Swimmer's Ear

Swimmer’s ear is commonly seen in the summer and is typically caused by dirty water getting trapped in the ear canal and causing infection. The infection is typically limited to the ear canal and does not spread to the middle ear. An easy way to tell the difference between swimmer’s ear and a middle ear infection is to pull on the ear - a person with swimmer’s ear will find this very painful whereas someone with a middle ear infection won’t.

Swimmer’s ear is easily treated with antibiotic drops. It’s also important to keep water out of the ear until the infection has cleared.

At BreatheMD, we offer ear check appointments for $75. Click here to schedule.

Feeling Powerless as a Patient

I received this email from a friend today. It made me embarrassed to be a physician and fearful of the time when I will likely be in a similar position. I didn’t learn how powerless it feels to be a patient until I myself became one - and because my memories are flooded by the joy of having kids, I have mostly forgotten the frustrations. But I’m certain a day will come when I will be be able to intimately relate to my friend’s plight as I try to navigate a broken system in the midst of a serious illness.

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Medication-Free Remedies for Sinusitis

The exact definition of ‘sinusitis’ is ‘inflammation of the sinuses.’ Bacteria are one source of inflammation, but in most cases, antibiotics are not warranted or helpful to treat sinusitis. Before seeing a doctor, several things can be tried at home to ease your symptoms.

Saline Irrigations

Saline irrigations - whether through a Neti Pot or a Neil-Med Sinus Rinse Kit - are the gold standard for improving sinus health. They keep the mucous thin, flush out pathogens and other irritants and have no side effects. Adding more salt (“hypertonic”) has a drying effect - helpful for runny nose but otherwise stick with the regular formula. Do at least twice a day - the more the better when your sinuses are congested.

Heat

Heat helps increase blood flow to the sinuses, allowing faster removal of pathogens and irritants, and also helps thin the mucous. Moist, warm compresses to the face, warm steam, hot showers, drinking hot tea, eating chicken noodle soup are great ways to deliver heat to your sinuses.

Humidity

If you’ve ever spent time in the mountains, you are familiar with the harmful effect of dry air on the sinuses. Humidity is important to keep the mucous thin and prevent sinus congestion. Sleeping with a humidifier next to your bed and frequent hot showers can be helpful. Avoid caffeine and alcohol which cause general dehydration and dry out the sinuses. Drink more water - a good rule of thumb is to drink half your body weight in ounces. Bloody mucous is usually a sign of dryness. To treat, dab the inside of both nostrils twice a day with bacitracin or Aquaphor ointment.

Diet

People with diabetes are more prone to infections due to high blood sugar. When you are sick or if you are prone to frequent sinus infections, minimize sweets and increase your intake of foods high in antioxidants. Avoid caffeine and alcohol and increase your intake of hot tea and soup.

Vitamins

Most people take in enough vitamins in their diet to avoid deficiencies, but a few have been shown to help during an illness including Vitamin D, Vitamin C, zinc and glutathione. The most common vitamin deficiency in our country is Vitamin D and low levels are shown to impair the immune system. The recommended daily allowance for Vitamin D in adults is 600IU per day but during an illness, 1000IU per day can be taken. Extra doses of Vitamin C (2000mg per day) have been shown to shorten the duration of illness, and zinc deficiency is associated with an increase in inflammatory markers. Taking zinc at the onset of a cold has also been shown to decrease the duration of illness. Glutathione is a strong antioxidant with anti- inflammatory properties; for best results, it should be administered as an IM injection.

Medication-Free Solutions at BreatheMD

BreatheMD provides a full range of natural treatment options for patients with sinusitis. Sinus therapy is a soothing treatment for sinus congestion that includes steam, saline irrigations, heat, massage and percussion. Our Infrared Saunas provide both heat and infrared light, which has been shown to increase circulation and decrease inflammation. IM and IV vitamins are available to boost the immune system and help rehydrate.

The essential strategy when battling a sinus infection is to keep the mucous flowing - with plenty of heat, humidity, saline, water, vitamins and healthy foods, medications won’t be necessary.

More on the T Cell Test for COVID-19

COVID-19 has graced the public with a crash-course in immunology - most of us are now familiar with the terms ‘PCR’, ‘rapid antigen’, ‘sensitivity and specificity’ and ‘antibodies.’   New to the syllabus is T cell immunity - a different arm of the immune system that has been largely ignored in the dialogue surrounding COVID-19 due to how difficult the T cell response has been to measure.  An innovative lab based in Seattle - Adaptive Biotechnologies - has figured out how to detect T cell responses and is the first in the world to offer this test to the public.  BreatheMD is proud to partner with Adaptive Biotechnologies to offer this breakthrough test to Houstonians.

What are T cells?

T cells are the first responders of the immune system and activate the antibody response.  They are highly specific (>99%) and respond to more than twice as many SARS-CoV-2 targets as antibodies.  T cells persist longer than antibodies with 95% detection 5+ months after PCR diagnosis compared to 52-71% detection with antibodies.

Who should get the T cell test?  

  • People who have tested positive for COVID-19 but have negative antibodies

  • People who have had symptoms of COVID-19 but tested negative on PCR

  • People who were exposed to COVID-19 but were never tested

More research is being done to determine how long the T cell response will stay positive.  Current data shows immunity to last at least 5 months in most people - 10 month data is on the horizon.  Additional research is ongoing to prove whether T cell immunity offers full protection against the virus; based on studies from other viruses, the assumption is that people with a positive T cell test are not susceptible to COVID-19.

The T cell test requires a blood draw and costs $250.  Results are back in 7 - 10 days.  The test is available in our office Monday - Saturday. 

COVID-19 and Sleep

Sleep and immunity are tightly connected, and getting adequate sleep is one of the best ways to prevent illness, speed recovery from infection and respond well to vaccinations.  Adults need 7 -8 hours of sleep per night; less than that significantly increases one’s risk of infection, obesity, heart disease, and other health problems.

If you do contract COVID-19, let your body rest, and try to get as much sleep as possible to speed your recovery.  Sleeping can be more difficult when you are ill due to respiratory tract congestion and irritation.  The following tips can help:

For nasal congestion and cough:

  • Elevate the head of your bed and sleep next to a humidifier.

  • Use Afrin nasal spray at night (note: don’t use Afrin for more than 3 nights as your congestion may worsen when used for long periods of time)

For body aches/muscle pains:

  • Before bed, take a warm bath and a pain-reliever such as Advil, Tylenol, and/or CBD.

  • Drink plenty of fluids. Dehydration can exacerbate muscle aches.

  • Take magnesium supplements to help with muscle relaxation.

For stress and anxiety:

  • Use a weighted eye pillow and/or a weighted blanket.

  • Meditate before bed and put your phone in another room.

  • Listen to an audiobook.

Additionally, melatonin has been shown not only to promote sleep, but also to assist the immune system by helping mitochondria inhibit viral replication. Taking a small dose before bed every night (1 - 3 mg) can help you sleep while also helping your body’s host defense system.  

For more information and tips on sleep, go to www.sleepassociation.org.


Sleep for Seniors

As we age, good quality sleep can be hard to come by.  Our master clock, the suprachiasmatic nucleus, works less efficiently, and our pineal gland secretes less melatonin.  These biological changes result in a propensity for older adults to both fall asleep earlier and wake up earlier.  None-the-less, seniors need just as much sleep as younger adults - 7 to 8 hours per night is ideal - yet 40 - 70% of them don’t get quality sleep.  

The number one sleep complaint among older adults is waking up too early and not being able to fall back asleep, and the number one reason seniors wake up too early is to use the bathroom. Other common reasons for poorer sleep as we age include chronic pain, medications, obstructive sleep apnea, restless leg syndrome and REM-behavior disorder.  

Sometimes the reason for inadequate sleep is unclear; in these people, daily exercise is the single most effective strategy to improve duration and quality of sleep. Other tips include getting enough daytime light, decreasing caffeine intake and keeping a good sleep routine.  Light is the most powerful cue for maintaining our circadian rhythm, and many seniors don’t get enough daytime light exposure.  Additionally, most people don’t realize that caffeine increases nighttime awakenings, so limiting caffeine is important even if it’s not keeping you from falling asleep.  Retirement brings less structure to our lives and the lack of a routine can easily lead to poor sleep habits.  Avoiding naps and keeping a regular sleep schedule are important; your iPhone can help by sending you daily reminders for bedtime and wakeup time.  

Ambien and other sleep hypnotics should be the last resort for sleep issues and should not be used for more than two weeks.  Hypnotics lose their efficacy after 14 days and can be dangerous in women and the elderly - blood levels are typically 45-50% higher in these groups. Unfortunately, Ambien and other sleep aids are widely prescribed; a recent study estimated that 77% of adults using Ambien are not following FDA safety recommendations.

At BreatheMD Sleep & Wellness, we are passionate about the importance of good sleep for better health. We get to the root cause of sleep issues and offer a wide variety of modalities - from our EmSella chair that decreases nighttime urination to guided meditation classes that ease insomnia -  to help our patients achieve great sleep.    


Keys to Better Sleep

Nothing has more impact on your overall health than the quality of your sleep, yet up to 30% of adults are routinely sleep-deficient and over 50% of adolescents suffer from excess daytime sleepiness.  Inadequate sleep - less than 7 hours a night in adults or 8 hours in teens - has been shown to cause weight gain, impaired executive functioning and attention, changes in memory and emotional dysregulation. People who routinely get less than 7 hours of sleep per night have a significantly higher risk of developing diabetes, hypertension, heart disease, and stroke.  Inadequate sleep decreases immune function, increases sensitivity to pain, and increases risk of alcohol and substance abuse.  

Rather than take a pill, the most important key to better sleep is plenty of physical activity during the day.  If you can’t motivate to exercise, try cleaning out your garage or a cluttered closet; organizing and getting rid of unnecessary things has tremendous mental and physical benefits.  

Here are my favorite sleep tips that anyone can try:

  • Aim to get 7 - 8 hours of sleep per night (adolescents need 8 - 10 hours per night.)

  • Limit blue light exposure at night - change the settings on your phone and computer to automatically block blue light after 8pm.

  • Use a weighted blanket and a weighted eye pillow. The pressure on the skin and eyes activates the parasympathetic nervous system which is conducive to sleep.

  • Lower the temperature of your bedroom to 60 - 67 degrees F.

  • Use a HEPA filter in your bedroom to keep the bedroom free from allergens and as a white noise device.

Everyone experiences insomnia from time-to time, but if difficulty sleeping persists for 3 months or longer, it’s best to seek professional help - early treatment has been shown to prevent development of long-term sleep problems.  In addition to trouble falling asleep, symptoms such as loud snoring, frequent awakenings during the night, inability to stay awake during the day, and leg discomfort before bed may be signs that an underlying medical problem exists and should be evaluated by a sleep physician.