Monday, March 25, 2013


An action plan for asthma

More than 23 million people have asthma in the United States, with nearly 9 million of them children, according to Medline Plus. In fact, it is the number one reason children are absent from school.

Flare-ups, or asthma attacks, are the most common cause of pediatric emergency department visits. But with the right asthma management plan —  and education —  asthmatics can learn to control their symptoms and flare-ups.  Asthma should not inhibit our daily activities.

Asthma is a lung condition that causes difficulty breathing. The symptoms include coughing, wheezing and shortness of breath. Although it may seem that an asthma flare-up happens without warning, the truth is the flare-up has been developing over time. It is caused by:

•  Swelling of the lining of the airways
•  Excess mucus that results in congestions and mucus “plugs” that get caught in the narrowed airways.
•  Tightening of the muscles surrounding the airways or bronchoconstriction.

When these three changes occur, it makes it difficult to take a deep breath. It feels like you are breathing through a straw. You may also experience coughing, wheezing, chest tightness, an increased heart rate, sweating and shortness of breath.

Asthma Triggers: Learn what triggers your asthma and eliminate these triggers.  Some common triggers can be allergies, airborne irritants or pollutants such as smoke, perfumes, strong odors from fresh paint or cleaning solutions, respiratory infections and even the weather.

Treatment: Asthma is treated based on its severity and triggers. Most asthma medications are inhaled, but some may be taken in pill or liquid form. Medications fall into two (2) categories: Rescue medications and controller medications. 

Controller Medications: Controller medications,  also called “preventative” or “maintenance” medications, manage asthma and prevent symptoms. Many people with asthma need to take a medication every day to treat the problem of airway inflammation. They work slowly, so it may take days or weeks for them to begin working. By taking a controller medication regularly, you may notice that you do not need to use your rescue inhaler as often.  Controller mediations are also prescribed to minimize any permanent lung damage associated with having asthma.

Rescue Medications: Rescue medications act quickly to stop the symptoms but are not long-lasting. Once they start working, they stop asthma symptoms — wheezing, coughing and shortness of breath.

Inhaler or Nebulizer? Asthma medications can be provided by two different types of devices – an inhaler or nebulizer. Most people use inhalers, but there are times when a nebulizer may be needed. Nebulizers are electric- or battery-powered machines that turn liquid asthma medication into a fine mist that is inhaled into the lungs.

An advantage of a nebulizer is that you can sit in one place and breathe in the mist. The disadvantage is that they take 5 to 10 minutes to deliver the medication, are noisy and not easy to carry around.

Inhalers, or metered dose inhalers, are portable hand-held devices that are small enough to carry in a pocket, purse or backpack. They deliver a premeasured puff of medication, and require the person to coordinate squeezing the inhaler and inhaling the medication into the lungs.

Sometimes when using an inhaler the medication will reach the back of the throat but not go down the lower airways --  where it needs to go to be effective.  Dr. Thinesh Dahanayake, a pulmonologist at Pulmonary Physicians of Norwich and member of the Backus Medical Staff, suggests most individuals use a device called a spacer when using an inhaler. According to Dr. Dahanayake, a spacer is easy to use and delivers the medication more effectively into the lungs, rather than in the mouth or throat.

Keep Your Inhaler Clean: Dr. Dahanayake also advises patients to keep their inhalers clean. If you see powder in or around the hole, clean it by removing the metal canister from the L-shaped plastic mouthpiece. Rinse the mouthpiece and cap in warm water, let it dry overnight and then put the canister back inside and replace the cap.

Asthma Action Plan: Your physician may provide you with an asthma action plan and peak flow meter. A peak flow meter is an easy-to-use handheld tool that measures breathing ability. If your peak flow readings are dropping, this is a sign of increasing airway inflammation, which can mean that you are not taking in a “normal” amount of air.

Your asthma action plan will have a green zone, yellow zone and red zone with a range for peak flow meter readings. Peak flow meter readings that fall in the green zone means the airways are open. A reading in the yellow zone means that there is a potential for an asthma flare-up and a reading in the red zone means the flare-up is serious and treatment is needed immediately, possibly a trip to your doctor or emergency department.

Controlling your asthma is as easy as 1…2…3…   1) Know what triggers your asthma; 2) take your medications as prescribed; 3) follow your action plan.

Lisa Cook is a community education nurse for the Backus Health System. To comment on this column or others, visit the Healthy Living blog at or e-mail Ms. Cook or any of the Healthy Living columnists at

Monday, March 18, 2013


Early treatment of Tourette's syndrome

Once considered a rare and sometimes strange disorder, some experts estimate that Tourette’s disorder impacts nearly 4% of young people between the ages of 5-18.

We are learning more about this disorder, which typically begins in childhood. Thankfully it is treatable, and we are beginning to break down barriers and reduce stigmas attached to these patients through education.  

One of the reasons Tourette’s is so misunderstood is because its symptoms can be seen and heard. Tics — rapid, repetitive muscle contractions (movements) or sounds that are involuntary —  are common signs of Tourette’s, and present themselves in various ways: 

•  Simple motor tics: Involve one or a small number of muscles, for example eye -blinking, grimacing, etc…
•  Simple phonic tics: For example, sniffing, grunting, yelping and snorting.
•  Complex motor tics: Contraction of several muscle groups and can mimic normal movements, for example knee bending, hopping, simultaneous extension of arms and legs, etc…
•  Complex phonic tics: Includes words or phrases like “Hi,” “I love you,” or obscene words. Repetition of someone else’s words is another common example.

Tics most commonly affect the face, head and neck, then limbs and trunk. Examples include blinking, raising eye brows, winking, grunting, snorting or clearing the throat.

Emerging data support the notion that tic disorders are genetic and involve disturbances of neurotransmitters in the central nervous system.

There is a close association between Tourette’s and Obsessive Compulsive Disorder and Attention Deficit Disorder.

Treatment of tics includes a combination of prescription drugs (including Risperidone, Clonidine, Guanfacine and Imipramine), psychotherapy (behavioral therapy, habit reversal, awareness training, family therapy)  and education (support groups and teaching families and teachers).

Research into Tourette’s continues. There is currently a clinical trial involving Aripiprazole , which  has been on the market to treat other disorders like bipolar, schizophrenia and depression,  which could have potentially excellent results. Progress is being made, and outcomes are improving.

Mahmoud Okasha, MD, is a psychiatrist with the Backus Medical Staff and an Associate Clinical Professor at the Yale University School of Medicine. To comment on this column or others, visit the Healthy Living blog at or e-mail Dr. Okasha or any of the Healthy Living columnists at

Monday, March 11, 2013


Is it normal forgetfulness or Alzheimer’s?

Haven't we all misplaced the car keys occasionally or drawn a blank on someone's name just as we were about to make introductions?

Sometimes we feel frustrated at this occasional forgetfulness. Sometimes we worry if it could be a sign of early Alzheimer's Dementia.

Recently, a vital, vibrant lady who is in her early 80s described some episodes of forgetfulness and asked me if she could be "getting Alzheimer's."

I reassured her that what she was experiencing was common for someone of any age. But I decided to do a little research to prove my assertions. I checked out the Alzheimer's Organization website

Here are some signs of Alzheimer's compared with typical age-related changes:

•  The most common sign of Alzheimer's is memory loss, particularly forgetting recently learned information. Asking for the same information over and over is another significant sign. Normal age-related change would be forgetting an appointment or event, but remembering it later.
•  We all lose things from time to time and that can be frustrating, but it's pretty normal. Misplacing things and being unable to retrace steps to find them is a sign of Alzheimer's.
•  Losing track of the date or the season is a sign of Alzheimer's. It is a typical age-related change to forget which day it is and remember it later.
•  We all make a bad decision once in a while. If poor decision-making and bad judgment becomes routine, further investigation is warranted.
•  A typical age-related change is sometimes forgetting which word to use. A sign of Alzheimer's would be difficulty having a conversation.

I was going to add something to this list, but now I don’t remember. Hopefully I’ll remember it later.

Alice Facente is a community education nurse for the Backus Health System. To comment on this column or others, visit the Healthy Living blog at or e-mail Ms. Facente or any of the Healthy Living columnists at

Monday, March 04, 2013


Improve health by washing away germs

Some might consider me a “germaphobe.” I consider myself safe.

In fact, many of nurses are commonly accused of being obsessed with washing our hands. That’s a good thing.

I’ll get back to what we do in the hospital in a moment. But here is something for you to consider:  Only one-third of people take the time to wash their hands after going to the bathroom, according to a study by the American Society for Microbiology.

During National Patient Safety Awareness Week March 3-9, hand washing is an appropriate topic. It’s the most important thing you can do to stop the spread of germs — during flu season and throughout the year, inside the hospital and out.

Outside the hospital, here are a few tips:

•  Keep your kitchens and bathrooms clean and free of clutter.
•  Sponges are filled with germs. To combat this, wet the sponge and microwave it on high for a minute.
•  Take care of leftovers as soon as everyone is done eating.
•  After washing dishes, clean the counters, faucets and sink.
•  Wipe down your bathroom every day.
•  Don’t just rinse your hands with water — soap should be used after going to the bathroom, before and after cooking and eating, etc…
•  Use the first stall in a public bathroom — it has fewer germs because people tend to pick others for privacy reasons.
•  Don’t put your bags on the floor of a public bathroom — it is loaded with bacteria.

In our hospital, we have a policy of “wash in, wash out.” This means that staff entering patients’ rooms are required to wash their hands when they enter and when they leave.

This is the single most important thing we can do to prevent the spread of infection in our hospital. We monitor this on a regular basis, and while I’d like to say there is 100 percent compliance, we are not there yet.

That’s where you come in. If you are a hospital patient, friend, or family member, I urge you to be a partner in your care. Be observant, and if you witness a staff member who does not observe this protocol do not be afraid to speak up. In fact, we encourage it.

Beth Sullivan is an infection control nurse for the Backus Health System. To comment on this column or others, visit the Healthy Living blog at or e-mail Ms. Sullivan or any of the Healthy Living columnists at

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