Obama banning medical devices he can"t pronounce (asthma inhalers banned over "environmental concerns")

I must have posted this video several dozen times already, usually associated with his propensity for gaffes:

Asthma Awareness

By Nurse Diane

A few years ago, a friend of mine, my doctor, had an asthma attack.  It was so severe that he was flown to Jackson to the hospital and put in ICU.  He did not survive this attack.  He was a young man, in his 40′s, a well-known physician, married to a nurse.

According to worldasthmaday.org, World Health Organization (WHO) estimates, 300 million people suffer from asthma and it’s the most common chronic disease among children. WHO also notes that asthma affects people in all countries around the world regardless of development although most deaths occur in lower income countries.

Asthma is a chronic disease of the air passages (or bronchial) that lead to and from the lungs that makes breathing difficult. Usually there is inflammation, which results in a temporary narrowing of the passages that carry oxygen to the lungs.

Symptoms vary from person to person and in intensity, but generally include coughing, wheezing, shortness of breath, chest pain or pressure. Asthma sufferers often have recurrent attacks of breathlessness and wheezing. Symptoms may occur several times a day or week and may become worse during physical activity or during the night.

During an attack, the lining of the bronchial tubes swells, causing airways to become narrow and reducing the flow of air in and out of the lungs. These attacks can cause sleeplessness, fatigue, reduced activity and absenteeism from work or school.

The basic causes of asthma are not completely understood, but risk factors for developing the disease include a genetic predisposition along with exposure to particles and substances that irritate the air passages and cause allergic reactions. Some irritants include dust in furnishings, pets, tobacco smoke, chemicals and air pollution.

Other causes include physical exercise, medications (aspirin and beta blockers), cold air and even emotional reactions such as stress, anger and fear.

Today is World Asthma Day.  World Asthma Day is an annual event organized by the Global Initiative for Asthma with a goal to improve asthma awareness and care around the world.  For ways you can help get the news out about asthma, visit this site: http://worldasthmaday.org/support/

Smoking and Asthma

Smoking is bad news for everyone, but especially for kids who have asthma. And yet between 15 and 20 percent of people with asthma still indulge in the habit, even though it makes them wheezier. Pregnant women who smoke increase the risk of the baby being asthmatic and having other respiratory illness. Tobacco smoke contains 4,000 chemicals, present either as gases or tiny particles.

You do not have to smoke yourself to inhale the fumes. Every time you walk into a bar you will get a blast of tobacco and if your asthma is severe you should avoid such places. Other people’s smoking habits can make your life a misery and if you live or work with a smoker there is little or no escape from smoke related risks.Children of smokers are more likely to have wheezy episodes and time off school than those with non smoking parents. It is generally worse when the mother smokes because many children spend more time with their mother than their father.

Keep your home smoke free. Remove all ashtrays and should a guest ask for one, explain that it is necessary to keep your home unpolluted, and suggest they smoke outside. Offer them a nicotine patch if they do not want to go out. It is important to have fresh air circulating throughout your home but beware of room fresheners as they also can be triggers. Open a window back and front of your home for a little while twice a day. Children are much more sensitive to cigarette pollution than adults. Seek out practical information on how to protect them against asthma using new and innovative methods. Look up a website with an alternative solution about how to cure asthma the natural way.

violations of civil rights page 16 Appeal to Federal Blue Cross/Blue Shield of ILLINOIS,TX,OK, NM

Attached are a recap summary of all claims back to 8/1/00 which are currently appealed or are new items received not paid correctly. All claims need to be referred first to federal workers compensation and your contact should be the regional office manager in Dallas, TX, not the non- compliantcontractor as to how this can be facilitated. New actions since your last, inaccurate decisions based on false and incomplete information. Remember you are alleging OPM’ past director gave you one set of ‘ facts’ and ACS, the paper controller and claims processor for US dept of labor, claims they were told an opposite set of ‘facts’ by that same director.  Trailblazers has been non cooperative with judges, etc. but Cigna Govt services did cooperate and the only Final decision was issued by Medicare’s appellate judge on 9/29/2010 was based on the  internal documents that were withheld from you, even from the officials at OPM? , by that director. Federal workers comp gets claims first. Then you and last would be Medicare for any co- pays or deductibles on medical issues not yet reviewed or accepted  yet. All conditions accepted or filed on 1/10/89 injury . HIPPAA reqeust for written recap of who said what, when to solve. not yet answered.

Strategies to Control Asthma

This summary from the NHLBI provides invaluable information to parents of children with asthma.  SS

World Asthma Day and Asthma Awareness Month

Together we can help control asthma.

This World Asthma Day (May 1, 2012) and Asthma Awareness Month (May) the National Asthma Education and Prevention Program (NAEPP) encourages you to discover how.

One of the first steps—whether you have asthma or know someone who does—is to develop a written asthma action plan (AAP) in partnership with your healthcare provider. AAPs that meet the specific needs of a patient include details ranging from how to take medication to reduce airway inflammation, to ways to reduce environmental triggers of asthma such as dust mites or tobacco smoke.

But AAPs don’t stand alone. 

They are part of a comprehensive approach needed to improve asthma care and control. Like diabetes or high blood pressure, managing asthma symptoms requires daily attention and ongoing education.

An APP is just one of  the following six key actions, recommended by the NAEPP, that clinicians, patients, and all others who touch the life of someone with asthma can work together on to seize control of asthma so that asthma doesn’t seize control of asthma patients.

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  Use inhaled corticosteroids to control asthma if you have persistent asthma. Your doctor will help you choose the best treatment.


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  Use a written asthma action plan to highlight two things: 1) what to do daily to control your asthma, and 2) how to handle symptoms or asthma attacks.


• 
  Assess asthma severity at the initial visit to determine what treatment to start to get your asthma under control.


• 
  Assess and monitor how well controlled your asthma isat follow up visits. Your doctor may need to increase, or decrease your medicine to keep asthma under control.


• 
  Schedule follow-up visits at periodic intervals, and at least every six months.


• 
  Control environmental exposures such as  allergens or irritants that worsen your asthma.

When taken with these other actions, AAPs can help people with asthma live without limits. The NAEPP has identified personalized AAPs as “must-haves” for allasthma patients, particularly those with moderate and severe asthma, a history of asthma attacks, or poorly controlled asthma. 

It may take time to develop and guide a patient through an AAP on the front end, but providing patients with detailed instructions and educating them on how to manage their asthma themselves will ultimately save clinicians time and effort on the back end. And, if followed as one of the NAEPP’s six recommended actions, it could ultimately save lives.

Currently, only about one in three patients with asthma has an AAP to guide them. So, for this World Asthma Day and throughout Asthma Awareness Month, the NAEPP and NACI encourage those without an AAP to get one.

Read more  below:

http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/news/world-asthma-day.htm

Is it Walking Pneumonia? Bronchitis? Or Asthma?

Sweet Baby Tate has had a cough for weeks now, at least 4.  It was a dry cough at first, and I was doing much the same thing.  It always felt like I had a frog in my throat that needed clearing.  I just thought we were both suffering from allergies.  The weather here unpredictable at best, with rain and wind blowing all the pollen and mold etc about all the time, 30 degrees one day and seriously 83 degrees the next.   As last year it never froze or truly got cold none of the spores died.  So now double the crap is flying about in the air.  People are miserable.

In any event, I just thought we were suffering from allergies.  While we were in Dallas in early January I was on a Z-pac that I requested from my friend as I felt like I had a sinus infection (Note to self who is a pediatric dentist, don’t ask S for a specific antibiotic for something of which you know nothing about; let her choose as apparently a Z-pac is not the drug of choice for a sinus infection.  But I digress.  Are you reading this S?).  I just felt a little gunky and had that strange yucky taste in my throat and was congested.  I suppose it helped as I never got a fever and I felt better a couple of days after we returned.  I mostly didn’t want to get my girl J sick who was possibly going to need to start chemo soon after the weekend (Sadly she got bad news and has finished one round. I’m so sad for her, but I’m positive she’s going to be cured!)

Then Tate started coughing;  the dry cough.  It was  sort of constant, but never seemed to bother him and it would be one hack and then 10 or 15 minutes later another hack.  Nothing concerning though.  He just seemed to always need to clear his throat.  H also had one fantastic screaming fit and became hoarse about 3 1/2 weeks ago.  But the hoarseness has never gone away.  Again I just thought well maybe it was coincidental to the screaming fit, and his little voice was going to be changing.  Now of course when I hear him I can barely remember what he used to sound like, so I’m wondering if there has actually been a change.

However, for about a week and a half now I’ve been given him an anti-histamine at night, usually Benadryl, approved by our allergist, for the cough.  It alleviated the cough and his sniffling while Zyrtec does not.  I’ve been keeping him on his Singulair now almost constantly since September where as last year he got a break November – March.  (I hate him constantly being on medications).  But when he goes off he tends to get a bit of a dry cough (ahhhh…asthma warnings right?.  Sigh)

But then this past Monday his teacher texted me twice saying he had been coughing all day long, so much so that he wasn’t able to nap.  He was doing fine, but poor baby had red eyes and looked so tired.  She asked if she could put a small piece of peppermint in some cold water to have him sip to help soothe his throat.  I gave my blessing of course.  He finally fell asleep after everyone else woke up, and she let him sleep an hour while keeping the other 4 kids sort of quiet, so he could rest (I love her!).  That night Tate told me “Ms. JoAnnie gave me some peppermint water, and it made my throat feel ‘bedder’.  I’m going to give her a little hug tomorrow.”  Not a big hug mind you, a little hug

Monday when I picked him up his cough was very wet and productive sounding and he coughed constantly.  I loaded him up with Benadryl and Singulair and he happily played as usual and went to bed just fine.  Yesterday, Tuesday, I called and made an appointment with his pediatrician for today.

My parents, who are AWESOME!, picked him up from school this morning and took him to his appointment.  I wrote the following note for them to give to his pediatrician…

Dr. R….

Tate’s tantrum behavior stopped about 2 days before his half year birthday on January 23.  It was as if a switch had gone off.  I’ve chalked it up to the half year disturbances.  His sleep went back to normal…which is minimal sleeping and fighting naps and he’s reasonable again.  Thank you so much for calling me and talking me off the roof.

This cough of his doesn’t have me terribly concerned as I’m thinking it’s just a cold.  But it’s been present in one manner or another for the past 2 1/2 weeks.  It was a  constant (all day long) dry cough (and his teacher called me twice concerned) until yesterday evening when it became productive and wet sounding.  He’s been afebrile and no change in behavior.

He takes 4mg Singulair in the evenings, though I ran out and he didn’t have it Friday-Sunday and that is when his cough worsened.  I’ve given him Benadryl (12.5mg) the past 3 evenings to help alleviate it otherwise he coughs all night.  He’s very congested and sniffing right now as he’s trying to go to sleep.  Dr. A said I could give him the Benadryl as it works on his cough better than Zyrtec or Allegra.

He had another skin test about 3 weeks ago and is still allergic to eggs and oranges.

Thanks so much!

(Dr. A is the allergist Dr. R referred us to).

She examined my Tate this morning and diagnosed him with having either walking pneumonia or bronchitis!!!  He had rales in his  chest. She also mentioned that sometimes the first episode of asthma can sound like this. (This was my biggest fear!  Though I wrote in that note I thought he had a cold, I knew it could be asthma simply from the way he was sounding)  She knows I’m desperately praying he doesn’t develop asthma as those medications to treat asthma have so many horrific side effects, but I will do what I need to do.  

She called in a prescription for a Z-pac and if he isn’t better by Monday or Tuesday I need to take him back in.  

I so pray he gets better with the antibiotics which would mean he has pneumonia or bronchitis.  He has more of the symptoms of bronchitis (to me) than walking pneumonia as he has no fever and he has the hoarseness commonly associated with bronchitis.  But who knows?  I just want him to stop coughing and I want him to be fine.  Absolutely fine.

So, if you pray, please pray for my sweet boy.  Pray that he is healed and that he isn’t developing a possible life long condition (asthma).  I’m also praying he continues to be his happy go-lucky train loving self and that he’s completely well soon.  

I do know that if he’s not better by Sunday, I’ll be taking him in to see his pediatrician on Monday myself.  While I’m so very glad my parents are so willing to take him to any and all appointments, I know that if he’s not better, it’s something serious and I need to be there to get all my questions answered.  I’m his mother after all.  

He’ll need his mother.  He deserves his mommy.  

When you’re ‘sick’ (his ped said he could return to
daycare!) Mommy lets you have a hot dog
AND hot cocoa in your Polar Express cup for dinner!

Medical News: ACAAI: Sublingual Ragweed Pill Wins in Pivotal Trials - in Meeting Coverage, ACAAI from MedPage Today

Medical News: ACAAI: Sublingual Ragweed Pill Wins in Pivotal Trials – in Meeting Coverage, ACAAI from MedPage Today

Healthy food for fussy eaters

How do working parents feed kids quick, healthy food on school nights and squeeze homework, bedtime stories, cleaning up and maybe some downtime into the remains of the day?

It’s easy to fall for convenience, kidding ourselves that peeling packages and microwaving their contents counts as cooking. But somewhere between frozen chicken nuggets and the time-consuming roasts our grandmothers made, there’s another way. Its acquiring a repertoire of easy, healthy dishes that are quick to cook (or cook themselves while you do something else) and flexible, meaning they can be simmered, easily reheated or eaten cold an important consideration given that many families eat in shifts.

Children drown silently, in mere minutes. Despite the best efforts of parents and caregivers to keep their children safe, drowning remains one of major causes of child death in Australia. 

Almost all parents have experienced losing sight of their child in a supermarket, in a park, at a backyard party, or even at home for a couple of minutes. If there is a source of open water nearby, this amount of time is all it takes for a child to wander or fall into the water and drown.

Left to their own devices, kids will likely eat what’s easy. So, in order to help them to consume a healthy, balanced diet, try to stock a variety of good-for-them snacks and pack lunches that include kid-friendly, but healthy items.

The Food Standards Agency estimates the number of food poisoning cases in the UK to be around five million people each year. Food poisoning varies from mild stomachache to extremely severe illness requiring hospital treatment. Young children and babies are most at risk from food poisoning because it doesn’t take much for them to lose a high percentage of body fluid and become dehydrated.

Food poisoning in the home can be kept at bay with stringent food hygiene practices. Many busy mums prepare food in advance, and often raise questions concerning the safety of cooling, storing and heating ready prepared meals. This article will address some of those questions and future articles will deal with raw food preparation and hygiene.

If you spend a great deal of time in the presence of babies, you have certainly noticed that it is becoming fairly common to see an infant with a flat spot on the back or side of the head. This phenomenon, known as positional plagiocephaly, or more commonly as flat head syndrome, is caused when babies spend a considerable amount of time with their head resting in the same position, such as when travelling in a car safety seat or Stroller.

Play is a vital part of child development and while safer than ever before, as parents we should remain vigilant about hidden hazards posed by toys on store shelves.
So what can we do to keep little ones safe at play? Useful points to consider include what to look for when buying toys, understanding safety marks and labelling, ensure that the right safety checks have been carried out, and considerations when giving and receiving used toys.

There are currently over 60 million mobile phones being used in the UK and they continue to increase in popularity, as new features become available. Just as you struggle to remember life before TV, it would be unimaginable not to have mobile phones – our children have never known a world without them.

While most studies have found no raised risk of brain tumours, the long-term effects of using a mobile regularly are still not known as they have only been in widespread use since the 1990s.

Babies spend a huge amount of time asleep – or at least, in theory they do – so ensuring your baby is safe and sound while doing so is crucial. To help your baby sleep safely, you need to take into consideration aspects such as where he sleeps, how he sleeps, the bedding you use and what’s in the cot.

Whoever coined the phrase, “sleep like a baby” must not have been a parent. As all exhausted parents will tell you, babies tend to sleep sporadically, at best. One night, your baby may sleep all the way through, but the next may have you getting up three or four times. After several months, most babies do settle into a predictable sleep pattern, and there are a number of things that parents can do to help their babies get the idea that nighttime is for sleeping.

Asthma

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  Researchers found an association between asthma and use of pesticides by male farmers. (Senthilselvan et al, 1992) Although this study involved adults, it raises concerns about children’s exposures to pesticides used in the home or residues brought home on parents’ clothes or equipment.
  
  
  
  
  
  

Birth Defects

• 
  
  The commonly used pesticide, chlorpyrifos (brand name Dursban) caused severe birth defects in four children exposed in utero. Chlorpyrifos is used widely as an agricultural chemical, but is also the most common pesticide used indoors to kill termites, fleas, roaches and in pest control strips. (Sherman, JD. 1996 Chlorpyrifos (Dursban)-associated birth defects: report of four cases. Arch. Env .Health 51(1): 5-8)
  
  
  
  

Teenage Smoking can be Reduced wtih Anti-Smoking Programs

Programs to reduce teenage smoking can be successful. A recent report for the Health and Wellness Trust Fund showed the percentage of middle-school students who smoke dropped from 5.8% in 2005 to 4.5% in 2007 in North Carolina. Their Trust Fund’s budget for anti-smoking programs is $ 17.1 million. This contrasts very sharply and very disappointingly with its neighbor, South Carolina (SC). For 2009, SC has budgeted NO money from its payments from the 1998 national settlement with tobacco companies. SC has budgeted $ 1 million on anti-smoking programs, but the source of these funds is the federal government.

More resources to help people stop smoking can be found at Smoke Free Homes. Note, the programs are free.

Why is my child coughing so long!

Some of you who know me pretty well know that our family has been put the the ringer the last few months with sickness.  It all started with my daughter Hannah who had a wet cough or phlegmy cough that started way back in July.  I took her to the pediatrician multiple times who said it was allergies or a virus.  She continued to cough everyday all day.  I knew it wasn’t allergies.  My husband, mother and son all have allergies, and they have never coughed everyday for months because of allergies.  I finally decided if the pediatrician wasn’t going to do anything that I would take her to an allergist to prove that it wasn’t allergies.   The allergist tested her for allergies, turns out she is mildly allergic to trees but that wasn’t what was causing the coughing.  The allergist determined Hannah had a sinus infection, that went undiagnosed for 5 months.  After a round or antibiotic and steroids the cough finally ended.

Next was my baby Noah(8 months old) who started coughing, I was ready to cry after the ordeal I went thru with Hannah.   I took him to the pediatrician who said “it’s a virus”, then a week later back to the pediatrician, “it’s a virus”, then another week went by, “it’s a virus”, then back again to the pediatrician it’s getting worse lets give him Omnicef, still not better lets’ give him breathing treatments and another round of Omnicef because I was  insisting it’s not a virus.  Still no improvement, Noah continued to get sicker and sicker and I was crying every night because I knew something was seriously wrong!  And my pediatrician kept telling me it was viral!  So in desperation I made another appointment with an allergist/immunologist praying he would have some insight.  After listening to my story the allergist/immunologist said he suspected it to be  Mycoplasma, after doing the physical exam he said Noah had pneumonia.  He didn’t have a fever which was throwing off my pediatrician .  After 10 days of Bactium, the antibiotic to treat walking pneumonia, (Mycoplasma Pneumonia), I am happy to say Noah has stopped coughing.  I am so thankful to God for leading me to the right doctor.  

I know this is going around so I hope that my story will help other moms who can’t figure out why their children are coughing!

The 3 most common causes of a cough that lasts 6 weeks or longer are postnasal drip (most commonly from allergies), asthma and gastroesophageal reflux (stomach acid coming up to the vocal cords and making him cough)–in that order. Often the history or exam guides you. For instance if there is wheezing, asthma is the likely candidate. If the lungs are clear but there is alot of snot, postnasal drip. 

The typical approach is a trial of treatment for the most likely culprit. Albuterol sometimes is helpful if you give it and you notice that for the next couple hours he coughs or wheezes less. It doesn’t do anything to make him get better faster but it does make him breath easier and wheeze and cough less until his body heals. If he is not getting better within a week or two, you can try oral steroids for 5 days or a steroid inhaler which gives the same medicine right to the longs but takes longer to work (maybe a month). Somewhere along the way a chest xray is good to get to make sure there is not a pneumonia or something unusual that might show up on xray.

For both asthma and postnasal drip from allergies, avoiding common allergens can be helpful. The most common ones are cats/hamsters, dust mites (cover mattress and wash sheets in hot water weekly) and pollen or mold.


My friend who is a doctor sent me this information.  I thought it might be helpful to someone.

My report on the American Academy of Allergy, Asthma, and Immunology"s 2011 meeting

I attended the AAAAI’s (for short!) 2011 meeting in March.  I thought this was a productive meeting for me.  This is an international meeting of allergists from around the world.

I got to investigate a number of Electronic Medical Record (EMR) systems firsthand.  This helped to crystallize my thoughts of the current status of EMR currently available.

Mannitol challenges seem to have replaced methacholine challenges to test for bronchial hyper-reactivity.  I do not see my practice using them often.

The general plenary sessions were interesting. (photo 1).  Some of the interesting topics: nanotechnology, asthma, studies on sublingual (under-the tongue) immunotherapy, safety of long-acting bronchodilating agents, food allergy, mold exposure.

There were no new medications debuting.

I spoke with allergists from around the world: Japanese, German, Turkey, Finland, Italy, and the U.S.  My conclusion: medical practices and health care systems differ widely, not only within the U.S., but in many countries.

I think there will be some subtle changes in my practice, which should improve my patient’s disease outcomes.

Incidentally, while in California, I visited the Ira F. Brilliant Center for Beethoven Studies, in the San Jose Public Library.  An ultra-fast visit is here and here.  You can see Beethoven’s hair.  A sample was used to discover that high lead levels probably contributed to his death.

The next weekend, I attended the Allergy, Asthma, and Immunology Society of South Carolina’s annual meeting.  This was a smaller scale meeting of allergists from South Carolina with 4 nationally known speakers. The topics included immunodeficiencies, EMR, drug allergies, food allergies, and occupational asthma.  The above comments apply here also.  Both meetings were intellectually stimulating and I think they will benefit my patients.

Medical Question: Pneumonia

Elaine asks: You’ve come highly recommended by quite a few author-friends and I’m hoping you can help me out with a medical question for my story.

I have a high school senior who comes down with a severe case of pneumonia weeks before her graduation. She is hospitalized in the ICU, pulls through, but doesn’t make it to graduation.

Plot wise I need her to miss the fall semester of beginning college & have her family keeping her home during the summer for extra rest while she recuperates more fully. I’d like to know if this scenario is feasible– that a case of pneumonia, if bad enough, could weaken someone enough that she’d postpone starting school in the fall and take it up again in the spring?

Jordyn says: Elaine—thanks so much for sending me your question. And thanks for the compliment! That means a lot to me.

As far as your question—there are a few issues with your scenario. In a previously healthy young adult, it wouldn’t be that feasible for her to be sick so long. Medical treatment for pneumonia is antibiotics for 5-10 days. Then maybe residual cough, easily fatigued for a couple of weeks. This is of course if it is a one-sided simple pneumonia. So, considering those factors, if she were sickened in May I would think she’d be able to attend school in the fall.

Also, people are rarely admitted to the ICU for pneumonia unless they need to be intubated on a breathing machine. So, say she had bilateral (both lungs involved) pneumonia, had to be intubated, popped a lung (called a pneumothorax), needed a chest tube, etc. Again, these might sicken her for a couple of weeks but if she’s generally healthy she should be able to overcome this, rest up for several weeks—back to school in the fall.

My suggestion would be this– give this character a chronic illness that puts her lungs in a more vulnerable state (broncho-pulmonary dysplasia, asthma, cystic fibrosis) and the pneumonia got to the point where she had to be admitted to the ICU on a ventilator and she blew a lung which complicated her situation. Considering her history of chronic disease—it would be more feasible that she’d have a long recovery time and she’d take the fall semester off.

Asthmatics on the ventilator are very hard to manage and get off and often have a complicated course. Most often, they have to be medically paralyzed and sedated. The patient is high risk for developing a pneumothorax. This would be my pick.

******************************************************************************

Elaine Stock is a former RWA member and has presented several writing workshops. Presently involved in ACFW, she was a 2011 semi-finalist in the prestigious Genesis Contest in the contemporary fiction division. She is also active on several social networking groups. Her first short story was published on Christian Fiction Online Magazine. New to the blogging world, Elaine started a blog this past April, Everyone’s Story. Since then, the blog has been graced by an awesome international viewership that totally pings her heart. Everyone’s Story features weekly interviews and reflections from published authors, unpublished writers…and just about anyone who wants to share a motivating story with others that may lift their spirit. She has also been the guest of several other blogs, helping to further grow her presence on-line.

She and her husband make their home in an 1851 Rutland Railroad Station they painfully but lovingly restored.

That Coughing Cat, Part Two: Feline Heartworm Disease, by Dr. Laura Theobald

Heartworm disease is typically thought of as a disease affecting dogs, however cats can also be infected with heartworms. It is transmitted by mosquitoes and is reported in all of the continental United States.

Cats can show symptoms with as few as one to three adult heartworms living in the heart. These signs include coughing, difficulty breathing, vomiting, lethargy, anorexia (decreased appetite), and weight loss. There can also be acute episodes of shock and respiratory distress, as well as sudden death. On physical exam, there can sometimes be a heart murmur noted.

Diagnosis in cats is difficult when compared to dogs as the standard in-hospital testing (antigen test) that is used for dogs is not always accurate in cats. This is because cats tend to have only a few worms. A send-out test to the reference laboratory (antibody test) may be more useful, but a negative result still does not rule out heartworms. Other helpful diagnostics include radiographs (x-rays), echocardiogram (an ultrasound of the heart), complete blood count (CBC), internal organ function testing (chemistry), and fecal exam (to rule out parasites that can live in the lungs and cause coughing).

Prevention is the same as that used in dogs and includes monthly oral medications such as heartgard or trifexis, or topical solutions such as advantage multi or revolution. A six month injection called Proheart is available in dogs, but a similar product is not available in cats at this time.

Though dogs can undergo risky heartworm treatment (a series of two to three injections of a drug called immiticide to kill the heartworms in the span of a month or two), no such treatment is available in cats. Treatment is limited to monthly use of preventive medications to prevent further infestation and shorten the life of the heartworm. Supportive care includes bronchodilators to help pets breathe easier and steroids to reduce inflammation.

Written by Dr. Laura Theobald
Lap of Love Veterinary Hospice

Dr. Theobald works with Dr. Hawthorne helping families in the Charlotte North Carolina region. For more information – please see their profile page. http://www.lapoflove.com/North_Carolina_Charlotte 

Study Shows Asthma Medications Prevent Hospitalization When Used Properly

The ICU is one place you don’t want to be if you have asthma.  Research shows that available medications for asthma are highly effective in reducing hospitalizations.  SS

Inhaled Steroids Lead to Big Drop in Asthma Deaths at Texas Hospital: Study

They reduce inflammation in the lungs, improving control of asthma symptoms

TUESDAY, May 15 (HealthDay News) — Patient education and medication compliance contributed to a 74 percent drop in the number of patients with life-threatening asthma admitted to the intensive care unit at University Hospital in San Antonio, Texas, researchers report.

Their review of 30 years of hospital data focused on patients with severe asthma who didn’t respond to standard inhalers.

They found that there were 227 patients admitted to the intensive care unit (ICU) with 280 episodes of life-threatening asthma between 1980 and 2010. One patient died, but the death was from a different cause after the patient’s asthma improved, according to the team at the University of Texas Health Science Center at San Antonio.

“The main reason for the decline in cases is that more of our patients are taking their controller medications, such as inhaled corticosteroids, which reduce the amount of inflammation in the airways,” lead author Dr. Jay Peters, chief of pulmonary diseases at the Health Science Center, said in a university news release.

The researchers also found that insertion of a breathing tube, called intubation, when patients arrived in the emergency department did not lead to longer hospital stays.

“I think our methods of treating patients in the emergency department have improved so much that previous studies of issues with intubation don’t hold up anymore,” Peters said.

The study appears in the journal Respiratory Medicine.

“On the front end, this study reinforces the importance of staying on controller medications,” he said. “On the back end, it shows low mortality for patients in the medical ICU and that we don’t need to be afraid to intubate patients and place them on mechanical ventilation if necessary.”

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Nasal sinus rinses with saline solution

Before we discuss using nasal sinus rinses with saline solution, I think it would better to review the anatomy and physiology of the nose and sinuses. I’m going to try something new, using Youtube videos that I have screened, and also not reinvent the wheel. The nose normally makes some mucus: to protect the mucosal lining from being too dry; to wash off particles, allergens, viruses, and bacteria off of the mucosal lining; and to protect the mucosal lining against infections. When the mucosal lining of the nose is irritated, we call this rhinitis. If the cause is from allergies, we call this allergic rhinitis. The sinuses are bony caves branching off from the nose. Here is a good review of sinusitis. This video says almost the same thing.

Saline solution introduced into the nose and sinus cavities will wash mucus and anything in the mucus off the mucosal lining. Here is a good video demonstrating nasal rinses on Youtube for an adult and another for a child. Some prefer to use the Netipot. Either work for me. Any product that works for you and is cost-effective is an acceptable product. It’s based on personal preference. In the top 3 photos to the right, I am demonstrating what I consider to be optimal technique: head down with chin above the eyes, saline solution being squeezed gently but persistently into the upper nostril, allowing the saline to drain out the lower nostril, mouth breathing. There is no downside when done gently. The three products (Nasaline, Ayr, NeilMed) in the bottom right photos were chosen simply because I had a sample in my office.

I am frequently asked about how much saline solution to use and how often. Mucus by its very nature is sticky, like syrup. So for the saline solution to effectively loosen the mucus up, it generally takes at least 8 ounces or 240 ml per session in my experience. I habitually rinse my nose and sinuses out at least four times per day. Why? I have several reasons. First, I am exposed on a daily weekday basis to many people. Rinsing is simply good hygiene. I have a family history of allergies, plus there’s my wife with very severe allergies, and I do not want my mucosal immune system to develop allergies, so I never let the allergens build up in my nose or sinuses. Think of it as constant spring pollen cleaning. Next, I find it refreshing, like splashing cool water on your face. Finally I am exposed to patient every weekday with respiratory infections. Some of them look pretty miserable. Some of the little twerps (or to be politically correct unhappy little children) cough or sneeze point blank right in my face as I try to examine them. Whatever they have, virus or allergy or bacteria, I DON’T WANT IT. So, once I have finished their office visit, I go straight over to the bathroom for handwashing + nasal sinus rinsing.

How much saline solution is safe to use? Remember what happens when you go swimming in either a pool or the ocean. Lots of water goes up your nose. Your nose and sinuses are getting washed out very thoroughly. Think about how your nose feels after a swim. Usually it is very clear for a few hours. Why? Your nose and sinuses have most of the mucus and anything in the mucus removed. Since mucus is produced normally, the clear feeling does not last forever.

I hope this discussion tells you how I feel about nasal sinus rinsing. As my friend Linus reminded me about Chicago voters each election, they vote early and vote often. Here I recommend rinse with lots of saline and rinse often.