Interstitial Lung Disease

Interstitial Lung Disease is nasty and can strike people at any age, regardless of physical condition.

What is it? This is a scarring of tissue in the spaces supporting air sacs in the lungs. The disease causes stiffness in the lungs, and can eventually make it impossible for the victim to get sufficient oxygen. That can presumably lead to a range of issues including dementia.

Symptoms:  Unfortunately, the symptoms can be hard to distinguish from other diseases:

• Dry cough
• Shortness of breath during exercise or at rest.

By the time these symptoms appear, there is probably irreversible damage to the lungs. In fact, the only known treatment for this disease is a lung transplant.

Causes:  Not all the causes of this disease are known.

The known causes include:

• Environmental factors
  • Asbestos fibers
  • Bird protein (live pets and feather-containing products)
  • Coal dust
  • Grain dust
  • Mold from indoor hot tubs, showers and prior water damage
  • Silica dust
• Radiation (especially the higher doses used in cancer treatment)
• Medications
  • Chemotherapy/immunomodulating drugs, such as methotrexate and cyclophosphamide; methotrexate is also used for treatment of rheumatoid arthritis and psoriasis as well as other serious skin conditions
  • Heart medications, such as amiodarone (Cordarone, Nexterone, Pacerone), propranolol (Inderal, Inderide, Innopran), and hydralazine
  • Some antibiotics, such as nitrofurantoin (Macrobid, Macrodantin, others),  sulfasalazine (Azulfidine), sulfamethoxazole/trimethoprim (Bactrim). The last is described as a “relatively rare cause” of this disease.
  • Seizure medications such as Phenytoin (Dilantin) and carbamazepine (Tegretol)
  • Aspirin and other NSAIDS (ibuprofen, naproxen)

Air quality at home and workplace matters. Spider plants can help clear indoor pollutants. However, having someone test air quality is probably a good idea. Any water leaks need to be addressed because that’s breeding ground for mold.

Taking drugs is something you need to do wisely. Talk to your doctor about side effects and getting rid of prescriptions that you really don’t need. Once a drug has stopped helping you, it might in fact hurt you.

 

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Sources:

1. Mayo Clinic, “Interstitial Lung Disease.” http://www.mayoclinic.org/diseases-conditions/interstitial-lung-disease/basics/definition/con-20024481
2. Dr. Sharon Orrange, “These Medications Could Harm Your Lungs,” Good Rx, 10 JUly 2017. https://www.goodrx.com/blog/these-medications-could-harm-your-lungs/?rs_oid_rd=1180733755670560&utm_medium=email&utm_source=sendgrid.com&utm_campaign=em_newsletter&utm_content=lungs&e=66e4013215cd54de978d8ff77403d770&c=fixed_69_2017-07

A Grim Reminder of the Link Between Heart, Lungs and Brain

Cerebral hypoxia is the medical term for an inadequate supply of oxygen to the brain. Brain cells can begin to die within 5 minutes of a cut-off or severe reduction of oxygen supply.

It’s a surprisingly common problem. That’s in part because of the variety of conditions that can cause oxygen deprivation. While oxygen deprivation (vascular dementia) is a more common cause of dementia among seniors than is Alzheimer’s, the condition isn’t limited to old age.

The BBC reports today that a 20-year old soccer player collapsed from brain damage after developing a heart arrhythmia during a friendly match played in Austria.(1) The brain damage appears to be severe and permanent.

Other causes for cerebral hypoxia include:

• COPD or severe asthma
• Drowning
• Strangling/choking/suffocation
• Cardiac arrest
• Head trauma
• Carbon monoxide poisoning
• Complications of general anesthesia
• Hyperventilation
• Consistent work in a nitrogen rich environment

Very low blood pressure can be a factor as well. That can result from medication, certain foods, frequent coughing (from congestion or allergies) and alcohol, and especially a combination of these factors.

Symptoms of hypoxia include

• Difficulty with complex tasks
• Poor short-term memory capacity
• Decreased motor control
• Cyanosis (bluish tone) of the skin
• Increased heart rate
• Fainting

The impact of cerebral hypoxia depends largely on whether the victim loses consciousness and for how long that occurs.  According to NIH,

During recovery, psychological and neurological abnormalities such as amnesia, personality regression, hallucinations, memory loss, and muscle spasms and twitches may appear, persist, and then resolve.(2)

However, it may take days or weeks before the full extent of damage from carbon monoxide poisoning becomes evident. Since carbon monoxide is odorless, that’s why monitors are so essential in the home. A simple act such as stacking boxes too close to a furnace can fill a home with this deadly gas.

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Sources:

1. BBC News, “Abdelhak Nouri: Ajax player suffers brain damage after collapse”
2. NIH, “Cerebral Hypoxia Information Page.” https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Hypoxia-Information-Page
3. Dementia.org, “Oxygen Deprivation Associated With Onset Of Dementia.” https://www.dementia.org/oxygen-deprivation-dementia

Coffee Addicts Rejoice!

Coffee might actually be very good for you.

You’ve probably heard some of this online in the last couple of days, but not the full story. That’s unfolded over two years, and Facebook and News sites don’t have that kind of memory.

Here’s a litany of documented health benefits of drinking coffee.

Before I go into the list, there are two one big caveats.

1. If you drink overly hot beverages of any kind — hot enough to burn the lining of your throat — you can be setting yourself up for Barrett’s Syndrome and esophageal cancer. Aristotle extolled the virtue of moderation, and moderation in this case includes temperature.
2. It is possible to overdose on caffeine. I knew someone in college who had to be hospitalized due to excessive consumption of caffeine via a carbonated soda, Tab. In fact, caffeine overdose was cited as the cause of death of a teenage in May of this year. (1) That case was also related to soda, not coffee. Aristotle is correct again. Moderation includes caffeine consumption.

However, there are a number of important documented benefits from drinking coffee:

• People who drink coffee appear to live longer.  In an analysis by researchers at the University of Southern California,

Drinking coffee was associated with a lower risk of death due to heart disease, cancer, stroke, diabetes, and respiratory and kidney disease for African-Americans, Japanese-Americans, Latinos and whites.(2, 4)

Previous research by USC and others have indicated that drinking coffee is associated with reduced risk of several types of cancer, diabetes, liver disease, Parkinson’s disease, Type 2 diabetes and other chronic diseases.(4)

According to one of the lead researchers,

“We cannot say drinking coffee will prolong your life, but we see an association,” Setiawan said. “If you like to drink coffee, drink up! If you’re not a coffee drinker, then you need to consider if you should start.”(4)

• Coffee-drinkers have better sex.  According to a report from the University of Texas in 2015, males consuming two to three cups of coffee per day reduce their risk of erectile dysfunction.(5)

• She might actually remember it. Seriously, another study from 2016 supports a role of caffeine helping reduce the risk of dementia among women.(6)

So, enjoy coffee but skip the decaf (unless your doctor says otherwise). Caffeine might actually be good for you.

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Sources:

1. http://www.nbcnews.com/health/health-news/south-carolina-teen-died-caffeine-overdose-coroner-rules-n759716
2. Marc J. Gunter et al. Coffee Drinking and Mortality in 10 European Countries: A Multinational Cohort Study. Annals of Internal Medicine, 2017 DOI: 10.7326/M16-2945
3. Song-Yi Park et al. Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations. Annals of Internal Medicine, 2017 DOI: 10.7326/M16-2472
4. University of Southern California. “Drinking coffee could lead to a longer life, scientist says: Whether it’s caffeinated or decaffeinated, coffee is associated with lower mortality, which suggests the association is not tied to caffeine.” ScienceDaily. ScienceDaily, 10 July 2017. <www.sciencedaily.com/releases/2017/07/170710172118.htm>.
5. David S. Lopez, Run Wang, Konstantinos K. Tsilidis, Huirong Zhu, Carrie R. Daniel, Arup Sinha, Steven Canfield. Role of Caffeine Intake on Erectile Dysfunction in US Men: Results from NHANES 2001-2004. PLOS ONE, 2015; 10 (4): e0123547 DOI: 10.1371/journal.pone.0123547
6. Ira Driscoll, Sally A. Shumaker, Beverly M. Snively, Karen L. Margolis, JoAnn E. Manson, Mara Z. Vitolins, Rebecca C. Rossom, Mark A. Espeland. Relationships Between Caffeine Intake and Risk for Probable Dementia or Global Cognitive Impairment: The Women’s Health Initiative Memory Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2016; glw078 DOI: 10.1093/gerona/glw078

 

 

 

 

Life Planning Fail

In preparing for battle I have always found that plans are useless, but planning is indispensable. Dwight D. Eisenhower

Life happens, but that’s no excuse for not knowing where you want to go. That’s a particular issue in healthcare.

People don’t like to think about negative events that are going to happen in the future. They’ll still happen, just the same. For Americans, the difference between life expectancy and “healthy life expectancy” is nine years.  They won’t necessarily come as a block toward the end of life. If fact, you don’t know when they’ll come.

A new study points out that people are often faced with making snap decisions about healthcare without adequate information. (1) That’s due to the failure to anticipate something that’s actually rather likely to happen.

People get hurt and sick. The roughly 320 million Americans generated 130.4 million visits to Emergency Rooms in 2016.(3) What are the odds you’re going to need one?

If you don’t know where you want to go in an emergency, you may get stuck someplace you don’t want to be.

Even if you’ve never had an illness in your life, you will. Nothing on this planet is immortal.

Like it or not, here are some questions for which you need to have answers.

• Financial
  • How do I cover sudden and potentially large medical bills? What does my insurance not cover that I’m going to have to pay?
  • How do I cover normal bills if I’m out of work for a few months? Or longer?
• Medical
  • In an emergency, where do I want to go for care? (Related: is my doctor affiliated with where I want to go?)
  • If I’m hurt and need rehab therapy, where do I want to go for care?
  • Does someone have access to my Living Will if I can’t speak for myself? (Having one isn’t a question.)
  • Who will advocate for me with medical personnel if I can’t speak for myself?
• Living
  • Whose going to care for me if (temporarily or permanently) I can’t care for myself?

Seriously, this matters. We have several local hospitals, two of which are problems.

• The ER department at one of them has misdiagnosed my wife twice out of two visits. That’s a 100% rate of being wrong. Do we want to test them a third time?
• The nurses at another consistently ignore a severe allergy that causes anaphylatic shock. Breathing is really nice, but you don’t really appreciate it until you can’t do it. It turns out, the nurses don’t pay attention to wristbands. (One nurse at that facility told us that they assume the allergy bands refer to drugs and not to more mundane and potentially lethal issues like iodine and latex allergies.) Going to that facility is like going to a casino. You might get fixed and you might die. How lucky are you?

As you age, where you go matters more. With seniors, for example, if taken to an ER for a serious fall, there’s a 50% chance of additional problems within six months of the initial injury, including death. Some of that risk is the result of decisions doctors make about medication.(4)

There’s no need to overthink this. Do your homework, ask questions, make decisions, and then get on with the rest of your life. Just get it done.

Aristotle was  right. Anything taken to excess turns bad. That includes both planning and lack of planning.

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Sources:

1. Emily A. Gadbois, Denise A. Tyler, Vincent Mor. Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives. Journal of the American Geriatrics Society, 2017; DOI: 10.1111/jgs.14988
2. American Geriatrics Society. “Hospitalized older adults may need more help selecting skilled nursing facilities.” ScienceDaily. ScienceDaily, 7 July 2017. <www.sciencedaily.com/releases/2017/07/170707211128.htm>.
3. Centers for Disease Control and Prevention, “Emergency Department Visits.” https://www.cdc.gov/nchs/fastats/emergency-department.htm
4. Jiraporn Sri-on, Gregory P. Tirrell, Jonathan F. Bean, Lewis A. Lipsitz, Shan W. Liu. Revisit, Subsequent Hospitalization, Recurrent Fall, and Death Within 6 Months After a Fall Among Elderly Emergency Department Patients. Annals of Emergency Medicine, 2017; DOI: 10.1016/j.annemergmed.2017.05.023

Medications: Reading the Mouse-size Type Isn’t Enough

A blast came out from Medscape about the FDA updating warning labels on some drugs based on reports from doctors about problems. Most of the drugs involved are injectables or IV medications that most consumers wouldn’t have in their home.

The one item on the new list that caught my attention is the anti-epilepsy drug, Keppra. The warning label has been revised to include the risk of  kidney damage (see chart below, which includes links to FDA pages).

This information was announced last week, and many of the websites that you trust for information (and the paper enclosed with pill bottles that you might have at home) may not have been updated with this new information.

If you take this medication, you might want to talk to your doctor.

Other drugs are under consideration for new warnings.

The details on the FDA’s Adverse Even Reporting System (FAERS) are here: https://www.fda.gov/drugs/guidancecomplianceregulatoryinformation/surveillance/adversedrugeffects/ucm070093.htm

The usual caveat applies. I’m not a doctor; I’m a researcher. My goal is to publish information that can help people make better decisions.

Keppra (levetiracetam) tablets, for oral use Keppra (levetiracetam) extended-release tablets, for oral use Keppra (levetiracetam) oral solution Keppra (levetiracetam) injection, for intravenous use

Acute kidney injury and interstitialThe  nephritis

The “Adverse Reactions; Postmarketing Experience” section of the labeling for Keppra and Keppra XR was updated to include acute kidney injury. Keppra XR labeling Keppra labeling (tablets and  oral solution) Keppra labeling (injection)

Air Pollution and Life Expectancy

A new study led by Prof. Mikael Skou Andersen of Aarhus University in Denmark finds that an increase of 10 micrograms per cubic meter in air pollution reduces an individual’s life expectancy by between 9 and 11 years. This is more than previously thought, although there is a debate about the “economic value” of those years.(1)

“Economic value” translates into an estimate of the amount of spending that is economically justified to reduce air pollution.  While life itself might have infinite value, no one wants to spend infinite money to preserve it. So we try to define how much money value there is in living to 90 as opposed to dying at 79. Under the theory, spending less than that money value to reduce air pollution is justified; spending more isn’t.

The challenge is that the European Union has set standards for air pollution reduction that some of its members are going to have difficulty meeting.

Needless to say, the European standards are more stringent than those in the US.

US rules:  The US has standards for two types of particulate matter air pollution:

• PM₁₀ : inhalable particles, with diameters that are generally 10 micrometers and smaller. Maximum of 150 micrograms per cubic meter of air in any 24 hour period. This may be exceeded once per year on average over a three year period.
• PM_2.5 : fine inhalable particles, with diameters that are generally 2.5 micrometers and smaller.(2) While the goal is 12 micrograms per cubic meter of air, there may be readings of up to 35 micrograms per cubic meter in any 24 hour period.(3)

European rules:

• PM₁₀: 40 micrograms per cubic meter of air, although there may be readings of up to 50 micrograms in any 24 hour period.
• PM_2.5 : 25 micrograms per cubic meter, no exceptions.

The difference in standards between the US and Europe exceeds the amount required to reduce life expectancy in Professor Andersen’s study. Life expectancy is greater in Europe than in the US. The residents of Monaco have a life expectancy that exceeds everyone else on Earth, and exceeds the US by more than 10 years.

What is 10 years of your life worth to you? Air pollution is yet another factor inflating US healthcare costs and the costs of your health insurance.

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Sources:

1. Mikael Skou Andersen. Co-benefits of climate mitigation: Counting statistical lives or life-years? Ecological Indicators, 2017; 79: 11 DOI: 10.1016/j.ecolind.2017.03.051
2. US Environmental Protection Agency, “Particulate Matter Pollution.” https://www.epa.gov/pm-pollution/particulate-matter-pm-basics
3. US EPA, “NAAQS Table.” https://www.epa.gov/criteria-air-pollutants/naaqs-table
4. European Commission, “Air Quality Standards.” http://ec.europa.eu/environment/air/quality/standards.htm

Be Safe

Fireworks are beautiful — and dangerous. According to Medscape, there were 11,900 people requiring treatment in ERs or urgent care facilities due to injuries from fireworks in 2015. Over half of these were under 24 years of age and most were male.

Damage to hands and eyes are the most common injuries.

However, as reported on the Weather Channel this morning, particulate matter from fireworks explosions can cause problems for persons with breathing issues (e.g., asthma and COPD).

The photos if injuries, including second degree burns and severe eye injuries, are simply grotesque, so I’m not going to show them here.

If you must do this, please be careful! If you have breathing problems, you might consider an air mask.

Data: US Consumer Product Safety Commission