Welcome to Spring! A Guide to Allergy Symptoms

Dear Dr. Deena,

Thank you for all your help.

How do I know if I have allergies? 

Debra

This is a great question, Debra, especially because we are entering into Spring! Spring is the most common season to develop allergies due to increased pollens in the air, as our trees and grasses begin to blossom once again!

Allergies affect roughly 30-40% of the population, which is likely an underestimation since many people don't even realize they have allergies.

Allergies occur when your immune system mounts a response against a foreign substance, known as an "allergen." Common allergens include pollen, dust, molds, certain foods, and animal dander (material shed from the bodies of animals).
Every individual has different sensitivities to these foreign substances, which is why not everyone develops or has the same types of allergies. 

The area of the body that is exposed to the allergen, is the area where symptoms will most likely occur. For example - if you are allergic to pollen and you breathe it in -- your symptoms will mostly be isolated to the airways (nose, sinuses, mouth, throat, lung) causing runny nose, itchy nose/throat, increased post nasal drip, difficulty breathing, wheezing, sinus congestion, etc. 
If pollen comes in contact with your eyes -- your symptoms will be isolated to the eyes causing itchy, watery, and/or red eyes. 

Allergic reactions can range from minor to severe. Symptoms develop based on the type of allergen, the areas of the body which are exposed to the allergen, and our own immune systems.

Here is a list of different types of allergies, along with their symptoms:

Seasonal Allergies: are generally caused by small airborne particles of pollens from trees, grasses, and weeds, as well as spores from fungi and molds. 

Symptoms of seasonal allergies may include:

-Sinus congestion

-Itchy nose

-Runny nose

-Itchy eyes

-Watery eyes

-Itchy throat

-Sneezing

-Increased post nasal drip (increased mucous production at the back of the throat or nose)

-Itchy ears

"Atopic Dermatitis" aka "Eczema": a type of rash which is very common among infants and generally outgrown before adulthood (See image below)

Symptoms of eczema include: 

- A red, itchy rash, +/- peeling and flaking of the skin

-Most commonly affected areas include face, neck, elbows, wrist, knees, and/or ankles

(courtesy of uptodate.com)

Food allergies:  caused by certain food proteins. Symptoms related to food allergies are dose dependent (meaning the more food that you eat which you are allergic to, the more severe your symptoms will be). 

Symptoms of food allergies may include:

-Tingling sensation of the lips and/or inside the mouth after eating a certain food

-Swelling of the tongue, lips, face or throat after eating a certain food. Which may look like this:

(courtesy of dxline.com)

-Development of "hives" which are raised, flat, red skin rashes that are generally itchy and look like this:

Anaphylaxis: is the most severe form of an allergic reaction and is LIFE THREATENING! 
It happens within minutes of exposure to an allergen

Symptoms of anaphylaxis may include:

-Most commonly patients will develop hives (generally all over their body)

-Difficulty breathing

-Chest tightness

-Increased wheezing

-Loss of consciousness

-Low blood pressure

-Dizziness

-Fast heart rate

-Nausea

-Vomiting

-Diarrhea

**If you are concerned with anaphylaxis, call 911!**

If you develop any of the above symptoms (especially during the spring and summer months) OR if you notice certain environmental triggers (food, dust, pollens, animals, etc.) always produce symptoms -- you may want to visit an Allergy specialist for evaluation. Luckily there are treatment options out there for you!

Here's a question for all of you -- what's another name for "Seasonal Allergies"? Leave your answers below!

Hope this information was helpful! As always, leave comments below and email all questions to DoctorDeenaMD@gmail.com. Happy Spring and I hope it's allergy free for all of you!!

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Tips To Adjust to Daylight Savings Time!

Do you find yourself even more tired now that daylight savings time is in effect? 

If yes - don't worry because this is completely normal! The first few days after the initiation of daylight savings are quite difficult since our body's natural rhythm is disrupted. 

According to the New England Journal of Medicine -traffic accidents are 8.6% more common on the first Monday of daylight saving time, according to an analysis of Canadian data from 1996.  

Here are some tips on how to adjust to daylight savings!

-- Avoid caffeine after lunchtime

--Eat dinner 3 hours prior to bedtime

--Avoid lying in your bed, until it is time to sleep

--Avoid taking naps during the day if possible

--Do not do any work in your bed, your bed should only be for sleep and sex

--Avoid dim lighting during the day, let as much bright light into your home or workspace as possible

--Exercise at least 3 times a week, but not before bedtime

--Play relaxing music to help soothe your mind and clear your thoughts while lying in bed before sleeping

--Find relaxation techniques that work for you - like deep breathing, stretches, or meditation that can be performed when you have difficulty sleeping

--Make sure that your room is dark when it's time for bedtime!

--Avoid alcohol before bedtime (tip: "nightcaps" might make you sleepy but alcohol decreases your quality of sleep)

Hope this helps to improve your sleep and your mood! 

Please email me at DoctorDeenaMD@gmail.com for any medical questions.

Sweet dreams everyone!


**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

All You Need To Know About Vitamin C!

Lets talk about Vitamin C!

Vitamin C is also known as L-ascorbic acid. It is very important for the functioning of our immune system and in the formation and maintenance of bones, teeth, cartilage and blood vessels. Vitamin C is an important factor in wound healing.

What Foods Contain Vitamin C?

It is important to make sure that our diet is rich in Vitamin C, since this vitamin is not stored or produced in our bodies.  Vitamin C can be found in many fruits and vegetables.  Although vitamin C is not naturally present in grains, it can be found in some fortified breakfast cereals. The vitamin C content of food may be reduced by cooking because ascorbic acid is water soluble and is destroyed by  high heat. Steaming or microwaving may lessen cooking losses. Fortunately, many of the best food sources of vitamin C, such as fruits and vegetables, are usually consumed raw.

 According to the Institute of Medicine - citrus fruits, tomatoes and tomato juice, and potatoes are major contributors of vitamin C to the American diet. Raw red peppers, orange juice and oranges have the highest amount of Vitamin C. 

Fruits containing Vitamin C include:
Cantaloupe
Citrus fruits and juices, such as orange and grapefruit
Kiwi fruit
Strawberries
Watermelon

Vegetables containing Vitamin C include:
Green pepper
Broccoli
Brussels Sprouts
Cabbage
Cauliflower
Spinach
Green peas

What Are The Symptoms of Vitamin C Deficiency?

-Poor wound healing
-Easy bruising
-Fatigue
-Mood changes (depression, easily irritability, etc)
-Bleeding gums
-Painful joints and muscles
-Nose bleeds
-Dry skin
-Dry, brittle hair
-Decreased ability to fight off infections leading to increased colds or other infections

Who is at risk for Vitamin C deficiency?

-Smokers (including those subject to second-hand smoking)
-Those with poor nutrition (the very poor, elderly, alcoholics, those with eating disorders, etc.)
-Those with severe intestinal malabsorption due to inflammatory bowel disease or who have had surgical resection of the intestines require higher amounts of Vitamin C
-Cancer patients require higher amounts of Vitamin C
-Patients on dialysis require higher amounts of Vitamin C

How Much Vitamin C Is Enough According to the NIH:

Infants:
0 - 6 months: 40* milligrams/day (mg/day)
7 - 12 months: 50* mg/day
*Adequate Intake (AI)

Children:
1 - 3 years: 15 mg/day
4 - 8 years: 25 mg/day
9 - 13 years: 45 mg/day

Adolescents: Age 14-18
Girls: 65 mg/day
Boys: 75 mg/day

Adults: Age 19 and older
Men: 90 mg/day
Women: 75 mg/day

Smokers or those who are around secondhand smoke at any age should increase their daily amount of vitamin C an additional 35 mg per day.

Women who are pregnant or breastfeeding and those who smoke need higher amounts of vitamin C. Ask your doctor what amount is best for you.


Fun fact: 
Did you know that Vitamin C deficiency was the leading cause of death among sailors between the 1500s and 1800s? 

After the 14th century, more and more sailors began to explore the Indian and Pacific Oceans -- leading to longer duration of voyages overseas. On these long voyages, a sailor's diet consisted largely of salted meat and biscuits made from flour. Since there was no way to preserve fruits and vegetables, these were never consumed while at sea.

Vitamin C deficiency first came into the public eye in Britain during the 1740s, after Commodore George Anson led 6 ships into the Pacific to raid Spanish shipping. He returned back to Britain with only 700 of his 2000 sailors, and it appears (from what has been described in stories and drawings) that most died from "Scurvy" , which is the most severe form of Vitamin C deficiency. Their symptoms were vividly described by Richard Walter: "skin black as ink, ulcers, difficult respiration,s, teeth falling out and, perhaps most revolting of all, a strange plethora of gum tissue sprouting out of the mouth, which immediately rotted and lent the victim's breath an abominable odour."  

This disease affecting only sailors was a true medical mystery at first, and  many physicians believed that the symptoms might be related to syphilis, dysentery or psychosis. What people did recognize; however, was that once on land the sailor's symptoms completely resolved as they resumed a normal diet. This made more physicians and sailors pay special interest to the foods on board the ship. 

In the 1760's the British used trial and error to research which foods might prevent this disease. They focused their interests on portable soup (a preparation of dried vegetables), malt, sauerkraut, concentrated lemon and lime juice (called "rob"), vinegar, mustard, molasses and beans. Different voyages sent out to sea took a different set of foods, and sailors were monitored for their symptoms. It turns out one group of sailors under Captain Cook was very lucky in preventing scurvy for three successive voyages, with the help of lemon and lime!

I hope you enjoyed my tips for Vitamin Week! Especially the little history about Vitamin C!

Please continue to email your questions/comments to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Vitamin Week Continues with Vitamin B-12 aka Cobalamin

Today I will discuss Vitamin B-12. This is a very important vitamin to know about because many of us will need supplementation after age 65!

Vitamin B-12 exists in many different forms and contains the mineral cobalt, which is why it is also known as "cobalamin."  Vitamin B-12 plays a very important role in the development and maintenance of our nervous system, red blood cell formation, and the synthesis of DNA.

B-12 is found in all animal products, dairy products, and fortified cereals. Cooked clams and liver are known to have the highest amounts of B-12.

According to the NIH - recommended intake of B-12 is the following:

Table 1: Recommended Dietary Allowances (RDAs) for Vitamin B12

Age	Male	Female	Pregnancy	Lactation
0–6 months*	0.4 mcg	0.4 mcg
7–12 months*	0.5 mcg	0.5 mcg
1–3 years	0.9 mcg	0.9 mcg
4–8 years	1.2 mcg	1.2 mcg
9–13 years	1.8 mcg	1.8 mcg
14+ years	2.4 mcg	2.4 mcg	2.6 mcg	2.8 mcg

* Adequate Intake

 In a well-balanced diet, a person obtains approximately 5 to 15 mcg of vitamin B12 daily, which is much more than the recommended dietary allowance noted above. This is why it takes years to develop true B-12 deficiency! For a healthy, young, individual - it takes anywhere between 3 to 5 years to develop B-12 deficiency since we have a huge reserve of B-12 stored in the liver.

Symptoms of B-12 Deficiency

Symptoms of B-12 deficiency can be divided into different categories as B-12 plays an important role in the formation of red blood cells and the functioning of our nervous system (nerves and brain).

The clinical manifestations of B-12 deficiency on the blood include anemia leading to feeling tired, weak, and/or short of breath. 

The clinical manifestations of B-12 deficiency on the nerves include:
-feeling numbness or "pins and needles" in your hands and/or feet
-loss of sensation in the hands and/or feet
-inability to walk
-inability to sense ones feet on the ground

The clinical manifestations of B-12 deficiency on the brain include:
-confusion
-change in mental status
-personality changes
-difficulty with memory
-depression

Who is at Risk for B-12 Defiency?

1) The malnourished

Those with limited access to foods containing B-12 (vegetarians) or who do not follow a well-balanced diet (such as the elderly or alcoholics) or at risk or B-12 deficiency. 

2) Those with diseases effecting intrisic factor production in the stomach such as pernicious anemia 

3) Those with decreased acid production in the stomach due to:
- medications for GERD/Acid Reflux (like "H-2 blockers" (i.e. Zantac) or "Proton Pump Inhibitors" (i.e. Nexium, Protonix, Prilosec))
-surgical resection of parts of the stomach (such as weight loss surgeries) 

Acid in the stomach helps to breakdown B-12 so that it can bind to intrinsic factor and be absorbed. If there is less acid in the stomach due to the conditions above, one might develop B-12 deficiency.

4) Older individuals

Older individuals are at risk for B-12 deficiency due to limited nutritional intake of B-12 and development of atrophic gastritis. Many elderly patients are predisposed to atrophic gastritis, since acid production decreases with age as the stomach lining begins to thin. 

5) Individuals with diseases effecting absorption of nutrients in the intestines such as celiac disease, inflammatory bowel disease, and those who have undergone intestinal surgeries

6) Those taking medications such as: Metformin, cephalosporins, aminoglycosides, etc.

Who Needs To Be Taking B-12 Supplements?

I would recommend having your B-12 levels checked if:

-you are experiencing any of the symptoms that I have mentioned above

-you consider yourself in one of the groups outlined above who are "at risk" for B-12 deficiency

-you are older than 65 years of age

Treatment of B-12 deficiency is quite common and curable, so be sure to ask your doctor if you need further supplementation! 

Please continue to email your questions/comments to DoctorDeenaMD@gmail.com


**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

First-Aid Tip #4: How to Control An External Bleed

To continue this week's trend of daily first-aid tips, today we will focus on first-aid tips for management of an external bleed.

Most external bleeds (bleeding from outside the body) can be controlled. If left uncontrolled, bleeding can lead to shock (a term used to a describe a condition where all the organs of the body stop functioning) and ultimately death. Thus, controlling an external bleed can be lifesaving with the following steps:

1. Call 911
This is a life-threatening emergency, and the person will need medical evaluation fast!

2. Check what I call -"the ABC's of life": Airway, Breathing, Circulation
Is the person talking to you? 
If yes - you can be confident that they are breathing. 
If the person is not able to talk and does not appear to be breathing-- check their airway (look at the back of the throat for any foreign objects that are obstructing the back of their throat, if you notice something attempt to take it out).

If there is no object obstructing the airway and you are certain the patient is not breathing begin mouth-to-mouth resuscitation and CPR if you know how. 

2. Identify the source(s) of bleeding
Look for the areas where there is the most amount of new blood accumulating.

3. Hold pressure over the wound site
One you have identified the source of bleeding, take a clean cloth, gauze, towel, clothing or any piece of material (the ones that are most absorbent are best) and hold pressure over the source of bleeding. This step is important for allowing the blood to form a natural clot. Depending on the severity of the bleed, you may need multiple layers of materials to hold pressure. Continue to hold pressure until help arrives.

4. Elevate the wound above the level of the heart
This will slow down the flow of blood from the heart and hopefully slow down the rate of bleeding. Don't forget to keep direct pressure on the wound...don't let go until help arrives!

5. Keep the wounded person hydrated
If there is water or fluids for drinking available, have the person continue drinking fluids since they are losing a significant amount of blood.

True or false:
Always use a tourniquet to control bleeding.

courtesy of www.firstaid.about.com

Answer: False!
Despite what you see in the movies where everyone puts on a tourniquet to control blood loss after they have been shot or wounded, tourniquets can actually be more harmful than beneficial. Using a tourniquet requires wrapping a piece of material around an extremity and tightening it until blood flow has ceased. 
 Using a tourniquet to stop bleeding has the potential to damage the entire arm or leg. Patients have been known to lose limbs from the use of tourniquets. Tourniquets should ONLY be used as a last resort to control a bleed!

Hope this information helps you feel more comfortable if you are a first-responder at an accident scene, etc...these tips might help you save someone's life one day!

Please feel free to leave comments below, and email me at DoctorDeenaMD@gmail.com with any questions or tips that you would like me to discuss!

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**