Category: Recommendations

RICE your knees…How to care for a sports injury

As the weather is starting to warm up, many of us are thinking about getting outside and getting active.  With this increased movement, it’s no wonder that a search of google trends from 2004-2016 showed that April of each year is the most common month for searches related to knee injuries (1).

The R.I.C.E. method is one of the most commonly recommended ways to treat sports injuries to joints and muscles.  It has even received a stamp of approval from the American Orthopaedic Foot and Ankle Society (2).  This method has 4 steps:

 

R is for Rest  Try to avoid using the injured area and putting weight on it for 24-48 hours if possible (3)

I is for Ice Every 4 hours, put rice on the injury for 20 minutes at a time (3).  For comfort, you can place a thin cloth between the ice bag and your skin (2).

C is for Compression Wrap the area with a bandage, like an ACE wrap, in order to gently compress the injured area.  This will help control swelling.  Just be careful not to wrap it too tight and cut of your blood flow (3).

E is for Elevation This is your opportunity to sit and prop your feet (or other injured spot) up.  Use pillows or other comfortable items to try to keep the area above the level of your heart.  This can reduce swelling (3).

 

Once you start feeling better, you can SLOWLY and GENTLY start using the injured area again.  Also, if you’re not sure how bad you’ve hurt yourself, be sure to get it checked out by a medical provider.

 

References

  1. Using Google Trends To Assess For Seasonal Variation In Knee Injuries. Dewan, Varun and Sur, Hartej. February 21, 2018, Journal of Arthroscopy and Joint Surgery.
  2. American Academy of Orthopaedic Surgeons. How to Care for a Sprained Ankle. American Orhopaedic Foot and Ankle Society. [Online] http://www.aofas.org/footcaremd/how-to/foot-injury/Pages/How%20to%20Care%20for%20a%20Sprained%20Ankle.aspx.
  3. Sports Medicine at the University of Pennsylvania Medical Center. How to Use the R.I.C.E Method for Treating Injuries. UPMC Health Beat. [Online] August 27, 2014. https://share.upmc.com/2014/08/rice-method-for-treating-injury/.

 

 

Welcome to Allergy Season

Right now, there is a yellow haze covering the state of North Carolina.  Noses are running, eyes are watering, and there are sneezes galore.  Welcome to allergy season.  Five North Carolina cities made the Asthma and Allergy Foundation’s list of the worst 100 U.S. cities for allergy sufferers (1).

 

If you’re feeling the effects of seasonal allergies, there are some things you can do in order to keep breathing clearly.

  1. Try to avoid tracking pollen into your home. This includes taking off your shoes when you come inside and wiping down pets when they come in.
  2. Dust and vacuum your home. Though the cleaning may stir up dust and make allergies worse in the short term, getting rid of allergens in your home can make a big difference overall.
  3. Netti pots are something else you can try if you’re not wanting to take medication. These allow you to flush your nasal passages with saline in order to wash the allergens out.
  4. Try an antihistamine. There are many over the counter antihistamines that can help decrease allergy symptoms.  Common non-drowsy options include loratadine and fexofenadine.  Diphenhydramine is another option, but it does make most people sleepy.  Cetirizine is one other over the counter antihistamine that make some people sleepy.
  5. Some people also benefit from an over the counter nasal steroid like fluticasone. It often takes 2-3 days of use before you see benefits, so it may not help much in the short term.  However, it can decrease overall nasal allergy symptoms.

As always, be sure to read the directions on over the counter medications, and check with your doctor if you have any other medical conditions before you try any new medicine.

 

Work Cited

  1. Asthma and Allergy Foundation. Spring Allergy Capitals 2016. Asthma and Allergy Foundation. [Online] 2016. http://www.aafa.org/media/Spring-Allergy-Capitals-2016-Rankings.pdf.

Crystal Bentley is a registered nurse with 2 years of dedicated allergy experience.

 

 

 

 

 

 

Headache Me This

What causes headaches? I find myself Googling this at least once every few months when a particularly nasty or persistent headache of my own decides to show up. And I think it’s because I never really get a satisfying explanation from my searches, likely due to the fact that there are hundreds of headache types and only 10% have a known cause. Let’s focus on primary headaches, ones not caused by an underlying condition.

There are a lot of culprits for primary headaches. Nerves/blood vessels/tissue around the skull, muscles of the head/neck, and chemical changes within the brain can spur on that pain. So what triggers these physical pain signalers? It is probably no surprise that stress or alcohol are included. Skipping meals, poor posture (thanks, laptops), disrupted sleep patterns, and changing weather as well.

Some of these triggers are outside of our control like the weather, but there are measures we can take for prevention. Even though yes, easier said than done, try to avoid known stressors where possible. Eat low-processed meals at regular intervals and prioritize consistent sleep habits. Deficiencies in magnesium may play a role so eat some avocado and nuts. And when all else fails, put the screens away, take a warm shower, apply a soothing compress to the neck, and go the heck to sleep. Admittedly just writing about all the things that I should be doing right now has not made my headache go away, so off to self-care I go.

Just Trust Me (Part IV)

In the past few weeks, I have illustrated how trust (or lack thereof) shapes the relationship between individuals and healthcare, and how mistrust is historically justified. In this last segment, I want to talk about potential solutions from a social justice standpoint.

Trust is often cited in public health from the angle of paternalism, something that public health is often associated with. When we think of optimal paternalism – using scientific knowledge to influence the health decisions of the general public – we ask ourselves: are we abusing trust, or using it for good?

Public health, while sometimes paternalistic, already stresses to its students the importance of working with oppressed communities as equals to identify and solve problems. Medicine needs to catch up. Many medical students already participate in racial and cultural training, but they need to be trained from a structural angle – to gain an understanding of oppression and policy – too.

We need to support training for healthcare providers that doesn’t shy away from the tough stuff. Hands-on learning, such as tactful poverty simulations, can help. This will allow them to understand things like how the cycle of poverty makes some patients less talkative with authority figures (such as doctors) than others. We need to support minority students in medicine, so that patients can see representation of themselves and feel understood. We need to provide incentives for students to stay in their own communities for residencies. Of course, broad class mobility-enabling policy is the ultimate solution.

Many times, our work seeks to increase trust, but that puts the burden on the patient instead of addressing the reasons behind mistrust. Teaching trust in and of itself is a paternalistic objective: we should instead focus on deserving it.

Crash or DASH- choosing the right diet

February is heart month.  We’re often told that in order to keep our hearts healthy we should maintain a healthy weight.  Many people try to do this by dieting, but do diets really make us healthier?

New research has emerged that meal replacement crash diets (typically consuming only 600 to 800 calories each day) can temporarily worsen heart function [1].  This means that if you have heart problems, these diets could actually make your health worse instead of better.  If you’re looking for a healthy way to lose weight, you may want to check out the National Heart, Lung, and Blood institute’s DASH diet.  In January, U.S. News and World Report ranked the DASH diet as the best overall diet plan for the eighth year in a row [2].  The DASH diet also claimed first place in the healthy eating and heart disease prevention categories.

If you feel like dieting, stop and ask yourself why you’re doing it.  If you’re trying to get your heart in shape, you may want to rethink that overly restrictive diet.

 

References

[1]   European Society of Cardiology (ESC). “Crash diets can cause transient deterioration in heart function.” ScienceDaily. ScienceDaily, 2 February 2018. www.sciencedaily.com/releases/2018/02/180202123836.htm

[2]  National Heart, Lung, and Blood Institute. (2018, January 3). DASH ranked Best Diet Overall for eighth year in a row by U.S. News and World Report. Retrieved from National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/news/2018/dash-ranked-best-diet-overall-eighth-year-row-us-news-and-world-report

 

Bare cupboards and full bellies: Food Purchasing patterns change over time

Food purchasing patterns are a pretty good indicator of what people eat on a regular basis.  If you purchase healthy food, it’s presumed that you eat healthy food.  Recently, research from the United States Department of Agriculture revealed that food purchasing habits are changing over time. The grocery carts of younger food shoppers’ look vastly different than previous generations’. According to one report, they may even be empty.

Millennials, anyone born between 1981 and 1996, tend to purchase more premade meals and eat away from home more than older generations [1].  Restaurants have become more popular among youth and time spent preparing meals at home is decreasing.  Overall, older generations consume food in restaurants and bars about 70 percent less than millennials. Millennials spend a large portion of their income on pasta, sugar/sweets, and prepared foods, and as they acquire more disposable income they purchase more vegetables to prepare at home.  These findings could indicate that although millennials are more likely to eat out as they move farther into their careers and acquire more household income, they could gravitate toward purchasing more fruits and vegetables.

While millennials gravitate toward healthier foods, we should pay attention to nutritious food options and the food available to lower-income millennials.  Foods prepared by restaurants and bars and premade foods are often high in sodium and sugar.  Fast food restaurants are notorious for these types of foods (think cheeseburgers, deep-fried French fries, milkshakes, and slushies) and found more often in lower-income communities.  These foods put people at risk for hypertension, heart disease, and diabetes.

Nutritionists could encourage eating and cooking at home more often because hello it’s cheaper, made just the way you like, and you know what’s going into your meals that’s not always feasible with busy schedules.  We can, however, consider the following tips for healthier meals away from home:

  1. Choose less processed foods. Foods that are less processed often have less sodium and sugar added. If you can choose between apple slices and an apple turnover, the apple is always a better option. Less sugar. More fiber.
  2. The more fruits and vegetables the better. Fruits and vegetables add a variety of nutrients, vitamins, and minerals to a diet. They also provide fiber, fill you up without so many calories and help you hydrate.
  3. Ask for nutrition facts. Nutrition labels which include sodium, calories, sugar, vitamins, etc let you know exactly what’s in your food.  If you need to cut back on sugar intake, you’ll know exactly how much you are getting.

References:

[1] https://www.ers.usda.gov/webdocs/publications/86401/eib-186.pdf?v=43097

The air up there: air quality for long-term health

As development and industrialization occurred, international and domestic societies became increasingly dependent on mass-produced products and, unknowingly, the chemicals used in their development. Chemicals are used in the production of everything from household products to organic foods, and many of these man-made compounds have detrimental effects on human, environmental and ecological health. One chemical exposure of greatest significance to human health is ambient and indoor particulate matter. These elements are often overlooked; however, a human health risk assessment can be used to determine the severity of their harm.

Particulate matter (PM) is defined as all hazardous particles (including solids and liquids) that are suspended in the air [1]. These pollutants are generally less than ten µg in diameter and include course, fine and ultrafine elements. PM has many detrimental affects on human health because it is so easily encountered and can be deeply inhaled. PM is known to elicit cardiopulmonary responses and is also a risk factor for cardiovascular disease morbidity and mortality. Atherosclerosis, myocardial infarction, and cardiac arrhythmias are just a few cardiovascular disease states with which PM is associated [2]. PM inhalation is also associated with cancer – the second leading cause of death globally.

All people are exposed to particulate matter because it is dispensed into the air we breathe. There are various sources, including aerosols, mist, and all forms of combustion, that emit particulate matter into the atmosphere many of which individuals encounter frequently throughout the day. To protect oneself from these harmful chemicals, it is important that people engage in protective behaviors. Below are a few that could help you improve your long-term health:

1. Use an air purifier in your home.
2. Avoid using aerosols.
3. Check for proper ventilation and air filtration when using a fireplace.
4. Avoid burning incense.
5. Avoid second-hand smoke and stop smoking.

References:

[1] “Ambient Air Pollution.” World Health Organization. World Health Organization, n.d. Web. 23 Feb. 2017.

[2] Du, Yixing, Xiaohan Xu, Ming Chu, Yan Guo, and Junhong Wang. “Air Particulate Matter and Cardiovascular Disease: The Epidemiological, Biomedical and Clinical Evidence.” Journal of Thoracic Disease. AME Publishing Company, Jan. 2016. Web. 23 Feb. 2017.

Using Behavioral Economics to Combat Antibiotic Resistance

By Elsbeth Sites

Antibiotic-resistant infections affect 2 million people and are associated with 23,000 deaths each year in the United States.1 Physicians link medicines and patients, so prescriptions are a target for reducing unnecessary use of antibiotics in humans. But physicians tend to prioritize the patient in front of them, rather than consider the long-term, societal implications of each prescription. How can we make appropriate prescription of antibiotics the new norm?

Behavioral economics embeds insights from psychology into neoclassical theories of behaviors. It’s hard to see the consequences of antimicrobial resistance in the day to day – discounting and present-bias de-emphasize long-term prevention in favor of immediate gratification. For doctors, discounting might take form in the satisfaction a patient leaving the office with treatment in hand, while discounting the long-term impacts of inappropriate antibiotic usage.

Recently, researchers have begun designing behavior-change programs for healthcare providers. One such “nudge” that has shown promise involves hanging letters of commitment in examination rooms that document the physician’s commitment to the appropriate prescription of antibiotics and explain why they are not useful in many cases 4. This strategy may be doubly effective because it helps make the physician feel accountable for their commitment, and facilitates discussions with patients.

Behavioral interventions at the provider level can be powerful tools to facilitate consideration of the long-term effects of a decision made today. Simple, inexpensive programs like this have enormous potential to stall the progression of antibiotic resistance by decreasing the flow of unnecessary antibiotics from doctors’ offices to patients.

References:

[1] Antibiotic/antimicrobial resistance. https://www.cdc.gov/drugresistance/index.html. Updated 2017. Accessed 11/19/, 2017.

[2] Meeker D, Knight TK, Friedberg MW, et al. Nudging guideline-concordant antibiotic prescribing: A randomized clinical trial. JAMA Internal Medicine. 2014;174(3):425-431. doi: 10.1001/jamainternmed.2013.14191.

Masters of Disguise: How artificial sweeteners make it past consumers

Viewed by consumers as a healthier alternative to sugary drinks, artificially sweetened beverages are becoming increasingly popular. These drinks include most diet sodas and juices, energy drinks, and flavored water. The shift away from drinks sweetened with sugar came after research showed the relationship between sugar intake and excess weight, obesity, and diabetes. Artificially sweetened beverages have little-to-no calories; however, the medical community has not supported any of their proposed health benefits. In fact, many scientists believe that artificially sweetened drinks lead to overeating and encourage sweet cravings. They could be an alternative route to health problems. Researchers are still looking into these associations, but for now, water is always a safe choice. Check out this article for tasty ways of sprucing up your water.

(1) https://www.ncbi.nlm.nih.gov/pubmed/17712114

Image: https://www.nerdfitness.com/blog/is-diet-coke-bad-for-you-what-about-artificial-sweeteners/

 

Cultural Challenges with the DASH Eating Plan

Heart disease is a leading cause of death in the United States contributing to over 633,000 deaths annually. Like most chronic diseases, individuals can reduce their risk of developing this condition with proper diet and exercise. When someone is at extremely high risk of developing heart disease, nutrition professions suggest a few things: exercise, stop smoking, eat nutrient dense foods and reducing sodium intake with the DASH eating plan. While these modifications are proven to reduce the risk of heart attack and stroke, the DASH eating plan can be problematic for communities of color.

DASH, or Dietary Approaches to Stop Hypertension, is a proven eating plan for lowering blood pressure without the use of medication. The reason blood pressure is so important is that it is one of many factors that contribute to heart disease. DASH recommends the following:

1. Eat fruits, vegetables, and whole grains
2. Including fat-free or low-fat dairy products
3. Consume fish, poultry, beans, nuts and vegetable oils
4. Limiting foods high in saturated fat
5. Limiting sugar-sweetened beverages and sweets

This diet is excellent for promoting a healthy diet; however, for communities of color which suffer in greater numbers from lactose intolerance DASH’s promotion of dairy products can cause discomfort. Lactose intolerance results in symptoms such as indigestion, bloating, stomach cramps, diarrhea, indigestion, flatulence and fatty stool after consuming lactose, a sugar found in dairy. The premise behind increasing dairy consumption is its higher calcium content which is associated with reducing blood pressure. The eating plan fails to acknowledge that there are other excellent sources of calcium like broccoli, calcium-fortified real fruit juices, beans, almonds, and sardines. In doing so, DASH recommends a diet that may lower hypertension, but that also makes people sick. This could diminish its credibility in communities of color. By including non-dairy sources of calcium, our healthcare systems and dietary recommendations could acknowledge and accommodate all people instead of offering a one-size-fits-all approach to health.