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


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 “How much sleep do I need?” is not easily answered.  As we spend an average of one third of our life asleep, it is an important healthy life activity.  There are multiple factors that influence our sleep including our personal sleep needs, underlying disease considerations, personal habits and bedroom environments.  As we mature, our sleep duration needs diminish over time.

The National Sleep Foundation has recently updated their suggestions of sleep times:

  • Newborns (0-3 months):  14-17 hours each day (previously it was 12-18)
  • Infants (4-11 months):  12-15 hours (previously it was 14-15)
  • Toddlers (1-2 years):  11-14 hours (previously it was 12-14)
  • Preschoolers (3-5):  10-13 hours (previously it was 11-13)
  • School age children (6-13):  9-11 hours (previously it was 10-11)
  • Teenagers (14-17):  8-10 hours (previously it was 8.5-9.5)
  • Younger adults (18-25):  7-9 hours (new age category)
  • Adults (26-64):  7-9 hours (unchanged)
  • Older adults (65+):  7-8 hours (new age category)

Pay attention to how you feel after a “good” night’s sleep versus a poor one.  What is your attitude, mood and energy?  How long has it been since a good night’s sleep?  You are probably fine if you are healthy, happy, alert and productive whatever your present sleep pattern.  However, if it has been awhile or you just can’t remember when you last good sleep has been, you may want to examine your barriers to sleep.

  • Maintain a schedule of bedtime and awakening times, even on weekends.
  • Practice a relaxing bedtime ritual such as reading, deep breathing, visual imagery, or meditation.
  • Daily exercise will help assure improved sleep.
  • A comfortable, quiet and dark bedroom is essential.  Remember the bedroom is for sleep.
  • Do not watch TV or work on your computer in the bedroom. Go somewhere else in the house.
  • Even limited amounts of caffeine or alcohol can impair restorative sleep.  Stop either or both.

Poor sleep patterns may also a sign of underlying health problems.  Anxiety and depression very commonly will negatively affect sleep patterns presenting as insomnia or excessive sleepiness.  Frequent awakening to use the bathroom may be an issue as well.  Obstructive sleep apnea (OSA) is becoming a more frequent finding as we learn to screen for it.  OSA is caused by a temporary collapse of the airway which prevents a breath from being completed.  Every time this happens, most individuals will “almost” wake up, and occasionally completely wake up.  As this may occur as often as every few minutes through the course of sleep, most will awaken unrested and fatigued.  The Sleep Apnea Foundation estimates that there are 22 million with OSA, and over 80% are undiagnosed.  Untreated, those individuals likely can lose eight to ten years of life expectancy.

There are a number of over-the-counter sleep aids available.  For infrequent or temporary use, most may be an appropriate treatment for occasional sleep problems.  If you have consistent problems with sleep, please consult your health care professional, as there may be more than meets the eye.

Bradford Croft, DO / East Flagstaff Family Medicine

Working Smarter

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Every June, the National Safety Council targets this month as National Safety Month.  Work place safety should be an ongoing effort of injury and illness prevention by employers and employees alike.  The first step to lowering the risk of getting hurt at work begins with a healthy employee at home. 

Adults usually need an average of six to eight hours of restful sleep each night.  Commonly this can be promoted by maintaining a dark, quiet bedroom and minimizing caffeine.  Weight maintenance is important, and can become more of a challenge as we age.  Eating a healthy diet is recommended along with maintaining a regular exercise program, typically consisting of a balance of muscle strengthening and aerobic activities.  Stress management is becoming an increasing concern to address our social pressures.

One of the most common work related injuries is the low back.  According to the Bureau of Labor Statistics, there were over 155,000 work-related back injuries in 2015.  Some general lifting-safety tips include bending at the knees, not the waist.  Keeping your feet shoulder width apart and a straight back with lifting may also be helpful – use your legs to lift.  If an object is too heavy to nudge with your foot, get help in lifting.  MedlinePlus is a resource from the U.S. National Library of Medicine that has additional suggestions under the search “lifting and bending the right way”.

Some employers require the use of personal protective equipment (PPE).  Examples of PPE include earplugs or hearing protective devices, safety glasses or goggles, work gloves, hard hats and hard-toed shoes.  When PPE is obliged, there will be guidelines for its use.  The most common injuries that occur when PPE is required are when the employee fails to properly use the equipment.  If you are compelled to use it, please use it correctly.

Work place injuries may also occur from sedentary activity.  Cumulative trauma injuries, also known as repetitive motion disorder, may occur from repetitive low force motions.  Some examples include carpal tunnel syndrome, bursitis, tendinitis, epicondylitis, tenosynovitis and trigger finger.  Usual causes include excessive uninterrupted repetitions of an action or motion, unnatural or awkward motions such as twisting the arm or wrist, incorrect posture or muscle fatigue.  Proper set up of your work station and equipment is necessary.  Sitting or standing straight along with proper height adjustment of chair and desk are necessary.  Keeping tools within easy reach of your workstation is important.  Taking breaks and stretching while doing repetitive tasks may be helpful.  Many larger employers may offer an “ergonomic assessment” of your work area upon request.  Make the work station fit the employee rather than adapt the employee to an improper work station.  A helpful guide can be found at https://www.ors.od.nih.gov/sr/dohs/Documents/ORS_Ergonomics_Poster_Rd5.pdf.

Some simple prevention can be helpful such as stretching before work.  Taking stretch breaks during repetitive tasks may also be helpful.  Even a short five-minute break during the work day may allow for better productivity as well as provide some stress relief.  Many additional resources are available on line.  Specifically, some examples provided by the National Institute of Health are available at https://www.ors.od.nih.gov/sr/dohs/HealthAndWellness/Ergonomics/Pages/exercises.aspx Certain employers may already have health resources available for the asking.  Any employer would likely appreciate suggestions or recommendations you may have to improve safety at work, so please speak up!

Bradford Croft, DO

East Flagstaff Family Medicine, LTD

Tough To Stomach

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The occasion of an “acid stomach” or “heartburn” is a common occurrence for many of us from time to time.  If the incidence and intensity increases over time, however, it may evolve into a more serious and long lasting form of reflux known as Gastroesophageal Reflux Disease (GERD).   A fairly common disease, the National Institute of Health estimates that one out of five individuals has some degree of GERD. 

Anyone can develop GERD, but individuals more prone to this problem tend to be overweight or obese.  It is also a common problem with women during pregnancy.  Smokers and those exposed to second-hand smoke seem to have a higher incidence of reflux disease as well. There are commonly used medications that treat asthma, allergy, blood pressure, depression, insomnia and painkillers all know to contribute to GERD.

GERD arises from irritation of the esophagus (connecting mouth to stomach) when stomach acid leaks upward through the lower esophageal sphincter that normally restricts acid from washing into the esophagus.  Most commonly, the complaint is that of a painful burning feeling behind the breastbone, back of the throat or middle of the abdomen.  Other symptoms may include bitter taste in the back of the throat, nausea and vomiting, painful swallowing, possible breathing problems and thinning of tooth enamel.     

As inflammation continues, there are complications of GERD that can develop.  When the acid irritates the airway and lungs, there can be persisting cough, sore throat or hoarseness. As inflammation increases, problems such as asthma and wheezing, chest congestion or fluid in the lungs, or even pneumonia can develop.  Persisting inflammation of the esophagus may lead to a condition called Barrett’s esophagus.  The tissues actually change in appearance over time, and for some individuals may lead to a rare cancer of the esophagus.

There are lifestyle changes that may help treat GERD.  Avoiding food and beverages such as greasy or spicy foods and alcoholic drinks may help.  Some other common foods that may worsen GERD include chocolate, peppermint, tomatoes or tomato products and coffee.  Not overeating and not eating within a few hours before bedtime may also be beneficial.  Additionally, sleeping on a mattress adjusted at a slight angle may help.  This can be achieved by safely putting six-inch blocks under the bedposts at the head of the bed.  Of course, weight loss and quitting smoking both may be helpful as well.

There are non-prescription medicines that are available to treat reflux.  Antacids such as Maalox, Mylanta and Rolaids work by buffering stomach acid.  H2 Blockers such as Tagamet, Pepcid AC and Zantac reduce the amount of acid produced.  Proton Pump Inhibitors (PPI’s) also reduce acid production, but more effectively than H2 Blockers.  Some brand names of this group include Nexium, Prilosec and Prevacid. 

It is important to see your doctor if GERD symptoms do not readily resolve within a few weeks of treatment.  There are several tests that may be appropriate if symptoms do not improve or return frequently.  You should be seen immediately if you vomit fluids that are green or yellow, look like coffee grounds or contains blood.  As well, you should be seen right away if you have problems breathing after vomiting, pain in mouth or throat with eating, or difficulty or pain with swallowing. 

Bradford Croft, DO

East Flagstaff Family Medicine