Welcome to Kaiser Wells Homecare

 

DIETARY SUPPLEMENTS AND HEART HEALTH

 

In 2005, more than 650,000 people died from heart disease, accounting for 27% of the deaths in the United States, making it the leading cause of death for both men and women. The development of cardiovascular disease is very complicated, and it is affected by multiple factors, including elevated cholesterol and triglycerides, coagulation factors, platelet aggregation, glucose metabolism, and smoking. To maintain good "heart health", the combination of a good diet, exercise, and no smoking is essential. For patients who need additional therapy beyond lifestyle modifications, doctor-prescribed medications are available and some dietary supplements may be considered. Some of the most common supplements used to improve heart health will be discussed. As with any over-the-counter products, it is very important to check with your physician before you begin taking any supplements as well as telling them of any you are currently using.

 

Omega-3 Fatty Acids:

There is good evidence supporting the conclusion that omega-3 fatty acids from fish or fish oil supplements significantly reduce triglyceride levels. They also may cause small improvements in high-density lipoprotein (HDL; "good cholesterol"). Increased levels of low-density lipoprotein (LDL; "bad cholesterol") were also  seen, however. Multiple studies report a reduction in secondary events associated with cardiovascular disease, including reductions in nonfatal and fatal heart attacks and sudden cardiac (heart-related) death. It is important to note that patients in these trials were also taking prescription drugs for the heart and were being routinely evaluated by a physician.

The most significant side effect associated with omega-3 fatty acids is bleeding, although this is seen more often with excessive use. Patients who are also taking any medication that may thin the blood should check with their primary care provider before beginning any regular supplementation with omega-3 fatty acids. Upset stomach, diarrhea, and nausea were also common with the use of fish oil supplements.

The American Heart Association (AHA) has released recommendations for the use of omega-3 fatty acids for the treatment of elevated triglyceride levels. For patients without coronary heart disease, the AHA recommends eating fish at least twice a week. For patients with coronary heart disease, the AHA recommends consumption of about 1 gram per day of omega-3 fatty acids. These patients may consider using supplements, such as fish oils. For patients who need to significantly lower triglyceride levels, supplementation with 2 to 4 grams per day of fish oil is recommended. Lastly, vitamin E is essential for the metabolism of omega-3 fatty acids, and with long-term use of fish oil supplements, extra vitamin E is needed. Because of this, many fish oil supplements contain additional amounts of vitamin E.

 

Garlic:

Garlic is one of the oldest recorded remedies used to treat disease. In recent clinical trials, the most important effects of garlic are those of mild reductions in cholesterol and reduced platelet clotting. The decrease in platelet clotting leads to its most common side effect, bleeding. Other side effects include asthma flares, dizziness, sweating, bad breath, body odor, headache, itching, fever, chills, and runny nose.

The current recommended dose for garlic supplementation is 200 to 300 mg of garlic extract 3 times a day (600-900 mg/day). If taken as part of the diet, 2 to 5 grams of fresh garlic is recommended daily.

 

Coenzyme Q10:

Coenzyme Q10 (CoQ10) is a substance produced by the human body that is necessary for the normal function of cells. It has been noted that levels of CoQ10 decrease with age and are lower in some patients with chronic conditions such as cardiovascular disease. There is a lot of controversy surrounding the use of CoQ10 supplements. The only clear indication is in patients who do not have enough CoQ10. Other promising areas of research include blood pressure and some other heart conditions.

Few side effects have been noted and include nausea, vomiting, rash, insomnia, headache, and flu-like symptoms. Organ damage due to lack of oxygen and blood flow has been noted in patients with heart disease during vigorous exercise. Additionally, CoQ10 supplementation may reduce the effectiveness of warfarin (Coumadin), a blood-thinning medication. It may also affect thyroid hormone levels and change your response to levothyroxine (Synthroid). Finally, CoQ10 may interact with antiviral medications and some medications used to treat HIV. The recommended dose ranges from 50 to 1200 mg/day in divided doses.

 

The cornerstone of any effort made for the prevention of heart disease is eating healthy, exercising, and not smoking. In fact, quitting smoking is the single most important factor patients can change to reduce the risk of developing or worsening heart disease. The AHA recommends that healthy people get their nutrients by eating a variety of foods, in moderation, rather than by taking supplements. Emphasis should be placed on fruits, vegetables, and whole grains. In nonsmoking patients with a healthy diet who exercise regularly, supplementation with certain substances, especially omega-3 fatty acids, can be associated with reductions in cardiovascular disease. Most importantly, a physician should be consulted prior to beginning any supplement, especially for those patients with known heart disease or who are already taking prescription drugs.

 

 

Combating Fatigue and Drowsiness

 

 Everyone has felt tired or sleepy during the day. Undue tiredness may be caused by a number of serious medical conditions, so if simple advice or OTC products containing caffeine do not help, it is wise to see a physician.

 

Before you take any medications for fatigue and drowsiness, you may wish to try some relatively easy solutions. You should not go to bed and arise at odd times or at different times each day. The best advice is to set a time for going to bed and also for arising and try to stick to them as much as possible. Everyone has experienced the "fun" of staying up till 4 am or later and then sleeping in until noon the next day. Even 8 hours of sleep cannot fool your body into normalcy, and you will feel the effects of your altered schedule the next day. In addition, strive to get at least 7 to 8 hours of sleep a night. Trying to get through the next day without adequate sleep leads to daytime drowsiness that is a major cause of fatal automobile accidents. Avoid stimulants such as caffeine or oral nasal decongestants (e.g., Sudafed) too close to bedtime, as the stimulant effect may not allow you to drop off to sleep at the right times, leaving you fatigued the following day.

You should always eat a healthy, balanced diet and drink sufficient water to keep fully hydrated. Avoid all alcohol, nicotine, and drugs of abuse. If you habitually drink caffeine-containing soft drinks, coffee, or tea, try to reduce the amount or eliminate them completely to determine whether they are responsible for a tired feeling. You should also be aware of any medications you are taking that may cause drowsiness, such as antihistamines, antihypertensives, corticosteroids, diuretics, and sleep aids.

One method to reduce fatigue is to reduce life stresses. It may be necessary to change from a job that causes severe stress to one that allows a more relaxing day of work. When you have spare time, do not spend it playing high-stress video games that require split-second timing and fast reflexes. Instead, go for a walk, read a book, or have a pleasant conversation with family and friends. If you are caught in a relationship that is fraught with problems, deal with them directly or end the relationship.

 

The only pharmacy product proven safe and effective in helping fight fatigue and drowsiness is caffeine, found in such OTC products as Vivarin and NoDoz. Each caplet or tablet contains 200 mg of caffeine. Take one dose not more often than every 3 to 4 hours. These products are only safe for those aged 12 years and above. They are not a substitute for healthy sleep and should never be used to keep you awake all night. They should not be used if you are pregnant or breastfeeding without speaking to your physician first.

 

Avoid the use of the popular energy drinks. Virtually all contain ingredients of unknown safety and effectiveness, such as herbs and dietary supplements. One contains such unproven ingredients as ginkgo, guarana, inositol, L-carnitine, ginseng, and milk thistle. Using products such as these is a risky gamble with your health, since they can have adverse effects and are not proven to provide a safe boost of energy.

 

• Keep the sick person away from other people as much as possible; especially others who are at high risk for complications from influenza.
• Remind the sick person to cover their coughs, and clean their hands with soap and water or an alcohol-based hand rub often, especially after coughing and/or sneezing.
• Have everyone in the household clean their hands often, using soap and water or an alcohol-based hand rub. Children may need reminders or help keeping their hands clean.
• Ask your health care provider if household contacts of the sick person - particularly those contacts who may be pregnant or have chronic health conditions- should take antiviral medications such as Tamiflu or Relenza to prevent the flu.
• If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. Infants should not be cared for by sick family members.

Placement of the sick person:

• Keep the sick person in a room separate from the common areas of the house. For example, a spare bedroom with its own bathroom, if that's possible. Keep the sickroom door closed.
• Unless necessary for medical care or other necessities, people who are sick with an influenza-like-illness should stay home and keep away from others as much as possible, including avoiding travel, for at least 24 hours after fever is gone except to get medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine). This is to keep from making others sick. Children, especially younger children, might potentially be contagious for longer periods.
• If persons with the flu need to leave the home (for example, for medical care), they should wear a facemask, if available and tolerable, and cover their nose and mouth when coughing or sneezing
• Have the sick person wear a facemask - if available and tolerable - if they need to be in a common area of the house near other persons.
• If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant.

Protect other persons in the home:

• The sick person should not have visitors other than caregivers. A phone call is safer than a visit.
• If possible, have only one adult in the home take care of the sick person. People at increased risk of severe illness from flu should not be the designated caretaker, if possible.
• If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable.
• Avoid having sick family members care for infants and other groups at high risk for complications of influenza.
• All persons in the household should clean their hands with soap and water or an alcohol-based hand rub frequently, including after every contact with the sick person or the person's room or bathroom.
• Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person.
• If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
• Antiviral medications can be used to prevent the flu, so check with your health care provider to see if some persons in the home should use antiviral medications.

If you are the caregiver:

• Avoid being face-to-face with the sick person.
• When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
• Clean your hands with soap and water or use an alcohol-based hand rub after you touch the sick person or handle used tissues, or laundry.
• Talk to your health care provider about taking antiviral medications to prevent the caregiver from getting the flu.
• If you are at high risk of influenza associated complications, you should not be the designated caretaker, if possible.
• If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. Designate a person who is not at high risk of flu associated complications as the primary caretaker of household members who are sick with influenza, if at all possible. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable.
• Monitor yourself and household members for flu symptoms and contact a telephone hotline or health care provider if symptoms occur.

Household Cleaning, Laundry, and Waste Disposal:

• Throw away tissues and other disposable items used by the sick person in the trash. Wash your hands after touching used tissues and similar waste.
• Keep surfaces (especially bedside tables, surfaces in the bathroom, and toys for children) clean by wiping them down with a household disinfectant according to the directions on the product label.
• Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
• Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Avoid "hugging" laundry prior to washing it to prevent contaminating yourself. Clean your hands with soap and water or alcohol-based hand rub right after handling dirty laundry.
• Eating utensils should be washed either in a dishwasher or by hand with water and soap.

For more information, The Centers for Disease Control and Prevention (CDC) Hotline (1-800-CDC-INFO) is available in English and Spanish, 24 hours a day, 7 days a week.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic condition characterized by abdominal pain or discomfort with recurrent episodes of such symptoms as diarrhea, bloating, constipation, gas and bloating, and urgency. The patterns of IBS symptoms and their severity vary widely among patients. Symptoms are usually classified as diarrhea-predominant, constipation-predominant, or alternating.

IBS is not the result of organic disease and no physical or structural abnormalities are associated with IBS. Patients may develop IBS symptoms after a gastrointestinal infection, other major illness, traumatic events, or stressful life situations. The neurological connections between the brain and the gut are known to be an important factor in regulation of bowel motility, absorption, and sensitivity. In addition, imbalances in the normal gut bacteria have been found in many patients and may be responsible for IBS symptoms.

There is no test or specific pathology to identify IBS. The patient with IBS should meet Rome criteria for the past 3 months, have had symptoms for at least 6 months, and not have warning signs that may indicate organic disease. Warning signs that may indicate diseases other than IBS include rectal bleeding, anemia, weight loss, fever, family history of colon cancer, onset of symptoms after 50 years of age, and a major change in symptoms.

Treatment options for IBS are targeted at normalizing bowel habits and reducing abdominal discomfort. Most patients find that certain foods may trigger episodes of IBS and learn to avoid them to reduce symptoms. Traditional over-the-counter medications for diarrhea or constipation are sometimes recommended for individual symptoms, but may have no effect on abdominal pain or bloating. Several prescription medications that affect the "brain-gut" connection have been developed for IBS, depending on the type of symptoms the patient is experiencing. These include alosetron (for diarrhea-predominant IBS) and tegaserod or lubiprostone (for constipation-predominant IBS). Low doses of antidepressants are sometimes effective for abdominal pain in patients with IBS, because of the neurological connections between the brain and the gut. These agents are generally given at lower doses than would be effective for mood disorders. Symptoms of bloating and gas have been shown to be affected by agents that change the balance of bacteria in the gut, such as antibiotics. Probiotic foods and supplements have received considerable promotion for improvement of intestinal health. The quality of these claims for probiotic products is difficult to ascertain unless the microorganisms have been standardized, identified to the strain level, and tested in randomized clinical trials. Recommendations for probiotics for patients with IBS should be supported by data from studies specifically in this population. The probiotic supplement Bifidobacterium infantis 35624 has been found effective in randomized, placebo-controlled clinical trials for global IBS symptoms, as well as the individual symptom of bloating in men and women with all subtypes of IBS. 

How to Fight Lactose Intolerance

Lactose intolerance means that you are unable to fully digest the milk sugar (lactose) found in dairy products. It can cause uncomfortable and embarrassing digestive problems. Fortunately, you can control your symptoms through a carefully chosen diet.

Milk, cheese, and other dairy products are made of a sugar called lactose (milk sugar). Lactose is made of two simpler sugars hooked together. It is broken down by lactase, an enzyme that turns it into the simpler sugars that your body can absorb to use for energy.

Some patients lack the enzyme lactase in their small intestine. They cannot digest milk and dairy products, and they are said to be lactose intolerant. In these cases, the lactose moves through the intestines without being broken down, as it cannot be used for energy. This causes a host of embarrassing problems.

What symptoms make you think that lactose intolerance is a problem? Symptoms usually begin 30 to 120 minutes after drinking milk or eating dairy products. The stomach rumbles and the abdomen feels swollen and uncomfortable. Nausea, abdominal pain and cramping, excess gas, and watery diarrhea are all common. However, it depends on how much of the offending food and drink was ingested.

Lactose intolerance is most often a result of one's genetic background. While many people of northern European descent can drink milk as adults without experiencing any problems, most people of African, Asian, American Indian, and Hispanic heritage cannot. In some cases, however, lactose intolerance can also occur after a person has a viral infection, experiences an episode of diarrhea, or undergoes certain intestinal surgeries. In these cases, the person may eventually be able to drink milk again without incident.

A true milk allergy is a dangerous disorder in which you may suffer a severe allergic reaction and possibly die if you ingest milk. Milk must be completely eliminated from the diet.

One way to prevent the symptoms of lactose intolerance is to reduce the amount of lactose ingested. Thus, you must avoid or reduce all sources of lactose, such as milk, cream, half-and-half, ice cream, and cheeses. You must also read all food and drink labels carefully. You may discover that lactose (i.e., milk sugars, whey, casein, caseinate, or nonfat dry milk solids) is included in dips, breads, sherberts, frozen dairy desserts, puddings, instant potatoes, salad dressings, prepared soups, butter, and canned/frozen fruits and vegetables. Actually, many people may still be able to ingest some of these products. The key is to know your own individual tolerance. Your pharmacist can help you determine this level.

Several manufacturers market lactose-free milks that may prevent symptoms. Some are also calcium-enriched to allow you to obtain adequate amounts of this vital nutrient. You may also choose from milk substitutes, such as soy-based or rice-based products.

Pharmacies also sell several products that contain lactase, the enzyme that you are lacking. Several of these are marketed under the Lactaid trade name. You should take the recommended dose at the same time as the offending food or drink is ingested. This may break down the lactose for you and prevent symptoms.

MYTHS AND FACTS ABOUT THE FLU AND COLDS

Myth: You can catch the flu from a flu shot.

Fact: The flu vaccine is made from an inactivated virus, so you cannot get the flu from a flu shot. Some people may be sore at the spot where the vaccination was injected, and in a few cases, may develop a fever, muscle aches and feel unwell for a day or two. In very rare cases when a person is allergic to the vaccine, there may be an immediate reaction.

Myth: One kind of flu is the "stomach flu".

Fact: About one out of three people with the flu may have an upset stomach, but this is rarely the main symptom of the flu. Other viruses and bacteria, and food poisoning are more common causes of nausea, vomiting and diarrhea.

Myth:There is nothing you can do once you get sick with the flu except stay home in bed.

Fact: Antivirals, when started within 2 days after flu symptoms appear, can reduce the duration of the illness and the severity of symptoms. Symptom relief medications and rest are other options that can also help to minimize the discomfort associated with flu symptoms.

Myth: You can catch the flu or a cold from going outdoors in cold weather.

Fact: The flu and colds are more common in the winter months because that is when the viruses spread across the country. It has nothing to do with being outside in cold weather.

Myth: Large doses of Vitamin C can keep you from catching the flu or a cold, or will quickly cure them.

Fact: These claims have not been proven. Still, it is important to one's overall health to consume the minimum daily requirement of Vitamin C.

Myth: "Feed a cold and starve a fever (flu)".

Fact: This is definitely not a good idea in either case. You need more fluids than usual when you have the flu or a cold. Drink plenty of water and juice, eat enough food to satisfy your appetite and drink hot fluids to ease your cough and sore throat.

Myth: Herbal remedies are an effective treatment for colds.

Fact: Echinacea and other herbs are getting a lot of publicity as cold remedies. Zinc lozenges are also said to cure colds quickly. To date, none of these claims are solidly supported by scientific studies.

Myth: Chicken soup and hot toddies are effective treatments for the flu or colds.

Fact: A bowl of chicken soup is a popular home remedy. While hot liquids can soothe a scratchy throat or cough, chicken soup has no special power to cure the flu or a cold. As for hot toddies, another folk remedy, any beverage containing alcohol should be avoided when you are sick.

In the United States, about 30,000 people suffer from cystic fibrosis, with 1,000 new cases diagnosed each year. Although years ago most children diagnosed with the disease did not reach elementary school age, today patients are likely to live into their late 30's and beyond.

Cystic fibrosis is an inherited disease caused by a recessive gene. There are 10 million carriers of the cystic fibrosis gene in the U.S., and many are not aware they carry it because they have no symptoms of the disease. This gene changes an important protein that controls the movement of salt and fluid in and out of cells, causing an imbalance of salt in the body. This results in thick mucus that clogs the passages in the lungs and pancreas, and in salty sweat that can cause problems in hot environments.  Frequent cough, respiratory infections, shortness of breath, wheezing, and sinus infections are the primary symptoms of cystic fibrosis. As respiratory complications are the most common cause of death in these patients, aggressive treatment to keep the lungs clear of mucus and free of infection is critical.

The mucus also stops the digestive enzymes from moving out of the ducts of the pancreas. These enzymes are needed to break down fat and protein in the intestines, so without them, nutrients and many vitamins in food are not absorbed. Often patients have diarrhea or greasy stools. Cystic fibrosis causes patients to become thin and malnourished even though they have good appetites. Enzyme supplements must be taken with every meal to help digestion and maintain nutrient absorption. An inflammation of the pancreas, called pancreatitis, can result when the pancreatic ducts are blocked by mucus. With an increase in the amount of salt lost in the sweat, a hot environment can easily cause dehydration.

Diagnosis is done with a simple test of the amount of salt in the patient's sweat, called the sweat test. Blood tests to identify the defective gene that causes cystic fibrosis may also be ordered. Since patients have many chronic, low-grade respiratory and sinus infections, x-rays of the lungs and sinuses are used to determine if inflammation or scarring is present. A culture of the sputum can show if there are bacteria present in the lungs and helps determine which antibiotics would be best to treat an infection.

The general goal of treatment is to minimize the complications of cystic fibrosis, since there is no cure at present. In order to keep the lungs healthy, infection-free, and clear of mucus, patients use daily chest physical therapy, exercise, and antibiotics. Chest physical therapy consists of pounding or clapping on the chest (percussion) to loosen the mucus, usually when the patient is sitting or lying in a position that will help the mucus drain (postural drainage). There are mechanical percussion machines that help loosen mucus, inflatable vests that help force the mucus out of the lungs, and breathing devices that cause vibrations to loosen the mucus. Exercise is also very helpful.

Oral and inhaled antibiotics are used to control the chronic bacteria present in the mucus of the lungs, and IV antibiotics are used when serious respiratory infections occur. Other inhaled medications, such as mucolytics and hypertonic saline, can be used to thin out mucus and make it easier to cough out. High doses of ibuprofen can be used to lessen inflammation in the lungs. Although ibuprofen is available OTC, it should be prescribed since the drug has several side effects and blood levels must be monitored by a doctor.

Digestive problems in cystic fibrosis are treated with the use of pancreatic enzyme supplements, taken before every snack and meal. These enzyme supplements help the body absorb the vitamins and nutrients in food and prevent malnutrition. Supplements of the fat-soluble vitamins (A, D, E, and K) are also needed to ensure enough are absorbed in the intestines. Some patients may have a feeding tube placed in their stomach overnight in order to receive liquid nutritional supplements.

Patients with cystic fibrosis should be treated by specialists in the disease. Your pharmacist can answer any questions you may have about the medications used to control the symptoms of cystic fibrosis.

 

 Glaucoma is the result of damage to the optic nerve, usually because of a fluid build-up that increases the pressure in the eye. However, not everyone with increased eye pressure will develop glaucoma, and some patients with normal eye pressure can develop optic nerve damage. Glaucoma can also occur when the pressure in the eye is normal; this condition is called normal-tension or low-tension glaucoma. This glaucoma is less common than those types caused by increased pressure in the eye, and it is not clear why the optic nerve suffers damage when the fluid pressure is not increased. Glaucoma can also be congenital, and early surgery on children born with glaucoma can often allow for the development of good vision.

The warm weather is finally upon us, and that means more aches and pains due to increased activity for many people. When you experience minor aches and pains such as a headache, toothache, or muscle ache, you can choose from hundreds of nonprescription analgesics or OTC pain medications for treatment. Each carries a set of labeled warnings that are vitally important to read before you purchase the product.