A heart attack occurs when blood flow to part of the heart muscle is blocked. If blood flow isn't restored quickly to that part of the heart muscle, it lacks nutrition and dies. That's why it's so important to seek medical help right away.

                If you or someone you're with may be having a heart attack, call 9-1-1 without delay. This needs to be an ambulance trip to the hospital, not a joy ride. If you get caught driving in traffic, you can lose valuable minutes. To help you visualize the urgency of the situation, think of a heart attack as a gunshot to the heart. If symptoms stop within five minutes or come and go, don't just thank your lucky stars. Call your doctor and describe what happened. A blood vessel could be on its way toward blockage.

                Cardiologists call the 60 minutes after a heart attack the "golden hour." That's because this is the narrow window of time when treatment can open arteries and prevent permanent heart damage. These heart specialists have two methods for doing this. They can use a clot-dissolving drug. Or, they can perform a procedure to open blocked heart arteries (angioplasty).

                If treatment is so effective, why don't people get themselves promptly to the hospital where they belong? Maybe it's because many have a Hollywood image of a heart attack: the clutching of the chest, the unbearable pain, the dramatic collapse onto the floor.

                But a heart attack can have several guises. Symptoms can begin quickly or slowly. They can be severe or mild. They may come and go. They can even vary from one time to the next. And some people may have no clear symptoms at all. These are called "silent heart attacks." They are more common in people with diabetes.

                Chest discomfort or pain may be a hallmark of heart attack. But it can feel more like pressure than pain. It may be a squeezing or heaviness, making it difficult to catch your breath. Or, you may have a feeling of fullness or indigestion, resembling heartburn.

                You may have other warning signs of a heart attack, including:

• Discomfort in one or both arms, or your back, neck, jaw, or stomach
• Nausea, vomiting, lightheadedness, or fainting
• Sweating

                So if this happen to you or someone you know, will you take the needed action? Or will you be afraid you're being alarmist and worry that the symptoms were nothing but a case of indigestion? If so, remember this: You can't die of embarrassment. But a heart attack can most definitely kill you.

                After a heart attack, doctors often prescribe medications to prevent a second one. These work in various ways.  For example, they might prevent blood clots, lower cholesterol, or lower blood pressure. Don't stop taking these without your doctor's okay. If you run into any problems or have any questions, I'm here to help guide you.

Sources

1. National Heart Lung and Blood Institute. "What Is a Heart Attack?"
http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/
HeartAttack_WhatIs.html

2. National Heart Lung and Blood Institute. "Heart Attack: Key Points."
http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/
HeartAttack_Summary.html

3. National Heart Lung and Blood Institute. "Heart Attack Warning Signs."
http://www.nhlbi.nih.gov/actintime/haws/haws.htm

4. WebMD: "Heart Attacks and Heart Disease." http://www.webmd.com/
heart-disease/guide/heart_disease_heart_attacks

Should you be concerned?

Nasal irrigation can improve symptoms when you have a cold or allergies. If properly used, a neti-pot or nasal irrigation's benefits out way the risk of causing an infection.

If you get frequent sinus infections and you use nasal irrigation, make sure you are using the product correctly. You should always wash out the irrigation device after each use with soap and hot water. You should never share the device with anyone else. If you correctly use the device and still get frequent sinus infections, discontinue use for a period of time and to see if the infections stop occurring. For some people irritation caused by use of a neti-pot can cause more sinus infections.  

Talk to your Doctor our Pharmacist about nasal irrigation and how to do it properly.

• Heart disease
• Certain cancers
• Multiple sclerosis, type 1 diabetes, and other autoimmune diseases
• Osteoporosis
• Parkinson's disease^1,2

            Vitamin D is a hormone your body makes from cholesterol. This is a process triggered by the interaction of sun on skin. Vitamin D is also a nutrient you can get from certain foods such as fatty salmon, tuna, and mackerel. Some foods are fortified with this vitamin. Examples include certain breakfast cereals, yogurt, juice, and milk.³ But it's hard to get enough vitamin D from foods or by being in the sun, especially with concerns about skin cancer. That's where supplements come into play.¹

            If you live at a higher altitude, shun the sun, have darker skin, are obese, or are older, you may be particularly deficient in vitamin D. The only way to know for sure is to have your blood tested.⁴ You can ask your doctor about this.

            In case you've missed it, there's an ongoing debate about how much you need to take to make up for any deficiency. In 2010, the Institute of Medicine (IOM) came out with new recommendations:

• 400 IU for infants
• 600 IU for people ages 1 to 70
• 800 IU for people older than 70¹

            But many scientists still feel this is too low to be fully protective. Doubling or tripling these numbers for those over age 2 may be optimal.¹ Even this may be too conservative. A new study reported that daily intake of vitamin D needs to be somewhere between 1,000 and 2,000 IU to maintain blood levels high enough to prevent major diseases such as cancer.⁵

            Are you considering doses higher than those recommended? Be sure to talk this over first with your doctor, as well as about potential interactions. Vitamin D can interact or interfere with certain medicines or supplements. Examples include prednisone, the weight-loss drug orlistat, cholesterol-lowering drugs and drugs used to control seizures.³

                Which type of Vitamin D is best – vitamin D2 or vitamin D3? Some scientists recommend D3 as it is closer to that produced in your body. However, others say the two are quite similar.  Talk to our pharmacist to help you to decide what is best for you and your family.⁶

                The jury is still out about exactly how much vitamin D you need to prevent serious diseases. But with so much research pointing in the direction of its benefits, surely vitamin D has earned its time in the sun.

Written March 2011

Sources

1. Harvard School of Public Health: "Vitamin D and Health." http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamin-d/index.html

2. MedlinePlus: "Vitamin D May Precede Onset of Parkinson's." http://www.nlm.nih.gov/medlineplus/news/fullstory_109815.html

3. NIH Office of Dietary Supplements: "Vitamin D." http://ods.od.nih.gov/factsheets/VitaminD-QuickFacts/

4. Harvard School of Public Health: "Comment on the IOM Vitamin D and Calcium Recommendations." http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamin-d-fracture-prevention/index.html

5. Harvard Website http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamin-d/index.html#iom-vitamin-d

6. Harvard School of Public Health: "Vitamins." http://www.hsph.harvard.edu/nutritionsource/questions/vitamin-questions/index.html#what-type-of-vitamind

Colds and flu – no big deal, right?  Well, yes and no. They usually don't last a really long time or cause serious problems.

                Colds can plague you with everything from a stuffy and runny nose to a scratchy throat and watery eyes – and nonstop sneezing that can even put your cat on edge. Flu bugs bring symptoms that can look a lot like a cold. But the flu tends to ambush you suddenly, last longer, and pile on other "treats" such as fever, fatigue, headache, chills, and achiness.

                Some people who get the flu, though, are at risk for pretty serious health problems. In fact, flu-related complications send more than 200,000 Americans to the hospital each year with thousands dying. Even the common cold takes a toll, accounting for 22 million lost school days in the U.S. each year.

                Prevention is looking better and better, isn't it?

                The number-one thing you can do to prevent the flu? Get a flu vaccine, which protects against the three most likely flu viruses to strike each season. The Centers for Disease Control and Prevention (CDC) now recommends that everyone six months and older get a flu vaccine. Get the vaccine as soon as it is available if you are at high risk – you are pregnant, 65 or older, or have a chronic disease. It's also more important if you are a health care worker or care for someone who is at increased risk.

                Available as a shot or nasal spray, the flu vaccine is best received in October or November, although you may still benefit in December or January. Ask your doctor or me if you have questions about this.

                Colds and flu are spread mostly by droplets in the air or by touching a contaminated surface, then touching your eyes or nose. So some other simple steps may go a long way toward helping you prevent these common diseases.

                Wash your hands often with warm, soapy water for about 15 to 20 seconds.  If you're away from soap and water, an alcohol-based hand rub will do. Avoid touching your eyes, mouth, and nose as much as you can. No free rides for these germs! Set a good example for your kids and encourage them to do the same. Also, try to limit being around people who are infected.

                Sneezing and coughing yourself? You know the drill: Cover your nose and mouth with a tissue, then throw it in the trash. If there's no tissue in sight, cough or sneeze into your elbow or upper sleeve. Be sure to pass this tip on to your kids. If you've got a fever, stay home for at last 24 hours after the fever is gone – that is, gone without the use of a fever-lowering medicine.

                Don't forget that other all-around healthy habits – a balanced diet, sleep, exercise, and stress control – can help prevent colds and flu. And, remember that exposure to tobacco – firsthand or secondhand – makes you more prone to respiratory illnesses.

Did you know that having diabetes before age 65 more than doubles your risk of developing Alzheimer's disease? A study of nearly 14,000 Swedish twins helped to confirm this link. Given that more than 23 million Americans have diabetes and 57 million more have pre-diabetes, this is a bit of a concern. But the link between these two diseases may be stronger still. In fact, some now think of Alzheimer's as a form of diabetes. They call it type 3 diabetes.

            But first, a review. What exactly are diabetes and Alzheimer's?

            Diabetes is a chronic disease where your body has high levels of sugar. That's true for one of two main reasons: Your body doesn't make enough of a hormone called insulin (type 1 diabetes). Or, your body doesn't respond well to insulin (type 2 diabetes). Diabetes can cause frequent urination, unusual thirst, and a wide range of other symptoms. It can cause serious – even fatal – complications. People with pre-diabetes also have high glucose levels. But they're not as high as with full-blown diabetes.

            Alzheimer's is a common type of dementia that worsens over time. It causes memory loss, confusion, and many other changes. It eventually leads to death. Scientists have long debated about the changes in the brain that lead to Alzheimer's. But now they are paying closer attention to the role of insulin. Not only are people at increased risk for Alzheimer's if they have diabetes. But many people with Alzheimer's are also resistant to insulin.

            Could low insulin or insulin resistance in the brain be the cause of Alzheimer's in some cases? Lower insulin islinked with mental decline. By helping cells take up energy in the brain, insulin likely plays a key role in the growth and survival of nerve cells and memories. Researchers are now experimenting with inhaled insulin as a treatment for Alzheimer's. It has improved memory in patients with early stages of Alzheimer's but it appears to have limitations.

            So, rather than diabetes simply being a cause of brain changes, both diabetes and Alzheimer's may result from similar causes. The idea that one disease can affect many organs is certainly not new. After all, atherosclerosis affects the kidneys, brain and heart. Now, we know that diabetes and Alzheimer's may be a part of the same disease process.

            Before you become too discouraged about the threat of all these diseases, though, remember this: Many of the factors that contribute to both Alzheimer's and diabetes (and atherosclerosis, for that matter) are within your control. Weight loss, exercise, stress management, and a healthy diet can help prevent or help keep diabetes in check. And, it's possible these lifestyle changes could play an even bigger role with Alzheimer's than once thought.

            For a wealth of information on these diseases, go to www.healthmart.com/. And, don’t forget: If you need any guidance on diabetes management, I'm here to help. Or, be sure to ask me if you have questions about your loved one's Alzheimer's medications.

As your parents enter their twilight years, you may feel as though you don't want to meddle in their affairs. But when it comes to their health and safety, try not to stay in the dark. By paying attention to any warning signs, you'll be in a better place to take steps that can help them stay independent as long as possible.

                Here are a few things to watch for.

                Parent trap? Has a parent suffered a fall at home? Or, is one of them about to undergo a major surgery such as a hip replacement? If so, it's likely time to view your parents' home through a new "lens." The loose throw rugs that were once no big deal may now be a set-up for trouble. See if other adjustments are needed, such as a raised toilet seat, extra handrail, or shower chair, for example.

                Mysterious weight loss. This is a red flag at any age, and is worth checking out. Often, it's the result of an underlying medical condition. But it can also mean something's "brewing" in the kitchen. Maybe the chef of the family is now having trouble with cooking tasks. Or, problems with taste or smell may have developed due to aging, illness, or a medication.

                Declining self care and home care. Is your normally fastidious father letting himself go – wearing the same clothes for three days in a row? Do you increasingly find rotten food in the fridge or an overgrown garden that was once your mother's pride and joy? These can be signs of Alzheimer's or depression. Or, there may be another underlying health condition that's partly to blame.

                Shifting behaviors. Have neighbors or friends noticed a change in one of your parents' behaviors? Maybe they've become unusually noisy, more agitated, or up at strange hours of the night. Maybe finances are in disarray or a large number of magazines are now showing up in the mailbox. Has a parent become unwilling to get out and see friends or to keep up with hobbies and activities? These could be signs of Alzheimer's or depression. But don't rule out physical sources for some of these problems.

                If you notice signs of a problem, where should you begin? Start by expressing your concerns with your parents. You might do this together with other loved ones or maybe a clergy. Or, offer to take your parent to a doctor appointment. Take an inventory of the house to see which safety issues need to be addressed first. Is it possible to hire someone to handle household chores or to run errands? Or, can you arrange for meals to be delivered or for a home health care aide to help with daily activities? If these measures are not enough, it may be time to suggest a move to an assisted living facility.

                If you don't know where to find resources, try the Eldercare Locator at eldercare.gov. It can connect you with services in the area where your parents live. And, remember that I'm always glad to consult with you about any concerns you have about your parents' medications.

                These can be challenging times, but with the right support, you can do it.

With middle age often comes an all too familiar visitor. Marked by the gradual loss of cartilage, osteoarthritis can show up in many joints – from keyboard-typing fingers to tennis-twisting knees. Over time, it can cause swollen, aching, gnarled joints – and put a major crimp in your style!

                For mild pain that comes and goes, rest – and maybe cold or heat – may be all you need. Then, over-the-counter (OTC) acetaminophen (such as Tylenol or Excedrin) or aspirin every four hours may relieve the kind of pain that shows up after an ambitious spring-cleaning or daylong tug o' war with some particularly stubborn weeds.

                When pain lasts longer, OTC nonsteroidal anti-inflammatories other than aspirin may do the trick. These work by not only decreasing pain, but also inflammation. Examples include ibuprofen such as Motrin or Advil, or naproxen such as Aleve or Naprosyn. Check the package for dosing instructions.

                For quick relief affecting just a few joints, topical medications may be the way to go. These are absorbed through the skin. They come as sprays, or creams or gels you rub in, or patches that stick to the skin. They're most effective for joints that are close to the skin's surface.

                You may be most familiar with topical medications containing salicylates, which is found in aspirin – think BENGAY, Aspercreme, or Flexall. Sometimes products with menthol (ArthriCare, Icy Hot, Therapeutic Mineral Ice) also work to override pain sensations with heat or cold. But, did you know that capsaicin, a substance found in chili peppers, is also sometimes used for arthritis pain? Olé! It works by depleting a chemical in nerve cells, thereby interrupting pain messages. Products include Zostrix and Capzasin-P.

                Do these products work? Well, some people say they help, but scientists note that the research only reports a mild benefit. Might be worth a try. Do take a few precautions, however. For example, be sure to wash your hands after applying capsaicin and avoid touching your eyes. If you've ever accidentally done this after chopping hot chili peppers, you know what I mean! Also avoid using any of these products on broken or irritated skin, or with a heating pad or bandage. If you know you're allergic to aspirin or you're taking blood thinners, check with your doctor before using products containing salicylates.

                Another topical option is a Lidocaine patch (Lidoderm). These are approved for shingles, but are sometimes also used to numb the pain of osteoarthritis for 12 hours at a time.

                NSAID pills can be tough on the stomach, so you might want to give topical NSAID creams or gels a try. The Food and Drug Administration (FDA) has approved a prescription NSAID gel containing diclofenac (Voltaren) for osteoarthritis in hands, wrists, elbows, feet, ankles, or knees. A patch is also available.

                If these steps don't manage your symptoms, or if you find yourself using OTC medications very often, be sure to have a talk with your doctor. Then, feel free to stop by with any questions you have for me.

Kids should learn to share, right? But, gee whiz…. When it comes to bugs and other contagious health problems in school, does your kid have to get everything that's passed around?

                Packed into a classroom and messing around on a playground or locker room, kids do tend to share lots of health problems in school. What can you do about it? And when should you be concerned? Here are a few things to think about.

                Does head lice top your list of concerns? Although these creepy insects might disgust you, it may help to know that they don't cause diseases or other health problems – other than maybe a red, rash-like reaction.  Of course, that doesn't mean you want to ignore them since they spread really easily. Follow up with the doctor if your child complains of an itchy scalp or you catch sight of tiny white eggs firmly attached at hair roots. These are often confused with dandruff. Your child's doctor may prescribe a treatment and other over-the-counter (OTC) shampoos or rinses. Follow directions closely and be sure to ask me if you have any questions.

                Viral infections such as chicken pox are common, too. Many are contagious before skin lesions appear. But be sure to keep your child home until the sixth day after the rash appears unless all lesions are dry and crusted over. To prevent this infection, have your child vaccinated.

                Fifth disease is another viral disease. It causes a lacy rash on arms and redness on cheeks that looks like the result of a well-placed slap. Unless your child feels too sick, there's no need to stay home. That's because the disease only spreads before symptoms appear. However, tell the school so female employees of childbearing age can be notified. Fifth disease can severely hurt a developing fetus.

                Although there are many kinds of hepatitis, hepatitis A is the most common type in children. This virus is in blood and bowel movements, so hand washing is really important to prevent its spread. A child with hepatitis A should stay home until a week after the onset of illness and until any jaundice (yellowed skin) disappears. Another disease spread through bodily fluids is HIV/AIDS. Although it can cause anxiety among parents, remember that casual physical contact – such as hugging, holding hands, or sharing a glass – does not transfer this virus.

                Then, there's the run-of-the mill colds and flu. Deciding whether or not to send your child to school can be a challenge. General rule of thumb? If there's a fever, keep 'em home – until the fever's been gone for at least 24 hours.  If there's no fever, more than likely it's a cold and it's okay to go to school. When in doubt, check with your child's doctor. And, don't forget the flu vaccine, which is recommended for everyone 6 months and older.

                Stop by, and I can advise you on the best way to keep your child comfortable while the cold or flu runs its course. I can also give you a brief overview of prescription or OTC treatments for the more common childhood viral infections.

Few things are as unsettling as a sick baby, struggling to breathe – especially when it's yours! And, figuring out the source of the problem can be a bit of a puzzle, particularly if your infant has asthma.  That's because asthma in infants can have many faces. Babies with asthma often have sudden, severe wheezing and trouble breathing, just as older children do. But asthma in infants may also show up as chronic coughing, noisy breathing, or "chest colds."

            Asthma is a chronic lung disease. It makes the airways swell, tighten, and produce too much mucus. Severe asthma attacks can require a trip to the emergency room. And, uncontrolled asthma can damage the lungs over time. So, this is not something to ignore. If your baby has unexplained respiratory symptoms, stay alert and in communication with the pediatrician. Be prepared to tell the doctor how and when symptoms get worse. This can help rule out problems and confirm a diagnosis of asthma.

            If anti-asthma medications relieve any wheezing and coughing, the diagnosis is pretty clear. But in some cases, other asthma mimics need to be ruled out. These include viral infections or congenital conditions or diseases such as cystic fibrosis. If it turns out your baby does have asthma, you may be wondering what caused it and what to do next! Although no one really knows the cause, your genes may play a role. Other factors may also come into play. Some doctors think breastfeeding the first year can help prevent asthma, but the evidence doesn't yet support this.  

            Keeping your baby away from common asthma triggers such as cigarette smoke, aerosol sprays, pet dander, and dust mites may lessen symptoms of asthma. If you suspect a certain food is causing an allergic reaction, this could also trigger asthma. Remove the food from your baby's diet, and then reintroduce it, to see what happens. However, it's hard to do very much about other common triggers, such as crying, respiratory infections, and weather changes.

            Prescription anti-inflammatory medications are the other mainstay of asthma treatment for infants. Your baby may need a combination of different types of medications. Be clear about whether you should give medication continuously or only when symptoms appear. A nebulizer uses forced air to send out a mist of medication that your baby can breathe through a mask. Don't be alarmed if it takes a little while for your baby to get used to this. If your child is a toddler, it may be possible to use an inhaler with a spacer (a small tube).

            Are you concerned about trying these medications in such a small child? Remember that, along with your child's pediatrician, I can help guide you in their safe and effective use. But whatever you do, don't put off seeking care – even if you think your child may "outgrow" this problem. Some kids' asthma does get better with time, but the best results come with adequate treatment.

In today's economy – where every dollar counts – budgeting can be about as painful as a root canal. So, when it comes to something like allergy control, you may feel you don't have anything left over to spend. Still, there's no need to suffer in silence. A few simple steps can make a big difference, while costing very little.

            To start, think about the things you can do that are free – or practically free. For example, clear out items that might be collecting dust mites. Think extra pillows, throw rugs, or stuffed animals. Are hypoallergenic pillows and comforters or allergen-proof covers (starting around $65) too costly for you? Then keep bed linens and other items around that can be washed in hot water. And, rent a steam cleaner for about $25 a day to steamroll those nasty little allergens lurking in carpets.

            Speaking of cleaning, dust and pollen masks and nonlatex gloves are very low-cost ways to whip through the housework (or gardening) without exposing yourself to extra allergens. Microfiber hypoallergenic cloths are specially designed to attract dust and allow you to clean without the use of chemicals. They generally cost around $1 to $2 a piece. Use a diluted bleach solution to wipe down surfaces in bathrooms and other places. And, even if you don't have a HEPA (High Efficiency Particulate Air) vacuum cleaner, don't forget to change your vacuum bag at least once a month. A washable rubber mat at the front door will cut back on what gets tracked in.

            If you can spring for a portable air cleaner, make sure you find one that doesn't produce ozone. This can make allergies worse. A good place to research these products is at the website of the Association of Home Appliance Manufacturers (AHAM) [www.cadr.org/]. Here, you can find information about all kinds air filtering technologies, from HEPA to ionization.

            Short of buying an air cleaner, though, it might help to buy a pleated paper furnace filter with a MERV rating of 7 to 13. These capture many of the allergens HEPA filters do and cost around $10. Electrostatic filters do a similar job and cost around $15.

            Humidity is also an important factor when trying to control allergies. You want it low enough to control dust mites, but not so low it irritates your nasal passages. A $15 hygrometer can help you see if you're in a safer range – between 30 and 50 percent humidity. Then you can use a humidifier or dehumidifier to achieve the right level. To help keep those nasal passages clear, consider using a bulb syringe or neti pot ($15), filled with lukewarm saline.

            Remember: Many of these products are available in our store. And, of course, don't forget about over-the-counter (OTC) allergy medications, such as pills, eyedrops, and nasal sprays. Check with me about any prescription medications that may now be available as cheaper OCT medications. For example, a wide range of Allegra products, the best-selling antihistamine, is now available over the counter.

            And one final note: If you or your child needs allergy shots, you may be heartened to learn this: A 10-year study showed that allergy shots reduce overall health care costs in children by one-third and prescription costs by 16 percent. A pretty sound investment.