Posts made in December, 2013

Cranberry Juice for UTI (urinary tract infection)?

Posted by on Dec 27, 2013 in News | 1 comment

Bathroom
UTI or urinary tract infection refers to an infection anywhere in the urinary tract. Urinary tract includes the two kidneys, ureters (tubes that connect kidneys and bladder), bladder and urethra (tube that carries urine to the outside of the body). Most of the time, it is the bacteria that cause an infection and E.coli is the most common bacterium. Women tend to get UTI more often than men because the urethra is shorter in female anatomy. Thus, it is faster for bacteria to reach the bladder. It is estimated that more than 50 percent of women experience UTI in their lifetime. Some healthy, young women may have recurrent UTI, which is having more than two infections in six months or more than three infections in a year.

There are a number of ways to prevent recurrent UTI. The doctor will often switch the contraceptive methods especially if they are using spermicides and diaphragm. The doctor will also recommend the women to use the bathroom right after the intercourse and drink some fluid to flush out the bacteria in the vaginal area. For postmenopausal women, he or she will prescribe estrogen cream to apply in the vagina. One study showed that estrogen cream nightly for two weeks then twice weekly for eight months reduced UTI infection in postmenopausal women. Some doctor will give antibiotic as a preventative therapy for women who have recurrent infections. Some will take nightly for six months while others are instructed to take one dose after the intercourse. Researchers are looking into whether cranberry juice or cranberry products can prevent UTI. It would be a great alternative to prevent UTI if cranberry products truly work.

Scientists have identified some compounds or chemicals in cranberry that prevent the attachment of E.coli to the cells in urinary tract. In order for an infection to occur, bacteria must attach to the cells in urinary tract. Studies found that women who drink cranberry juice or consume cranberry products have less UTI infection. More significant decrease was seen in women with recurrent UTI. However, researchers concluded that it will require more studies to confirm whether cranberry prevents UTI and how much cranberry you will need to consume to be effective. It is suggested that you should try drinking 100 percent cranberry juice instead of mixed juices such as cranapple or crangrape.

Contributed by Patricia Hsiao M.D.
Sources: nejm.org, npr.org, uptodate.com

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First-aid Tips for Nosebleed (Epistaxis)

Posted by on Dec 17, 2013 in News | 0 comments

Nasal congestionNosebleed or medical term epistaxis is a very common medical problem and up to 60 percent of the general population experiences it once in their lifetime. But the good news is that only 10 percent of the time it requires medical attention. For majority of the cases, it would resolve with simple first-aid measures at home. Nosebleed is more common in children under 10 years of old and adults over 50 years old. Most common causes include vigorous nose picking, foreign object in the nose especially in young children, common cold, allergic rhinitis, dry, hot weather and injury to the nose. In adults, it can be due to high blood pressure, chemical irritants (cigarette smoke, cocaine and etc), some medications (aspirin, warfarin and nonsteroidal anti-inflammatory drugs) and other medical conditions.

If you or someone you know experience nosebleed, first try these simple steps to stop the bleeding.

  • Sit down and lean forward slightly at the waist. Do not lie down. You want to avoid the blood going into your throat.
  • Try to breathe through your mouth.
  • Gently squeeze the soft part of your nose (nasal alae) and apply pressure continuously for at least 5 minutes. Do not squeeze the bony part of your nose.
  • Check to see if the bleeding stops in 5 minutes. If not, you can continue applying pressure for another 5 minutes.
  • You may apply cold compressor over the bridge of your nose. Do not put anything inside of your nose.
  • You may use over-the-counter decongestant spray such as oxymetazolin (Afrin, Neo-Synephrine, Vicks and etc) if available. Spray into the bleeding side of the nose and apply pressure for about 5 minutes.
  • Once the bleeding stops, avoid blowing or picking your nose for several hours.

When to seek medical attention

It is important to seek medical attention in some cases. If you have followed those simple steps and your bleeding is not controlled after 20 minutes of applying pressure on your nose, go to the nearest emergency department. Also, if you have nosebleed after the injury to the face or nose, see a physician immediately.

Prevention

Nosebleed may occur for no particular reason but there are measures you can take to reduce future episodes of nosebleed in some cases.

  • Avoid frequent nose picking or blowing your nose
  • Use saline nasal spray or gel to keep your nose moist especially during winter months. You may use it two to three times daily in each nostril
  • Use a humidifier in your bedroom at night
  • Quit smoking if you smoke. Avoid places with cigarette smoke
  • Talk to your doctor if your nosebleed is related to your allergy symptoms

Talk to your doctor if you have a nosebleed after starting a new medication.


Contributed by Patricia Hsiao M.D.
Sources: aafp.org, clevelandclinic.org, nlm.nih.gov, uptodate.com

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Things to do When You Have Traveler’s Diarrhea

Posted by on Dec 9, 2013 in News | 0 comments

Tummy acheTraveler’s diarrhea is a common gastrointestinal illness that occurs to people who are traveling especially to the developing countries in Latin America, Asia, Middle East and Africa. About 20 to 50 percent of travelers develop diarrhea when they travel to regions where weather and sanitary conditions are different from home. Traveler’s diarrhea is defined as three or more loose stools within 24 hours period of time. Some people may also have nausea, vomiting and abdominal pain. Most travelers experience symptoms within the first week of travel. The most common organism is E. coli and the condition is caused by eating or drinking contaminated foods and water. Often time, traveler’s diarrhea resolves on its own but it may be more severe in people with diabetes or inflammatory bowel disease or weakened immune system.

Treatments for traveler’s diarrhea
You may not need any medications for traveler’s diarrhea but it is very important to replenish the fluid you lose in diarrhea. Keep yourself hydrated with plenty of clean or bottled water. In some countries, you may be able to get oral rehydration packages from pharmacy. If unavailable, you can make your own by putting ½ teaspoon of salt, ½ teaspoon of baking soda and 4 tablespoons of sugar to one liter of water. Pedialyte and Rehydralyte are good for children if you can get them. Avoid alcohol and caffeinated drinks. Try to stay away from sugary drinks such as juices and sodas because they can make diarrhea worse.

You can take over-the-counter bismuth subsalicylate (Pepto-Bismol) to shorten the duration of traveler’s diarrhea. Follow the instructions on the bottle. You can take up to eight doses in 24 hours period. Pepto-Bismol is not for children, pregnant women and people who are allergic to aspirin. Side effects include black stool and ringing in the ears. Furthermore, anti-motility or anti-diarrheal agents such as loperamide (Imodium A-D) and diphenoxylate (Lomotil) can be used to slow down the process in your digestive tract. Again, these drugs are not for children. If you have abdominal pain and diarrhea continues after taking the anti-motility drugs, you should see a doctor.

If you have three or more loose stools within 8 hours period of time accompanied by fever and blood in the stool, it is best to consult a doctor. In this case, you would need antibiotic for 3-5 days. Antibiotics from quinolone class (ciprofloxacin, norfloxacin, levofloxacin) are currently given to treat severe diarrhea. They are not given to children and pregnant women. Azithromycin is used in children.

Prevention
There are a few measures you can take to prevent yourself from traveler’s diarrhea while traveling outside of the U.S.
• Drink only bottled water. If unavailable, boil water for 10 minutes before drinking
• Drink sodas and juices from the cans without putting local ice cubes
• Avoid raw and uncooked meats as well as dairy products
• Try not to eat salads or uncooked vegetables
• Peel fruits before you eat them
• Always wash your hands with soap and water before you eat

Are there preventative drugs for traveler’s diarrhea?
Although some studies showed that antibiotics in quinolone group are effective in preventing traveler’s diarrhea, it is not recommended for everyone. Preventative antibiotic therapy is only given to people with serious medical conditions. Studies showed a decrease in traveler’s diarrhea in people who are given bismuth subsalicylate (Pepto-Bismol). It can be taken as two tablets four times daily or 2 fluid ounces four times daily. Pepto-Bismol should not be taken for more than three weeks and it is not for people who are allergic to aspirin. Children and pregnant women should not take this drug. The fact that Pepto-Bismol has to be taken four times a day is inconvenient for most travelers. Other studies showed that probiotics (Lactobacillus GG) is also for effective for preventative therapy but it is not confirmed yet.


Contributed by Patricia Hsiao M.D.
Sources: nejm.org, jamanetwork.com, cdc.gov, mayoclinic.com, uptodate.com

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What Can I Do for my Insomnia?

Posted by on Dec 2, 2013 in News | 0 comments

InsomniaMost of us experience difficulty falling asleep once in a while. Insomnia is defined as having poor quality of sleep due to difficulty falling asleep or difficulty maintaining sleep or waking up too early. Ultimately, it will result in daytime sleepiness or fatigue, poor concentration and irritability. Today, insomnia is a very common medical complaint in doctor offices. A national survey indicated that approximately 35 percent of adults have insomnia in any given year and about 10 percent of adults reported to have chronic (long-term) insomnia. Insomnia is even more common among elderly population. It is true that you tend to sleep less as you get older. Keep in mind that the number of hours of sleep per night varies from person to person.

You could have acute or short-term insomnia from jet lag, stressful life events and recent illness but it often resolves on its own. On the other hand, long-term or chronic insomnia lasts for more than a month and it may be related to medical/psychological conditions or medications you take. Your doctor will try to find the underlying causes of insomnia. If no causes are found, the doctor may try cognitive behavioral therapy or medications or combination of behavioral therapy with medicines. Cognitive behavioral therapy consists of stimulus control, relaxation, sleep restriction therapy and cognitive therapy. Studies showed that for short-term (6 weeks) treatment, both cognitive behavioral therapy and combination therapy have similar improvements in the amount of time it takes to fall sleep, time awake after sleep begins and total sleep time compared to the time spent in bed. But the best outcome was seen with combination therapy initially, followed by cognitive behavioral therapy without medication in a long-term treatment.

Before looking for over-the-counter sleep medications, there are a few changes you can make to improve your sleep hygiene:
• Maintain a regular sleep schedule. For instance, try to go to bed the same time and wake up the same time every day
• Try not to take nap during the day. If you must do so, make sure you don’t nap for more than an hour
• Try to minimize light and noises in the bedroom. Keep a moderate temperature and turn off the TV or radio
• Try to finish your regular exercise 3-4 hours before bedtime
• Avoid eating heavy meal close to bedtime
• Avoid caffeinated drinks after lunch
• Avoid nicotine close to bedtime
• Avoid drinking alcohol late in the evening

There are a few over-the-counter products available for insomnia but many of them are not regulated by FDA (Food and Drug Administration). Therefore, we are not sure how effective they are or how safe they are for the consumers. Among them, melatonin and valerian are well known products. Melatonin is a hormone produced by the pineal gland in the brain. Melatonin appears to prevent jet lag when crossing time zones. Some studies showed that melatonin may decrease the time it takes to fall asleep, increase the number of sleep hours and keep you alert during the day when taken it for short-term (a few days or a week). A few studies suggested that melatonin works best for people over 55 years of age. Valerian and L-tryptophan are popular herbal products in the U.S and they may have potential side effects. Thus, it is best to talk to your doctor before using them. Always let your doctor know if you are using over-the-counter products.


Contributed by Patricia Hsiao M.D.
Sources: ncbi.nlm.nih.gov/pubmed, jamanetwork.com, umm.edu, aafp.org, uptodate.com

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