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Emergency Instructions: Often Missing or Muddled!

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Ah, yes.  The instructions.  One of those Venus and Mars examples: women read them, men blunder ahead without them.  But even with written instructions, results are not always assured.  Just ask anyone trying to assemble a Swedish bookshelf with an Allen wrench, a bag of metal pieces and instructions in twenty languages other than your own.  To make matters worse, it seems there is always one missing Umvaart. 

But sometimes instructions are a matter of life and death.  A case in point is with emergency self-injections of adrenaline, and with puffers for acute asthma attacks.

A recent US study shows a dismal 16% rate of correct usage of prescribed adrenalin auto-injectors, like the EpiPen. If someone is highly allergic to something, such as a bee sting or foods such as peanuts or shellfish,  then swift and proper injection of adrenaline is lifesaving.  Common errors include not pushing down forcefully enough to have the needle tip penetrate through the skin, or not holding  the device in place for at least 10 seconds.  Not to mention forgetting to carry it with you on that canoe trip.

For acute asthma, where one expects to have a greater frequency of crises than food allergies, the error rate for puffers was even worse.  Only 7 % of asthma sufferers could use their puffers properly, according to the Annals of Allergy, Asthma and Immunology. 

The leader of the study, Dr. Rana Bonds from the University of Texas Medical Branch, notes that people were not trained properly in the first place, and/or “forgot the instructions over time”.   Similar studies show the problem is universal around the world.

Apart from the obvious personal distress, the financial consequences are immense.  Asthma medications constitute literally billions of dollars of expense, and if most of it is squandered, then our tax and insurance dollars are being wasted. 

So here is how to use the epipen:

For video demonstration of the epipen use:


And here is how to use your inhaler for asthma:

For video demonstration of your inhalers:



And for the use of an inhaler with the spacer, please review this video:

One last point about the inhaler, it would make far greater sense to extend the neck into a straight line, rather than expecting the inhalations to bend around a 90 degree corner to get from lips to lung.  Just as the sword-swallower at the circus knows, along with the bronchoscopy surgeon in the operating room, you need a straight line to get a straight shot.  That’s not in the instruction manual, just one of my own observations.

Be sure to discuss with your pharmacist as well, in case any different brand or model is being substituted, there may be a new set of instructions to review. 

As a precaution, remember to carry a spare.  Just like propane tanks for that big weekend bbq, inhalers are hard to check for remaining capacity.  Also remember to check stale dates, as there is no point  trusting your life to an out-of-date product. 

Please make sure you check regularly with your doctor, and follow any instructions for additional testing, monitoring, or changes of strategy. 


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Stress and Synthetic Fingernails

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Are you one of the thousands who use acrylic fingernails? Well, there are a few things you should know about them first.

An image of someone typing on a keyboard

For today's working woman, and increasingly, for today's working man, fingernails have become a cosmetic fashion point. With most people now working in front of keyboards, and with many driven to distractions such as chewing their fingernails,  more cases of broken or damaged nails are being seen. An easy way to fix the problem is to check-in for fake fingernails, which use acrylic in one form or another. Some are plastic nails glued with an acrylic adhesive, some are repaired by wrapping them in silk or linen, then bonding them to the nail plate with acrylic glue, and still others use various acrylate polymers which are then shaped or sculpted onto the surface of the fingernail plate. The problem is that there can be risks, and they are right at your fingertips.

Fake fingernails lengthen the nail plate, meaning greater leverage is applied to the nail beds. That is why longer nails break more often, and the real fingernail underneath can come away from its nail bed. Real fingernails are highly permeable to water, fake nails of course are not. This means that fingernails  made soggy through sweat or immersion cannot evaporate water through a fake nail that is adhered on top of it. This means the real nail has a greater chance of separating and becoming infected with bacteria and yeast. In some people, acrylic glues can cause a local allergic reaction with dermatitis or inflammation, infection, and even permanent fingernail loss. In addition, the common practice of sanding the fingernail surface before attaching the acrylic can damage the natural protective coating.

Sometimes a gap develops between the acrylic nail and the natural nail. If the acrylic fingernail is bumped or jarred, it can separate from the natural nail. This gap provides a moist, warm environment in which a nail infection can flourish. A fingernail infection might also occur if acrylic nails are too long or too rigid, or the nails are applied with unsanitary tools. If you develop a nail infection, your natural nail might become thick or ragged and appear discolored.

It's also possible to have an allergic reaction to components of acrylic nails or the adhesives used to apply them. This can result in redness, swelling and pain around the nail.

Here's an action tip:

Prevention is always the best technique in nail care. If you damage your fingernails  in housework, wear gloves. If you break them on keyboards, try keeping them trimmed a little shorter. If you chew your fingernails, why not save a step by simply chewing acrylic nails straight out of the box.

If you choose to have acrylic fingernails applied in a salon, take steps to minimize the risks:

  • Stick to salons that display a current state license, and work only with technicians also licensed by the state board.
  • Be wary if you notice fumes. A strong odor could be a sign that the salon is poorly ventilated.
  • Make sure your nail technician properly sterilizes all tools used during your treatment and washes his or her hands between customers.
  • Soak your fingernails in a fresh bowl of soapy water before treatment begins.
  • Don't allow your cuticles to be pushed back or trimmed. This can increase the risk of a fingernail infection.
  • Don't allow the surface of your natural nails to be filed or roughened before the acrylic nails are applied. This weakens your natural nails.
  • Request a new nail file — or consider bringing your own, since nail files can't be sterilized.

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Herbal Remedies for Aches and Pains

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Lets face it, many people are over-medicated, either from over the counter products or from prescription drugs, and many of their complaints could have been better handled with grandmother's old fashioned herbal remedies. An image of useful herbs But that does not mean that drugs from factories are bad, while drugs from plants are safe.

Plants can produce very potent drugs, some of which are the raw materials for medicines such as digitalis, morphine, aspirin, and quinine. When taken in their raw form, it can be a tricky thing to get the dosages right.


Much has been written and claimed about herbs, but here are a few guidelines. The following herbs can be very helpful:

  • Aloe gel from the inner leaves of the aloe plant whose derivatives are natural herbal remedies for the pain of burns, including sunburns.
  • Chamomile tea can relieve indigestion, and act as a mild sedative.
  • Feverfew tea is said to help colds, flu, and migraine-headaches.
  • Gingerroot tea can counter motion sickness.
  • Peppermint and spearmint tea can help heartburn, indigestion, and cold symptoms.
  • Raspberry leaf tea can help alleviate diarrhea and menstrual cramps.

With all of these, as with most medicines, there can be individual allergic reactions. However, others are not herbal remedies at all, and are downright hostile. Calamus and coltsfoot and Sassafras contain suspected carcinogens. Ginseng and licorice, when taken in large amounts, can raise blood pressure, and in the case of licorice, cause fluid retention. Goldenseal and senna can both cause miscarriage and severe stomach pains, and can be fatal in large doses.

Here's an action tip:
Just because a herbal remedy is marketed as natural, organic, or herbal doesn't mean it is free from side effects. Check with your doctor to see if your herbal remedies are appropriate for you, especially if you are on prescription medications or are pregnant or breastfeeding, and don't give them to children.

Because herbal medicines can be so powerful, they deserve all the respect you would give prescription drugs.

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Sinus Troubles - It's All in Your Head

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Patients often present with sinus symptoms, or a sinus infection, both in the winter flu season as well as in the summer allergy season. 


Often there is pain, discharge from the nose or down the back of the throat, and sometimes fever.  Many patients will  not be able to inhale through one or both nostrils, and wake up with dry, sore throats as a side effect.

As these symptoms can be caused by either an infection or an allergy it's good to be able to tell which you may have.

What is a sinus infection?

A sinus infection is an invasion of your body's tissues by disease-carrying microorganisms. Your body initially reacts to these microorganisms with an innate (or automatic) response followed usually by some type of adaptive (or specific) response depending on the microorganism.

What are allergies?

An allergy is hypersensitivity disorder within your immune system. Your immune system reacts to a normally harmless substance in your environment with sinus infection-like symptoms except that an allergy is generally acquired, predictable, and rapid. 

To put sinuses in perspective, we should review the whole story.


1.    Anatomy: The word sinus actually means any “bay” or “pocket” in the body.  While there are sinuses in the GI tract, or under the skin, for purposes of this discussion we are referring to the NASAL sinuses.  These are basically 4 “caves”, each with a bottle-necked opening into the nasal passage.  Normally air-filled, they are lined with the same mucosa that covers the whole nasal passage.



2.   Function: These provide reservoirs of moist mucosal secretions for helping to humidify and filter dry air as it is breathed through the nostrils.  In addition, sinuses are “reverberating chambers” that allow the human voice to resonate.  To demonstrate how this affects voice, just ask a singer to demonstrate a few notes when they plugged with bad sinus infection. 



3.   Pathology: When the nasal lining gets puffy, the “bottle neck” openings quickly close up.  Then the sinus fills up, as more secretions are produced , either from allergens (such as pollen and dust), or from infections (such as the common cold), either viral or bacterial


4.   Complications: With the opening of the sinus sealed off, changes in pressure inside the cavity can become very painful.  That pressure could be from excessive fluid production inside the sinus, which can even be filmed on X-rays or scans.  External gradients of pressure can come from either extreme: from too much pressure (eg Scuba divers under several atmospheres of water pressure), or too little pressure (eg driving to high altitudes in the mountains).  In airline travel, clogged sinuses can produce pains of both kinds, on the way up to altitude, or, if the sinuses open and then re-close, on the way back down.  In such cases the pain can be intense.


5.   Treatment: For simple sinus cases, a non-prescription antihistamine works well.  Some will also have a form of ephedrine added, for extra sinus relief. Nasal sprays, from simple saline to medicated ones can also help to open up the passages.  Finally, in cases of bacterial infection (green or yellow colored discharge is often a feature) an antibiotic may be needed.  In all cases, a measure of pain relief may be needed with anti-inflammatories or even prescription strength pills from your doctor. 


6.   Prevention: As with any mucous membrane issues, avoid anything that inflames them.  If your doctor’s tests prove allergies, take measures to avoid them.  This might mean air filters, replacing old carpets with wood floors, or simply having the dog and cat sleep further away from your bed.  If you are sensitive to foods, avoid all dairy products when you have sinus problems, as the milk-based proteins will cause the mucous to become thickened, and further clog the sinuses.  Once the sinuses clear, use your own judgement and return to dairy if you insist.  In the meantime, use chicken or vegetable soups as a good basis for thinning your mucous, and always seek to drink plenty of water (hot or cold) to fully  hydrate your body.


7.   Finally: If the sinuses are simply not responding to the above, please consult your doctor for more advice.  If you do need to take antibiotics, don’t forget to read our article on probiotics.


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