Category: California

Nasal steroid sprays. Biologics. Surgery. These are some of the treatments your doctor may have recommended to manage your nasal polyps.

In other words, if you feel like your nasal polyp treatment isn’t working, you’re not alone. Here are some common reasons your treatment may not be working, plus what you can do to get relief.

1. You’re Not Being Monitored Properly

After you’ve been prescribed medication to treat your polyps, it’s important that you receive proper follow-up care, says Dr. Yao. In his practice, his patients come in for a computed tomography scan three or four weeks after the initial appointment to see how large the nasal polyps are and how well the medication is working.

If your doctor determines that your current medication is not effective — or is no longer as effective as it once was — they may talk to you about adjusting your treatment or other things you can do, including considering surgery, says Yao.

2. Your Medication May Not Be Reaching Your Polyps

Another reason your nasal polyps symptoms may persist despite treatment: not taking the medication as directed — or using it ineffectively.

For instance, if a nasal polyp is large, it’s possible that you’re only getting at the front surface of the polyp with the spray, says Yao. “You’re attacking it little by little, but the medicine may not be reaching the root of the polyp,” he says. “Another possibility is that there is a lack of space for the medication to get into the nose [due to the polyp].”

To work around this problem, try to aim toward your ears rather than straight up into your sinuses when you aim the nasal spray, he says. Aiming up — rather than to the side — will shoot the medication up into the middle of your nose toward your septum, missing the polyps, which grow from the sides of the nasal cavity. Alternatively, your doctor may recommend a steroid nasal wash to help you access hard-to-reach polyps.

3. You’re Not Treating Your Allergies

Environmental allergies can trigger swelling in your nasal passages, promoting the development of polyps. An undiagnosed allergy could be the reason your nasal polyp treatment may not be working. “It’s important to assess for allergies, as this is the cause of inflammation and polyps in some cases,” says Jesse Ryan, MD, associate professor of otolaryngology and communication sciences at Upstate University Hospital in Syracuse, New York.

If allergies are indeed the culprit, treating them with a medication like cetirizine (Zyrtec) can help control nasal polyps too, adds Yao. In addition, removing allergens from your home (such as by vacuuming regularly to reduce particulates and washing bedding regularly to cut down dust mites) can help reduce the likelihood of polyps returning, says Dr. Ryan.

4. You’ve Stopped Your Treatment

It’s important to stick to nasal polyp treatment plans, but many do not use their steroid nasal spray consistently, says Yao. “Nasal polyps are a chronic thing,” he explains. “You have to use your medication daily — there are no cheats or secrets around it.”

If you’re experiencing side effects or other problems that are interfering with your ability to stick to your nasal polyp treatment, talk to your healthcare provider, who may be able to work with you to find other options. “Effective treatment can be a trial-and-error process,” says Ryan.

5. Your Polyps May Need to Be Removed

If your nasal polyp symptoms persist despite you following your treatment plan, your doctor may recommend surgery to remove the polyps. Surgery may “improve nasal congestion, sense of smell, reduce risk of infection, and help allow medications to get deeper in the sinuses,” says Ryan.

And thanks to surgical advancements, you can now have polyps removed through an endoscopic procedure under local anesthesia. “Many procedures that used to be done in the operating room can now be done right in the office with a short recovery time,” notes Ryan.

That means it’s still important to monitor your sinus health and practice healthy habits to reduce inflammation in your body, which, in turn, lowers your risk of polyps.

6. You May Need a Step-Up in Treatment

When to See Your Doctor ASAP

It’s important to tell your doctor if your symptoms get worse or are recurrent. And be sure to call your doctor or go to the emergency room right away if you experience any of the following:

• Vision changes
• An altered mental state
• Eye swelling

“Polyps can cause a blockage of the sinus, making you more prone to infections,” says Yao. “[While rare], a bad infection can get into the eyes and progress to the brain.”

The Takeaway

• Nasal polyps treatment typically involves medication, but surgery may also be recommended.
• If symptoms persist despite treatment, there are several potential reasons why, including using nasal steroid sprays incorrectly or inconsistently. Or you may have undiagnosed and untreated allergies.
• Treatment can be a trial-and-error process and may involve combinations of treatments and/or medications. It’s important to maintain communication with your doctor and attend follow-up appointments, so that you can successfully manage your nasal polyps.

Measles — a highly contagious and potentially life-threatening respiratory virus that is often characterized by a blotchy rash — is spreading fast in rural Texas, with some other states also seeing an uptick in cases.

More Measles Cases Expected in the Weeks Ahead

Health authorities warn that many more people are likely to fall sick with measles in the weeks ahead.

“Measles is the most contagious infectious disease known in humans,” says virologist Gregory Poland, MD, president of the Atria Research Institute in New York City and a spokesperson for the Infectious Diseases Society of America. “If you are not immunized and walk into a room with somebody who has the measles, 12 hours later you almost certainly will develop the illness.”

A Warning Sign of an Undervaccinated Population

For Deborah Fuller, PhD, a professor of microbiology and a vaccine researcher at the University of Washington School of Medicine, the spike in measles is especially worrisome because it indicates a drop in vaccination rates and suggests that outbreaks of other vaccine-preventable diseases may be coming our way.

“It’s sort of the harbinger that signifies vaccination rates have declined below the level needed to protect the population,” she says.

“Because measles is so infectious, 95 percent of a community needs to be vaccinated in order to stop transmission and create herd immunity,” says Catherine Troisi, PhD, a professor of management policy and community health at the UTHealth Houston School of Public Health. “However, there can be pockets of unvaccinated [individuals] even when the larger community’s immunization rate is higher, and this can result in measles outbreaks.”

Who Should Get the Measles Vaccine?

Teens and adults are advised to check with their healthcare provider to make sure they are up to date on their MMR vaccination.

Most people who have received two doses of the MMR vaccine do not need a measles booster shot, but some specific individuals may benefit, such as those who have undergone certain treatments for cancer and have lost some immunity, according to Dr. Fuller.

“Luckily the measles virus does not mutate to the extent that new vaccines are needed,” adds Dr. Troisi.

Measles Can Make You Extremely Sick

The health effects of measles can be devastating and even fatal in some cases, according to Dr. Poland.

• A distinct rash that usually starts on the hairline and moves down to the face and upper neck. It then spreads to the rest of the body, including the hands and feet. On lighter skin, the rash appears red. On darker skin, the rash can be hard to see, though it may appear purple or darker than the surrounding skin.

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• High fever that may spike to more than 104 degrees F
• Cough
• Runny nose
• Red, watery eyes
• Tiny white spots (called Koplik spots) that may appear inside the mouth two to three days after other symptoms begin

Common complications are ear infections and diarrhea, but more severe outcomes can develop, including pneumonia and encephalitis (brain swelling), which may result in permanent brain damage.

Reversing a Downward Immunization Trend

Even as the numbers remain relatively low, health officials are concerned about the current case count inching up.

“I think there’s kind of an anti-vaccine skepticism in our culture right now, and vaccination is not being given its proper perspective by health authorities in our current climate,” says Poland. “This is a terrible disease and there is no treatment for it. There is, however, a near perfect preventive for it, and that’s the vaccine, and once you have the shot, you’re pretty well set for life.”

Postpartum depression may result from a combination of different factors. Researchers believe that, in general, genetics, hormonal changes, and emotional issues are key contributors.

“After giving birth, hormone concentrations drop by a hundredfold within a matter of days,” says Katherine Wisner, MD, the director of the Asher Center for the Study and Treatment of Depressive Disorders at Northwestern Medicine in Chicago. The sudden plunge may create disturbances in mood, particularly in women who have a prior history of depression or anxiety.

Periods of hormonal fluctuation, such as menstrual cycles or perimenopause, are associated with major depressive episodes, adds Dr. Wisner. The fluctuations that occur during and after pregnancy may affect certain neurotransmitters (chemical messengers in the brain) or brain function in other ways.

“This massive drop in hormones, along with the initiation of breastfeeding, disrupted sleep, and adapting to motherhood, all contribute to the risk of developing depression,” Wisner says.

Risk Factors for Postpartum Depression

• History of depression or bipolar disorder
• Symptoms of depression during or after a previous pregnancy
• Having family member who’s been diagnosed with depression, postpartum depression, or another mood disorder like premenstrual dysphoric disorder
• Having a stressful life event within the past year, such as job loss, death of a loved one, domestic violence, or personal illness
• Medical complications during childbirth, such as premature delivery or having a baby with medical problems
• Having twins, triplets, or other multiple births
• Having conflict or relationship issues with your spouse or partner
• Having an unwanted or unplanned pregnancy
• Having mixed feelings about the pregnancy
• A lack of strong emotional support from others
• Having financial difficulties
• Being younger than 20
• Being a single parent
• Having a baby with medical needs
• Having a baby who cries very often

Men and Postpartum Depression

Sleep Deprivation and Postpartum Depression

Factors that lead to depression and anxiety in people with IBD may include:

• Financial difficulties

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• Social isolation

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• Not having effective enough tools to cope with the effects of IBD

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• Social stigma

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• The effects of IBD on intimate relationships

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This type of anemia occurs when you’re not getting enough iron or are losing too much iron. Your body needs adequate iron to produce hemoglobin, a substance in red blood cells that enables them to carry oxygen. This is why iron-deficiency anemia may cause fatigue and leave you feeling short of breath.

Although low iron levels in your body can have a number of potential causes, in people with Crohn’s disease, the most common cause is blood loss in the digestive tract. When this happens, people “are usually unaware that they are losing blood,” says James F. Marion, MD, a gastroenterologist and IBD expert at Mount Sinai Hospital in New York City. That’s because the blood loss can happen gradually over a long period of time without overt symptoms.

In people with Crohn’s disease, Dr. Marion says, this blood loss usually occurs because of disease activity. The digestive tract contains lots of blood vessels, he notes, which can rupture when Crohn’s-related ulcers and fissures penetrate beneath the inner mucosal layer of the intestines.

Anyone with Crohn’s disease can develop iron deficiency in this way. But Marion notes that people who already have a higher risk of iron deficiency to begin with — namely, women of childbearing age, who may lose a significant amount of iron each month in their menstrual blood — are more likely to develop the condition and to develop it more quickly.

Other potential causes of low hemoglobin include vitamin B12 deficiency due to poor absorption in the intestines and anemia of chronic inflammation — a form of anemia, Marion notes, that’s often seen in many chronic and inflammatory disorders.

The first step in minimizing ITP symptoms is to treat the condition with medication. But there are also lifestyle strategies you can try to manage these challenges:

1. Extreme Fatigue

As with most autoimmune diseases, fatigue can be a problem, says Alexandra Wolanskyj-Spinner, MD, a hematologist at Mayo Clinic in Rochester, Minnesota. “The root of fatigue is inflammation. When your body is inflamed, the cytokines that are released in blood circulation will lead to fatigue,” she says.

Steroids, which are a common first-line treatment for ITP, can also cause fatigue, she says. They can not only have an impact on sleep, causing insomnia, but also worsen your mood and cause depression, which can also contribute to fatigue.

While it may sound counterintuitive, be more active. A lack of physical activity can cause poor sleep, says Dr. Wolanskyj-Spinner. Try to keep your sleep habits consistent, too.

2. Heavy Menstrual Bleeding

An important piece of managing this challenge is open communication between you, your hematologist, and your gynecologist to discuss the best treatment options for you, says Dr. Martin. You can also ask your doctor whether you should:

• Take iron supplements to prevent anemia
• Eat more iron-rich foods, such as beans, beef, and spinach
• Drink more water, which can help boost blood volume

3. Physical Activity Restrictions

You may have routinely enjoyed sports and physical activities before your ITP diagnosis, but you may need to give them up if they carry a high risk of injury or bleeding.

“No contact sports, no horseback riding — nothing that could end in traumatic injury,” says Martin. He uses his patients’ platelet numbers as his guide for when to suggest limiting activity and when to “loosen the reins.”

That doesn’t mean you can’t be active in other ways, though: He suggests generally safer activities, such as walking, running, tennis, and swimming, for people with ITP.

4. Anxiety or Depression

Mood changes and depression can result from having to give up a favorite activity that poses a bleeding risk. Steroids are also known to affect mood and could be the root of anxiety.

These feelings are real. But you can also take steps toward managing emotions, so you can have a healthy approach to living with ITP. Some strategies include:

• Physical Activity Even a brief walk outside can lift your mood. Any safe physical activity that you enjoy is worth the time.
• A Balanced Diet While quick, processed foods are easy and seem comforting when you’re dealing with uncomfortable emotions, healthier eating options are better for your physical and mental well-being.
• Positive Thinking Staying positive can help your outlook and have a positive impact on your health.
• Cognitive Behavioral Therapy Talk to a mental health practitioner if your feelings of anxiety and depression persist, says Martin. Cognitive behavioral therapy, or CBT, has been shown to be particularly beneficial for improving stress and mood for people with chronic diseases and may also be helpful for ITP.

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5. Frequent Medical Appointments

If ITP is having an impact on your ability to work, says Martin, consider talking to your employer about accommodations. “I encourage them to speak to their employer about their need for treatment, so they are able to focus on their health.”

The Takeaway

• Immune thrombocytopenia (ITP) is treatable, but the condition can still cause some challenges that can affect day-to-day life.
• ITP-related problems, such as fatigue, activity restriction, and heavy menstrual bleeding, can pose challenges.
• Work with your doctor and ITP care team to find ways to improve symptoms and your quality of life.

Living with chronic immune thrombocytopenia (ITP), a blood disorder that can lead to excessive bleeding and bruising, can be frustrating in many ways. Aside from getting the proper treatment and medication from a doctor, many people with ITP may wonder if dietary changes can help get their platelet count up.

“I think we all wish there was one food you could eat or one thing you could do,” says Ginger Hultin, RDN, who is based in Seattle and is the author of How to Eat to Beat Disease Cookbook. “But the fact of the matter is, what we’re trying to do is support the body’s natural ability to create the type of cells that it needs.”

For people who have ITP, getting enough calories and protein to support the body’s normal functions and a consistent energy level is probably the most important aspect of their diet, Hultin says. She advises eating on a regular basis, “so breakfast, lunch, dinner, and probably a snack or two in between.”

While it can be frustrating that there isn’t a dietary magic bullet for ITP, “diet does matter, and there are things you can do,” Hultin says.

Beyond the foundation of eating enough and eating regularly, Hultin notes that specific nutrients found in foods may help support platelet production and clotting. The Platelet Disorder Support Association (PDSA) advises people with ITP to focus on eating more whole foods, healthy fats, and leafy greens, and to opt for organic whenever possible to reduce their exposure to chemical additives and sprays. The PDSA recommends limiting canned foods, processed foods, products with sugar and white flour, red meat, dairy products, and alcohol.

Start with this list of foods and beverages when considering what to include and limit in your diet when you have ITP.

1. Eat: Fresh Fruits and Vegetables

One nutrient that may support platelet production and function is folate. “That’s actually really easy to get as long as you’re eating fruits and vegetables,” says Hultin, especially if you’re eating leafy green vegetables.

2. Avoid: Concentrated Foods That May Interfere With Clotting

Certain foods, including red grapes, blueberries, garlic, onions, and ginger, may interfere with clotting when eaten in large quantities, per the PDSA. But in most cases, small amounts of these foods in your diet shouldn’t be a problem, says Hultin.

“If you have low platelets and you eat a little bit of garlic in food, I’d be surprised if that would drastically thin your blood,” Hultin says. “Where I’d be more worried is a supplemental form or if you’re using lots of garlic powder — that’s more concentrated than a garlic clove.”

When in doubt, Hultin says to talk to your doctor about any foods you should be avoiding because of your ITP.

3. Eat: Foods That Contain Healthy Fats

Healthy fats include nuts and nut butters, seeds, and avocados, which provide not just unsaturated fat but a wide range of other helpful nutrients, says Hultin.

What’s more, Hultin adds, these foods can help you get enough calories and provide an antidote to the fatigue that at least half of the people who have ITP experience, per the National Organization for Rare Disorders. “With fatigue, people need to focus on getting enough calories,” she says. “You’re not going to feel energized if you don’t get enough calories.”

4. Avoid: Foods High in Saturated and Trans Fats

While avoiding unhealthy forms of fat is good advice for most people, this precaution may be even more important for people who have ITP because of the long-term corticosteroids sometimes prescribed for the condition, Hultin says. People who receive corticosteroid treatment could be at an increased risk for high blood pressure, so heart-healthy foods are recommended, she adds.

Saturated fat can be found in meat and high-fat dairy products, while trans fats are found in processed foods that contain the word “hydrogenated” before a type of oil in the ingredients list. The PDSA advises people with ITP to avoid hydrogenated, partially hydrogenated, or trans fats as much as possible.

5. Eat: Lean Sources of Protein

Including protein in your diet not only provides the critical building blocks for many processes in your body but it can also help ensure that you avoid spikes and dips in your energy level throughout the day.

Quality sources of lean protein to include in your diet are poultry, fish, beans and lentils, nuts and seeds, and soy products.

Meat provides an easily absorbed form of iron, although Hultin says that you can get enough iron in your diet from other sources, including plants. “One of the biggest challenges with red meat from a health standpoint is saturated fat,” she says. The Cleveland Clinic has compiled a list of 52 foods that are high in iron.

6. Avoid: Fatty and Processed Meat

Not only do fatty and processed meat provide potentially unhealthy levels of saturated fat, they also contain less protein and are often high in sodium. Too much saturated fat and salt can be a concern for your heart health, Hultin notes. So be sure to stay away from items like bacon, sausage, and deli meat.

7. Eat: Whole Grains

Whole grains are an important source of complex carbohydrates, which form the basis of a balanced diet along with healthy fats and lean protein, says Hultin. Some options include oats, whole-wheat bread and pasta, quinoa, and other grains. These foods are also often a good source of B vitamins, she adds.

The PDSA conducted a survey on nontraditional treatments for ITP. One of them was the effect of the macrobiotic diet (a diet high in whole grains and fresh and seasonal produce) on bleeding symptoms and platelet counts. The survey found that 40 percent of patients reported improvements after following a macrobiotic diet.

8. Avoid: Refined Grains and Added Sugars

While it’s probably not realistic to avoid all refined grains and processed foods, these types of carbohydrates tend to be absorbed more quickly and don’t contain the nutrients found in their whole-grain counterparts.

Added sugars are especially important to limit, says Hultin, to ensure that your blood sugar and energy levels remain stable. “Added sugars often come with other refined carbohydrates, so if you’re avoiding that, you often get a two-for-one” benefit, she says. Refer to the nutrition facts label and ingredient list for added sugars. Added sugars include brown sugar, maple syrup, and honey.

9. Drink: Water and Other Fluids

Hydration is an important part of overall health and nutrition that is often overlooked, says Hultin. Consuming enough water can help you fight fatigue and may help improve digestion.

While beverages other than water can help you stay hydrated, make sure you’re not consuming added sugars in large amounts. Unsweetened herbal teas and flavored water may be good options if regular water doesn’t excite you.

10. Avoid: Alcoholic Beverages

Alcohol has well-established anticoagulant properties and should be consumed with caution if you have ITP, says Hultin. According to the PDSA, alcohol damages the bone marrow, which produces platelets.

Whether you need to avoid alcohol entirely depends on your individual counts and where you are with your treatment, Hultin says: “Some people won’t be able to drink much, if at all. And they definitely need to be talking to their doctor about that.”

11. Maybe Eat: Dairy Products

While some people with ITP avoid dairy entirely, dairy products offer nutritional benefits, according to Hultin. Dairy is “a good source of calories and protein, it’s a natural source of B12, and it’s a bone builder — there’s phosphorus and calcium,” she says.

But if you’re eating dairy products that are high in saturated fat or sodium, “you might need to look at the way you’re eating dairy,” says Hultin, who generally recommends low-fat dairy products.

12. Maybe Avoid: Coffee

Coffee “can be a mild anticoagulant,” says Hultin. “With coffee, I would suggest that each individual work with their doctor and ask, ‘How much can I have, if any?’”

The caffeine in coffee may be helpful to combat occasional bouts of fatigue, Hultin notes, but if you find yourself needing caffeine often to stay energized, “go back a little bit and make sure that you’re hitting the basics: getting enough calories, protein, and fat; getting enough water; and eating on a regular schedule,” she says.

The Takeaway

Living with chronic immune thrombocytopenia can be challenging, and it is especially important to support your platelet count through diet. Some ways to do that include these practices:

• Eat well-balanced meals that provide enough calories and essential nutrients like folate, healthy fats, and protein.
• Avoid trans fats, refined grains, and excessive alcohol.
• Aim to maintain steady energy by having regular meals and healthy snacks throughout the day.

Additional reporting by Ashley Welch.

You may want to clean your shoes if they are dirty or smelly, or if you’ve stepped in something nasty, but you aren’t going to catch a virus from your shoes, says Donelan.

How Frequently Should You Wash Your Shoes?

You really only need to wash your shoes when they’re soiled, says Donelan.

When Should You Wash Your Shoes?

You may want to wash shoes if they have a bad odor or have mud or debris on them, says Donelan. In that case, use a hose or cleaning tool to get any loose dirt off before you put shoes in the washing machine (once you check the cleaning information on the manufacturer’s website — some footwear shouldn’t go into the washing machine).

Is It Unsanitary to Wear Shoes in the House?

What Are the Best Products for Cleaning Your Shoes?

Many shoes that are made mostly of fabric can be put into the washing machine, says Donelan. Look at the shoe manufacturer’s website for instructions on how to best clean your shoes.

• Antibacterial wipes can be used to clean the soles of your shoes.
• Antibacterial spray or solution can be used on the soles of your shoes.

Read the instructions on the bottle to find out how long to leave cleaning solution on any surface, including shoe bottoms, before wiping it off. “You want to give the solution time to kill the virus or bacteria,” says Donelan.

Coffee may aid your weight loss efforts in the following ways.

It Revs Up Your Metabolism

Caffeine also affects your body’s physiology in ways that may support a healthy weight. “Coffee increases metabolism because its main component, caffeine, is a stimulant that enhances your metabolic thermogenesis, which is the process by which the body generates heat from digested food substances,” says Daniel Boyer, MD, a medical researcher in Des Moines, Iowa, who focuses on molecular biology and pharmacology, among other subjects, and is associated with the Farr Institute.

It Suppresses Your Appetite

It’s Associated With Reduced Body Fat