7 Şubat 2013 Perşembe

Day 1285 - It's All In Your Head

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"Many people know about other contributing factors such as heredity, food triggers, lack of sleep, poor posture, etc., but are not aware of any psychological connection.
Headache specialists report that many of their patients resist any discussion of emotional or psychological contributors to their recurrent headaches. Some people fear that pursuing this avenue could uncover evidence of "mental illness." Others feel that the existence of these factors would make their pain less real because it would then be "all in their heads". In just about all cases, neither of these 2 things is true!

Headache is definitely a biological disorder. However, since the body and the mind are interconnected, your emotional and psychological states can have an effect on your overall health, including your headaches. Here's why:

- When your emotional and psychological systems are in good working order, they help to create a positive environment that contributes to the health of your body.
- When these systems aren't working so well...for example, if you feel anxious, depressed or angry on a frequent basis — and especially if you find it difficult to shake these feelings — a negative environment can be created in your body that may contribute to a specific headache episode or create a fertile breeding ground for headaches to occur.

The relationship between anxiety, depression and headache is not fully understood. However, it is known that the brain chemical serotonin plays a role in all of them. Some headache specialists have theorized that these disorders may share a common mechanism in the brain.

Research has shown that some chronic headache sufferers also suffer from depression and/or anxiety. It is important to note that these sufferers' psychological conditions may not be caused by their headaches. Rather, tendencies towards depression or anxiety may be inherent in their personalities or ways of thinking. Or, they may be the result of an intense and prolonged level of stress which may lead to psychological conditions such as anxiety or depression. Regardless of the cause, having frequent headaches and feeling a lack of control over them may cause an existing condition of depression or anxiety to worsen. This situation can easily snowball, creating a vicious cycle of headache and emotional distress.

Unfortunately, emotional and psychological factors are often not considered in the treatment of headache. Doctors (especially those who are not headache specialists) tend to emphasize medical treatment — and rightly so. This is the traditional "first line of defense" and is effective for most headache patients. So is appropriate to start — and, for most, to stop — there. Also, some doctors today are cautious not to focus on psychological factors during the earlier stages of headache treatment — possibly overcompensating for the days when many doctors treated patients as if the pain was "all in their heads."
Doctors who do bring up psychological contributors as a possibility often find that their patients want to avoid psychological treatment, fearing a "mentally ill" diagnosis or having a concern that the presence of these factors would mean that their headaches are not a serious medical problem. This is very unfortunate because nothing could be farther from the truth!"*
*http://www.excedrin.com/psychological-contributors-to-headaches.shtml


It has taken me over three years to write this post.

When the headache started - which now seems all those years ago - I went to see a psychologist about it. The headache had exacerbated to such a degree that I was unable to work and felt completely depressed about my situation. After telling her about the distress that the headache had caused, she looked at me, arms gently folded over her lap, and stated “It must be such a headache having this pain!” and gave a little chuckle. I brushed aside this silly joke, ignoring it and thinking that maybe she had unintentionally let it out. However, when the very same joke repeated itself over the course of the next sessions, I felt hurt, frustrated and angry that a person contending to be there to help could actually end up aggravating a situation. I could bear it no longer and after a few sessions I left. That was the last of any psychological treatment I have undergone.

The possibility of the headache being related to a close friend’s death which took place a few months before the onset of my headache, has crossed my mind more than once. But nearly four years down the line I do not think the headache is related to this, or at least entirely to this. It is possible that I have not yet recovered from the shock of losing such a close friend. I truly believe there is a strong link between body and mind and that a traumatic event can undoubtedly have consequences on one’s body. The passage above taken from a Headache Centre webpage discusses this in further detail. Just today I also came across an article on the BBC website on a similar topic.

The reason it has taken me so long to write anything on this is that I am unable to draw the line between the “it could be a psychologically caused headache ” to a “it’s all in your head” (i.e. fictional). I am certain, from the manner in which this question is usually addressed to me, that by ‘psychological’ the word ‘fictional’ is intended. Does anyone feel the same?

Shingles Cures Tips - Let's reduce pain and Anxiety from it

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You will have to deal with painful rashes that keep on appearing from time to time whenever you are suffer from it because of Your doctor will be unable to give you a permanent cure of them and will only be able to give you medications that treat your symptoms.

Shingles Treatments are not always the best thing for you because they consist of powerful antiviral medications as well as antihistamines and corticosteroids also might find the side effects of these drugs as hard to bear as the symptoms of them.

Skin Balm is one of the most effective remedies for it which you can easily make out of ingredients easily available at home or at health food stores.

You need good quality olive oil to start with, to which you should add drops of lavender, tea tree oil, geranium and oregano.

Peppermint oil also has excellent pain killing properties. The combination of essential oils helps to kill viruses and bacteria on the skin while the olive oil soothes the itching on the skin and helps to trap in moisture.

It will help prevent you scratching your rashes. This is one of the biggest reasons for a secondary bacterial infection taking place, leading to scarring. This mixture of oils is extremely fragrant and will also help put you in a good mood.


Another simple way of reducing your itching, and therefore your irritation and anxiety, is to apply petroleum jelly to the areas that have rashes.

This is an inexpensive solution to the problem of itching. These tips will help reduce your dependence on medication by giving you lots of comfort and peace of mind.

6 Şubat 2013 Çarşamba

If you were speaking to a medstudent interested in pursuing a career in A/I, why would you tell them to choose it?

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If you were speaking to a medical student who was interested in pursuing a career in A/I, why would you tell him or her to choose it?

Anne-Marie A. Irani, MD, FAAAAI answers:

The field of allergy and immunology allows the practitioner to apply a comprehensive approach to medical care as it is based on an understanding of immune mechanisms and therefore goes beyond caring for a particular organ system.

For example, a patient with asthma, allergic rhinitis, atopic dermatitis and eosinophilic esophagitis could be cared for by a team consisting of a pulmonologist, ear, nose and throat practitioner, dermatologist and gastroenterologist, or the patient could receive comprehensive care from an allergist/immunologist.

The practice of allergy/immunology is grounded on an increasing amount of evidence-based recommendations and practice parameters, which move the field from an art to more of a science. The demand for specialists in our field will continue to increase as new immune-mediated disease entities are described and new biologic therapies are developed, resulting in expansion of our scope of practice.

The 2012 ACAAI President provides a considerably more guarded perspective for the future of the specialty here: Impressions from the annual meeting of the allergy/immunology fellowship program directors http://bit.ly/WMUopo

Comments from Twitter:

Dr. Ellis @DrAnneEllis: Grateful patients that you more often than not make a huge improvement in their quality of life... in Canada, lots of job prospects for most, a great work-life balance; great variety of patient problems; and "one stop shopping" as your blogger mentions.

References:

News & Notes http://bit.ly/12GHjmc
Image source: Wikipedia.

Epinephrine use with a food allergy attack: A Parent's Experience (video)

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Beth Creech describes the first time she used an EpiPen to treat her daughter's severe allergic reaction (National Jewish video):



When to Use an EpiPen

National Jewish Health pediatric allergist Kirsten Carel, MD, explains when to use an EpiPen to administer epinephrine for a severe allergic reaction.



Learn How to Use an EpiPen -- It Could Save a Life

National Jewish Health registered nurse Emily Cole explains how to use an EpiPen, a potentially lifesaving medication for children and adults suffering a severe allergic reaction.

Factors associated with negative oral food challenges in suspected food allergy

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Food-specific IgE (FSIgE) cutoffs associated with 50% likelihood of negative OFC include:

- below 2 kUa/L to milk, egg, or peanut
- below 5kUa/L to peanut without history of previous reaction

Such children are appropriate candidates for oral food challenge (OFC) to investigate resolution of food allergy.


Oral Food Challenges (click to enlarge the diagram).

444 OFCs were included in this study. The proportions of negative OFCs performed based on FSIgE cutoffs alone were:

- 58 % for milk
- 42% for egg
- 63% for peanut

These are not great success rates, in particular, 42% rate of a negative challenge for egg is not very encouraging.

Here are the independent factors associated with negative OFCs:

- lower FSIgE levels (all three foods)
- higher total IgE (milk)
- consumption of baked egg products (egg)
- non-Caucasian race (eggs and peanuts)

Combinations of these factors identified subgroups of children with proportions of negative OFCs of:

- 83% for milk
- 75% for egg
- 75% for peanut

Combinations of clinical and laboratory elements (FSIgE values) might identify more children who are likely to have negative OFCs compared with current recommendations using FSIgE values alone.

The practical implications of this study are uncertain. The best approach is to see a board-certified allergist who will help the family select the best diagnostic method based on the combination of:

- history and physical examination
- skin test and blood test
- safety of the oral challenge
- importance of food introduction


8 top allergens account for 90 percent of food allergies. Specific IgE levels (sIgE) that predict the likelihood of passing an oral food challenge are shown in the figure. (click to enlarge the image).



Comparison of diagnostic methods for peanut, egg, and milk allergy - skin prick test (SPT) vs. specific IgE (sIgE) (click to see the spreadsheet). Sensitivity of blood allergy testing is 25-30% lower than that of skin testing, based on comparative studies (CCJM 2011).

References:

Clinical and laboratory factors associated with negative oral food challenges. Allergy and Asthma Proceedings, Volume 33, Number 6, November/December 2012 , pp. 467-473(7).
AllergyCases.org: Food Challenges for Diagnosis of Food Allergy

From blog to Facebook page

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A sign of the times:

Asthma.ca Blog Closure http://bit.ly/Vir6zt

"Asthma Society of Canada has decided to close it's blog due to the popularity of social media sites. Instead of following our blog, we encourage you to visit the Asthma Society of Canada's facebook page and follow us there."

All organizations must allocate resources appropriately and sometimes a blog requires too much time and effort for too little return. Facebook provides the sense of engagement that blog comments do not nowadays.

However, a blog definitely has its place. For example, where do you point your Facebook page followers when you have written a longer post? How do you make sure that important posts stay on top (for example, videos of asthma inhalers use, etc.)?

Immunology in the Gut Mucosa - beautiful animation by the journal Nature

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The gut mucosa is the largest and most dynamic immunological environment of the body. It hosts the body's largest population of immune cells. It is often the first point of pathogen exposure and many microbes use it as a beachhead into the rest of the body.

The gut immune system therefore needs to be ready to respond to pathogens but at the same time it is constantly exposed to innocuous environmental antigens, food particles and commensal microflora which need to be tolerated.

Misdirected immune responses to harmless antigens are the underlying cause of food allergies and debilitating conditions such as inflammatory bowel disease. This animation introduces the key cells and molecular players involved in gut immunohomeostasis and disease.

Nature Immunology in collaboration with Arkitek Studios have produced an animation unraveling the complexities of mucosal immunology in health and disease:




T helper cells (click to enlarge the image).

Comments from Twitter:

FoodAllergySupport @FASupport: More fun than Magic School Bus!