Cardiovascular System, Circulatory System, Digestive System, Ears, Nose and Throat, Healthy Living, Immune System, Muscular System, Nervous System, Reproductive System, Urinary System

What to Do If You Just Had a Surgery?

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Surgeries & Procedures

These past 2 months I’ve had a number of people ask me about what to do after a surgery so I’ve decided to post a blog to help others who might have similar questions that they asked.

Before I start, though, let me be clear that I am going to discuss uncomplicated surgeries like, appendectomy, excision, incision and drainage, mastectomy, biopsy, endoscopy and the like, but not limited to these. If you’re asking if a cesarean section is considered uncomplicated, the answer is – it depends. Childbirth in itself, no matter how painful the mechanism is, is considered a normal process. A good question though, is what the reason was for a cesarean procedure and how the delivery process took place, and then we can decide whether it is an uncomplicated or a complicated one. I will talk more about labor and delivery in a separate post in the future.

Now back to surgery – first of all, it will be the safest to ask your doctor if there is any ongoing or possible complication on your case. Some of the most common complications to consider include: site or wound infection, fever, embolism (lodging of a blood clot, air bubble or foreign material in the bloodstream) or worse collapsed lungs, and many others.

If it’s been determined that you have a complicated case, then the principles I will discuss may or may not not be appropriate for you.

What to Expect After Surgery:

First 24 Hours

Pain
The first 24 hours will depend on your tolerance to pain. Normally, people just sleep over this stage for the most part, but some people experience the pain sooner than expected. No worries though because you will be given pre-scheduled pain relievers during this period.

Diet
A “nothing by mouth” policy is strictly implemented to avoid sucking of food into the airway, and to wait for the digestive function to return to normal.

Activity
You will be placed flat on bed during the first few hours after surgery, and then will be turned from side to side with help after a few hours to promote blood circulation.

After 24 Hours

Pain
Here is usually the difficult part because the effects of anesthesia will begin to wear off; so be ready for moderate to severe pain. Again, pain sensation differs from person to person depending on an individual’s tolerance and threshold. Pain relievers are still on regular schedule. Your nurse or healthcare provider will be your best friend during this time.

Diet
Your diet regimen will start slowly from sips of water, liquid diet, soft diet before you return to full diet. You may find it weird whenever your nurse or healthcare provider asks you “Have you farted yet?” Surprisingly, your precious gas determines how soon your diet plan will return back to normal. Reason is, this signals the return of your bowel function.

Activity
READ THIS CAREFULLY. Contrary to common myths that you have to stay longer in bed to prevent your stitches to tear off; you actually need to ambulate early because it promotes blood circulation, and therefore, speeds up healing. But mind you, you cannot do this in haste or you might experience what is called spinal headache, dizziness or vomiting.

Ambulate by moving your arms and legs and then when you’re comfortable with it, move from side to side. After a while, add more pillows to your head to raise it up, and then move to the side of your bed to sit up and dangle your legs. Finally, try a few steps to your side chair and then your first trip to the bathroom. When you are able to do this without any symptoms of headache, dizziness, nausea or vomiting, then you are good to go.

atnurse
Early ambulation speeds up your healing.

Discharge Plan:

Medication
Be sure to follow your prescription up to the last dose especially your antibiotics because this will prevent infection. Pain relievers may now be taken as needed, meaning when in moderate to severe pain, take it. If it’s tolerable, you may just need a distraction.

Diet
Diet is usually as tolerated, but I suggest you take more proteins because this is important for body and organ repair and recovery. Have more fruits and vegetables too for additional boost on your immune system, plus it eases up your bowel movement. You may also take your nutritional supplements to feed your cells.

Activity
Just like your diet, activity needs to be slowed down. You can return to your activities of daily living like bathing and grooming, office working, and non-straining house chores like cooking and washing light dishes. Avoid heavy tasks like doing the laundry or lifting heavy objects like your big pans and pots; have someone do it for you.

Special Note on Fever after Surgery

Rule of Thumb: Fever within 24 hours is usually normal; it’s your body telling you it is adjusting to the trauma after the surgery. If the fever shows up after 24 hours, you have to inform your doctor because it might be a sign of an infection setting in.

We’ve covered the most part and if you make it to the second week without any problem, then you are on your way towards full recovery.

Signs of Complication:
Watch out for the following and report it immediately to your doctor or healthcare provider:

1. Fever after 24 hours.
2. Increasing pain around the surgical area.
3. Swelling that does not subside.
4. Red discoloration around the surgical site.
5. Surgical site warm to the touch.
6. Presence of discharges around the surgical site.

Media Credits:
Surgery & Procedures: http://www.estermaneye.com/services/surgery-procedures/
WebMD: http://www.webmd.com

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Ears, Nose and Throat, Healthy Living, Immune System

Did You Know that You Can Develop Allergies even When You Didn’t Have them as a Child?

A few months ago, two cases of allergy were brought to my attention from two women who both said they were unexpected – the reason being for this blog, which is by the way long overdue.

One of the two women had a bothersome itch on her neck, while the other had a near death experience with her husband who was rushed to the hospital due to anaphylactic shock. In both instances though, one thing was common – both individuals never had any history of allergy in the past. So, what just happened?

Upon probing, it turned out that the first woman vacuumed her house in the middle of a hot summer day, and only after a few hours, she developed red rashes on her neck that felt itchy. My analysis: the vacuuming stirred up the dust particles into the air making its way to her nostrils. This gave easy access for the allergens found in the waste products of the dust mites to enter her body, leading to an unexpected allergic reaction.

The husband, on the other hand, ate mackerel sushi for dinner that the wife bought from a local supermarket and prepared personally. This fish according to her is a usual viand in their home, so she had the slightest idea that this would cause her husband’s near death experience. Imagine her shock when after a few hours, her husband suddenly lost consciousness while preparing for bed that night. She recalled feeling so scared and confused while calling for the emergency services. My analysis: her husband had what is called, Scombroid Fish Poisoning. Here is a detailed explanation of this condition:

“This is an allergy like reaction that occurs after eating fish that have been improperly refrigerated after capture. Bacteria in and on the fish break down proteins into histamine, one of the major mediators of allergic reactions. Fish with a high content of red meat, which turns brown upon cooking are commonly involved such as mackerel, tuna, king fish, herring, sardines, marlin, anchovies and bluefish. Affected fish often have a metallic or peppery taste. Symptoms usually commence within 30 minutes of eating, and include flushing, itch, hives (urticaria), nausea, vomiting, stomach cramps, dizziness, palpitations and headache. Severe episodes may result in wheezing and dizziness or a drop in blood pressure.” Australian Society of Clinical Immunology and Allergy

Factors that Trigger Adult Onset Allergy:

Genetic History

An allergy can occur anytime during your lifetime if you have the dormant antibodies in your body, and yes, even if you didn’t have them during your childhood.

Exposure to High Levels of the Allergen

Sometimes, exposure to small levels of an allergen does not cause any reaction, but high titers of the same will cause moderate to severe allergic reactions.

Compromised Immune System

A poor immune system is not a very good defense in combating the effects of allergens during an allergic reaction process.

Allergies are common occurrences that can manifest in many ways such as rhinitis, asthma, skin rashes, dermatitis or in more serious cases anaphylaxis. Whatever the cause, however, points to a particular allergen as the culprit. In the medical community we call it “antigen-antibody reaction” where a foreign object or allergen, referred to as the “antigen” triggers an attack to a person who has a dormant antibody.  Once triggered, the “antibody” cascades a host of reactions in response to the “antigen”, which can vary from a simple rash to a fatal anaphylactic shock.

“The term atopic allergy implies a familial tendency to manifest such conditions as asthma, rhinitis, urticaria, and eczematous dermatitis (atopic dermatitis) alone or in combination. However, individuals without an atopic background may also develop hypersensitivity reactions, particularly urticaria and anaphylaxis, associated with the same class of antibody, IgE, found in atopic individuals. Inasmuch as the mast cell is the key effector cell of the biologic response in allergic rhinitis, urticaria, anaphylaxis, and systemic mastocytosis, the introduction to these clinical problems will consider the developmental biology, activation pathway, product profile, and target tissues for this cell type.” Harrison’s Principles of Internal Medicine, 17th Edition

atnurse
Know your “Asthma Triggers”

What should be done to avoid such fateful episodes?

  1. Dig in your family’s health history. If you have anyone among your relatives from (at least) the past two generations who had a history of allergy in any form, chances are, you might also have this dormant antibody genotype.
  2. Take a mental note of any incidence that caused you symptoms like rashes, sneezing, stomach upset, eye irritation and other unusual episodes that are not directly related to any bacterial or viral exposure. These incidents might give you a clue of possible antigens or “trigger allergens“.
  3. Avoid exposure to your “trigger allergens” at all cost.
  4. Invest in your health and keep your immune system in constant optimal condition. You can do this by eating healthy, exercising regularly, sleeping sufficiently, hydrating adequately, avoiding stress and keeping well-nourished cells.

It’s difficult to say when an allergy will hit just like what these two women experienced; especially when the cause or trigger is unknown. In these cases, however, both persons probably have the dormant antibody that reacted instantly upon exposure to the allergen. So, I’d say that the best way to avoid an allergic reaction is to be informed of your health exposure and risk factors.

The prudent understand where they are going and they carefully consider their steps. Proverbs 14: 8, 15 (NLT)

Resources:
Anaphylaxis: http://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis.aspx
Dust Mites: https://www.aafa.org/display.cfm?id=9&sub=18&cont=228
Allergic and toxic reactions to seafood: http://www.allergy.org.au/patients/food-allergy/allergic-and-toxic-reactions-to-seafood

Media Credits:
Dust Mites: http://www.pestfreeliving.ca/blog/wp-content/uploads/2015/04/7020081293_00a1f35a2a.jpg
Dust Mite Allergy: http://www.aamfoundation.com/wp-content/uploads/2014/03/girl-with-back-rash.jpg
Scombroid Poisoning: http://image.slidesharecdn.com/foodpoisoning-120213022212-phpapp01/95/food-poisoning-21-728.jpg?cb=1329101316
Mackerel: http://paleodiet.co.uk/wp-content/uploads/2013/09/mackerel.jpg
Asthma Triggers: http://www.smerete.com/wp-content/uploads/2013/06/Smerete_Types_Of_Asthma.png

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Ears, Nose and Throat, Healthy Living, Immune System, Infectious Diseases

Warning: Cold and Flu Season Ahead

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Flu Pandemic in the Philippines in 2009

It’s the rainy season again, which also marks the cold and flu season in the Philippines. There is no better way to beat these viruses than an ounce of prevention, so I chose to re-post an informative article written by Nick Peterson on “Scientifically Speaking: What’s the Cold Got to Do with It?”. I did a few editing to make the article appropriate for a tropical country setting.

Although, there is no winter in the Philippines and the viruses do not reach their gel state, flu spreads fast during the rainy season because of the cooler temperature, and the increased humidity and moisture of the air. Therefore, the air droplets easily carry viruses and transfers them from person to person. Another obvious reason is that the cooler season tends to dry up the mucosal cavities of the mouth and nose, making them a good breeding ground for viruses or bacteria for that matter.

On another note, if you ask me what is my position on whether to stay at home or to go out during the cold and flu season? I’d say, I had better stay at home, as long as, I am sure there is no carrier of the virus in our household.

“People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses are spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose.” – Centers for Disease Control and Prevention

An article by Nick Peterson, which was originally posted at What’s Up, Usana?

This month’s edition of Scientifically Speaking goes out to all the moms and dads who’ve warned their children throughout the years about exposure to the cold weather, which will inevitably lead to “catching a cold,” right?

Seriously though, as I’ve gotten older, I’ve started to wonder if my mom was just duping me the whole time. Both a cold and the flu are caused by viral infections, so what in the heck does cold weather have to do with anything?

It looks like we’ve stumbled across a great topic for Scientifically Speaking. I did a little digging and — as always — got a few leads from our expert scientists. I’d like to say I’ve got a solid answer for you guys, but there seems to be some difference of opinion within the medical community. Let’s break down my findings, shall we?

 

Cold vs. Flu

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Cold versus Flu

Before we dive into all the cold weather talk, let’s discuss what a cold actually is. With more than 200 viruses causing it, the common cold is a viral infectious disease that usually leads to symptoms such as coughing, sore throat, runny nose, and sneezing.

The most common virus strands that cause a cold are rhinoviruses, and all of those nasty symptoms you experience are actually a result of your body’s immune response to the infection rather than the deterioration of tissue that the actual virus causes. In more extreme cases, the virus causing your cold can lead to viral or bacterial pneumonia.

The flu, or influenza, is also a respiratory infection, but it’s caused specifically by influenza viruses and usually leads to more severe symptoms such as fever, body aches, chills and headaches. There are three different types of flu viruses, all of which humans are susceptible to.

What the Experts Say

The National Institutes of Health uncovered some evidence that might back up your parent’s argument to keep warm during the cold season. These findings are specifically associated with the flu virus and its outer covering, or envelope.

The study showed that colder temperatures (in case of areas with winter – near or below freezing), cause the flu virus to form a rubbery, gel-like covering that shields the virus, allowing for easier transfer from person to person. Once the virus enters the body, usually through mucus membranes in the mouth, nose or eyes, it reaches warmer temperatures in the respiratory tract and causes the covering to melt. The virus’ outer covering then reaches a liquid phase, allowing it to infect the cells of its new host.

On the flip side, during warmer seasons the temperature is too high for the viral membrane to enter its gel state. Because of this, flu viruses often can’t withstand the elements and will dry out and weaken, leading to the end of “flu season.” This led the scientists to wonder whether people might better protect themselves against the flu by remaining indoors at warmer temperatures than usual.

What the Other Experts Say

According to other experts, staying indoors might be the worst thing you can do for yourself throughout the colder season. A leading theory is that confinement breeds infection.

“In winter, we spend more time indoors, in rooms that may not get a lot of circulation, giving us more opportunities to be exposed to respiratory viruses,” says William Schaffner, M.D., chairman of the department of preventive medicine at the Vanderbilt University School of Medicine in Nashville, in this Real Simple article.

Additionally, Schaffner adds, the winter air, inside and outside, also tends to be less humid, drying nasal passages and making them more vulnerable to viral invasion.

What You Can Do

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Flu Prevention Tips

These are only two opinions on the subject, but there’s a lot of information out there. Do some investigating yourself to see what the research tells us.

In the meantime, the best thing you can do to fight that cold or flu virus is take preventative measures that support a healthy immune system. Evidence suggests that a healthy dose of both vitamin C and zinc may help. Deficiency in either of these may make individuals more susceptible to impaired immune response. Healthy adults generally need at least 75–90 mg of vitamin C and 8–11 mg of zinc per day to avoid severe deficiency.

Another important way to protect yourself from a virus is to avoid any kind of hand-to-face contact. Typically, a virus enters through hand-to-eye, -nose, or -mouth transmission. And of course, don’t forget to take the obvious precautions: healthy diet and exercise, sufficient amounts of sleep, disinfecting germ-susceptible areas, and regularly washing hands.

Media Credits:
Flu Season Ahead: http://greenprescription.net/home-remedies/8-home-remedies-for-flu/
Monsoon Rains: http://newsinfo.inquirer.net/694214/dry-winds-giving-way-to-monsoon
Woman with Flu: https://www.lloydspharmacy.com/en/info/Flu
Flu Prevention Tips: http://www.aboutflusymptoms.com/wp-content/uploads/2015/01/Flu-Prevention-Tips.png
Cold versus Flu: http://www.codral.com.au/cold-and-flu-symptoms

Ears, Nose and Throat

Is Your World Spinning Round?

Health Trivia:

Did you know that almost 50% cases of dizziness are due to a condition called Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is one of the most common problems of the vestibular system, and, as Vestibular.org explains:

“The vestibular system includes the parts of the inner ear and brain that process the sensory information involved with controlling balance and eye movements. If disease or injury damages these processing areas, vestibular disorders can result. Vestibular disorders can also result from or be worsened by genetic or environmental conditions, or occur for unknown reasons.”

atnurse
Is Your World Spinning Round?

4 days ago I ended up stuck in bed because of vertigo (literally ‘spinning sensation’), severe dizziness and on one occasion, vomiting. It felt like I was inside a spinning wheel uncontrollably being tossed and turned. It was like a magnitude 7 earthquake! It was really terrible. These symptoms are due to my condition called “Benign Paroxysmal Positional Vertigo (BPPV)” It has been almost 4 years, since I last had such a severe attack that pinned me down on my bed.

I was diagnosed with BPPV way back in the early 2000. It started with recurrent ear itchiness and ringing of the ears that triggered symptoms of ear pain and later on moderate to severe dizziness. Then my ENT (Ears, Nose and Throat) doctor took my medical history where I learned that my condition was caused by several factors: one, was my love for swimming, which chronically exposed my ears to chlorine and bacteria from the pool, the doctor called it the “swimmer’s ear”, two, my habit of cleaning my ears everyday made the ear canal very dry which triggered the itchiness, and three, my history of allergy to sudden changes in weather was also one of the culprits. And, I guess now, my age is also catching up with me. Aha!

What Causes Inner Ear Problems?

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This is how the Inner Ear looks like.

There are actually many types of vestibular conditions that can cause problems with balance, it can either be physiologic (problem with the structure and function) or pathological (disease process).

Conditions include “benign paroxysmal positional vertigo (BPPV), labyrinthitis or vestibular neuritis, Ménière’s disease, secondary endolymphatic hydrops, and perilymph fistula. Vestibular disorders also include superior canal dehiscence, acoustic neuroma, ototoxicity, enlarged vestibular aqueduct, and mal de débarquement. Other problems related to vestibular dysfunction include migraine associated vertigo and complications from autoimmune disorders and allergies.”

However, and as mentioned earlier, almost 50% of cases of dizziness are caused by BPPV. So, it pays to know your trigger factors and how you can minimize, if not avoid the symptoms.

What are the Symptoms of BPPV?

Vertigo is the distinct symptom of an inner ear problem, which is commonly mistaken for dizziness. It is characterized by a spinning sensation that does not stop even with the eyes closed and is worsened by sudden head movements. Dizziness on the other hand, is often described in many ways such as feelings of light-headedness, whirling movements or giddiness, faintness, blurred vision, mental confusion, headache and/or tingling sensations. Both symptoms of vertigo and dizziness may be present in BPPV, but the former cannot be eliminated.

Other accompanying symptoms of BPPV include unsteadiness of gait, loss of balance, ringing of the ears, abnormal eye movements, nausea, vomiting, and in rare occasions stomach upsets.

What Triggers the Symptoms of BPPV and How To Manage Them?

atnurse
Like a Spinning Wheel

1. The most common trigger in most cases of a bad vertigo attack is the sudden movement of the head.

What to do:

  • Be conscious of your head movements and control the pace of your head turns.
  • Know which ear has a problem and recall positions that trigger the spinning sensation.
  • Move from side to side before settling down or getting up from bed.
  • Ask your doctor about repositioning head maneuver exercises or home-based exercise therapies that may be appropriate for you. These may help control your vertigo symptoms.

2. Another trigger is the lack of sleep as this weakens the ability of the inner ear to cope up and send signals to and from the brain whenever there are sudden head movements.

What to do:

  • Make sure to have enough sleep each night. It depends from one person to another, but for adults 6 hours of sleep is relatively good.
  • Get a job that will not require you to be in graveyard shifts, because night sleep has more rejuvenating effects than a long nap in the morning.
  • Take mental note of the sleeping hours that make you feel completely energized for the day. Then if work prevents you from getting enough sleep daily, make an inventory of your “sleep debt”.

An example would be:

Monday to Friday: only 5 hours of sleep per night = accumulated 5 hours of “sleep debt” for the week

Then make sure to pay off your “sleep debt” over the weekend, which means:

Saturday 6 hours + 2 and ½ hours = 8 and ½ hours
Sunday 6 hours + 2 and ½ hours = 8 and ½ hours

Note: This tip is from my ENT and also my cardiologist who taught me the damaging effects of “sleep debt” to the heart.

3. Another trigger is the unnecessary cleaning of the inner ears.

What to do:

  • Clean ONLY the outer ears if that is part of your everyday routine. You can use your cotton buds or your towel. Never attempt to use your cotton bud for the ear canal as this will only push the ear wax (that may contains dirt and bacteria) towards the inner ear. Doing this may give you more serious problems.

4. Another trigger is swimming.

What to do:

  • Avoid getting your inner ears wet, but if you are scheduled to swim, buy some ear plugs to cover them.
  • Make sure that the pool you are going to dip in is acceptably clean.
  • Do not even consider swimming if you have an allergy to chlorine or if you have an active ear irritation or infection, as these conditions may give you days of terrible vertigo attack.

What are Other Treatment Options for BPPV?

There are medications you can take that can help control the symptoms of dizziness, nausea, vomiting and headache. In some severe cases, surgery may be necessary to correct the inner ear problem.

Based on my personal experience, sleep therapy for 2 to 3 days can really do wonders. Immobilization of the head also for 2 to 3 days will also help the inner ear to regain its control of your balance.

Resources:
Benign Paroxysmal Positional Vertigo (BPPV): http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo
Vestibular Conditions: http://vestibular.org/understanding-vestibular-disorder
Vertigo Symptoms: http://www.mayoclinic.org/diseases-conditions/vertigo/basics/symptoms/con-20028216
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. (2008). Harrison’s principles of internal medicine (17th ed.). New York: McGraw-Hill Medical Publishing Division. ISBN 978-0-07-146633-2
Link: http://www.mhprofessional.com/product.php?isbn=007174889X