Asthma: Medications and Alternative Treatments

As previously discussed, Asthma is a long-term disease that causes a narrowing of the airways due to an allergic or hypersensitive reaction.  The bronchus spasm, and make breathing very difficult.  There are numerous medications that can be taken either in pill form or inhaled, that are FDA  approved, or you can try some different alternative therapies: some include taking herbal supplements (which may or may not be helpful) and  some include diet, exercise, and breathing techniques.

Modern Medical Treatments:
Allergy medications– like Zyrtec or Claritin to prevent common allergies and possible flare-ups
Inhaled Corticosteroids- like Flovent or Pulmicort. These are inhaled medications that have low risks from long term use and take a few days to a week to build-up in your system and are used for long term prevention of symptoms.
Leukotriene Modifiers: Oral medications such as Singular that prevent asthma symptoms for 24 hours at a time. They can have some serious mental side effects like depression and hallucinations, so you need to be aware of any feelings of sadness that are new and unlike you.
Long Acting Beta Agonists (LABA): like Serevent are inhaled medications that open airways and prevent inflammation but they have been linked with severe asthma attacks if they are not taken along with an inhaled corticosteroid.
Combination Inhalers: a mixture of a LABA and corticosteroid, like Advair. They work well for long-term control of symptoms, but there is a risk of asthma attack because of the LABA involved.
Theophylline: a daily pill that helps to open the airways by relaxing the muscles around the airways. It is kind of a treatment of the past, and not used very frequently these days….it was a first line treatment years ago.

What are Alternative Treatments?
Breathing exercises: in which you stretch the volume of your lungs and learn to relax to take deep breaths, can help to decrease the amount you need medications. Yoga breathing techniques can help to learn to relax and the feelings involved with taking deep, relaxed breaths.
Diet: eating fresh fruits and veggies high in antioxidants can help improve lung functions and prevent asthma symptoms.  As well, Omega-3 Fatty Acids (found in fish, flax, etc) have been found to reduce inflammation throughout the body, including the lungs, so it can help to improve asthma symptoms as well.
Exercise: regular cardiovascular inducing workouts can hep to strengthen your lungs and improve their function.  Working out in cold weather can trigger asthma, or if outdoors during high allergy season, but in a gym with AC you can work out your lungs and body all at the same time!

Are there Herbal Supplements?
As always, they haven’t been extensively studied or FDA approved, so I can’t say I condone the use of herbal supplements but many people have reported decreased asthma symptoms when using these products, and they may benefit you: butterbur, dried Ivy, Ginko extract, Indian frankincence, reishi mushroom, and Choline.  It is best to take these under direction of your HCP or an herbal healer, so please discuss so they can talk to you about any interactions to look for and any reactions that may occur.

Does anything make Asthma worse?
Exposure to allergens: if you are allergic to something, and know it, it can make your asthma symptoms worse, or cause flare-ups so you should stay away from that allergen, or do your best to avoid it (like cigarette smoke, exhaust, or foods that cause allergic reactions.)
Cold weather: As stated above, it can cause constriction of the bronchioles and make asthma symptoms worse.
– Anything high in saturated fats (meats, butters, etc) can make asthma symptoms worse
– Additives and preservatives can cause people to have reactions and common additives are artificial sweeteners and sulfites (found in cheeses, red wines, etc.)
– Milk products can cause an increase in mucus production and a thickening of the mucus, making asthma symptoms worse.

Asthma is different for everyone and the way we all react can be very different, so work with your HCP to see what best fits your lifestyle and your beliefs.  Work with your HCP on your Action Plan and take into account all aspects of alternative and medical therapies. You know your body best, so learn what your triggers are, and how to prevent them!

Yours in Good Health

A little overhung??

Why do we get hangovers? I think people don’t really understand the metabolism of alcohol, because there are ways to prevent hangovers, and make that fun night that you may have imbibed too much, into a much softer morning wake up!

 How the body responds to alcohol metabolism:
Its how our bodies convert substances into other compounds that we can either use  or excrete . Oxidation is the process by which alcohol is metabolized in the blood. Obviously the alcohol is distributed throughout the body, including the brain, organs, and tissues after ingestion and during metabolization, and small amounts are excreted through your breath and urine in unmetabolized forms.
You have your favorite adult beverage, it goes into your intestines, then is absorbed into your blood stream, it is metabolized by various enzymes.  In the liver the enzyme that breaks down alcohol is called alcohol dehydrogenase (ADH) which turns alcohol into acetaldehyde, which is then broken down to carbon dioxide and water.  Alcohol is also broken down by an enzyme in the liver called P450IIE1, which can increase in number with chronic drinking (hence how people build up a “tolerance” for drinking….increase P450IIE1) and this is where most alcohol is metabolized.

The liver can only metabolize a certain amount of alcohol per hour, no matter if you are a virgin drinker or if you have your sea legs.  That being said, the ability to metabolize alcohol is dependent upon the number of metabolizing enzymes, which varies in each individual and can be genetic (i.e. over half of all east Asians have low numbers of ADH enzymes so they tend to get drunk easily, have wicked hangovers, and get flushed with drinking which is due to a fast heart rate which is how their bodies respond to metabolism of alcohol.) Usually, once you have a drink, your blood alcohol level peaks within 30-45 minutes.

Wilkinson et al., Journal of Pharmacokinetics and Biopharmaceutics5(3):207-224, 197
What other factors influence alcohol Metabolism?
Food: The higher the dietary fat content in the stomach/GI tract increases the amount of time it takes for the alcohol to get absorbed into the blood stream.  One study showed that people who ate a meal of fat, carbs, and protein absorbed alcohol 3 times more quickly than those who drank on an empty stomach.
Gender: Unfortunately, women absorb alcohol differently than men.  Us ladies will have a higher Blood Alcohol Content (BAC) than men drinking the same amounts, and we are more susceptible to alcoholic liver disease, heart muscle damage, and brain damage.  It is presumed that the difference is due to women having a smaller amount of body water and we may have a lower amount of ADH (never been proven but highly likely based on numerous studies).
Effects of Alcohol:
Body Weight: interestingly, Women who drink (moderately) tend to have significantly lower body weights than those who don’t drink at all.  Men, there is no weight difference, but if non drinkers add alcohol to their diet, they don’t tend to gain any weight.  Chronic alcoholics tend to lose weight because they substitute alcohol for food….
Sex Hormones: Chronic alcohol intake causes significant hormonal imbalances; the liver metabolizes estrogen into testosterone, but when damaged, it is unable to do that, so you can have decreased sperm production.  In men who consume 220 grams of alcohol daily for 4 weeks, testosterone levels decreased after 5 days and kept dropping throughout the study period.  Also, chronic alcohol intake in men can lead to testicular atrophy (getting smaller) and the growth of male breast tissue. In women, we can create estradiol, which increases bone density and decreases the risk of cardiac disease (whoo hoo!!)
Medications: Tylenol (paracetamol, acetaminophen) can be toxic in the liver in large doses by itself, but add alcohol and it is a HUGE problem that can lead to immediate liver failure.  Like 4-5 extra strength pills in the course of the day with someone who is drinking can cause death. Other drugs such as pepcid (famotidine), ranitidine (zantac), and cimentidine (tagamet) can cause alcohol to be metabolized slower for reasons truly unknown at this point.
What can also cause increased rate of metabolism?  
The only thing known to increase the rate of metabolism of alcohol is fructose!! Consuming 100 grams of fructose has been shown to increase alcohol metabolism by 80%!  So, not helpful for people like me that drink vodka sodas, but great for the rum and coke (not diet coke) drinkers of the world!!  I guess I need to go back to my gin and Q-Tonic beverages OR maybe a handful of skittles after every drink???
So, the best way to prevent a hangover is to eat a meal with fat, protein and carbs (cheeseburger anyone?), increase your water (before bed chug a coconut water if you have one, or just regular water) because we all know the metabolism process dehydrates our bodies (because of the effects of alcohol), and increase your sugar intake….high fructose corn syrup does count!!  So seriously, a great idea for a bar is to hand each patron a bag of candy with each drink!!  Actually, one of the reasons why “fruity” drinks tend to make you less drunk 🙂 hmmmm…..  BUT I must say, carbonation supposedly increases your alcohol absorption, so maybe a Harvey Wallbanger is the way to go…and try to stick with the same kind of alcohol.  Really, I think we all knew these tips except for the sugar.
So, ladies apparently drinking is good for you?!?!  And men, if you are looking to be more manly, you may want to lay off the booze for a bit….
Yours in Good Health

This is a little hard to talk about: Erectile Dysfunction

Many people are unclear as to what Erectile Dysfunction (ED) actually is, despite those really ridiculous Cialis and Viagra commercials on TV (which can be horribly awkward to watch in mixed company at times!!) ED affects between 15 and 30 million men in the US and approximately 22.3% of all office visits to HCP’s are for ED.  It is something that many men are embarrassed about and feel unable to speak to their partner about, and it can cause huge rifts in relationships. It is important to know that signs and talk to your partner about it, it is a physical issue that is normal, and totally fixable, so go to the doctor together and make it a couple problem, and don’t let your partner suffer and feel badly alone!

What exactly is the definition of ED?

It’s the inability to maintain an erection that is firm enough to have sex, on an ongoing basis, along with trouble getting an erection, difficulty maintaining an erection, and/or a reduced sexual desire.  If you have any of these symptoms, especially if you have diabetes or heart disease, you should go see your HCP and talk to them about it, your options, and to find out what might be going on with your body. Don’t let it get too far that your partner might get upset or think that they are the one causing the problem…be open about it and go to see your HCP.

erectile-dysfunctionWhat are the causes?

There are SO MANY possible causes of ED, in which some are physical, mental, and a combination of the two.  Some physical causes are: heart disease, atherosclerosis, high blood pressure, diabetes, obesity, metabolic syndrome, Parkinson’s disease, Multiple sclerosis, low testosterone, Peyronies disease (a build up of scar tissue in the penis), tobacco use, alcohol (alcoholism), substance abuse, pelvic/spinal cord surgery, enlarged prostate, and prostate cancer.  So, obviously it goes from being something that is easily fixed, to things that are more serious. As far as psychological issues: stress, depression, anxiety, fatigue, and relationship issues can all cause ED. Another psychological reason that many men have a form of ED, in this current society, is due to the inability to get their partner pregnant; we have a society wrought with infertility and it can case serious relationship problems on many levels. As well, many medications that your HCP might put you on for various health issues, can also cause ED.

Before you go to your HCP appt:

Write down symptoms that you have had even including things that you might think unrelated to ED.  Also, write down any life changes going on, including anything that might be causing relationship stress.  An update list of current prescribed and over the counter medications are always important to bring to every appointment, but especially to an appointment regarding ED.  Try to bring your partner to your appt and both of you talk before you go and both write down list of questions both separately and together.

What might happen at/after your appt?

A physical exam, which is standard at all appointments, but your HCP will inspect your penis, testicles, and check for nerve feelings.  Most likely you will have blood drawn to assess your risk of heart disease, diabetes, cholesterol, and testosterone levels.  A urinalysis may be performed to also look at your risk of diabetes, etc.  An ultrasound may be done to look at blood flow to your penis, it uses a plastic probe on the outside of your penis to project a video of the current blood flow (a non invasive exam). They also might have you go home and perform an overnight erection tests; many men have erections at night during sleep, and have no idea that they had an erection, if the test is positive, then the reason you have ED is psychological.  What they will ask you to do is to put a piece of tape that they will give you (it is easily split) around your penis, and if you wake up in the morning and the tape it split open, you’ve had an erection.

How do we treat it?

You can take oral pills like Viagra, Cialis, and levitra which are medications that enhance your bodies natural nitric oxide levels which helps muscles relax and allows more blood flow to your penis, allowing for a stronger erection.  You may need to change doses and change times that you take before getting an erection.   You need to talk to your HCP to take these drugs if you also take any nitrate drugs like nitroglycerin, Imdur, or Isosorbide because you can have too much of a build up of nitrates in your blood.  Also be careful with blood thinners and alpha blockers (for enlarged prostate).  Your HCP will have to discuss using medications if you have had a stroke, have either low blood pressure or uncontrolled high blood pressure, heart disease or heart failure, and/or uncontrolled diabetes.
Other medication options:
Alprostadil injections: a small needle is inserted in the base or side of the penis and you inject the medication, due to the small size of the needle there is usually little to no pain, and you can get an erection within 5-20 minutes and the erection usually lasts around an hour.
Alprostadil penis suppository: Using a special applicator, you insert a small suppository 2 inches up the inside of the urethra. The side effects can be pain, bleeding from the urethra, dizziness, and can cause a fibrous build up inside your penis.
Testosterone replacement: if you have low testosterone levels, oral supplements can help to increase your levels and ability to maintain/obtain an erection.
Other options:
Penis pumps: a hallow tube with a hand or battery-powered pump, you put your penis inside, pump out the extra air, which causes blood to flow to the penis and cause an erection, you need to put a tension ring on the base of your penis, then remove the pump.  The erection usually lasts long enough to have sex, then remove the tension ring.
Penile implants: implants are surgically places on both sides of the penis, either inflatable or semi rigid rods.  The inflatable implants, are inflated before sexual intercourse to help obtain an erection and the semi rigid rods allow for a firm but flexible penis at all times. Due to it being surgical in nature, there is a risk of infection, and usually a later option for ED.
Blood vessel surgery: at times a leaking vessel can cause a decrease in blood flow to the penis, a simple surgical procedure may be able to fix that problem.
Psychological counseling: if the problems are psychological in nature, counseling can help to talk about the problems and may help to decrease ED issues.

How can you fix it with lifestyle changes?

If you use tobacco, quit. Lose weight to get to a healthy level, exercise regularly, get treatment for alcohol and drug abuse, and work through relationship issues with your partner and with the help of a professional.

Alternative medicine:
Acupuncture is said to help with ED and relieve stress and anxiety, so it can help with some psychological problems.

Due to all of the possible causes, it is not only the first sign that something serious might be going on, but it also is something that might be fixed simply and easily, so I really encourage seeing an HCP early to talk about it.  Be open and honest with yourself, your partner, and your HCP.  ED is not something to be embarrassed about or something that you should allow to ruin a relationship.  If you notice any of these problems with yourself or your partner, please talk about it and go see you HCP ASAP!!

Yours in Good Health