Perforated eardrum from vigorous nose blowing

Ok, so you’re probably wondering what on earth there is to learn about nose blowing. Actually, how you blow your nose is important.

Everyone blows their noses differently. Some are honkers, some blow in short, rapid bursts, others sort of sniff – you get the picture.

Well as it turns out, how vigorously we blow our noses can determine if we end up with a sinus infection. A study done by the National Institutes of Health measured the amount of force that occurs in the nasal passages during nose blowing, coughing and sneezing.  Scientists wanted to measure how much nasal mucus was propelled into the sinus passages during the common cold. So they devised a method of actually measuring how much pressure there is in the nasal passages when you cough, sneeze and blow your nose. As it turned out, the intranasal pressure when blowing your nose is 10 times greater than when you sneeze or cough.

So why is all of this important?

Well up to 1 milliliter of mucus can be propelled into our sinus passages when we blow our nose. Considering that the average person blows her nose up to 45 times a day during the first few days of a cold, that’s a lot of bacteria-laden mucous getting into our sinuses.

The more this mucous build-up occurs, the less functional the tiny little hairs that line our sinus passages become. These mucous-ladened little hairs (“cilia”) can no longer propel the nasal debris out of the sinus cavities. Bacteria becomes trapped and multiplies until, voila! - A sinus infection is born!

What’s the take-home message?

BLOW GENTLY when you have a cold!

For more information on this study, click on this link.

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The flu is different from other viral upper respiratory illness. The common cold does not produce the fever and horrible body aches and pains that is associated with the flu. In fact, the sudden onset of the illness is one of its hallmarks. Those most at risk for dying from the illness are the very young, the elderly and those whose immune systems are compromised. The Centers for Disease Control (CDC) estimates that between 5% and 20% of people become infected annually during the flu season, which is from November to March.

So what exactly is the flu virus? The virus is classified by its protein structure: hemagluttinin (HA) and neuraminidase (NA). The first protein, HA, enables the virus to penetrate the host cell while NA enables the virus to exit the cell once it has replicated.

What makes a virus particularly dangerous is its ability to cross-infect different species. The influenza virus is a great example of this. There are 3 types of flu virus: Types A, B and C. Type A infects many animals including pigs, birds, whales, and humans. Type B is transmitted between humans and Type C only causes minor respiratory infections despite being found in dogs, pigs and humans. Type A is the one scientists worry about because it is the most virulent and can cross species.

Each year scientists get together to determine the three most common Type A influenza viruses. Vaccines are then made to protect people against these three strains that are most likely to cause an epidemic.

Because children get the flu more than adults, it’s quite easy for whole families to become infected. If you have young children or you’re in contact with elderly people or if you suffer from a chronic illness such as asthma, diabetes, heart disease, etc, then it is really important for you to get the flu vaccine each year.

To find out more about the flu vaccine, incubation periods, and signs and symptoms, check out my article entitled “Flu Vaccine for Flu Prevention – 5 Facts You Should Know”.

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It’s important to remember that I’m talking about the absence of food – not water. An adult generally can not survive more than 7-10 days without water but can survive, depending on body mass and initial health status, anywhere from a month to much longer, if water is readily available.

Research on this topic yielded an interesting article published May 29, 1945 by the Royal Society of Medicine. The panel of medical doctors had convened to discuss the treatment of starvation that was discovered among many prisoners of war, the victims of German concentration camps and among the population of war-torn Europe at the end of World War II. The article goes on to discuss the physiology of starvation in some detail.

I learned that “…the deprivation of food progressively destroys the digestive, absorptive and protective functions of the alimentary canal”. This is turn leads to a destruction of the epithelial layer of the digestive tract, explaining why ulcers are found along the digestive tract during post-mortems. The loss of cells that absorb nutrients leads to massive diarrhea when food is introduced orally. Diarrhea of course, leads to further dehydration. In fact, food becomes an irritant to the gut in cases of extreme starvation.

Hunger strikes that have been well documented, such as in the case of Mahatma Gandhi, are rare. In Gandhi’s case, as a 74 y.o. rather thin man to begin with, he succumbed to starvation after 21 days.

Alan Lieberson, a medical doctor, lawyer wrote in Scientific American:

Unlike total starvation, near-total starvation with continued hydration has occurred frequently, both in history and in patients under medical supervision. Survival for many months to years is common in concentration camps and during famines, but the unknown caloric intake during these times makes it impossible to predict survival. What is evident is that the body can moderate metabolism to conserve energy and that individual survival varies markedly.

So after several weeks of not eating, I can only presume that the 2 young Wall Street Occupiers have ended their hunger strike. I hope however, that the OWS movement doesn’t lose its momentum.

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Videonystagmography is an interesting tool that uses infrared techonology to record eye movements. There are four parts to the test:

1. saccade test
2. tracking test
3. positional test
4. caloric test

The saccade test evaluates rapid eye movements. The patient is asked to follow objects as they a jump across the screen or stand still or move slowly. The tracking test asks the individual to follow larger objects as they move across the screen. Both tests look for any lag time in eye movement. The patient wears infrared goggles which record eye movements during the test.

The positional test involves moving the head/body into different positions to see if there are any abnormal rapid eye movements known as nystagmus.

The caloric test uses warm and ice water (sometimes warm/cold air) to see how well each ear responds to stimuli. This determines if the problem is related to one or both ears.

If the videonystagmography testing is normal, then the cause of dizziness is not related to inner ear dysfunction. Not everyone who experiences dizziness requires this type of testing. More than anything, a careful history taking by the practitioner can help determine the cause of the dizziness.

As usual, if you have an abrupt onset of dizziness, be sure to see your practitioner for evaluation and treatment.

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Kyphoplasty involves the use of an inflatable bone tamp into the fractured vertebra to elevate the fractured part to its pre-fractured height before inserting the bone cement. This allows more space to be filled with bone cement than if a vertebroplasty was performed. In a vertebroplasty, there is no attempt made to raise the fractured vertebra to its previous height.

In the procedure, a thin needle and tube is inserted on both sides of the vertebral body. Orthopedic balloons are then inserted and inflated before the cement is injected.

The long term efficacy of both procedures are the same – meaning that one procedure is not better than another in the long run. In the short term, kyphoplasty seems to enable better functioning. Both procedures provide equal pain reduction.

For more information about the procedure, follow this link.

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SLE is an autoimmune disease that affects the skin (butterfly rash across the cheeks and nose), kidneys, brain, and joints – in fact the entire body can be affected. Although there is no cure, there are various degrees of involvement and treatment can vary widely because of this. An autoimmune disease occurs when the body’s immune system revs up and begins to attack healthy tissue.

SLE affects more women than men, and more African-Americans, Asians and Hispanics. Although it can occur at any age, it generally occurs in women of childbearing age. The cause of SLE is not fully known although it may be associated with deficiencies in a large number of genes.

The 11 criteria used to diagnose the disease are:

1. Malar rash: “butterfly rash” across the cheeks and nose
2. Discoid rash: red, raised rash in the shape of a disc
3. Photosensitivity: rash that occurs w/exposure to sunlight
4. Oral ulcers
5. Arthritis: joint pain and swelling in 2 or more joints (usually the wrist, fingers, knees)
6. Serositis: inflammation of the lining of the heart and lungs that cause pain w/deep breathing
7. Kidney disorder: persistent protein or cellular casts in the urine
8. Neurologic disorder: seizures or psychosis
9. Blood disorder: low red blood cells, low platelets, low white blood cells etc
10. Immunologic disorder: positive test for anti-double-stranded DNA, anti-Sm or antiphospholipid antibodies
11. Abnormal antinuclear antibodies

Contact your medical provider if you feels you have any of the above symptoms.

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A new study has now shown that for those people being treated for Osteoporosis with any of the bisphosphonates such as Actonel, Fosamax or Boniva, a minimum Vitamin D level of 33 ng/ml is necessary in order to have a favorable response to the medications.

Vitamin D insufficiency is defined as a level between 20 -30 ng/ml while Vit D deficiency is defined as a level less than 20 ng/ml.

Those whose levels were 33 ng/ml or higher, had a fivefold greater response rate to bisphosphonate therapy if they maintained that level.

If you are on bisphosphonate therapy for osteoporosis, be sure to get your Vitamin D levels checked at least yearly…and in the winter months, make sure that you take your supplements.

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The answer can’t always be determined in hindsight either – take Steve Jobs for example. His tumor was found as an incidental finding. Before rushing to have it removed, he sought the advice of leading experts. Would it have made a difference if he had it removed 6 months earlier?

To read about this dilemma, follow this link to the NY Times.

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The patient was convinced he had a kidney infection yet some of the classic signs were missing and there were some other details that simply didn’t fit the diagnosis. No worries – a simple, in-house urinalysis would help clear up the matter.

“My insurance won’t let me do any testing here. I have to go to Mercy hospital,” he said.”Otherwise I have to pay and I can’t afford that.”

“Well, this is just a urinalysis that we can do right here,” I responded. “Without it I won’t be able to treat you. If I send you out for a u/a, I won’t get the results until the beginning of next week.”

“Can you call my insurance company then?” he asked. Here I was, running 40 minutes behind and this would set me behind further.

Well maybe after examining him I’d feel more confident about the diagnosis but instead I was not convinced I was dealing with a urinary tract infection, urethritis, kidney stones or prostatitis. Sighing, I asked him to wait while we put in a call to his insurance company to request that we do a urine test right there and then.

Sure enough, they refused.

My choices were limited – we were running into the weekend and I didn’t want to leave him without an antibiotic on the slim possibility that he did have a urological issue. But which antibiotic?

Angry, but running too far behind to have the luxury of indulging in that emotion, I decided to send an antibiotic to his pharmacy and await the results on Monday. I figured giving him an antibiotic was better than having him visit the ED in case his symptoms worsened.

This is not the kind of care I like to give. First of all, it wasn’t fair to the patient and put an undo burden on him to travel miles away to get the lab work done. Since I couldn’t know the results immediately, I ended up ordering more labs than I might have done otherwise if I could have done the urinalysis.

Should I have done the test anyway and had our practice eat the expense? We see mostly Medicare and Medicaid patients and our reimbursement levels don’t always cover our actual expenses. Those who do not work in primary care often erroneously believe practices like ours make a lot of money and assume we can easily afford to give away services. We can’t.

This is just another example of how ludicrous the health care industry has become – everything about the visit ended up costing the system more money.  Don’t let health insurers fool you: they are for-profit organizations and are more interested in protecting their bottom line than in protecting the patient’s health. This is yet another reason why I’m for a government-backed single-payer health care system.

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Hearty Do-Ahead Dishes
By MARTHA ROSE SHULMAN
This week’s hearty one-dish vegetarian meals are meant to appeal to families that include a mix of meat-eaters and vegetarians. My best friends have a vegetarian relative who is undergoing some serious surgery and will be recuperating at their home. They’re in need of several do-ahead recipes that they can all enjoy throughout the week, dishes that can be reheated at different times, as they often get home from work late.

What I’ve come up with is a mix of humble stews (beans and lentils) and more complex casseroles. The lentil and bean dishes back up the point that Mark Bittman made in his recent Op-Ed  article that dispelled the myth that fast food is cheaper than healthy meals prepared at home. A great pot of beans or lentils, even when you add to it a bunch of chard from the farmers’ market, costs no more than $4 to make, and it feeds four to six people.

French Lentils with Chard

This combo of lentils and greens is inspired by a classic preparation for the tasty French Le Puy green lentils that traditionally includes salt pork and/or bacon and sausage. For this vegetarian version, I don’t insist on Le Puy lentils, although I highly recommend them. Meat eaters in the family might want to accompany this with sausage, cooked separately or with the lentils. I recommend topping the lentils with goat cheese or feta.

1 tablespoon extra virgin olive oil

1 onion, chopped

2 carrots, chopped

1 celery stalk, chopped

4 large garlic cloves, minced

1 pound lentils, preferably imported green lentils, washed and picked over (2 1/4 cups)

A bouquet garni made with 2 bay leaves, a Parmesan rind and a sprig or two each of thyme and parsley

Salt and freshly ground pepper

1 bunch Swiss chard (3/4 to 1 pound), stemmed, washed and coarsely chopped

Freshly grated Parmesan, crumbled goat cheese or feta for serving

1. Heat the olive oil over medium-high heat in a heavy soup pot or Dutch oven. Add the onion and cook, stirring, until it begins to soften, about 3 to 5 minutes. Add the carrot and celery and cook, stirring, until all the vegetables are tender, about 5 minutes. Add the garlic and continue to cook, stirring, until fragrant, 30 seconds to a minute. Add the lentils, 2 quarts water and bouquet garni. Bring to a boil, reduce the heat, and simmer 40 minutes. Add salt and pepper to taste. Remove the bouquet garni.

2. Stir the chard into the simmering lentils. Cook another 10 minutes or so, until the lentils and greens are tender. The chard should be tender but still bright. Taste, adjust seasonings and serve, passing the cheese at the table for sprinkling. Alternatively, transfer to an oiled baking dish, top with rounds of goat cheese, crumbled feta or grated Parmesan, and heat through in a medium oven.

Yield: Serves 4 to 6

Advance preparation: You can cook the lentils through Step 1 and keep in the refrigerator for 2 or 3 days. Bring back to a simmer and proceed with the recipe. The finished dish will keep for 2 or 3 days in the refrigerator, but the color of the chard will fade.

Nutritional information per serving (4 servings): 462 calories; 1 gram saturated fat; 0 grams polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 80 grams carbohydrates; 21 grams dietary fiber; 221 milligrams sodium (does not include salt to taste); 28 grams protein

Nutritional information per serving (6 servings): 308 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 2 grams monounsaturated fat; 0 milligrams cholesterol; 53 grams carbohydrates; 14 grams dietary fiber; 150 milligrams sodium (does not include salt to taste); 19 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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