Gang of Cysts (Ganglion Cysts)

*That aforementioned word-root is inaccurate*

In fact I don’t know why ganglion is part of the name and even went to the urban dictionary in vain

Ganglion cysts are benign (harmless) lumps of lubricating fluid found around joints (think moving parts) like hands, wrists, knees, ankles, and feet.

Believed to occur as a response to micro-trauma e.g. dancer’s feet and called an “internal blister”. The trauma leads to a leakage of lubricating tendon fluid. Think of it like a car engine leaking oil…except

Ganglion cysts are usually harmless but sometimes causing aching or pain when pressuring an underlying nerve or when moving a joint.

Oddly it affects women mostly between the ages of 20-40.

Signs and Symptoms

-large lump/multple small lumps soft to the touch

-apparent muscle weakness

-aching when moving the joints

Given a couple of months these things will go away

Options are to : A) wait it out B) Aspirate with a fine needle, and C) surgically cut it

Unfortunately ganglion cysts can sometimes recur for which we must simply repeat the aforementioned options.

 

Urinary Tract Infections (UTIs) in Men

UTIs are a common occurence in women but what about men?

Young men are 30x less likely to suffer this problem but as men age past 50, the occurance rates catch up to that of women.

In fact a UTI in men is viewed at more seriously than if it were in women purely based on the physical differences between the two sexes. Men have a longer urethra (passage for urine), men also have greater distance between rectum and urethra (bacteria have less chance for cross-contamination). Thus a UTI in men is rare and when noticed, is treated with a higher level of suspicion for reasons I’ll get into shortly.

What are the symptoms of a UTI?

  • burning pain when urinating
  • frequency: running often to the toilet
  • urgency: sudden urges to pee
  • blood in urine (slightly pink)

UTIs are an umbrella term that covers infections stemming at different locations including: the urethra, bladder, kidneys, prostate. As such, the symptoms can vary and this helps doctors on their diagnosis.

Symptoms of a more serious infection:

  • dribbling urine (could be sign of blockages at prostate)
  • pain in pelvis
  • chills
  • side/flank/back pain
  • fever
  • nausea and vomitting

Bacteria have a knack for spreading. They will spread given the food and the path. Unfortunately for men and women, the path is through the urethra, into the bladder, across to the prostate and epididymis, and even up to the kidneys via the ureters. Have I lost you?!

Don’t fret. It’s rare that these things happen but here’s my rule of thumb: if you’ve got flank pain and fever, its probably spread to your kidneys. If you’ve got pain in the pelvis and dribbling at the urinal, it’s probably in the prostate. See your GP either way.

Word of warning: men get familiar with the “digital examination”. I’ve been there before lool. It’s when doc puts on his latex gloves with a snap, lubes up, then inserts his/her finger into your butt hole to feel for the prostate. Men as we age our prostate can enlarge putting undue pressure on the outflow of urine. Sometimes the prostate can become cancerous and this is one one for docs to keep a finger on the pulse. Ahem.

Treatments:

Antibiotics. Whilst this sounds straightforward enough, there are a spectrum of bacteria (sometimes even viruses) and so a urine and blood test are required to know what the culprit is before a doctor can prescribe anything.

Treatment is usually for 7 days.

Things your doctor ask you:

Do you have:

  • a history of diabetes?
  • nocturia (peeing at night)
  • prostate issues
  • urine sample
  • blood sample maybe

Know your own risks

  • Are you immobile? patients stuck in bed often find their bladders filling up and overtime the stagnant urine can foster bacteria.
  • Dehydrated? Drink one too many cups of coffee? Coffee has a diuretic effect causing build up of urine in the bladder too
  • Uncircumcised men can potentially harbour bacteria under their foreskins
  • Engage in unprotected anal sex? Use a condom
  • Aged 50+ and Male? Your prostate enlarges with time and can put undue pressure on your urethra causing backlog of urine
  • Finally Go when you feel the urge to go. Holding back on urinating puts you at risk too

Alright men, remember if you have ANY symptoms, get it checked!

xoxo

Vien

Hand Foot Mouth disease

This is a condition that I personally have had but never really thought twice about until I saw it first-hand in the pharmacy.

Hand Foot and Mouth Disease!

Sounds terrible. In reality not so!

Capture.PNG

Source: Google of course!

What is it?

An infection caused by the: coxsackievirus

How did I catch it?

chances are you (or your child) walked into someone’s sneeze path (lol I made that up but it sounds cool) or contracted it sharing a harmless looking crayon at day-care

It can also spread via the oral-fecal route which is fancy for saying YOU DIDN’T WASH YOUR HANDS!

How do I treat it?

  1. Do not bust the blisters. This will only spread the disease to others!
  2. Fever: give paracetamol or ibuprofen (avoid aspirin in kids)
  3. Hydrate: sores/ulcers in the mouth can discourage kids (and adults) from eating or drinking. Instead offer sips of water or electrolytes e.g. Hydralyte
  4. Wait it out…the virus goes away after 4-7 days. No antibiotics are not effective against viruses. No vaccines exist at this point

How to prevent the contagion?

img_8979-e1525165133104.jpg

Four things to minimize spread: 1) use tissues when coughing/sneezing 2) wash hands before/after eating or using bathroom 3) Minimize sharing of utensils, brushes, and 4) Reduce the kisses hehe

  1. Sneeze/cough etiquette: use a tissue or at the very least sneeze/cough into your elbow
  2. Wash your hands before/after eating, using the bathroom
  3. Minimize sharing of utensils, toothbrush etc as well as kissing (sorry folks!)
  4. Stay at home to cut down spread to others
img_8978-e1525165070249.jpg

The virus incubates for 7 days, then pops up as a rash/lump/blister. Another 7 days pass before they dissappear

Hey if you like these blogs, try our videos-it’s where those last two photos are from.

Here: https://www.facebook.com/canterburylatenight/

 

Sleep Apnea in a Young Asian Male

We had a lovely friend, Steve swing by recently to trial our CPAP machines for sleep apnea…

Strange thing is….he looks perfectly healthy!

  • Lean and in shape
  • Doesn’t smoke
  • Doesn’t drink
  • Doesn’t have heart conditions

He does however complain of sleep anpea tiredness and him and his dad both snore the house down!

Considering all the rah rah around how bad sleep apnea is on life expectancy (reduced by up to 15 yrs), and blood pressure (increased)…I did some research into why this happens and whether our friend is at risk

The reduced life expectancy is believed to be the stress caused by frequent wake-sleep-wake cycles and the cortisol response (stress hormone).

This also leads to the second issue: frequent “jump starts” to the nervous system causes a constant state of red alert constricting blood vessels and spiking blood pressure.

It gets worse…people with apnea tend to have lower reserves of nitric oxide and this is the exact thing that reverses constricted blood vessels. Side note: nitrix oxide helps men get erections. Apneic men often suffer erectile dysfunction. Go figure..

nitrix oxide helps men get erections. Apneic men often suffer erectile dysfunction

What are the stats?

Apneic people suffer 

  • 140% more risk for heart failure
  • 60% more risk for stroke
  • 30% more risk for a coronary 

If I may indulge….30 years ago there was an interesting study done: apneic patients that chose to undergo a tracheostomy (that classic move you seen in medical shows where they cut a hole in your throat/or stab with a pen depending on your gore tolerance) saw their apnea go, but so did any atrial fibrillation (a heart condition), blood pressure normalized, and they lived ten years longer than their counterparts who opted out.

And den..

So back to our mate Steve, he chose the less gory route of using our CPAP machine and unbelievably his AHI score went from 30 down to 5. That’s a total normalization of his apnea! Not surpringly he felt energetic!

Moral of the story:

If you snore, get checked for sleep apnea-its a simple $99 overnight test done at home

If you are overweight, try lose 10% and that can have dramatic improvements to apnea

If your bed partner gasps for air at night and snores it could be a sign…get them tested!

xoxo

Vien

Nail Care for Men

If you’re a woman you probably can skip this whole article.

But for us men, read on for the essential nail care!

My promise is I’m not going to bog you down with products and laborious routines.

So basically I had a wife come ask about her husband’s problem nail…

It had broken off almost in half and the nail plate was almost detached….

Ouch!

So what to do?

Here’s the 5 step Guide:

  1. Soak the nail in cold salty water to disinfect
  2. Carefully trim any snags which may catch on clothing
  3. Put on Vaseline or Pawpaw
  4. Cover with a non-stick dressing (avoid sticky bandaids)
  5. Take Nurofen for the pain

Repeat for at least 10 days to allow your skin to regain its strength.

How long till my new nail grows out?

Finger Nails: 6 months

Toe Nails: 18 months

GERD: Gastro Eosophageal Reflux Disease

Today we had a customer with chest pains complaining that it wouldn’t go away..

Handing me two scripts: one for Gaviscon and another for Somac…I put on my detective hat and asked her about any history of stomach issues starting with the questions:

  • Do you think this is related to any foods you eat? (No I eat very healthy)
  • Do you drink much coffee? (I used to but now just 1 cup a day)
  • Are you bowel motions regular? (Yes, every day)

She appeared lean and told me she is super fit as in: plays soccer twice a week and gyms every other day.

Hmmmm

At this stage it hasn’t quite clicked in my mind yet so I’m digging and digging…I really like solving puzzles like this…someone so young and fit shouldn’t be having symptoms that more often are seen in someone overweight and eats crap.

Now lets not get ahead of ourselves..the doctor has prescribed an antacid and a proton pump inhibitor (PPI). So there must be a diagnosis here…

So now I’m suggesting to her that perhaps it’s worth investigating for bacteria if her symptoms persist. In my mind I’m thinking perhaps it’s Helicobacter Pylori….but part of me is resisting the diagnosis. First because it’s too early..she’s only had persistent chest pain over the last three days…and secondly because she is so young and fit.

To reaffirm this thought…The customer interjects that she’s been on the diet and routine for ages and never has this occurred before.

I suddenly recall a condition called GERD ….not goat…but GERD: gastroeosophageal-reflux-disease. A mouthful I know! It’s basically when people suffer heart burn and chest pains for no apparent reason. Well actually the medical definition is the reflux of stomach contents up the food pipe thereby causing irritation and the physical symptoms of pain. Anyway I never really liked this diagnosis as the treatment always revolved around fluffy ideals like: stress less, lose weight, cut cigarettes, cut alcohol, cut spicy and fatty food. Heck this patient doesn’t have a problem with any of these!

But hang on, she does stress….stress in the physiological sense. She has been exerting herself in soccer matches and at the gym non stop basically….and GERD does have stress as one of the triggers. Still very fluffy but its in the definition……I hold that thought in mind…..

I loop around to the fact that she drinks coffee and ask her:

What time do you have it? (Timing is important see..) What do you know? She has it at 7.30AM-first thing in the morning BEFORE her Weet-bix; which by the way is my favourite breakfast cereal (with honey).

Suddenly I have a light bulb moment! Hang on….if she has coffee, it’s most likely to have gradually irritated her stomach lining to the point of inflaming it.

To test this hypothesis of mine, I ask her questions to see if there are OTHER signs of inflammation:

Do you suffer from break outs (aka acne) or cold sores ever?

Legit as soon as I said that I noticed what looked like a cold sore on the corner of her top lip. She says…YES! I have two cold sores, one right here as you can see (points) and three ulcers at any one time over the last few weeks!

BINGO!

I excitedly explain to her that despite her diet being on-point, the fact that she is under so much physical strain means perhaps her body is running a deficit of nutrients during those exact times….and as such is manifesting these symptoms in her mouth: ulcers and cold sores AND the stomach pain.

It makes sense when you think about the body’s fastest growing cells being those lining your stomach, and the skin in your mouth and hair on your head. Those undergoing chemo often lose their hair first and suffer terrible nausea as these cells are the most demanding in terms of nutrients and so if supply cannot keep with demand…you have problems.

if supply cannot keep up with demand…you have problems.

Before I get to what I finally recommended her lets touch on GERD….

GERD is represented by symptoms of

  • acidic taste in the mouth
  • heart burn
  • bad breath
  • chest pain
  • vomiting

Alarm symptoms that demand immediate GP attention include:

  1. difficulty swallowing
  2. bloody stools
  3. weight loss
  4. anaemia

So to my final recommendation:

I told her to start a multi-vitamin.

Guess what: she just started one that day!

Good on her! I told her to continue that as the extra nutrients will act like a buffer especially during times of physical stress (soccer/gym).

Think of it this way: if the recommended dietary intake of Vitamin C is 75mg daily and she obtains this through her diet..fantastic. But what happens when you are training 7 days a week? You’re probably going to need more in reserve. Hence why I suggested she start that multi-vitamin, to increase her reserves.

Go for goal!

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Constipation: How to fix chronic constipation

The following is the script to the podcast :

https://anchor.fm/e/d38bdc?at=1358881

Young lady suffering a slow tract for 5
yrs…holddd up! what’s a slow tract i hear
you say!

it’s when you cant shit! A simple test: what
you eat generally exits within 2 days..if it
takes 3 or more days to pass..you’ve got a
slow gut. Caveat…must be ongoing for
6months+ your norm will be different to my
norm….some go three times a day…others
go every THREE days..

who cares i hear you shout! You’re right!
you’re more concerned about the blating, the
nausea, the stomach pain!

but plz, let me drop some knowledge:

technical term for it is when your colonic
transit time (CTT) is >48hrs, as measured by
swallowing a radioactive dye and seeing how
long it passes through.

For px with STC, laxatives dont work well
and neither does more fibre in the diet.

About 1 in 10 poeple with constpiatoin will
suffer the type known as a slow tract. The
other kind of constipatoin is where there
are obstructions. i shouldnt laugh here but
that sounds kinda funky…rectal
obstructions

 

Why does this even happen? is it cos you eat
a shit diet? I went in hunt of the answers

Reasons..
1) obstructions….maybe the theres a
prolapse of the rectum,
2) slow colon (colonic inertia)
3) IBS
4) psychological stress
5) nerves being numb

 

STC confirmed by nuclear transit
study..basically u swallow some radioactive
barium and monitor its progress from mouth
to anus…fun days

Another method is the popular Wexman
Questinnaires which asks: how often u go,
pain level when you shit,
did you go fully or half way,
pain in stomach,
time to shit, how much help did u need to
shit-im talking laxatives,
how long uve been constipated, how many
unsuccesful attempts at pooping.

 

//////////////////// clinical trials///////

 

lets move onto the clinical trials. Now be
forewarned that some of these experiments
will sound very wacky….like real wacked.
eating poop kind of wacked. But im getting a
head of myself…lets start with the more
acceptable studies done.

three entrepreneurials scientists stuck
electrodes to childrens belly buttons and
found that after six months, with one hr of
stimulation daily…that the kids started
pooping more…gosh hardly exciting to be
hooked up to some electrodes when u just
wanna go play in the sandpit.

http://onlinelibrary.wiley.com/doi/10.1111/n
er.12734/full

Another group in Britain did a similar thing
but found no benefit…mind you they were
sticking the electrode to the soles of the
feet….kind of sounds farfetched, we’re
trying to fix something at the buttocks not
the feet…but if you look at the nerve path
it does seem to converge at the spinal cord
level.

http://onlinelibrary.wiley.com/doi/10.1111/c
odi.13388/full

An australian bunch did a similar thing but
placed the electrode pads on the tail bone
area and found this to be somewhat
effective. The real issue is the effect
didnt last too long after stopping therapty.

http://www.nobleresearch.org/Content/PDF/16/
2399-8199.2017-1/2399-8199.2017-1.pdf

By now you’re probably thinking, gosh
scientists sure like to zap things…first
Pavlov’s dogs and now kids…rest assured,
things get real wacked now…

///////wacked up research/////

FMT? Fecal microbiota transplantation. The
process of donating someone elses poop and
putting it into your stomach. WTF?! Yep
there woudl be a donor who would rock up on
the day of the experiment, dump a shit, then
scientists would whizz it up in a blender
and pump it via a nose tube into actual
patients.Bat shit crazy!
And if u were wondering, the amount of shit
used was 100g blended in 500mL of saline.
that’s half a litre of brown stuff.
Not surpringly, side effects included:
venting, nausea, abdominal pain and
diarrhoea. what’s venting? i had to look it
up. it says here: a vent is an opening such
as one that discharges pus like the anus.
hmmmm

an opening permitting the escape of fumes,
liquid, gas or steam

So the verdicT? about a 30% improvement…an
increase in number 2s, softer shit, faster
transit times (this is the bus timetable but
the time it takes to pass out some feces

http://journals.plos.org/plosone/article?
id=10.1371/journal.pone.0171308

//////////////////////average Joe and
probiotics//////

 

OKAY so whats the average Joe do when he
listens to all this…well basically if you
wanna avoid constipation…ensure you
actually drink water each day, have fibre in
ur diet from food sources like fruits and
vegetables and add a yoghurt to your routine
as this has been shown to help gut motility.

Now on the topic of yogurt, we all know that
yoghurt contains beneficial bacteria called
probiotics…well

China scientists are pumping real
interesting research on this area. In
fact…at the time of writing my notes…I
had a Eureka moment! Lots of laxatives are
exported to china each day…if you work in
pharmacy you’ll notice this too…things
like Nulax sell like hot cakes! Could it be
something in the water?…a topic of another
podcast no doubt!

 

///////////////HOW do these critters affect
us?///////////

One example are:

methanogens..these methanogens are elevated
in harder stools and correlated with
farting…true enough we all learned in
science lab that methane gas is that partly
the gas found in fart.

another example are the byproducts of
probiotics….

SCFAs and Bile acids….these were shown to
stimulate serotonin receptors in the gut
producin muscle contractions! so how do we
get more of these two acids? more fibre! and
for the case of Bile acids….healthy fats!
hohoho sounds like a healthy balanced diet
to me!

 

A fun point of this research was that the
poop belonging to a group of chemicially-
induced constipated rats were pumped into
stomachs of healthy rats….in turn causing
the healthy rats to be constpiated!

https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C5428802/

now……Taking a slight tangent in our
thought processes

Perhaps its the degeneration of nerves in
the gut that is responsible for slow tract
constipation! kinda like neurodegenerative
disease like Alzheimers and Parkinsons?!
Again a third group of Chinese researchers
took biopsies of peoples lower guts and
examined it under powerful electron
miscroscopes.
They found that in one 69yo woman..that her
nerves had shrivelled up into whats known as
a vacuole and is possibly why she has taken
laxatives for the last 6 yrs!! They rkn that
the same nerves that can be damaged during
child birth are the ones damanged in this
69yo.

https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C5369939/

 

///////// in closing////////
To close of this podcast…i’d like to
return to our original customer’s anxieties
and would just like to say that her
condition is a rare one, and isn’t something
to laugh about….its quite
debilitating….it affects one’s social
life, causings much psychological and
physical distress…..To this friend, I
would say that getting a good doctor on your
side who is willing to try different
approaches to this riddle is key. Very key.
as there are alot of doctors who will just
shrug this into the “too hard basket”.

for the average person, the key take aways
are to eat a diet filled with fibre and
healthy fats along with fermented foods that
are high in probiotics like yoghurt kimchi,
pickles, kombucha etc…

As I mentioned earlier, the probiotics eat
the fibre to product beneficial SCFAs and
bile acids which promote a regular bowel
movement.

Now how many times have you heard this said?
HEAPPPS….well now you have the science to
back it up. Enjoy..

Now before you all head off…if you enjoyed
this podcast, please leave a commment, pass
it onto a friend who may benefit, show us
some love!

 

 

 

Wexman scale:
https://pdfs.semanticscholar.org/9c30/96521a
00e759a1cd345b6aec3ee88a9fc9e2.pdf

 

phyla Bacteroidetes, Firmicutes, and
Actinobacteria. Bacteroidetes:Firmicutes
ratio, and negatively related to Akkermansia
and Methanobrevibacter abundance.
unclassified_Ruminococcaceae, Alistipes,
and Oscillibacter were negatively correlated
with the mean stool frequency3

Question of the Day: Should I stop my Acne medication?

Question Of The Day! 

 
Latif asks: should I stop my isotretinoin?
 
Disclaimer: if you are on any prescribed medications, speak to your doctor before you start/stop anything.
 
Isotretinoin better known under the guise of Roaccutane, Oratane, Accutane etc… it’s a wonder for severe cystic acne and many other skin conditions.
 
What concerns us in today’s question is that Latif was getting stomach aches about 6 days into using it and needed to know whether to be concerned or not.
 
Vien’s Answer: I said look probably a good idea to stop it and speak to your doctor the following Monday. In the meantime I did some digging around and basically found the following:
 
1) there is a long history of associations of isotretinoin and stomach issues like irritable bowel disease (IBD); a form in inflammation in the gut
 
2) whether there are links to Crohn’s disease (a much more severe form of inflammation that continually relapse) we cannot say for certain
 
3) some people have even gotten IBD AFTER stopping isotretinoin which may suggest a dormant form of IBD which may have been triggered by the drug.
 
4) It isn’t practical to check every single person for signs of inflammation so common sense should say: be more cautious if you have a family history of gut issues; if you take non-steroidal anti-inflammatories e.g. Nurofen, aspirin; and if you smoke.
 
Summary: before starting isotretinoin, review your medical history thoroughly with your doctor. If you notice anything out of the ordinary, err on the side of caution and tell your doctor!

Apple Cider Vinegar (ACV)-Does it actually do anything?

“One might think that fresh lemons and limes and raw organic apple cider vinegar are acidic, but they actually become alkaline when consumed.”

What a non-sensical claim! Before I get into the details of this, I’d like to say that after spending almost 12hours looking at material online regarding apple cider vinegar (ACV), I haven’t found any shred of evidence to show of it’s 20+ health benefits.

origins

ACV is basically apple pulped up, placed into wooden barrels and allowed to ferment. Much like the process of making wine, alochol is formed by this process. ACV however requires one further fermentation cycle to then produce the acetic acid aka “vinegar.” In fact, vinegar is French for “wine gone sour.”

 

Cider-making process in France.png

Microorganisms in Fermented Apple Beverages: Current Knowledge and Future Directions by Fabien J. Cousin and others.

Now before anyone gets upset, I’ll state clearly that a lack of evidence does not equate a lack of effect. A lot of drugs lack evidence for their effects/side effects until years down the track. In the case of the humble ACV, it’s been around since ancient Egypt times-analysis of urns have revealed traces of acetic acid. Ironically, anything left for that long would go “off” (ferment).

Now the purported benefits of ACV range from the mundane to the fantastical: antibacterial, reduces blood pressure, antioxidant, reduce sugar levels in diabetics, reduce cholesterol, improve brain function, relieve acid reflux, treat warts, treat cancer, treat bad breath, treat gout, treat urinary tract infections, and of course treat head lice.

 

Basically summarised, it can detox, help digest, and improve your energy levels. But does it really?

Rather than repeat what other reputable sources already mentioned on this topic, I will simply provide a summary of it below and provide links to a few reputable sources of information (see below).

 

Stated Health Claim Believable or Not?
Antibacterial Believable: acetic acid at concentration of 3% have been tested. Household vinegar is typically 5% (1)
Reduce blood pressure No studies found
Antioxidant Perhaps: like most plants, there exists phytochemicals (aka bioactive substances) that may defend against free radicals. There are thousands of these in nature and we can’t be sure which is what
Reduce diabetes Unlikely: there was a study on 30 people (FYI a good study requires thousands of people to have enough power). Ten were diabetes, ten were non-diabetics, and ten were pre-diabetic. After about a month of ACV, there fasting sugar levels were slightly lower.  These sorts of studies are too small for drawing conclusions. They also don’t look at factors like participants changed diets whilst in the program. (2)
Brain function No studies found
Acid reflux No large studies done. One was a doctoral thesis project consisting of a handful of volunteers with no conclusive answer.
Warts No studies found. Warning: chemical burns can occur with even standard 5% ACV despite being a weak acid. See images below.
Arthritis No human studies found. One study on arthritis-induced rats showed no effect. Link below
Antifungal One study on denture-associated candida showed it had some effect
Antidandruff Folk remedy but otherwise no studies found
Probiotic Whilst there does exist plenty of probiotics in ACV, there were no human studies on the benefits.

Studies in carp fish show that using ACV in combination with other probiotics may boost the immune system. Whether this relates to humans is unknown.

Helicobacter pylori Studies show that taking ACV with triple-therapy did not show benefit towards H. pylori eradication

What’s my take on it? Drink it for it’s likely beneficial probiotic effects. Always dilute it with a glass of water-add honey to taste. Ignore all the other “benefits.”

 

References

  1. Antibacterial effects of ACV
  2. Vinegar improves insulin
  3. Mother Earth-make your own ACV
  4. superFoodly’s analysis of ACV
  5. Dr Mercola’s analysis of ACV
  6. Science behind why pH won’t budge
  7. Fish fed ACV+probiotics
  8. Helicobacter pylori eradication with ACV
  9. Probiotics in ACV

Spinning out-You too have Vertigo?

Dim asks: “I have vertigo, what medications are available apart from Serc (betahistine)?”

*Couple of scrap notes from my research on Vertigo..

Almost 25% of the elderly have dizziness lasting more than one month.

Targets for therapy:

  1. hallucination alleviated through vestibular suppressants eg anticholingerics, benzodiazepines, or antihistamines
  2. Nausea and vomiting plus anxiety alleviated through antidepressants
  3. Enhance vestibular compensation through physical head exercises

Armamentarium:

  • benzodiazepines
  • histamingerics
  • Sympathomimetics
  • Calcium channel blockers
  • Steroids methylprednisolone
  • repositioning maneuvers

Differential diagnoses:

  • psychiatric
  • motion sickness
  • otitis media
  • cerumen impaction
  • herpes zoster (shingles)
  • seizures

Risk factors (elderly syndrome? like falling, delirium, incontin)

  • anxiety
  • depression
  • hearing impairment
  • taking more than 5 medications
  • postural hypotension
  • balance impairment
  • past heart attack

Dizziness shouldn’t be taken lightly (even though the majority of cases resolve on its own) as there is greater morbidity associated such as: increased chance of falls, having a stroke, ending up in nursing home care.

Types of dizziness:

  • paroxymsal positional
  • acute vestibular neuronitis/labyrinthitis
  • Menieres+tinitus
  • migraine
  • anxiety disorders
  • vertigo
  • presyncope
  • disequilibrium
  • peripheral vs central vertigo
  • and the list goes on!….

A simple screening test to separate dizziness requiring medicines and those that require further checkup is if the dizzy spell lasts less than one minute or if it lasts for hours to days. The latter you would consider trial of certain medications and following this further medical treatment should it not improve.

Causes:

  • Ototoxic: some medications can be toxic the little hairs in our ear leading to permanent hearing loss and dizziness.
  • Multi-system impairment: data shows that elderly people suffer more dizzy spells than young people. We’re not sure why but perhaps a combined deterioration in visual acuity, muscle strength, hearing ability, etc is the reason; much like in dementia and falls.
  • Viral infections: of the inner ear leading to inflammation of the vestibular nerve causing mixed signals at the brain.

Tests

American guidelines do not recommend any lab tests except for:

  • Audiometric tests: when suspecting hearing loss
  • Brain imaging: when suspecting tumor or stroke
  • MRI: when suspecting acute vertigo with hear loss

Treatments

Type of dizziness Treatments
Labyrinthitis (inflammation of inner ear) Triggered by cold or flu virus, therefore goes away on it’s own. In resistant cases: vestibular suppressant + vestibular rehabilitation
Ménière’s disease No cure. Just relieve symptoms with: a low-salt diet, and/or diuretics
Vertiginous migraine Dietary changes, a tricyclic antidepressant, and a beta blocker or calcium channel blocker.
Vertigo with anxiety Slow introduction of selective serotonin-reuptake inhibitor (SSRI)