Category: Medicine Hat News

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Anaphylactic Shock

Dear Dr. B: What is anaphylaxis?

Anaphylaxis (say “anna-full-ax-iss”) is a life-threatening allergic reaction. It occurs when a person becomes sensitized to a substance and is again exposed to that substance.

The body responds with release of histamines and other substances into the bloodstream. This results in dilated blood vessels and swollen tissues. Swelling of the tongue and throat may be life-threatening if obstruction of the airway occurs, if blood pressure drops, or if cardiac rhythm becomes abnormal.

Reaction starts soon after you are exposed to something you are severely allergic to. There may be swelling, itching or a rash. You may have trouble breathing, with a tight feeling in the chest or dizziness. You may feel anxious. There may be stomach cramps, nausea or diarrhea. Some people lose consciousness.

There are many causes of anaphylaxis. Here are few examples:
-Foods, such as shellfish, nuts, peanuts, eggs and fruits
-Medicines, such as antibiotics, aspirin, over-the-counter pain relievers, allergy shots and contrast dye for radiologic procedures
-Latex or rubber found in surgical gloves, medical supplies and many products in your home
-Insect stings, especially from bees, wasps, hornets, yellow jackets, sawflies and fire ants

A severe allergic reaction requires immediate treatment. If anaphylaxis is suspected then check the airway for tongue swelling or swelling of the soft palate or uvula. Check the blood pressure and the pulse. Low blood pressure and rapid pulse raises the suspicion of anaphylaxis, although neither is necessary for diagnosis.

Certain individuals are at a high risk of fatal anaphylaxis. These are the individuals who have had previous severe reaction to a substance, leading to progressive reaction and asthma. Certain medications may increase the risk because some agents like aspirin, non-steroidal anti-inflammatory drugs like Ibuprofen, beta-blockers and ACE inhibitors are well known to intensify reactions.

Once anaphylaxis is diagnosed, epinephrine should be injected immediately by intramuscular route. It should injected into the muscles of your arm are thigh. Epinephrine will quickly raise the blood pressure by constricting the blood vessels, it will increasing the heart rate, reduce swelling around the face and throat and relax smooth muscles in the lungs to make breathing easier. CPR may become necessary. This will allow time to call 911 and transport the patient to the nearest hospital for further stabilization and treatment.

Epinephrine is available as an auto-injector. That means you can inject it yourself or your friend or family member can inject it for you if you are having a severe allergic reaction. There are two kinds of auto-injectors: EpiPen and Twinject. EpiPen has one dose of epinephrine and Twinject has two doses of epinephrine. If symptoms do not subside within 10 minutes of the first injection then second dose of epinephrine is required. This happens in 35 per cent of people with severe allergic reaction.

It is very important to learn how to use the auto-injector. It is of no good use to carry one in your pocket or purse if you do not know how to use it. Also check on the expiry date. These auto-injectors have a short expiry date of a year or so. Replace expired auto-injectors. Wear a medical alert bracelet or necklace. Also carry antihistamine like Benadryl with you which is helpful in case of a mild allergic reaction.

As always, prevention is better than treatment. See a doctor to identify the causative agent of your allergy. It is not always easy to find the causative agent as we come in contact with numerous substances each day. If the causative agent is known then avoid it at all cost. Ask your doctor if you need desensitization shots. Make sure people around you – your family, friends, teachers, co-workers and others are aware of your allergy. Live a normal life but be careful of what you eat and what you touch.

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You and Flu Vaccine

Have you had your flu shot yet?

If yes, then you are smart and you do care about your health. If no, then you should worry about your health and get a flu shot. Here are some reasons, summarized from an article in the Canadian Medical Association Journal (October 23, 2007), why it is important to get flu shot each year:

In Canada, more than 4000 people die from influenza each year.

Influenza comes every year during the winter months (January–March). The specific types of influenza viruses change each year.

Because the influenza virus changes every year, a new vaccine has to be developed each year. If there is a good match, that is how closely the virus in the vaccine matches the type of influenza virus in the community, then the vaccine prevents illness in 70 to 90 per cent of people.

The flu shot protects for less than one year, and it protects only against the types of influenza virus in the vaccine. For the best protection, the flu shot should be taken every year.

The influenza virus can cause severe illness like pneumonia, especially in people who are very young or very old, or who have conditions such as cancer, heart disease, asthma and diabetes.

People with influenza are often too sick to go to work, school or daycare. There is a sharp increase in the number of doctor visits, admissions to hospital and respiratory outbreaks in long-term care facilities.

Infected people spread influenza by coughing or sneezing, or by touching things with their hands after coughing or sneezing.

Adults with influenza can spread the virus from one day before their symptoms appear to up to seven days after their symptoms appear. Children may spread the infection for more than seven days, especially if their symptoms persist.

The combination of receiving the influenza vaccine and cleaning your hands many times a day during flu season can prevent most influenza cases.

The flu shot does NOT cause influenza because there is no live virus in the vaccine.

For best results, the flu shot should be given before influenza comes into the community. The flu shot does not work if it is given after the symptoms have started.

The influenza virus used in the flu shot is grown in eggs, so anyone who is allergic to eggs cannot get a flu shot. Development of Guillain–Barré Syndrome, a nerve disorder, following flu vaccination is very rare (about 1 in 1 000 000 people vaccinated).

Most people do not have any side effects other than a sore arm at the injection site for one or two days.

People at risk of serious complications because of influenza and the people who care for them (e.g, in the health care system or at home) are strongly urged to get the flu shot. This includes
-people aged 65 years or older
-those aged 6–23 months
-those with select chronic health conditions (e.g., heart disease, asthma, cystic fibrosis, diabetes, cancer, renal disease and anemia)
-people of any age who live in a long-term care facility
-pregnant women
-people who provide care to people with the health conditions listed above should also get the flu shot to prevent the spread of influenza.

Healthy people between the ages of two and 64 years also benefit from receiving the vaccine.

I think there are enough good reasons for us to go and get a flu shot. If you haven’t had one then talk to your doctor and get one. Plan for a healthy winter.

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Marijuana and Madness

A recent British study reveals that all users of cannabis (marijuana and hashish) are genetically at risk of developing schizophrenia or a related psychotic disorder.

What is psychosis?

According American Heritage Dictionary, psychosis is a severe mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration of normal social functioning.

What is schizophrenia?

Schizophrenia is any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions and hallucinations and accompanied in varying degrees by other emotional, behavioral or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and may have an underlying genetic cause.

How bad is the problem?

Canada is the industrial world’s leading consumer of cannabis. In 2004, the Canadian Addiction Survey found that 22 per cent of all male and 10 per cent of all female respondents aged 15–24 use cannabis on a weekly or daily basis. In Alberta, the most popular illicit drug is cannabis.

Those who use illicit drugs are usually chronic tobacco and alcohol abusers as well.

Tobacco use continues to be the leading lifestyle-related cause of death in Canada – 45,000 each year. About 30 percent of adult Canadians over 15 smoke regularly. Teenage girls are more likely to smoke (39 percent) than teenage boys (22 percent).

Everybody knows smoking is harmful. But not many people know that smoking may cause infertility in both men and women. In experimental animals, nicotine has been shown to block the production of sperm and decrease the size of a man’s testicles. In women, tobacco changes the cervical mucus, thus affecting the way sperm reach the egg.

Alcohol use takes its toll as well. About 10 percent of adult Canadians have a drinking problem. Impaired driving is a major cause of death. About 45 percent of the dead drivers have some alcohol in their blood and 38 percent are over the legal limit of blood alcohol concentration. In 2005, French researchers found people who drive after using marijuana are nearly twice as likely to be involved in a fatal car crash. Quite often there is a combination of marijuana and alcohol.

Marijuana has been found to cause other problems as well. In 2006, a report in Neurology found smoking marijuana may gradually fade verbal memory and other mental skills. Marijuana has been found to disrupt a woman’s ovulation cycle (release of the egg). Marijuana use affects men by decreasing the sperm count and the quality of the sperm.

The most important message for the youth is smoking cannabis, or marijuana, as a youth significantly increases the risk of developing a psychotic illness later in life by about 40 per cent. Those who use illicit drugs, tobacco and alcohol are danger to themselves, to their families and to society at large. I hope we can all pass this message to our children and grandchildren.

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A man with benign enlarged prostate gland – What are the treatment options?

A man has symptomatic benign enlargement of the prostate gland. What are his treatment options?

“Prostatic disease eventually affects almost all men; benign prostatic hypertrophy or hyperplasia (BPH) is an inevitable part of aging,” says an article in the Canadian Medical Association Journal (CMAJ June 19, 2007).

Do we need to worry about prostatic hypertrophy or hyperplasia which in simple terms means prostatic enlargement? Sure, we have to worry. Who knows, it could be malignant. Although prostatic enlargement eventually affects almost all aging men, not all men suffer from prostatic cancer. The lifetime risk of diagnosis of prostatic cancer is 18 per cent and death from prostatic cancer is three per cent.

Enlarged prostate gland has several effects. These include difficulty with voiding urine and blood PSA levels may go up. Other complications are urinary retention, urinary bleeding, bladder stones, recurrent urinary tract infections and renal failure. These effects become progressively worse requiring frequent medical attention and rising PSA requires multiple tests to rule out prostate cancer.

About 20 years ago, the standard treatment for benign enlargement of prostate gland was surgery. Now, patients with mild symptoms do not need any treatment. Patients with moderate symptoms are treated with medications. These medications have shown to improve the flow of urine and improve the quality of life. Do these medications prevent complications of BPH? Studies have shown that this is possible.

The two major classes of drugs used to treat BPH are: a) alpha-blockers like doxazosin relax smooth muscle fibers of the bladder neck and prostate gland to reduce prostatic obstruction, b) five- – reductase inhibitors like finasteride decrease levels of testosterone in the prostatic gland itself but do not affect the systemic testosterone level. This leads to reduction of the prostate gland by 20-30 per cent.

With -blockers, patients experience relief of symptom within two weeks of starting the medication, compared with several months with finasteride. Researchers have found that doxazosin and finasteride slowed down the growth of BPH compared with placebo; the combination therapy was significantly more effective than either drug alone.

The CMAJ article says that the Medical Therapy of Prostatic Symptoms study showed that:
-BPH is a progressive disease
-progression can be prevented by medical therapy
-patients at risk for progression can be readily identified by PSA level, prostatic volume and symptom severity
-and the combination of finasteride and doxazosin is more effective than either alone in preventing progression, particularly in high-risk groups.

Are there any side-effects to these medications?

The article says that clinically significant side effects, mainly postural hypotension (low blood pressure), were infrequent and they led to cessation of therapy in 18–27 per cent of the men involved in the study. Side effects that occurred were minor and related mainly to sexual function.

Patients treated with finasteride had significant benefit with improvement in urinary symptoms. There was also an added advantage in that the finasteride-treated patients saw reduction in the overall risk of prostate cancer by 25 per cent – a rate almost unheard of in the field of cancer prevention, says the CMAJ article. The authors of the article say, “Because PSA levels are reduced in men with BPH who are taking finasteride, rising PSA findings are more likely to be caused by prostate cancer. Taking this drug may therefore provide a diagnostic advantage as well.”

The article poses the question: Should selected patients now be offered finasteride to lower their risk of developing prostate cancer and BPH progression?

“The answer, based on these trials, is unequivocally yes,” conclude the authors of the CMAJ article.

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