Category Archives: Dr. Croft’s Blog

TESTING…One….Two…Three

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We continue to be bombarded by media and hearsay about COVID-19 testing.  Hopefully this information may help offer some guidance regarding the testing issues and some direction for you to consider personal testing.  There are two types of COVID 19 tests available at this time, the molecular testing for active disease and the antibody test for the exposure to or recovery from the disease.

The molecular test looks for active disease.  This involves taking a cotton swab of one nostril for about a five second duration.  This sample is then sent to the lab to undergo a polymerase chain reaction (PCR).  This testing checks for the presence of the genetic material of the virus.  A positive PCR test identifies the presence of two specific SARS-CoV-2 genes.

If there is only one gene present, the test is reported as an inconclusive result.  This testing can only diagnose a current active case of COVID-19.  Common symptoms include a cough and/or shortness of breath.  At least two additional symptoms including fever/chills, muscle pain, headache, sore throat and loss of taste or smell are suspicious of disease.  Some individuals may have only a few or no symptoms whatsoever, but still be actively infected.   Negative test during the presence of acute respiratory symptoms indicates that the illness is not COVID-19.

False negative testing may occur if the test is collected too early in the exposure of the disease.  The usual period from catching the infection to developing symptoms averages 5-6 days, but may be up to 14 days.  During the “pre-symptomatic” period, some individuals may be actively spreading the infection.

At this writing, the only way to access local molecular testing is with a physician order through the Coconino County Health Department.  The collection sites for testing are at Fort Tuthill and their King Street building, but schedules may vary.  For more information and updates, visit www.coconino.az.gov/2294/COVID-19-Information.

Coronavirus COVID-19 SARS-CoV-2 Antibody IgG testing may show individuals who have recovered from exposure to COVID-19. This test searches for the presence of specific antibodies that the body has produced to fight the virus.  A blood sample is needed to run this test, and there are a number of commercial labs producing these serologic tests.  This testing should not be considered until at least ten days or longer after symptoms develop, as it can take one to three weeks for the body to develop antibodies.

A positive test shows that antibodies are present, a negative indicates no antibodies present.  There are some questions that arise about such testing.  By recent reports, some of these lab tests may be up to thirty percent inaccurate.  False positives may indicate antibodies, but may not be specific to SARS-CoV-2 as there are other common Coronaviruses including HKU1, NL63, OC43 and 229E.  There is also no distinction as to recovering from a present COVID-19 infection or a previous common non-SARS-CoV-2.

One needs to use some care in interpreting the value of antibody testing.  There is no assurance that antibody positive individuals may continue to be resistant to future exposures.  Or, if positive, for what longevity may their resistance be present.  That said, the presence or absence of antibodies should not be used to definitively diagnose or exclude COVID-19 infection or designate the status of infection.  Be careful about using these test results alone to make health related decisions.  Because of these problems, some medical clinics are not offering this test to their patients.  Consult your health care provider for guidance regarding testing during these challenging times.

Bradford Croft, DO

East Flagstaff Family Medicine

What You Should Know about Coronavirus

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With the increasing concern of COVID-19 in our communities, our first and foremost concern is for the health and safety of our patients and our people. We want you to know what you can do to prepare for the coronavirus at home and if you need to visit a healthcare center.

What you should know
• COVID-19 is a respiratory disease caused by a novel (new) coronavirus that was first detected in China. It is now being spread from person to person in multiple locations across the U.S.
• Health experts are still learning the details. Currently it is thought to spread:
o Between people who are in close contact with one another (within about 6 feet).
o Via respiratory droplets produced when an infected person coughs or sneezes.

Personal precautions
Here are a few tips to help prevent infection:
• Wash your hands often with warm, soapy water for at least 20 seconds and/or use hand sanitizer.
• Cough into your elbow. Cover your mouth and nose with flexed arm or tissue when coughing and sneezing. Clean hands with hand sanitizer or wash hands thoroughly after.
• Avoid touching your eyes, nose and mouth.
• Clean and disinfect high touch areas such as desks, doorknobs, keyboards, phones, etc.
• Please do not use a mask if you are not sick. Masks don’t protect healthy people from getting sick. They help keep sick people from spreading illness to others if they cough or sneeze.

Medical care
• If you are sick and have a fever, or signs of cough/flu/pneumonia, shortness of breath, or other respiratory conditions please stay home from work or school.
• Call your primary care provider before traveling to a care center to understand the appropriate plan of care if you know you have been exposed to somebody with the COVID-19 virus or if you have a fever above 100.4 associated with a cough.
• Consider a telephone visit for simple illness if possible.
• If you arrive at a care center with respiratory symptoms, ask for a mask to wear.

More information and resources
• For all that you need to know, including travel advisories: www.cdc.gov/coronavirus/index.html
• For specific questions, see the CDC’s FAQ section: www.cdc.gov/coronavirus/2019-ncov/faq.html
• For information about COVID-19 in your state, search your state’s health department, which works with the CDC to monitor and implement all recommendations: www.cdc.gov/public…/healthdirectories/healthdepartments.html

Say Again??

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Have you ever experienced difficulty in hearing after a night at a concert?  Have you had an exposure to a sudden loud noise that caused reduced hearing in one or both ears for any period of time?   How about a buzzing or ringing in your ears after noise exposure?  If any of those rings a bell (which you may or may not be able to hear), you may be experiencing Noise Induced Hearing Loss (NIHL).  In fact, about fifteen percent of Americans between twenty and seventy may have hearing loss from exposure to noise at work or in leisure activities according to the National Institute of Deafness, https://www.nidcd.nih.gov/.

There is not one simple situation that causes NIHL.  The damage to hearing after loud noise exposures may not be immediately apparent.  Commonly it is a subtle, progressive damage caused by repeated exposure to loud noises, many times from varying sources over years.  The individual may not even be aware until family members or friends point out the concern.  The repeated damage from loud noise even from short exposures over time may progress to permanent loss.  It is important to wear hearing protection when you anticipate such exposures.

Excessive noise exposure in the workplace is readily recognized as a potential hazard for as many as 30 million Americans.  Employers are required by law to evaluate and monitor noise exposure levels that identifies workers at risk.  The threshold to provide an OSHA Hearing Conservation Program is that of 85 decibels (dB) or above averaged over an eight hour day. But as damage may also occur accruing from sporadic and intermittent noise, the range of exposure must be monitored from 80 dB to 130 dB.  Employers must provide hearing protection in the workplace for these individuals, the type and extent of such can be calculated from the average noise exposure level.  Baseline and annual hearing tests must also be provided to these individuals to assure adherence to the Hearing Conservation Program, that progressive hearing loss does not occur.  Prevention is paramount, as NIHL is progressive and permanent.

Although the higher pitches of hearing (frequency) are usually the first lost, it is the volume (amplitude), of sound, measured in decibels (dB), that causes damage.  Examples of common volumes are: whisper at three feet = 30 dB, conversation at three feet = 60 dB, vacuum cleaner at three feet = 70dB, busy road at fifteen feet = 80 dB, diesel truck at thirty feet = 90 dB, concert three feet from a speaker = 100dB, chainsaw at three feet = 110dB, ambulance siren at 100 feet = 130 dB.  The OSHA standard for the work environment is 85 dB averaged over eight hours of exposure.  For every three dB of volume increase, the “safe” exposure time is cut in half.  At 88 dB, the limit of exposure is now cut to four hours before hearing will become further damaged.

As the work environment is only responsible for about eight hours of our daily living (for most of us), consider the cumulative effect of noise exposure throughout the twenty-four hour day.  What is the “safe” level of noise exposure then?  According to hyperacusisresearch.org the only evidence-based safe noise level for hearing is a surprisingly low 70 dB when it is averaged over twenty-four hours.  Consider personal hearing protection when working with power tools or at sporting events.  You may want to turn down the volume on your headphones or earbuds.  At maximum volume, you may be generating 100 dB volume, loud enough to begin causing hearing damage at only fifteen minutes of exposure per day. Additional information on NIHL may be obtained from the Occupational Safety and Health Administration link: https://www.osha.gov/Publications/osha3074.pdf  or your PCP.

Bradford Croft, DO

East Flagstaff Family Medicine

Take It to Heart

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In addition to St. Valentine, February helps to remind us of other things that impact the heart. Multiple factors can influence your risk of heart disease that include several health conditions, your lifestyle, age and family history.   It is important to know your risk factors as some can be changed, others cannot.  As heart disease is still the number one killer of both men and women in the US, these are issues that should truly be taken to heart.

According to the Center for Disease Control, almost half of the US population have at least one of three main risk factors of cardiovascular disease: high blood pressure, elevated cholesterol and smoking.  High blood pressure can silently damage the heart, kidneys and brain among other systems over time.  When the damage comes, its first symptom will usually be a heart attack, kidney failure or stroke.   As there are rarely any physical complaints associated with untreated hypertension, the only way to determine the problem is to check your blood pressure.  If elevated, treatments may include lifestyle changes as well as medication.

Cholesterol is a natural substance in the body, but with elevated levels may cause deposits in the blood vessels over time.  As these plaques occur, circulation can be compromised to organ systems, again leading to damage to brain, heart and kidneys.  And again, its first symptom may present as a stroke, heart attack or kidney failure.  The two major cholesterol subgroups include HDL (good cholesterol), the higher the better, and LDL (bad cholesterol), better lower.  Depending on risk factors, the goals for the cholesterol components may vary among individuals.  A simple blood test can determine your values and imply your risk.

Smoking is well known to increase the negative effects of both hypertension and hyperlipidemia.  The effects of nicotine, either smoking or vaping, will further heighten blood vessel resistance, contributing to worsening hypertension and vascular damage.  High cholesterol will be adversely affected by further lowering HDL, further increasing plaque formation.

Diabetes will compound the likelihood of cardiovascular death.  Management of diabetes is critical to decreasing the risk of cardiovascular disease.  The impact of obesity further worsens adverse cholesterol and elevates blood pressure.  Poor dietary habits, sedentary lifestyle, excessive alcohol intake and uncontrolled anger or stress all are additional contributors as risk factors.  As difficult as it may be, however, all of these risks can be modified and improved with lifestyle and medical intervention.

Some risk factors can’t be changed including family history (following genetic blueprints), age (risk increases with age), gender (males more likely than females, but the odds equilibrate after menopause), and race (African American, Native American and Hispanic American are at higher risk than Caucasian).  Even though these risks cannot be changed, the spectrum and contribution of the additional treatable risks can be addressed and monitored over time to improve the outcomes and minimize the cardiovascular consequences.  If you are not aware if you have any of these risk factors, this would be the month to visit with your primary care provider for screening.  If you do have any of these risk factors, this would be the month to visit with your primary care provider for treatment.  Take it to heart.

Bradford Croft, DO

East Flagstaff Family Medicine

The Eyes Have It

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Over ten million Americans suffer from vision loss secondary to macular degeneration, more than glaucoma and cataracts combined.  The retina is the back lining of the eye, responsible to receive images projected by the lens.  The central portion, or macula, is where the ability to focus central vision occurs.   As that lining deteriorates, the ability to read, recognize faces or colors, drive a car and see objects in fine detail becomes compromised.   In the early changes of macular degeneration, the individual may not yet be aware there are any changes in vision.  As the disease progresses, there may be wavy or blurred vision.  With additional change, there becomes a loss of the center of the visual field.  Imagine looking at a photograph with the center of the picture erased.

Macular degeneration is a little known disease, but research continues.  There is evidence that lifestyle, genetics and environment all contribute to the development.  People with a family history are at greater risk.  Whites are also at greater likelihood than Blacks or Hispanics/Latinos. Those with light colored eyes are more prevalent, as are those with long term UV exposure over time without protection.   Those with cardiovascular disease, overweight, eat high fat diet or are females are at greater risk.  Smoking doubles the risk of macular degeneration.  The threat increases with aging, particularly over age 60.

Because the disease most commonly occurs with age, it is referred to as Age-related Macular Degeneration (AMD).  The early stage of AMD may not be evident to the patient.  A careful eye exam may identify the initial presence of drusen, the degenerative deposits found in the retina as the disease is diagnosed.  Intermediate AMD develops as the number and size of drusen increase, which may provide some degree of visual changes, but still may not necessarily be apparent to the individual.  A comprehensive eye exam along with additional testing should show larger and increasing drusen or changes in the retinal pigment.  Late AMD has established apparent vision loss.  There is another form of macular degeneration known as Stargardt disease. This type is genetic in nature and commonly presents in young individuals, earning the name of early onset or juvenile macular degeneration.

Dry degeneration (atrophic) is far the more common type of macular degeneration (85-90%) while the balance is wet degeneration (exudative).  Although both are problems, the wet form is a much more aggressive form of the disease.  Dry degeneration involves the proliferation of drusen, where eventually the macular cells will thin and die, causing loss of central vision.  Wet degeneration involves overgrowth of blood vessels in the eye, causing bleeding and fluid in the retina, eventually causing scarring and vision loss.

At this time, macular degeneration is an incurable disease.  There are opportunities to reduce your risk and slow the progression once diagnosed.  Risk reduction may include exercise, diet changes, protecting your eyes from UV exposure and not smoking.  Regular eye examinations may be the single most important factor in intervention, especially if you have risk factors or a family history of macular degeneration.

Bradford Croft, DO

East Flagstaff Family Medicine

Vaping – Our New National Nemesis

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As of end-October 2019, there have been 1888 lung injury cases associated with the use of e-cigarettes, with thirty-seven confirmed deaths in 24 states.   There are some common findings that are associated with lung damage from e-cigs or vaping, but there are many variables that may contribute to the damage.  All patients reported the use of vaping as a common denominator.  Both the exclusive use of nicotine in some patients along with the combined use of nicotine with THC have been reported by others.  According to the CDC, the latest national and state findings suggest that products containing THC, especially those obtained off the street or other informal sources are linked to most of the cases and play a major role in the outbreak.  But as some patients had reported only using nicotine and still experienced lung damage, nicotine should not be excluded as playing a role as an antagonist as well.

To date, the FDA and the CDC have not isolated specific agents producing the lung injuries in these cases.  There may be multiple substances that are contributing to the outbreaks as many product sources continue to be investigated.  As there are currently no ingredient requirements or contaminant controls imposed on vaping fluids, there are no required quality guidelines or measures imposed on manufactures at this time.  Home based fluids can be exceptionally risky, particularly those with THC.

The CDC data reports seventy percent of e-cigarette/vaping lung injury (EVALI) patients are male.  The median age of patients is 24, ranging from 13 to 75 years old, with 79% of patients under 35.  Of 864 patients with established disease report using the following within three months from the onset of their disease:  86% with THC containing products, 34% exclusively THC, 64% with nicotine containing products and 11% exclusively nicotine.  Listing patients by age group category: 14% of patients are under 18 years old, 40% are 18 to 24, 25% are 25 to 34, and 21% are 35 or older.

Symptoms of EVALI can be very nonspecific and vague.  Listed complaints of the disease include cough, shortness of breath, or chest pain; nausea, vomiting, abdominal pain, or diarrhea; fever, chills, or weight loss.  The onset of symptoms can be as brief as a few days after exposure, others have taken weeks to develop.  A common acknowledgement is that lung infections do not appear to be the underlying cause of symptoms, rather it is the vaping products themselves.

As you would expect, the CDC recommendations include not using vaping or e-cig products, especially those that contain THC.  Given no product quality controls, you may reconsider buying any type of commercial products, especially off the street.  If you are using vaping as an alternative to smoking, please do not go back to cigarettes.  Consider using FDA approved nicotine replacement therapies.  If you are trying to quit tobacco products and need assistance, contact your health care provider.  The Arizona program ASHLINE is a free nicotine cessation program at www.ashline.org  and has a helpline 24/7 to get started at 1-800-55-66-222.  For youth or adults with marijuana addiction, support and treatment is available through the Substance Abuse and Mental Health Services Administration (SAMHSA) Flagstaff Office at (928) 774-7128.

Should you need additional support or information regarding vaping or e-cigarettes, search https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html or contact your health care provider.  The urgent message regarding vaping – don’t start, quit if you do!

Bradford Croft, DO

East Flagstaff Family Medicine

The Common Cold is Indeed

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As we approach the colder, shorter days of winter, it is not unusual to “catch a cold”.  There are over two hundred viruses that cause the common cold, the most common being the rhinovirus.  At the beginning of infection of the nose and sinuses, the body produces increasing clear mucus to try to wash out the germs (rhinorrhea).  After a few days, the mucus thickens and changes to white or yellow as the immune system kicks in.  As the natural bacteria reestablish themselves, the mucus may turn greenish, which is a normal finding.  It also occurs as the mucus thickens from the significant dryness of our region in winter, known as inspissation.

As the virus continues to grow, it will increase mucosal inflammation and produce complaints including low grade fever, sneezing, stuffy or runny nose, sore throat and painful swallowing, coughing, watery eyes, headaches and body aches.  The best treatments for the common cold are rest and lots of fluids.  Over-the-counter (otc) medications may help to make you feel better in relieving the symptoms.  However, the virus will run its course, typically over a period of days to a week or so.  If you use the otc medicines, make sure to use them only as directed.  These medicines will list the symptoms that they treat, so read the labels and pick the appropriate medicine for your complaints.  You may want to avoid multi symptom treatments, as they often contain treatments for symptoms you don’t have or need.

Antihistamines such as Claritin (loratadine), Zyrtec (cetirizine) or Allegra (fexofenadine) may help to reduce the inflammatory response.  Guaifenesin such as Mucinex or Robitussin helps loosen and thin mucus. Dextromethorphan – commonly seen as “DM” in the medication name (Robitussin DM) may help control the cough.  You may want to avoid decongestants, as their drying effect may worsen symptoms.  Tylenol or ibuprofen may help the fever, aches and pain with plenty of hydration.

Antibiotics do not help get a common cold better, as these medicines do not affect viruses.  In fact, using antibiotics may actually worsen the infection from a virus. These meds may kill the bacteria that normally would compete with the virus, allowing your infection to worsen.  Unnecessary antibiotics may increase complaints from the medicine itself, including gastrointestinal effects, skin rashes, and increase the risk of acquiring an allergic reaction to the medication.

The diagnosis of the viral sore throat (pharyngitis) does have challenges.  Our environment will contribute to a sore throat due to allergies, pollution and smoking or smoke exposure.  Another common culprit in the winter is the cold, dry air so common in Northern Arizona. The viral sore throat typically includes low grade fevers of under 101F as a common symptom of a “head cold”.  However, with persisting sore throat, high fevers, skin rash, redness or pus in the throat, the infection may be the bacterial Group A Streptococcus (or “strep”).  Strep infections can only be determined by a lab test, as the infection cannot be diagnosed on appearance alone.  Strep infections are important to diagnose, and DO need treatment with antibiotics.  Strep is a highly infectious disease, and is readily spread.  If you do have a diagnosis of strep and are treated with antibiotics, please stay home from work, school or daycare for at least 24 hours after starting the Rx in order to not spread infection to others.

Some important things to do stay healthy are to wash your hands often, either with soap and water, or waterless antibacterial such as Purell.  Avoid close contact with others who have a sore throat or head cold.  Stay home and away from others if you are already sick.  Avoid smoking or vaping and avoid second hand smoke.  And, of course, seek care with your primary care provider if you have any concerns or questions regarding your proper care.

Bradford Croft, DO

East Flagstaff Family Medicine

Flu Season 2019-2020 – It’s that Time of Year Again

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Last year was a much better influenza season compared to the 2017-18 epidemic, causing record death and disease.  There were improved influenza protections with the seasonal vaccines.   As well, the viruses were not as virulent, which all may explain the milder season.  The following is some disease information that you should be aware as we approach this year’s flu season.

Influenza is a respiratory infection that causes fever, cough, sore throat and nasal congestion.  Additional symptoms include headaches, muscle aches and fatigue.  Although these complaints sound similar to the symptoms of the common cold, the severity commonly is much worse.  Not only can the intensity be serious enough to cause weeks of lost work or school, but the infectiousness can be so powerful as to infect the majority of a workplace or school from a single source.  Influenza can cause complications which kills thousands of Americans every year, more commonly those with chronic health problems, the elderly and very young.  However anyone can suffer a complication of this illness, sometimes requiring hospitalization with significant lost time from daily routines, or even resulting in death.

A severe outbreak may commonly last up to eight weeks regionally, and can often infect one out of every three people in a community.  Hand washing and hygiene are always important, but the single best prevention of influenza is the seasonal immunization.  Appropriate for almost everyone six months or older, it is especially important for those with any chronic disease such as asthma, COPD, diabetes, heart, kidney or liver disease, and any kind of cancer.  Also, those who are overweight or 50 and older are at a significant risk as well.

The influenza immunization recommendation from the CDC for the 2019-2020 season again includes trivalent and quadrivalent injectable vaccines.  This year vaccines have been updated to match the expected circulating viruses, and are most commonly provided as the inactivated influenza vaccine (IIV) and the recombinant influenza vaccine (RIV).  The nasal spray / live flu vaccines (LAIV) are again available but may be limited.  The CDC does recommend LAIV as an alternative choice for children who would not otherwise receive a conventional vaccine.

For those interested, the protections for this year’s likely infections are designed to include:

A/Brisbane/02/2018 (HINI) pdm09-like virus (changed from A/Michigan)

A/Kansas/14/2017 (H3N2)-like virus (changed from A/Singapore) and

B/Colorado/06/2017-like (Victoria lineage) virus (unchanged) in the trivalent vaccines.

B/Phuket/3073/2013-like (B/Yamagata lineage) virus (unchanged) is added to quadrivalent.

Annual flu vaccines are commonly covered by most health insurance programs at no cost to patients.  These immunizations are usually readily available at county health clinics, most retail pharmacies and many family doctor offices.  Nobody knows when the flu will show up in the community, but is often seen as early as October.  Of course, the sooner the administration, the more effective the immunization for the entire influenza season which may go well into the spring.  It can take up to two full weeks to acquire immunity from the shot.  Now is the time to prevent the flu!  Immunize, and don’t let the flu get YOU!

Bradford Croft, DO

East Flagstaff Family Medicine

 

Lurking Within You?

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Here is the latest news from our blog, featuring Sara Reeves, FNP, who is one of our providers here at EFFM/FIM.

Lurking Within You?

Hepatitis C Virus (HCV) is a contagious liver disease spread through contact with the blood of a person who has the virus. It can result in serious liver damage, including liver failure. Chronic Hep C affects an estimated 2.4 million people in the United States.

A onetime HCV screening is now recommended for all individuals who were born between 1945 and 1965. Other individuals considered high-risk who should also be tested include injectable drug users (now or even one time in the past), anyone who received blood products including transfusions, dialysis, or an organ transplant before July 1992, and those who are HIV positive.

At the beginning, HCV usually has no symptoms and usually shows itself through routine lab testing. Liver enzyme elevation is commonly the first indication that someone has HCV. There is no predicting how quickly the virus will cause permanent damage, so early detection is important. Over time, Hep C will cause scarring and cirrhosis of the liver. These conditions can encourage the development of liver cancer (about 5% of those infected). More common is the development of liver failure secondary to cirrhosis and fibrosis (scarring) that can require a liver transplant. Fifteen to twenty percent of those infected with HCV recover without treatment. The remaining 80-85% progress to chronic Hep C.

Testing for HCV is quick and easy, requiring a simple blood test. While testing liver enzymes in part of a routine metabolic panel that is usually done yearly, HCV testing is not. There is no vaccine for HCV. Many insurances cover the test at no cost.
HCV is now treatable. Treatment is 90-100% effective in curing this disease progression. Treatment at any stage will stop the progression of the disease and prevent further damage from any existing liver disease. Medications can be very expensive and not all insurance plans cover them. Medication assistance programs are common and help to make this treatment affordable for most people.
If you are unsure if you need to be tested, please discuss it with your primary care provider. If you have been tested in the past, please make sure that your current provider is aware of this and your results.

Sara Reeves, FNP
East Flagstaff Family Medicine

A Breath of Fresh Air

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                “Snore, snore…….SNORE, snore, snore……. SNORE, snore…..”  If you have ever heard this breathing pattern before, you may have been witness to sleep apnea.  These pauses in breathing may last from a few to prolonged seconds, happening fifteen, thirty, even sixty or more times in an hour.  Another presentation of sleep apnea may be present as very shallow breathing.  Either problem will commonly disrupt sleep as it drives sleep patterns from deep to shallow sleep.  The result of this poor quality sleep may cause daytime fatigue and tiredness.  Signs of this include falling asleep during the day, at work, or while driving.  Other signs and symptoms may include morning headaches, memory complaints, irritability or depression, frequent nighttime awakenings and dry mouth or sore throat upon awakening.

                Mild sleep apnea affects about one out of five people, and moderate to severe impacts one out of fifteen.  In the United States, that influences about 22 million Americans.  As there are no physical findings or lab tests that diagnose the problem, sleep apnea is not a problem that can be found on a routine exam.  Most often, the question is brought to the attention of the patient or physician by the spouse or bed partner.     

Obstructive sleep apnea, the more common form of this sleep disorder, occurs when the muscles of the throat and tongue relax excessively and allow the tissues to collapse, blocking off the upper airway.  When breathing stops and oxygen levels drop, the brain is triggered to disrupt sleep, tighten the muscles and stimulate a breath.  But in addition to disruptive sleep, the stress hormones that are released can raise your heart rate and increase the risk for high blood pressure, heart attack, stroke and arrhythmias (irregular heartbeats).  Although sleep apnea can occur in anyone, it is commonly associated with men more than women, and increases with age.  People who are overweight may be prone to sleep apnea as well as those who drink alcohol, smoke, take sleep aids, or sleep on their back.  Other considerations include those with smaller upper airways, allergies or other airway congestion, facial disfiguration, or in children, swollen tonsils.

Central sleep apnea is less common than obstructive, and occurs when the brain fails to send the correct message for the respiratory muscles to function properly.  As a result, breathing simply ceases momentarily.  Although snoring doesn’t typically occur with central apnea, there can be mixed apnea, that both forms are present in a patient.

When sleep apnea is suspected, testing includes an overnight study. Screening may be done at home, (commonly the preference of many insurances) measuring breathing patterns and air flow, heart rate, lung expansion and oxygen levels of the patient in his own bed.  More extensive evaluation may be required in a sleep lab clinic that includes, among other measurements, heart and brainwave monitoring by a technician.

The treatments for sleep apnea depend on type and severity.  In mild cases, a dental appliance worn in the mouth while sleeping may be effective.  The most common treatment of more severe apnea consists of CPAP – continuous positive airway pressure.  A mask covers the nose, nose and mouth, or inserted into the nose (nasal pillows) and is connected by a tube to a small pressure pump.  The onboard computer monitors airway resistance, and increases air pressure when resistance increases or breathing diminishes.  This pressure balance keeps the airway open and prevents the collapse and obstruction.   

Untreated apnea may shorten your expected lifespan eight to ten years, as well as make other diseases more difficult to treat.  If you have concerns regarding sleep apnea, please contact your health care provider. 

Bradford Croft, DO

East Flagstaff Family Medicine