. Curcumin, a compound found in the spice turmeric, has been combined with standard ulcerative colitis therapies in clinical trials. There is some evidence of benefit, but more research is needed.

Chron’s Disease Treatments

There is currently no cure for Crohn’s disease, and there is no one treatment that works for everyone. The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. It is also to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission.

 Anti-inflammatory drugs

Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

  • Corticosteroids. Corticosteroids such as prednisone and budesonide (Entocort EC) can help reduce inflammation in your body, but they don’t work for everyone with Crohn’s disease. Doctors generally use them only if you don’t respond to other treatments.Corticosteroids may be used for short-term (three to four months) symptom improvement and to induce remission. Corticosteroids may also be used in combination with an immune system suppressor.
  • Oral 5-aminosalicylates. These drugs include sulfasalazine (Azulfidine), which contains sulfa, and mesalamine (Asacol HD, Delzicol, others). Oral 5-aminosalicylates have been widely used in the past but now are generally considered of limited benefit.

Immune system suppressors

These drugs also reduce inflammation, but they target your immune system, which produces the substances that cause inflammation. For some people, a combination of these drugs works better than one drug alone. Immunosuppressant drugs include:

  • Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, such as a lowered resistance to infection and inflammation of the liver. They may also cause nausea and vomiting.
  • Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). These drugs, called TNF inhibitors or biologics, work by neutralizing an immune system protein known as tumor necrosis factor (TNF).
  • Methotrexate (Trexall). This drug is sometimes used for people with Crohn’s disease who don’t respond well to other medications. You will need to be followed closely for side effects.
  • Natalizumab (Tysabri) and vedolizumab (Entyvio). These drugs work by stopping certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Because natalizumab is associated with a rare but serious risk of progressive multifocal leukoencephalopathy — a brain disease that usually leads to death or severe disability — you must be enrolled in a special restricted distribution program to use it.Vedolizumab recently was approved for Crohn’s disease. It works like natalizumab but appears not to carry a risk of brain disease.
  • Ustekinumab (Stelara). This drug is used to treat psoriasis. Studies have shown that it’s useful in treating Crohn’s disease as well and may be used when other medical treatments fail.

Antibiotics

Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn’s disease. Some researchers also think antibiotics help reduce harmful intestinal bacteria that may play a role in activating the intestinal immune system, leading to inflammation. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Other medications

In addition to controlling inflammation, some medications may help relieve your signs and symptoms, but always talk to your doctor before taking any over-the-counter medications. Depending on the severity of your Crohn’s disease, your doctor may recommend one or more of the following:

  • Anti-diarrheals. A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium A-D) may be effective.
  • Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others) — but not other common pain relievers, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve). These drugs are likely to make your symptoms worse, and can make your disease worse as well.
  • Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia and need to take iron supplements.
  • Vitamin B-12 shots. Crohn’s disease can cause vitamin B-12 deficiency. Vitamin B-12 helps prevent anemia, promotes normal growth and development, and is essential for proper nerve function.
  • Calcium and vitamin D supplements. Crohn’s disease and steroids used to treat it can increase your risk of osteoporosis, so you may need to take a calcium supplement with added vitamin D.

Nutrition therapy

Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn’s disease. This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term.

Your doctor may use nutrition therapy short term and combine it with medications, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier prior to surgery or when other medications fail to control symptoms.

Your doctor may also recommend a low residue or low-fiber diet to reduce the risk of intestinal blockage if you have a narrowed bowel (stricture). A low residue diet is designed to reduce the size and number of your stools.

Surgery

If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your signs and symptoms, your doctor may recommend surgery. Nearly half of those with Crohn’s disease will require at least one surgery. However, surgery does not cure Crohn’s disease.

During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses.

The benefits of surgery for Crohn’s disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication to minimize the risk of recurrence.

Alternative medicine

Many people with digestive disorders have used some form of complementary and alternative medicine (CAM). However, there are few well-designed studies of their safety and effectiveness.

Some commonly used therapies include:

  • Herbal and nutritional supplements. The majority of alternative therapies aren’t regulated by the Food and Drug Administration.
  • Fish oil. Studies done on fish oil for the treatment of Crohn’s haven’t shown benefit.
  • Acupuncture. Some people may find acupuncture or hypnosis helpful for the management of Crohn’s, but neither therapy has been well-studied for this use.
  • Prebiotics. Unlike probiotics — which are beneficial live bacteria that you consume — prebiotics are natural compounds found in plants, such as artichokes, that help fuel beneficial intestinal bacteria. Studies have not shown positive results of prebiotics for people with Crohn’s disease.