Achoo! Arizona

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So many of us in Northern Arizona either know of others who suffer or personally agonize from seasonal allergies. Springtime is commonly the start of the annual season. As spring is in the air and the blooms begin, the cedars and junipers are the hallmark of misery to many. At lower altitudes the ash and cottonwoods are offenders as well. Moving into the summer, the many wildflowers and grasses may also be sources of hay fever symptoms. There are also year-round offenders that may lurk anywhere, all of the time, such as dust mites and molds.

The symptoms of hay fever may include the complaints of sneezing, coughing and itching. Other conditions include eye irritation, skin complaints including hives, eczema and rashes. Many times the symptoms are just a nuisance, but for some may be life threatening. For others, the seasonal flares may also be associated with chronic conditions such as sinusitis and asthma. According to the CDC, there are over fifty million Americans who suffer annually from seasonal allergies.

Anyone may have or develop an allergy. Babies may be born with a sensitivity to milk, or others may acquire sensitivities over years. With repeated exposure to irritants, one may develop reactions as time goes by. The allergic reaction is a heightened response of the immune system to irritants. There are many chemicals released by the body during an allergic reaction, the most abundant being histamine.

Although allergies cannot be prevented, the reactions can be treated and possibly minimized. If you know your sensitivities, it may be possible to avoid some of them. Some other strategies include air conditioning or HEPA filters, especially in the bedroom. Eliminating dust mites and animal dander may help others.

Common treatments include medication therapies. Antihistamines such as Allegra (fexofenadine), Zyrtec (cetirizine) and Claritin (loratadine) are a mainstay of therapy for many. Additional medications are also available, now without prescription, including inhaled nasal steroids such as fluticasone. Supplementary therapies exist for those of us who are not adequately controlled with these treatments. The next steps are commonly prescription medications, so seek the advice of your health care provider for assistance with these treatments. Beware, as there are many non-prescription allergy medications that may potentially conflict with existing prescriptions and other health care issues. It may be wise to have that visit regardless prior to self-treating with over the counter medications, as some may actually be dangerous to your health.

If control is still not adequately achieved, an additional option may be treatment with “hyposensitizaiton”. Commonly provided by an allergist or ENT specialist, the offending irritants are identified with lab testing. Once known, the serum is custom made to build resistance by the patient to the allergens with increasing dose concentrations over time. Historically this treatment was provided with a series of injections, but as technology moves on, this care may be available with a series of drops under the tongue.

There is NO reason to suffer needlessly from seasonal allergies as treatments abound, and your primary care provider is the first step to relief.

Bradford Croft, DO

East Flagstaff Family Medicine

Healthy Hearts are Happy Hearts

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Healthy Hearts are Happy Hearts

Although there has been improvement over the years as to the impact of heart disease and health, cardiovascular disease is still the number one cause of death in men and women in the United States. Every year, February is the hallmark of American Heart Month. Thinking of Valentine’s Day is a good opportunity to do a little self-assessment and personal reflection of your heart health status and risks.

High blood pressure is one of the common contributors to heart disease and stroke. Known as the “silent killer” there are no warning signs or symptoms to alert its presence. It is estimated that one in three people have high blood pressure, but only about half are controlled. A very simple screening test is to check your blood pressure. To be aware of risks changing as time goes by, these checks should be done regularly. If you have high blood pressure, there are steps to take to treat and control it. Lifestyle changes and medication are commonly used to treat this problem.

Elevated cholesterol is another concern. High lipids can contribute to atherosclerotic cardiovascular disease, or ASCVD. This problem leads to the blocking of arteries in the heart and other parts of the body. As this plaque builds up in arteries, the circulation lessens over time, again contributing to the risk of heart attack and stroke. There again, lifestyle and dietary changes as well as medications are available to address these problems. A simple blood test can check cholesterol levels.

Diabetes and prediabetes are problems with different levels of elevated blood sugar. Again contributors to cardiovascular risk, high blood glucose over time will lead to damage to the heart, kidneys, blood vessels and nerves. This damage leads particularly to the risk of heart attack and stroke as well as other organ failure. Treatment again consists of medication and lifestyle changes.

The other risks on the checklist are those of lifestyle and behavior issues. Physical inactivity, unhealthy diet, obesity, excess alcohol and smoking are all concerns that remarkably increase the impact and threat to cardiovascular health. Your annual wellness exam commonly is a covered benefit by most commercial health insurances. This visit is an excellent starting point to address these concerns, risk factors, lifestyle changes and medications if needed in treating these problems and reducing your risk of cardiovascular disease. Make your pledge to yourself and loved ones this month to step up to the plate and commit to have a healthy, happy heart!

Bradford Croft, DO

East Flagstaff Family Medicine

Weighing In On the Holidays

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Weighing In On the Holidays

The “holiday season” is synonymous to many of us with the “eating season”.  Starting at Thanksgiving, our feeding frenzy extends relentlessly through Christmas and New Year’s, and continues to perpetuate all the way through the football playoffs into the February Super Bowl.  And every holiday deserves a feast!  Not just the holiday dinner, but also the endless numbers of parties, events and treats at the workplace as well as those at home all contribute to the caloric avalanche we experience through the winter months.   No wonder it is not a surprise that most people gain the most weight every year in the month of December.   They also commonly do not lose all of those acquired winter pounds.  Maintaining just two of those extra pounds each season makes you twenty pounds heavier in a decade.

The answer is, of course, calories.  Some fun facts are that, on average, the adult male needs 2500 calories to maintain his current weight.  The average female needs only 2000 calories per day.  It only takes an extra 500 calories each day to gain a pound every week.  Imagine that the typical holiday dinner alone packs a usual 3000 calories, and with appetizers and drinks may top 4500 calories for just that meal and up to 7000 for the day.  “Not bad”, you say.  “There are only a couple of excessive meals during that season in which I indulge”.

However, add the onslaught of holiday snacks, those extra calories may be easy to accrue.  A couple of calorie counts for example: a slice of pumpkin pie is 279, slice of pecan is 532, cherry pie is 304 and apple pie alamode is 414 calories.  Not a pie person?  How about cookies, then.  Each sugar cookie from Subway is 220 calories.  Beer is anywhere from 64 calories in the ultralight to 200 for a hearty IPA.  Wine may range anywhere from 110 to 300 calories per glass depending on sweetness and alcohol content.  If you are considering the playoff parties, a serving of beef nachos is 430 calories, a chili cheese hotdog is 340, one pork rib is 370 and a half dozen chicken wings is 616 calories (

The point is not so much the specific calorie count, but rather the ready availability of “extracurricular” food and treats in which we mindlessly and consistently indulge.  Adding this onslaught of calories consumed throughout the “season”, one could readily pack on two, five or even ten extra pounds this year.

Your awareness of these points may make it easier not to go overboard this year.  Some tips include limiting your choices to eating only your favorite foods.  You do not have to try one of everything.  Serve yourself smaller portions, as most holiday foods are rich and should readily fill you up.  Only eat one helping at a service.  If you feel you must have more, drink a big glass of water and set your timer for twenty minutes.  It is likely by then that meal has caught up, and you will not be hungry for a second helping.  Finally, eat slowly, taste every bite and enjoy these special treats.  Celebrate the holidays and enjoy your time with family and friends.

Bradford Croft, DO
East Flagstaff Family Medicine

Flu Season – Coming Again Soon!

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It is, once again, time to consider our health concerns as days are growing shorter. Social distancing and health hygiene are lessened with the relaxation of COVID precautions. We definitely should beware of the influenza season this winter. Less competition from COVID provides more opportunity for influenza. Things you should know…

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 are similar to the common cold, the severity is typically 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 impact 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. Fortunately, there is treatment for influenza with early intervention.

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 2022-2023 season includes only quadrivalent injectable vaccines. This year vaccines have been updated to match the expected circulating viruses and are provided as the inactivated influenza vaccine (IIV), the live attenuated nasal spray (LAIV4) (ages 2-50), and the recombinant influenza vaccine (RIV). There is also a high-strength vaccine indicated for those 65 and older.

For those interested, the updated protections for this year’s likely infections include: (*updated strains)


A/Victoria/2570/2019 (H1N1) pdm09-like virus;

* A/Darwin/9/2021 (H3N2)-like virus;

* B/Austria/1359417/2021-like virus (B/Victoria lineage)

B/Phuket/3073/2013-like virus (B/Yamagata lineage)


A/Wisconsin/588/2019 (H1N1) pdm09-like virus;

* A/Darwin/6/2021 (H3N2)-like virus;

* B/Austria/139417/2021 – like virus (B/Victoria lineage);

B/Phuket/3073/2013-like virus (B/Yamagata lineage).

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. You should best have your immunization by the end of October. Of course, the sooner the administration, the sooner you are protected 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. Talk to your health care provider soon. Now is the time to prevent

Bradford Croft, DO

East Flagstaff Family Medicine

Keeping an Eye Out

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Keeping an Eye Out


The leading cause of blindness worldwide as well as vision loss in the United States is cataracts. The process that occurs causes increasing cloudiness in the eye’s lens. There are several reasons to develop cataracts and can be present anytime from birth to old age.

An estimated 20.5 million (17.2%) Americans aged 40 years and older have cataract in one or both eyes, and 6.1 million (5.1%) have had their lens removed operatively. The total number of people who have cataracts is estimated to be over 30 million currently. Although treatment for the removal of cataract is widely available, access barriers such as insurance coverage, treatment costs, patient choice, or lack of awareness prevent many people from receiving the proper treatment.

In the early stages of development, you may not even be aware of it. Early cataracts may only be seen with a dilated eye exam from your ophthalmologist. As symptoms develop, there may become a blurriness to vision acuity, or colors may appear faded or dull. There may be difficulty with day-to-day tasks that require visual scrutiny like reading, driving, or watching TV.

The most common reason for cataracts is age related. As the eye ages, the transparency of the lens may begin to cloud as a natural course of maturity. Other reasons may include a response to trauma or possibly a result of surgery to the eye, as may be needed to treat glaucoma. As well, those using long term oral and inhaled steroids may be at risk. Additional considerations include increased likelihood to those who have diabetes, smoke, or drink too much alcohol.

Although uncommon, children can get cataracts too. Those who are born with them have congenital cataracts. There is usually a family history of same for those individuals. As with adults, a history of trauma or infection may also be reasons for cataracts. Small cataracts may not pose a significant problem and may just be monitored. If there is any compromise to vision, however, cataracts should be treated as soon as possible. The development of lazy eye (amblyopia) is a very real problem.

Those exposed to radiation are another risk population. We would usually think of those in the medical field who are involved with x-ray or radiologic guided procedures in surgery. But all of us are exposed to sunlight, especially in the Southwest. The ultraviolet radiation from the sun is the source of the risk. The best protection is to wear UV shielding sunglasses routinely to lessen the possibility of cataracts.

The cure for cataracts is always surgery. This very safe and common procedure done with a topical anesthetic and lasts about an hour. The clouding natural lens is replaced with an artificial lens, called an intraocular lens. There is the possibility of developing a “secondary” cataract which is a cloudiness on the outside of the lens. This problem is treated with a quick and easy repair using a laser.

As with routine wellness visits to your health care provider, annual eye exams with your ophthalmologist or optometrist are strongly encouraged.

Bradford Croft, DO

East Flagstaff Family Medicine

Neuropathic Pain

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Neuropathic Pain

Your peripheral nervous system acts as the hardwiring of your body. Each nerve serves one of two essential functions. Afferent nerves bring sensory messages to the central system such as smell, touch, taste, or pain. Efferent nerves send motor function messages to the body, such as ‘make a fist’ or ‘stand up.’ Have you ever been sitting too long, and when you get up, you “can’t feel your legs”? On occasion, you might even stand or try to walk and your legs “give out” from under you. These transient episodes are the result of irritation or compression of a nerve resulting in temporary impairment of function.

However, there are other nerve related circumstances that are harbingers of problems that persist. These are usually resulting from the progression of chronic diseases and subsequent ongoing damage to the nervous system. One quite common disease resulting in neuropathy is the progression of diabetes. As longstanding elevated blood glucose gradually damages the peripheral nerves, commonly in the lower extremities, the ability to feel becomes compromised. Without the perception of pain, ulcers may occur, or small injuries may readily become infected. As circulation concurrently diminishes, these wounds may result in a need for amputation. Pins and needles sensation may give way to chronic pain or no sensation at all. Muscle weakness may also develop, contributing to balance and coordination issues. As multiple nerves are impacted, there are other system failures that may develop including vision, digestive and urogenital systems.

Multiple myeloma, multiple sclerosis and cancer are also diseases that can cause similar neurologic changes to occur. Chronic use of alcohol over time can also contribute to multiple health problems. Long term toxicity from alcohol has a possibility of causing chronic nerve damage as well with similar outcomes to diabetes. These nerve problems are progressive and unrelenting.

Injury is another widespread problem that may give rise to neurogenic pain. Damage to nerves from trauma may provide a source of chronic pain mediated directly from the nerve itself. An example of such trauma would be a herniated disc in the spine. As the disc extrudes, it can trap the nerve root and physically compress it. This acts as a source of constant pain until the nerve is decompressed. In addition to significant pain, this entrapment can also cause subsequent permanent muscle weakness to develop.

Infection is not a usual source of neurogenic pain, apart from shingles. This viral infection from childhood chicken pox will live and remain dormant in the spinal cord for decades. Later in life there may be some compromise to one’s resistance and the virus will break out. This presents as a painful, blistering red rash that follows the course of a nerve, commonly on the scalp, trunk, or extremity. As the inflammation occurs directly in the involved nerves, the pain can be severe and last for weeks to months. There are occasions that the pain does not resolve, causing persisting post-herpetic neuralgia. Fortunately, there is a readily available vaccine available from your doctor or pharmacy for shingles outbreak prevention.

The final example is the “phantom limb.” There are occasions where an amputated extremity continues to be perceived by the brain. This instance results from damage to the nerve at the site of the amputation which “misfires,” producing the perception of the persisting absent appendage.

Prevention and early treatments may be the best way to address the onset of neuropathic pain. When unsuccessful, there are alternative treatments that may be available including surgery, medications, and other interventional procedures. As with all health issues, your best resource for information should be

your primary care provider. Please consult your PCP should you have any issues, concerns or questions regarding your risks or treatments of neurogenic pain.

Bradford Croft, DO

East Flagstaff Family Medicine

Spot On

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Spot On

As the days are longer in the summertime, we are outdoors a lot. But as we are, how many of us are thinking about the impact of the sun relating to our increased risk of cancer? Over time, we accumulate the long term effects of our solar exposures with an increasing risk to develop skin cancers.

The most common and widespread of cancers in the United States are those of basal cell and squamous cell carcinomas. There are about four million and one million respectively diagnosed annually. Generating from the layers that make up skin structures, these skin cancers usually develop as a response to repeated exposure to ultraviolet (UV) light. The most common source of UV light is sun exposure. Not to be forgotten is the risk associated with the use of tanning beds.

A basal cell cancer commonly presents as a skin colored, pearly looking bump or growth that does not go away. Sometimes it may develop as a pink or red scaly patch or have a waxy surface. A squamous cancer may be a thick, rough scaly patch that sometimes bleeds and refuses to heal. They may look initially like a wart, and sometimes have a crusty surface. Both cancers may grow over time, but usually grow slowly. With early intervention, both of these cancers can be usually cured with medication or surgery. With delay of treatment, these treatments may become expensive, prolonged and disfiguring.

A much less frequent but much more deadly form of skin cancer is melanoma. Originating from the melanocytes (the cells that give skin its pigment or color), this type is also associated with UV exposure. About half of these cancers on discovery are surface level. The other half likely have already penetrated into deeper levels of the skin, requiring more extensive treatment. Lesions of this type typically may show up earlier in life as compared to the basal and squamous cancers, but all kinds may also show up as we mature. Melanoma is responsible for over 9000 deaths annually in the US, about one out of every ten of these cancers once diagnosed.

To help tell a melanoma from a common mole, use the ABCDE:

“A” is for asymmetrical. Does the mole have an irregular shape with different looking parts?

“B” stands for border. Is the border jagged or irregular?

“C” is for color. Is the color uneven shades of brown, or with any black or bluish color?

“D” stands for diameter. Is the spot larger than the size of a pea?

“E” is for evolving. In the past few weeks or months, has the spot changed?

Actinic keratosis are changes to skin that indicates sun damage, but has not yet evolved to a cancer diagnosis. These scaly patches on a reddish base also have treatments available, the earlier the better. Although sun protection is the keystone to healthy skin, many of us in the Southwest get unintentional exposure. It is likely you may have developed some spots and patches over time you wonder about. Should you have skin lesions of question, the earlier you seek a professional opinion with your primary care provider or dermatologist, the better your outcome likely will be.

Bradford Croft, DO

East Flagstaff Family Medicine

Go With the Flow

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There is a lot of public awareness regarding heart attack and stroke.  Lesser known may be the presentation of vascular disease other than the heart or brain, commonly referred to as peripheral vascular disease or PVD.  Blood vessels may narrow, spasm or obstruct in arteries or veins.  Often seen in legs, PVD commonly presents as pain and fatigue, especially during exercise, and may improve with rest.  Arms and internal organs can be also be affected.  A large percentage of this disease is specific to the arteries, known as peripheral artery disease, or PAD.  Both terms commonly may refer to the same condition.   According to the CDC, over 8.5 million people over 60 have PAD in the United States.

Two different situations occur to develop vascular blockage.  Hardening of the arteries or atherosclerosis develops from plaques or blockages that slowly build up over time.  As vessels slowly narrow, circulation is diminished.  If the plaque ruptures or clots, there is an immediate and complete blockage of the vessel causing acute symptoms.   When this occurs in the heart or brain, the result is a heart attack or stroke.  With PVD, muscles demand higher oxygen during exertion, but the inability to provide adequate circulation results in pain and spasm.  In some situations, a blood vessel that is otherwise undamaged may go into spasm and prevent circulation with similar outcomes.  This can occur from exposure to cold temperatures, vibrating machines or tools, emotional stress or drugs that cause vessel spasm, such as some stimulants.  There are diseases that greatly contribute to the development of PVD.  Those individuals who have high blood pressure, high cholesterol and diabetes are at much greater risk of PVD.  Smokers are at great risk as well from the damaging effects of smoking harming the blood vessels over time.  Just the ageing process alone is a risk to those over sixty.

Common symptoms of PVD known as claudication may be the spasm, aches and fatigue of exertion, but sometimes may occur during sleep.  Over time, there may be a noticeable reduction in the growth of hair on the legs.  Thin or pale skin may develop as well, leading to the development of sores or ulcers that will not heal.  Discoloration or blueish skin, especially fingers or toes may become evident.  With continued diminishing blood flow, tissues may subsequently die leading to gangrene and amputation.   An acute blockage results in significant pain along with a cold, pulseless and pale or blue skin.  This is a medical emergency and needs immediate attention.

There are multiple ways to evaluate for PVD.  Doppler ultrasound measures the sound waves from the blood flow in arteries and veins and can determine compromises.  Ankle-brachial index, or ABI, compares the blood pressures of the upper and lower extremities.  As blood pressures are generally consistent throughout the body, a difference between extremities can indicate PVD.  Angiography injects contrast into the blood vessels and can visualize narrowing or obstruction in the arteries.  Magnetic Resonance Angiography (MRA) or Computerized Tomography Angiography (CTA) are also radiology studies that image vessels to visualize disease.

The main goals of care are to stop the disease and manage the pain.  Treatment may initially involve diet, increased exercise, weight loss and stop smoking.  Management of underlying chronic disease is critical.  There are various medications that may be appropriate as early treatment.  In more severe cases, surgical intervention may be necessary to open and re-establish blood flow in the obstructed vessel.  Early diagnosis is critical.  Symptoms of PVD?  Contact your primary care provider as soon as possible!

Bradford Croft, DO

East Flagstaff Family Medicine

What’s the Buzz?

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Many folks start their day with a cup of coffee.  In fact, according to the Food and Drug Administration, about 80% of us consume caffeine on a daily basis.  Most people are aware of the stimulating effects of caffeine, but a lot of us do not know the other impacts of caffeinated beverages.

Caffeine is the most commonly used psychoactive drug worldwide.  Coffee, tea and sodas are typical sources of the caffeine we ingest, for many of us regularly.  But foods, nutritional supplements and medications may also be sources.  For healthy adults, a moderate intake of up to 300mg per daily intake is considered “generally safe” by the FDA.  The Dietary Guidelines of America recommends, however, women who are pregnant and those breast feeding consult their health care providers for advice on caffeine consumption.  For children and adolescents, the American Academy of Pediatrics takes the stance that there is “no place for stimulant-containing energy drinks” for this population.

Federal guidelines require that the presence of caffeine in beverages or foods be listed as an ingredient.  However, the amount of caffeine does not.  To give you an idea as to how much caffeine is present, here are some common listings from based on an eight ounce serving:

Brewed coffee                   102-200mg.             Brewed decaf                  3-12mg.

Expresso (1 oz.)                30-90mg.                 Brewed black tea            40-70mg.

Brewed green tea             40-120mg.                Cold brew coffee             110-200mg.

The following sodas contain the following based on a twelve ounce serving:

Pepsi One                              57mg.                                     Pepsi                                      39mg.

Diet Pepsi                              37mg.                                     Coke Zero                              36mg.

Coca-Cola                              34mg.                                     Diet Coke                               46mg.

Mountain Dew                        54mg.                                     Dr. Pepper                            41mg.

IBC Root Beer                         0mg                                      Orange Crush                         0mg.

A Monster Energy Drink contains 80mg caffeine in an eight ounce serving and has 27gm of sugar.

Many non-prescription medications that treat drowsiness, headaches and migraines will commonly have caffeine, from 60 to 200mg per dose.

The most commonly anticipated effect of caffeine is to stimulate the brain.  Within minutes, there is increased alertness, and there may be a buffering of drowsiness and fatigue – our morning “wake-up”.  Other positives include a decreased suicide risk as well as developing Alzheimer’s and dementia for those who consume caffeine on a regular basis. In addition is a reported decreased risk of oral and throat cancer.

According to the Mayo Clinic, there may be some negative effects may occur after 400mg of caffeine is consumed routinely (about four cups of coffee).  If the brain is over-stimulated, there may be side effects of restlessness, anxiety, headaches or insomnia.  Urine output is increased, producing a diuretic effect.  There may be an increase of symptoms from those already suffering from bladder problems.  Gastrointestinal stimulation may produce heartburn and diarrhea, with nausea and vomiting developing at higher doses of ingestion.  Calcium absorption into the bones is decreased, increasing the risk of developing osteoporosis and fracture.  The cardiac effects of caffeine increase heart rate, blood pressure and contribute to skipping beats.

Over time, your body becomes more tolerant to your daily dose.  Should you develop adverse effects from your caffeine consumption or just be concerned to the long term effects as listed, you should taper down gradually.  Headaches are the most common presentation of caffeine withdrawal.  There are websites available providing information about caffeine from the FDA and Mayo Clinic, among others.  How much caffeine are you consuming?

Bradford Croft, DO

East Flagstaff Family Medicine

Assess MS

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Multiple Sclerosis is a disease of the brain and nervous system. The body immune systems create a response that destroys the insulation sheath (myelin) that protects nerves. As the disease progresses, it can disrupt the messages carried from the brain to the rest of the body that can potentially become crippling over time. A common presentation interferes with the ability to walk but may initially return to normal for extended periods of time.

Depending on the nerves involved, symptoms may include numbness or weakness that may occur in limbs, electric shock sensations in limbs, and / or tremor or lack of coordination when put to task. Balance issues may be another that may present temporarily. Many of these signs will improve spontaneously at first. Eye complaints may include partial or full loss of vision and may be associated with eye pain. Double vision or blurring of sight may also present. Additional nerve complaints may include slurring of speech, fatigue, dizziness, or bladder / bowel control difficulties.

The typical presentation of MS initially develops varied symptoms over days or weeks but then improve either partially or completely for a duration of months to even years. This is the most usual form of MS that follow such a relapsing / remitting course. About half of these cases will show a steady degree of progression over the next ten to twenty years of the onset known as secondary progressive MS.

The cause of MS is unknown. The usual onset is in those between twenty and forty years old but may vary above or below those ranges. Women are two to three times more likely to develop MS. Those with parents or siblings with a history of disease have a higher risk as well. White people have the highest risk associated. Asian, African, and Native American descent have the lowest risk.

There are other health related issues that may increase the likelihood of MS. Those with low vitamin D levels and minimal exposure to sunlight may be at risk. As well, other autoimmune diseases such as thyroid disorders, pernicious anemia, psoriasis, type one diabetes, and inflammatory bowel disease are shown to have an increased risk as well. And smokers, as with many other health problems, are at a higher risk of developing MS than non-smokers.

With progression of the disease, muscle spasm or paralysis may develop directly. Other effects may include worsening problems with bowel, bladder, or sexual function. Additionally, the onset of depression or even epilepsy may occur. There are associations from infections such the Epstein-Barr virus responsible for mononucleosis, as well as those with Guillain-Barre that directly affects the spinal cord. Conversely, there is no increased risk of developing MS after receiving any of the following immunizations: HBP, HPV, influenza, MMR, variola, tetanus, BCG, polio, or diphtheria. There have been only two reported cases of MS relapse after receiving the COVID-19 vaccine, which were due to exacerbating the known underlying disease rather than causing it.

There are no specific tests that diagnose MS, the diagnosis is made from the clinical course combined with radiologic imaging and nerve studies. As well, there are no medications or treatments that will cure the disease, but there are medications and therapies designed to improve current symptoms and manage the progression of symptom development. Earlier intervention typically leads to best outcomes. Should you have concerns or questions about MS, consult your health care provider.

Bradford Croft, DO
East Flagstaff Family Medicine