By Dr. Rebecca Wise

5 Wise Ways To Beat Seasonal Allergies:

1. Identify triggers (Are you allergic to pollen, dust, mold, animal dander?)

2. Avoid triggers when possible (being in an air-conditioned environment during peak hay-fever season, avoiding certain foods, and eliminating dust mites and animal dander from the home.) If have hay-fever (allergy to pollen) monitor pollen counts in your area to help you determine when to limit your exposure to the outdoors or to know when to take allergy medications.

3. Talk to your doctor about starting an OTC product such as Zyrtec, Allegra, Claritin. Some products do not work for everyone. If you have given a specific product an adequate trial, try another agent before getting discouraged. Other products that can help manage allergy symptoms include nasal steroids and decongestants.

4. Learn to distinguish allergy symptoms from cold symptoms. Both can cause sneezing, runny and stuffy nose. Symptoms more common in cold than allergies include: Cough, sore throat, fever. Symptoms more common from allergies include: itchy eyes. Duration is also different. Allergies can last for weeks while a cold should end in 3-14 days.

5. If you have asthma in addition to allergies, make sure to have a rescue inhaler available in case your asthma is triggered by the allergen. Prevent emergency situations by making sure you have refills left on your prescription and that your inhaler is not expired. If your asthma is not under control, talk to your doctor about the addition of a long term controller medication to prevent asthma episodes.

Be well, Be Wise.

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Dr. Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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Free Rx Discount Cards – too good to be true?

By Dr. Rebecca Wise

A friend of mine asked me about a card he got in the mail that claimed to be a prescription discount card – up to 75% off – entirely free to him. He said that it’s just “too good to be true”.

In this tough economy, our wallets are emptier than we’d like, and it becomes easier and easier to be enticed into programs that look like they will save us money. When a person has no insurance, and he reads about a FREE card that will save him a lot of money, of course he will sign up for it. But, some words of caution…

If it seems too good to be true, it probably is.

First, there are eligibility restrictions. Some of these cards can only be used once. Some are only for specific disease diagnoses or specific medications. Some of them are “unrestricted” but charge your credit card a “processing fee” each time you use the discount. Often the discount they offer is less than the discount offered by the pharmacy. But, once in a while, the long list of criteria match up and you, your diagnosis, your medication, and your pharmacy all qualify for a discount and you save a few dollars.

But, these cards all ask for demographic information, even if it is just your phone number. In this age of telemarketers and identity theft, I again caution you about giving out personal information. Until you have seen clear documentation, with a legitimately contracted company, do not give them anything that could jeopardize your financial identity – and this could be as simple as giving them your phone number.

The best prescription discount cards are from companies that have become known for their good reputations and longevity like AARP, Sams Club, and United Way, or a drug manufacturer discount card such as Merck or GlaxoSmithKline. If it is a company that you’ve never heard of then you are essentially trusting a complete stranger with your information.

So how can you determine if a card is legitimate or not?

1. Is there a fee? If there is, is it a monthly or recurring fee; is it a fee for each prescription processed; or is it a one-time enrollment fee? Before you give out your credit card number, make sure you add up how much you will be charged in total. This may very well offset any discount you will get.

2. Is the card honored by the pharmacy you use? If it is not, talk to the pharmacy manager about why. He or she may already know about a card that generally costs you more than it saves you.

3. Is use of the card an agreement to join some other service? Sometimes by accepting the discount offered, you are agreeing to join a mail-order pharmacy for all subsequent refills, or sometimes you are agreeing to put your name into a database for telemarketers to call you about products related to what you got. For example, if you used the discount Rx card for a diabetes medicine, you are placed on a call list for several hundred diabetes product suppliers to call your phone.

4. Does the card cover you, your drug, and your diagnosis? There are many restrictions in the “small print”. Be sure to read them all and if you don’t understand them, take the information to your pharmacist for him to look it over and advise you.

5. Most importantly, if I use the card, will I actually save money. Ask the pharmacist what the store price is for the drug and if any discounts are available. Then ask how much the prescription will be if you use the card. But don’t forget to factor in the fees associated with using the card.

So, get the facts, know the risks, talk to your pharmacist, and make an informed decision. Then, if you save a few dollars, you know it is well worth it!

Check out this great (and legitimate) resource for more information: http://patients.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=patients&cdn=health&tm=25&f=10&su=p284.13.342.ip_&tt=2&bt=1&bts=1&zu=http%3A//www.fda.gov/cder/ob/default.htm

Be well, Be Wise.

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Dr. Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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Stress and depression are very common during the holidays with an enormous demand on our time, money, and emotion. Whether it’s a work party you have to attend, an unexpected gift you have to buy, or friends and family that expect you to host them in a clean and beautifully decorated house, the Season of Giving can sure take a lot out of you! Here are some helpful ideas to keep your sanity, and your health, during this wonderful time…

First, let yourself feel all those emotions! It’s ok to stop, go in another room, close your eyes and either cry or scream.

In fact, letting the emotion out is much better for your psyche and your body. When you bottle it up, or hold it in, you are actually causing your body to go into a sort of “fight or flight” reaction, which does lots of damage to your body and your mind. It’s ok to let the kids, or family and guests, out of your sight for 10 minutes (as long as they are safe), for you to go into another room, shut out the world with your favorite music, and get your thoughts back to a good place. A few minutes of meditation, deep breathing, and release of emotion can put that smile back on your face. If fact, I’d say that that is best for the kids or guests too. If you don’t take care of yourself first, you can’t take care of anyone else.

Second, be realistic! No one is perfect. Not your kids, not your guests, not your partner, and not YOU! I’m sure not, and acknowledging that has helped me lower my expectations of the holidays. They won’t be perfect either – and THAT is perfect! There will be beautiful moments. There will be love. There will be laughter. Cherish those wonderful moments, and let all the rest go. The spirit of the season is about sharing time with those who we hold dear, not about how clean the house is, or how many different kinds of cookies there are (my husband disagrees on this point), or how many presents are given. When everyone is gone, I want my friends and family to have memories of my love and laughter – not the sweater I bought. The sweater will, hopefully, be a reminder of the great TIME we had together, not how much I spent on it.

Third, plan and then try to stick to the plan! This is especially true for finances. You should set a budget for each person for whom you must purchase a gift and stick to it. Do NOT be lured into all the marketing myths that the holidays are about how many and how much. Happiness does not come from a giant pile of presents, nor from all those bills after the holidays because of overspending. Happiness, again, is being together. Way back in 7th grade I wrote a poem for a class using question words (and it ended up in the school year book) that explains this very well:

It doesn’t matter what you have,

It doesn’t matter where you go,

All that matters is who you have beside you!

But you should also plan your time. If some friend or family member springs a party on you at the last minute, and you do not have time to go, it’s OK to say no. You can say that you simply do not have time, but you’d be happy to get together at a later date. If someone wants you to take your time that you don’t have to give, think of time as money, and that will help you say no more easily.

Finally, don’t forget about your health. It’s a great time of year for incredible indulgence on good food, good wine, and of course, those cookies! Just remember that every calorie you consume must be burned back off with physical activity or you will gain weight. If you are also skiing, running a race, cleaning your house like a crazy-person, or otherwise continuing to exercise, it’s ok to indulge. Just remember that “every calorie” rule. The more our bodies weigh above our own personal idea, the more health problems we have. Staying at a healthy weight, for your own body (never compare yourself with anyone else), is tough this time of year, but think of the new year when we all feel like we have to make the same resolution I make every year – lose weight!

So, be good to yourself this year. Work hard to keep the spirit of love alive in your heart and that will help you stay healthy. Health is not about money spent, or a clean house, or being exhausted. Health is about knowing your limits, and not straying outside those limits because some crazy TV commercial says you should.

Be well, Be Wise.

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Dr Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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Save your Ta-ta’s!

Many of us wear pink in October every year to help raise awareness of Breast Cancer. We have pink ribboned shirts, pink bejeweled pens, and great Facebook status updates. All that lady-centered fun to help “save the ta-ta’s”. But, do you do the simplest thing for your own breasts – are you saving your own ta-ta’s? Do you perform breast self-exams?

It is so simple, and takes only a few minutes. I chose the date of my birthday – the 28th – to do them every month, so then, 12 times a year, I give myself a great birthday present by taking away some of the worry and stress of “what if”. I put a heart on my calendar on the 28th of every month because I love myself enough to do the exam. So, here are the steps from the American Cancer Society:

Lie down with one arm behind your head and use your right hand’s middle 3 fingers with alternating light and medium pressure in small circles to examine your left breast. Pretend there are graph lines on your breasts and move along them up and down, then left and right. Be sure to go over the chest and underarm areas. Then alternate hands and examine the other side.

Now stand up in front of a mirror and put your hands on your hips. Visually examine each breast – using the same imaginary grid lines. Look for any changes in discharge, size, shape, or color including redness, scaling, or dimpling. Remember, no two breasts are alike – compare each one to itself, not to its partner.

Finally, still standing, raise your arms above your head and repeat the visual exam once more.

If you find any changes, write them down – using those imaginary grid lines again. Maybe even draw a picture of what you see that is different. Then when you call your Ob/Gyn you will be better armed to describe it and answer questions.
If you are menstruating or having breast sensitivity, postpone your exam for 5 to 7 days, but mark your calendar so you don’t forget. And finally, if you love your breasts, you can reduce your risk of developing cancer or other abnormalities in a few other ways as well: stop smoking, lose the belly fat, exercise to raise your heart rate at least 3 times a week, and reduce caffeine and alcohol intake. And don’t worry, we are all “works in progress” – let’s just make sure the progress is toward health!

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Dr Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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What happens during a food-drug interaction?

When you get a prescription medication, there is often a sticker that says how to take the drug. For example, “take with food” or “take on an empty stomach” or “drink water” or “avoid dairy”. Food-drug interactions can happen with both prescription and over-the-counter (OTC) medications, including antacids, vitamins, and iron pills. Some nutrients can affect the way you metabolize certain drugs by binding with drug ingredients, thus reducing their absorption or speeding their elimination. For example, the acidity of fruit juice may decrease the effectiveness of antibiotics such as penicillin. Dairy products may blunt the infection-fighting effects of tetracycline. Antidepressants (called MAO inhibitors) are dangerous when mixed with foods or drinks that contain tyramine (for instance, beer, red wine, chocolate, and some cheeses). Grapefruit juice can interfere with some blood pressure medications and organ transplant medications by increasing their metabolic breakdown.

Not all medications are affected by food, but many can be affected by what you eat and when you eat it. Sometimes, taking medications at the same time you eat may interfere with the way your stomach and intestines absorb medication. Other medications are recommended to be taken with food. Be sure to ask your physician or pharmacist for specific directions on eating prior to or after taking any medication.

What you should remember about food-drug interactions:

Ask your pharmacist or doctor if there are foods, beverages, vitamins, or supplements you should avoid with your medications.

Read the prescription label on the container. If you do not understand something, or think you need more information, ask your physician or pharmacist.

Read directions, warnings, and interaction precautions printed on all medication labels and instructions. Even over-the-counter medications can interact with foods, beverages, or supplements.

Take medication with a six-ounce glass of water unless it says specifically to take it with milk.
Do not stir medication into your food or take capsules apart (unless directed by your pharmacist or physician). This may change the way the drug works.

Check with your pharmacist or doctor before taking vitamin pills at the same time you take medication – vitamins and minerals can interact with some drugs.

Do not mix medication into hot drinks, because the heat from the drink may destroy the effectiveness of the drug.
Never take medication with alcoholic drinks. Alcohol can change medication absorption and may increase or decrease the effectiveness of many medications.

Be sure to tell your physician and pharmacist about all medications you are taking, both prescription and non-prescription.
Obtain all your medications from one pharmacy and tell your pharmacist about any OTC, supplements, herbs, or vitamins that you take.

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Dr Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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Its name says it all – Acne is Vulgar. The marks it causes are called “blemishes” because they mar an otherwise beautiful face. It can cause more mental anguish than just about any other physical difference among teenagers.

Those are a lot of unpleasant statements about such a common condition! Maybe this article will help give a more positive spin on this generally negative subject.

More than 20% of dermatologist’s visits annually are due to acne and Americans spend more than $100 million annually for OTC products to treat it. It affects 85% of people 15-24 to some degree, usually affecting males at 12-18 years old and females at 15-17 years old. However, It affects 40-54% of people over 25 years old, 3% of men middle age, and 12% of women in middle age. It does spontaneously disappear in some adult, and some babies get acne at 2-4 weeks old which spontaneously disappears by the 6th or 7th month of life.

Environmental and physical factors may play a role in who gets acne and who doesn’t. Some of these factors include:

High-humidity environments
Prolonged sweating
Occlusive clothing
Resting hand on chin or cheek for long periods
Use of oil-based cosmetics or lotions on skin
Severe or prolonged periods of stress
Other emotional extremes

Hormone changes and some medications may also cause acne. At puberty, menarche in females, and gonadarche in males indicates a radical change in hormone production, which is likely to result in the first break-outs of acne. Pregnancy causes another shift in hormones and ladies often experience acne during those months, but some chronic acne sufferers experience a clearing of the skin during pregnancy. Oral contraceptive also may cause a worsening or improvement in acne, depending on the individual female. Other medications that can cause acne include phenytoin, isoniazid, phenobarbital, lithium, ethionamide, steroids, azathioprine, rifampin, and quinine.

The best indicator of whether someone will have acne is genetics. Chances are highest when both parents had acne or if one parent had severe, scarring acne. Add that chance to a poor diet, sexual activity, improper hygiene, or even excessive scrubbing to open blocked pores, and acne is a sure bet.

How does a pimple develop?

Each hair follicle is associated with a sebaceous gland and a duct for it to pass through. Sebaceous glands around the follicle secrete sebum into the duct which seeps onto the surface of the skin to prevent water loss and keep the hair and skin supple. As puberty approaches, sebum production is increased due to increased androgen hormones. The cells that line the duct cannot manage the increase, giving bacteria a chance to grow more, causing inflammation and blockages of the duct. Once the duct is blocked, the increased production of sebum creates a sort of wound. This causes an increase in white blood cells for healing – creating a pus pocket. There are 4 grades of the severity of acne, Grade I being mild to Grade IV, which is severe, cyst-forming, scarring acne which is also associated with severe psychological symptoms.

How is acne treated?

Unfortunately the simplest answer is often the most difficult to heed. Consistent long-term methods to unblock the pores are the best treatment and include increased daily exercise, eating a proper diet, practicing some form stress-relieving activity, getting proper rest, and thorough gentle cleansing of the skin 2-3 times daily. Before any kind of medication is used, these techniques should be practiced for at least 6 weeks to see if there is improvement. If there is still acne present, then OTC medications may be implemented. These include Benzoyl Peroxide, Salicylic acid, and sulfur (or a combination product). These treatments should be used sparingly, especially if dry, red, flakey skin appears on the face. Frequency should be reduced to once daily (while still cleansing 2-3 times daily). The major issue with these products is the unpleasant odor associated with them. They are available as lotions or creams which are recommended for people with naturally dry skin, or as gels which may be more effective, but also dry the skin much more, and may even leave a film behind.

If, after use of OTC products and the non-pharmacological techniques for at least 3 months, the acne is still bothersome, a doctor’s visit may be warranted. The physician may order a topical or oral antibiotic or another topical medication called a retinoid. These act to reduce the number of bacteria, thus reducing the amount of inflammation and pus formation.

In females with suspected hormone changes as the causative factor, the doctor may order oral contraceptives to regulate the monthly change in hormones. In the worst cases, Grade IV, Oral Retinoids may be ordered. However, these have severe side effects, some of which are permanent, so the use of these is strictly regulated by the FDA. The acne must be bad enough to be causing long-term psychological issues for these medications to be used and may never be used in children under 12 years old.

So, acne is sometimes a difficult condition to live with, but it can usually be effectively treated without medication, or with just OTC medications. However, there are prescriptions that can help in severe cases.

The point to take home is this – it is something that nearly everyone experiences to some degree and is nothing to be embarrassed about. And, you can usually take care of it yourself, if just take care of yourself!

Check out these two websites for more information.

www.acne.org

www.nlm.nih.gov/medlineplus/acne.html

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Dr Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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by Dr. Rebecca Wise

At the end of winter in NW PA, folks often feel a little “cabin fever” and schedule a vacation to escape the weather. Time away from the rigors of daily life is important and can be a wonderful way to create memories to cherish for years to come.

These memories are healthy and can continue to reduce stress, long after the vacation is over.

Recently, deep sea cruises seem to be an increasingly popular choice for vacation travel and there are some things to know before you take to the seas to keep the memories positive. Every ship that carries 13 or more passengers and travels from the US to a foreign port is required to follow the CDC’s Vessel Sanitation Program, including inspections twice a year. These inspections focus on the potable water supply, pools and spas, food preparation and storage, interventions to prevent contamination, hygiene of staff, general condition of the ship including cleanliness and absence of vermin, and training programs for onboard employees. A low score on the inspection does not necessarily mean that passengers will suffer from a gastrointestinal illness, but records will be kept for each guest and staff member affected. If two or more people have an issue on any given cruise, the CDC may initiate a further investigation, but the overall rate of gastrointestinal issues on cruise ships is quite low considering the number of guests who enjoy this form of vacation every year.

However, there are some ways to help you make sure you are not one of the unlucky few.

First, before you leave, have a doctor checkup and make sure to get the proper immunizations. Also discuss how to take your medicines in different time zones, and write this information down to take with you on your trip. While you are at the doctor’s office, get a statement from your physician regarding your health history, meds, allergies, and immunizations.

Next, check your medical insurance coverage for travel abroad, and which claim forms you may need. Get an emergency release form and fill out your passport with emergency contact information. Keep enough meds for your entire trip in the original, labeled containers – never use unmarked or hand marked vials or boxes. Also, make a list of generic names for the meds you use (other countries use differing brand names).

Take an extra pair of glasses, extra medicine, and extra medical devices (like a glucometer) in your carry-on luggage in case the checked bags are lost. Also include a “travelers first aid kit” in your carry-on. This should include: adhesive bandages, alcohol swabs, hand sanitizer, antibiotic cream, moleskin, tweezers, thermometer, ibuprofen or acetaminophen, medicine for colds, diarrhea, and motion sickness.

Again, make sure the medications are in their original packages. Wear a medical alert bracelet for chronic medical conditions, allergies, etc. and pack an Epipen if you might need one.

Finally, consider checking with the American Embassy in the country where you are headed to request the list of specific medical rules or prohibitions.

You should also consider what you might be eating during your vacation and what to be careful of to prevent gastrointestinal discomfort. To avoid diarrhea, drink commercially bottled water or carbonated beverages, straight from the bottle, and avoid ice.

Also, try to eat foods that are steaming hot and well cooked, avoiding food from street vendors (no matter how great they smell). Avoid unpasteurized dairy and under-cooked or raw meat and seafood and peel your fruit yourself, after you have rinsed it with bottled water. Use bottled water when you brush your teeth, and use that hand sanitizer before you eat, every time.

To avoid constipation, eat plenty of fiber like that found in prunes or vegetables, and avoid lots of carbohydrates like pasta and bread. Finally, try to eat yogurt (if you open the package yourself) to keep your normal bodily flora healthy – to prevent both diarrhea and constipation.

Other than GI distress, there are a few other issues you may face as you travel. Swimming in non-chlorinated waters, in certain regions, may increase your risk of diseases transmitted by mosquitoes, ticks, worms, or other parasitic organisms.

Check with your travel agent for specific recommendations, but protect yourself with insect repellent. Also ask about recommendations for special clothing and bed netting.

Finally, after you return from your vacation, if you experience fever, diarrhea, vomiting, jaundice, urinary issues, skin or other infection, or flu-like symptoms, you should schedule a doctor visit to be sure you get proper care.

If you follow these simple steps, you should have a wonderful vacation cruise and give your mind and body the rest and relaxation it needs to de-stress and stay stress, at least for a while!

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Dr Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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by Dr. Rebecca Wise

When you get a prescription medication, there is often a sticker that says how to take the drug. For example, “take with food” or “take on an empty stomach” or “drink water” or “avoid dairy”. Food-drug interactions can happen with both prescription and over-the-counter (OTC) medications, including antacids, vitamins, and iron pills. Some nutrients can affect the way you metabolize certain drugs by binding with drug ingredients, thus reducing their absorption or speeding their elimination. For example, the acidity of fruit juice may decrease the effectiveness of antibiotics such as penicillin. Dairy products may blunt the infection-fighting effects of tetracycline. Antidepressants (called MAO inhibitors) are dangerous when mixed with foods or drinks that contain tyramine (for instance, beer, red wine, chocolate, and some cheeses). Grapefruit juice can interfere with some blood pressure medications and organ transplant medications by increasing their metabolic breakdown.

Not all medications are affected by food, but many can be affected by what you eat and when you eat it. Sometimes, taking medications at the same time you eat may interfere with the way your stomach and intestines absorb medication. Other medications are recommended to be taken with food. Be sure to ask your physician or pharmacist for specific directions on eating prior to or after taking any medication.

What you should remember about food-drug interactions:

• Ask your pharmacist or doctor if there are foods, beverages, vitamins, or supplements you should avoid with your medications.

• Read the prescription label on the container. If you do not understand something, or think you need more information, ask your physician or pharmacist.

• Read directions, warnings, and interaction precautions printed on all medication labels and instructions. Even over-the-counter medications can interact with foods, beverages, or supplements.

• Take medication with a six-ounce glass of water unless it says specifically to take it with milk.

• Do not stir medication into your food or take capsules apart (unless directed by your pharmacist or physician). This may change the way the drug works.

• Check with your pharmacist or doctor before taking vitamin pills at the same time you take medication – vitamins and minerals can interact with some drugs.

• Do not mix medication into hot drinks, because the heat from the drink may destroy the effectiveness of the drug.

• Never take medication with alcoholic drinks. Alcohol can change medication absorption and may increase or decrease the effectiveness of many medications.

• Be sure to tell your physician and pharmacist about all medications you are taking, both prescription and non-prescription.

• Obtain all your medications from one pharmacy and tell your pharmacist about any OTC, supplements, herbs, or vitamins that you take.

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

Dr Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
******************************************************************************************************

by Dr. Rebecca Wise

This is cold and flu season, and one of the most common complaints is fever. Fever (also called pyrexia) is defined as body temperature that is higher than normal for each individual. It generally indicates that there is an abnormal process occurring in the body. Exercise, hot weather, and common childhood immunizations can also make body temperature rise.

Fever is not an illness, but, rather, a symptom or an indicator that something is not right within the body. A fever does not tell you what disorder is causing it, or even that a disease process is occurring. It may be a bacterial or viral infection, or simply a reaction from an allergy to food or medication, or becoming overheated at play or in the sun. Although high fevers may bring on convulsions or delirium, generally, it is not how high the temperature is, but how rapidly the temperature rose that causes a convulsion.

What are the signs that indicate fever?

If symptoms of an illness are present:
• A temperature between 99.8° F-100.8° F is considered a low-grade fever.
• A temperature between 101° F-102° F is considered a mild fever.
• A temperature between 102° F-103° F is considered a moderate fever.
• A temperature around 104° F or above is considered a high fever, and delirium or convulsions may occur.

Your physician may have different definitions of fever than these, and will provide guidelines for when to treat fever yourself and when to call the physician’s office.

Because a baby, young child, or disabled person may not be able to express how he or she is feeling, be sure to look for signs (outward indications) that fever is present before using a thermometer. Signs that indicate fever may include the following:

• Flushed face
• Hot, dry skin
• Low output of urine, and/or dark urine
• Not interested in eating
• Constipation or diarrhea
• Vomiting
• Headache
• Aching all over
• Nausea

Taking the temperature:

The best means of taking temperature is with a thermometer. There are several types of thermometers, including the following:

• Glass thermometers (oral or rectal)
• Digital thermometer
• Ear thermometer

Taking a temperature reading with a thermometer directly touching certain areas of the skin, such as under the arm or in the bend of the elbow, is not recommended because it is not considered to be reliable.
About glass thermometers containing mercury:

According to the Environmental Protection Agency, mercury is a toxic substance that poses a threat to the health of humans, as well as to the environment. Because of the risk of breaking, glass thermometers containing mercury should be removed from use and disposed of properly in accordance with local, state, and federal laws. Contact your local health department, waste disposal authority, or fire department for information on how to properly dispose of mercury thermometers.
Treating fever:

Once you have determined that the person has a fever, you may treat it by giving acetaminophen (Tylenol®, Tempra®, or FeverAll®) or ibuprofen (Advil® or Motrin®), or both, in dosages or combinations advised by your physician. Never give aspirin to a child or young adult who has a fever.

A tepid bath (water is neither too cool nor too warm to the touch) may reduce the fever, as well as comfort the person. Alcohol rubdowns are no longer recommended.

Call your physician for guidance anytime you are uncomfortable with the conditions of the fever, and remember to contact your physician anytime a temperature spikes rapidly or persists despite treatment.
When to call your physician:

Call your physician immediately if any of the following conditions accompany a fever:

• Seizure
• Feeling dull or sleepy
• Irregular breathing
• Stiff neck
• Confusion
• Purple spotted rash
• Ear pain (a child tugging on his/her ear)
• Sore throat that persists
• Vomiting
• Diarrhea
• Painful, burning, or frequent urination

These guidelines may ease your mind about what to do if you, or someone you love gets a fever. But, if you are ever really concerned, call your doctor or the hospital to determine the right course of treatment. Fevers are a natural process, but knowing how to handle them will help.

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Dr Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
******************************************************************************************************

by Dr. Rebecca Wise

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as complications of having diabetes. All can cause severe vision loss or even blindness, but diabetic eye disease often can be treated before vision loss occurs. All people with diabetes should have a dilated eye exam at least once a year.

Diabetic eye diseases include:
• Diabetic retinopathy
• Cataract
• Glaucoma
Diabetic retinopathy is the most common eye disease in people with diabetes, so we will discuss that one first.

Diabetic retinopathy is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina, where blood vessels may swell and leak fluid, or abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness. It can never be completely avoided, but the risk can be greatly reduced. Better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

There may be no symptoms or pain in the early stages of the diabetic retinopathy, and vision may not change until the disease progresses. A condition called macular edema may occur when the macula, a part of the retina, swells from the leaking fluid and causes blurred vision. When new vessels grow on the surface of the retina, they can bleed (hemorrhage) into the eye, blocking vision.

Anyone with diabetes is at risk for diabetic retinopathy. The longer a person has diabetes, the more likely it becomes that he or she will develop diabetic retinopathy. And, although diabetic retinopathy cannot be prevented, the risk of developing it can be reduced by having a dilated eye examination once a year, and strictly managing diabetes:

o Taking medications as directed
o Using insulin as directed
o Eating appropriate foods to manage blood sugar level
o Exercising to lower and help the body use blood sugar
o Testing blood-sugar levels regularly
o Testing urine for ketone levels regularly

How is diabetic retinopathy diagnosed? In addition to a complete medical history and eye examination, your eye care professional may perform the following tests to diagnose diabetic retinopathy:

• Visual acuity test. The common eye chart test (see right), which measures vision ability at various distances.
• Pupil dilation. The pupil is widened with eyedrops to allow a close-up examination of the eye’s retina.
• Tonometry. A standard test to determine the fluid pressure inside the eye.
• Ophthalmoscopy. A doctor performs a detailed examination of the retina using a special magnifying glass.
Specific treatment will be determined by your doctor(s) based on:
• Your age, overall health, and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

According to the National Eye Institute, part of the National Institutes of Health, even people with advanced retinopathy have a 95 percent chance of keeping their vision when they seek treatment before the retina becomes severely damaged. Treatment for diabetic retinopathy may include:

• Laser surgery. Often used to treat macular edema and proliferative retinopathy; involves shrinking the abnormal blood vessels, or sealing the leaking ones.
• Vitrectomy. A type of procedure that involves removing the cloudy vitreous (the clear, jelly-like substance that fills the center of the eye) and replacing it with a salt solution. Vitrectomies are particularly effective in persons with insulin-dependent diabetes, who may be at a greater risk of blindness due to a hemorrhage in the eye.

The second most common diabetic eye disease is formation of cataracts. A cataract is a clouding or opaque area over the lens of the eye–an area that is normally transparent. As this thickening occurs, it prevents light rays from passing through the lens and focusing on the retina–the light sensitive tissue lining located in the back of the eye. This clouding is caused when some of the protein which makes up the lens begins to clump together and interferes with vision.

In its early stages, a cataract may not cause a problem. The cloudiness may affect only a small part of the lens. However, the cataract may grow larger over time and affect more of the lens, making it harder to see. As less light reaches the retina, it becomes increasingly harder to see and vision may become dull and blurry. While cataracts cannot spread from one eye to another, many persons develop cataracts in both eyes.

Although scientists do not know for sure what causes cataracts, they suspect there could be several possible causes including smoking, diabetes, excessive sunlight exposure, steroid use, or diuretic (water pill) use. For several of the potential causes additional research is needed to differentiate the effect of the disease from the effect of the drugs themselves.

The following are the most common symptoms of cataracts. However, each individual may experience symptoms differently. Symptoms may include:

• Cloudy or blurry vision
• Lights appear too bright and/or present a glare or a surrounding halo
• Poor night vision
• Multiple vision
• Colors seem faded
• Increased nearsightedness, increasing the need to change eyeglass prescriptions
• Distortion of vision in either eye

Often in the disease’s early stages, you may not notice any changes in your vision. Since cataracts tend to grow slowly, your vision will worsen gradually. Certain cataracts can also cause a temporary improvement in close-up vision, but this is likely to worsen as the cataract grows. The symptoms of cataracts may resemble other eye conditions. Consult a physician for diagnosis.

According to the National Eye Institute, part of the National Institutes of Health, cataract types are subdivided accordingly:

• Age-related cataracts (most common)
The majority of cataracts are related to aging.
• Congenital cataracts (Some babies are born with cataracts or develop them in childhood, often in both eyes. Some congenital cataracts do not affect vision, but others do and need to be removed.)
• Secondary cataracts are due to some other disease, or use of certain medications.
• Traumatic cataracts due to sustained an injury may develop immediately following the incident, or several years later.
Other sources, including the American Academy of Ophthalmology, describe the different types of cataracts according to the cataract location on the eye lens, including:
• Nuclear cataract: This is the most common type of cataract, and the most common type associated with aging. Nuclear cataracts develop in the center of the lens and can induce myopia, or nearsightedness – a temporary improvement in reading vision which is sometimes referred to as “second sight.” Unfortunately, “second sight” disappears as the cataract grows.
• Cortical cataract: This type of cataract initially develops as wedge-shaped spokes in the cortex of the lens, with the spokes extending from the outside of the lens to the center. When these spokes reach the center of the lens they interfere with the transmission of light and cause glare and loss of contrast. This type of cataract is frequently developed in persons with diabetes, and while it usually develops slowly, it may impair both distance and near vision so significantly that surgery is often suggested at an early stage.
• Subcapsular cataract: A subcapsular cataract usually starts as a small opacity under the capsule, at the back of the lens. This type of cataract develops slowly and significant symptoms may not occur until the cataract is well developed. A subcapsular cataract is often found in persons with diabetes, myopia, retinitis pigmentosa, and in those taking steroids.
In addition to a complete medical history and eye examination, diagnostic procedures for cataracts may include a visual acuity test with a common eye chart or pupil dilation and close examination of the retina. In addition, other tests may also be performed to help your eye care professional learn more about the health and structure of your eye.

Possible risk factors for cataracts include:

• Age: Probably the greatest risk factor for cataracts is age. And, although age-related cataracts may develop between 40 and 50 years old, vision is usually not affected greatly until after age 60.
• Geographic location: Recent studies have shown that people who live in high altitudes are more at risk for developing a cataract(s).
• Excessive sun exposure: Person who spend more time in the sun may develop cataracts earlier than others. The American Academy of Ophthalmology now recommends wearing sunglasses and a wide brimmed hat to lessen exposure to ultraviolet rays.

Specific treatment for cataracts will be determined by your physician based on your age, overall health, and medical history, extent of the disease, your preferences, and your tolerances to specific medications. In its early stages, vision loss caused by a cataract may be aided with the use of different eyeglasses, a magnifying glass, or stronger lighting. When these measures are no longer helpful, surgery is the only effective treatment available, for most individuals. It is important to note that a cataract only needs to be removed when vision loss interferes with everyday activities such as driving, reading, or watching television. You and your doctor can make that decision together. Cataract surgery is one of the most common operations performed and one of the safest and most effective. Surgery involves removing the cloudy lens and replacing it with a substitute lens. If cataracts are present in both eyes, they cannot be removed at the same time. Your physician will need to perform surgery on each eye separately.

According to the National Eye Institute, in most cataract surgeries the removed lens is replaced by an intraocular lens (IOL). An IOL is a clear, artificial lens that requires no care and becomes part of the eye. With an IOL, a person has improved vision because light will be able to pass through the retina. The recipient of the new lens does not see it or feel it. An “after-cataract” occurs when part of the natural lens not removed during cataract surgery becomes cloudy and blurs vision. Unlike a cataract, an “after-cataract” can be treated with a technique called YAG laser capsulotomy. In an outpatient procedure, the doctor uses a laser beam to make a tiny hole in the lens to let the light pass through.
After-cataracts may develop months, or even years, after cataract surgery.

Finally, glaucoma is a condition in which the normal fluid pressure inside the eyes (intraocular pressure, or IOP) slowly rises as a result of the fluid aqueous humor – which normally flows in and out of the eye – not being able to drain properly. Instead, the fluid collects and causes pressure damage to the optic nerve (a bundle of more than 1 million nerve fibers that connects the retina with the brain) and loss of vision. While physicians used to think that high intraocular pressure (also known as ocular hypertension) was the main cause of optic nerve damage in glaucoma, it is now known that even persons with normal IOP can experience vision loss from glaucoma. Thus, the causes are still unknown.

What are the different types of glaucoma?

• Open-angle glaucoma: With this most common type of glaucoma, the fluid that normally flows through the pupil into the anterior chamber of the eye cannot get through the filtration area to the drainage canals, causing a build-up of pressure in the eye. Nearly 3 million Americans – half of whom do not know they have the disease – are affected by glaucoma each year.
• Low-tension or normal-tension glaucoma: While normal intraocular pressure ranges between 12 to 21 mm Hg, an individual may have glaucoma even if the pressure is within this range. This type of glaucoma presents optic nerve damage and narrowed side vision.
• Angle-closure glaucoma: In angle-closure glaucoma, the fluid at the front of the eye cannot reach the angle and leave the eye because the angle becomes blocked by part of the iris. This results in a sudden increase in pressure and is generally a medical emergency, requiring immediate treatment to improve the flow of fluid.
• Childhood glaucoma: Childhood glaucoma is a rare form of glaucoma that often develops in infancy, early childhood, or adolescence. Prompt medical treatment is important in preventing blindness.
• Congenital glaucoma: Congenital glaucoma, a type of childhood glaucoma, occurs in children born with defects in the angle of the eye that slow the normal drainage of fluid. Prompt medical treatment is important in preventing blindness.
• Primary glaucoma: Both open-angle and angle-closure glaucoma can be classified as primary or secondary. Primary glaucoma cannot be contributed to any known cause or risk factor.
• Secondary glaucoma: Both open-angle and angle-closure glaucoma can be classified as primary or secondary. Secondary glaucoma develops as a complication of another medical condition or injury. In rare cases, secondary glaucoma is a complication following another type of eye surgery.

Most people who have glaucoma do not notice any symptoms until they begin to lose some vision. As optic nerve fibers are damaged by glaucoma, small blind spots may begin to develop, usually in the side or peripheral vision. Many people do not notice the blind spots until significant optic nerve damage has already occurred. If the entire nerve is destroyed blindness results.

One type of glaucoma, acute angle-closure glaucoma, does produce noticeable symptoms because there is a rapid build-up of pressure in the eye. The following are the most common symptoms of this type of glaucoma. However, each individual may experience symptoms differently. Symptoms may include:

• Blurred or narrowed field of vision
• Severe pain in the eye(s)
• Haloes (which may appear as rainbows) around lights
• Nausea
• Vomiting
• Headache
The symptoms of acute angle-closure glaucoma may resemble other eye conditions. Consult a physician for diagnosis immediately if you notice symptoms, as this type of glaucoma is considered a medical emergency requiring prompt medical attention to prevent blindness.

How is glaucoma diagnosed?

In addition to a complete medical history and eye examination, your eye care professional may perform the following tests to diagnose glaucoma:

• Visual acuity test – the common eye chart test (see above), which measures vision ability at various distances.
• Pupil dilation – the pupil is widened with eye drops to allow a close-up examination of the eye’s retina.
• Visual field – a test to measure a person’s side (peripheral) vision. Lost peripheral vision may be an indication of glaucoma.
• Tonometry – a standard test to determine the fluid pressure inside the eye.

Although anyone can develop glaucoma, some people are at higher risk than others. The following are suggested as risk factors for glaucoma: race (African Americans are most susceptible), age (over 60), family history, high intraocular pressure (IOP) (over 21mm Hg). The National Eye Institute, part of the National Institutes of Health, recommends that anyone in these risk groups receive an eye examination with dilated pupils every two years. Specific treatment for glaucoma will be determined by your physician based on your age, overall health, medical history, and your tolerance of medications and therapies.

While glaucoma cannot be cured, early treatment can often control it. Treatment may include:

• Medications: Some medications cause the eye to produce less fluid while others lower pressure by helping fluid drain from the eye.
• Conventional surgery: The purpose of convention surgery is to create a new opening for fluid to leave the eye.
• Laser surgery (also called laser trabeculoplasty): There are several types of surgical procedures that can be performed with a laser that are used to treat glaucoma, including:
o Trabeculoplasty
In this, most common type of laser surgery to treat open-angle glaucoma, a laser is used to place “spot welds” in the drainage area of the eye (known as the trabecular meshwork) which allows fluid to drain more freely.
o Iridotomy
In this procedure, the surgeon uses the laser to make a small hole in the iris – the colored part of the eye – to allow fluid to flow more freely in the eye.
o Cyclophotocoagulation
A procedure that uses a laser beam to freeze selected areas of the ciliary body – the part of the eye that produces aqueous humor – to reduce the production of fluid.
• Tube shunt: This implantable drainage device creates an artificial pathway in the eye. It is made from a miniature, stainless steel tube, and can be implanted in less than five minutes. A tube shunt is usually selected after it is determined that a patient cannot benefit from conventional surgical treatments.

In some cases, a single surgical procedure is not effective in halting the progress the glaucoma, and repeat surgery and/or continued treatment with medications may be necessary.

However, remember that with close monitoring of your diabetes, and with annual eye exams, these conditions can be delayed so that your quality of life will not be further hindered by a lack of ability to see the world around you.

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Dr Rebecca Wise

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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