What is Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a condition that makes it difficult for those who have it to exhale air which, in turn, causes problems inhaling air. The two most common manifestations of it are Chronic bronchitis and Emphysema. (The latter of these affected my grandmother and, eventually, caused her death.) (Medline Plus, N.D.) It is caused by long-term exposure to substances that irritate the lungs and damage them. By far, the worst culprit is cigarette smoke, although air pollution, chemical fumes, or dust can also cause it.

Diagnosis of COPD typically diagnosed using Spirometry where the doctor (a pulmonologist) measures lung function. The test can be done in the office and involves having the patient exhale (blow) into a spirometer. This determines how much air you lungs can hold (total capacity) and how quickly you can expel the air from your lungs. For a healthy adult, the lung capacity is approximately six (6) liters (Lung Institute, 2017). Depending on the results of the spirometry, your health care professional can prescribe medications to aid in your breathing and might suggest dietary changes and exercises to improve your lung function.

BIBLIOGRAPHY

Lung Institute (2017). Lung capacity: what does it mean? Retrieved on April 30, 2018 from https://medlineplus.gov/copd.html

Medline Plus (N.D.). COPD. Retrieved on April 30, 2018 from https://lunginstitute.com/blog/lung-capacity-what-does-it-mean/

Epilepsy and seizures (Part 1)

What is epilepsy?

The cause of epilepsy varies by the age of the person. Some, for example, with no obvious physical manifestation for it, might develop epilepsy as a result of genetic issues. Generally, however, it is caused by a central nervous system disorder in which brain activity becomes abnormal (the image at left shows the area(s) of the brain affected and how the activity looks on an Ecoencephlogram [EEG]). Interestingly, not all seizures result in extraneous body movements, some result in periods of unusual behavior or sensations. For example, with me, I have what medical experts refer to as an "absence (pronounced 'absonce') seizure". When they occur, I don't shake or lose consciousness, but I "zone out" and can't speak for 30 seconds to a minute.

What are the symptoms of epilepsy?

Since it is caused by errant electrical activity, symptoms can affect any process your brain coordinates. They include: 1) Temporary confusion; 2) Episodes of staring (absence seizure); 3) Uncontrollable jerking movement of the arms and legs; 4) Loss of awareness or consciousness; 5) Psychic symptoms such as a fear, anxiety, or deja vu. Symptoms can vary depending on the type of seizure, however, most people with epilepsy have the same type of seizure each time. This means there symptoms will not vary from episode to episode.

The medical community classify seizures as either focal or generalized

Focal seizures

Focal seizures (No loss of consciousness) were once referred to as a simple partial seizure and do not result in a loss of consciousness. It is possible for them to alter the patient's emotions, or cause changes in the way something looks, smells, tastes, feels, or sounds. They can also cause an involuntary jerking of a body part (referred to as a Convulsion) as well as spontaneous sensory symptoms.

Focal seizures (impaired awareness) were once referred to as a complex partial seizure and can result in either an altered level of awareness and/or consciousness or a total loss of consciousness. They might also cause the person to stare off into space, or not respond in an expected way to the environment around them. In addition, they might perform repetitive movements such as rubbing their hands.

The symptoms associated with a focal seizure can be confused with those of other neurological disorders such as a migraine headache or Narcolepsy.

Generalized seizures

This type of seizure appears (italicized emphasis added) to involve all areas of the brain.

Absence seizures previously known as petit mal seizures frequently occur in children - although the can occur in adults - and are characterized by staring into space or subtle body movements such as smacking the lips. They can occur in clusters and result in a brief loss of awareness.

Tonic seizures cause stiffening of the muscles. Primarily they affect muscles in the arms, legs, and back. As a result, persons with tonic seizures may fall to the ground during a seizure.

What is sudden cardiac arrest? (Part 1)

What is sudden cardiac arrest?

Sudden cardiac arrest or SCA occurs when the heart suddenly and unexpectedly stops beating thereby cutting off the blood supply to your brain and vital organs. To understand why this happens lets go back to the basics your learned in a high school anatomy class: our heart serves as the body's electrical system and is responsible for controlling both the rate and rhythm of the heart. When this fails to happen, irregular heart beats called Arrhythmias (pictured at right). These can cause the heart to be either too slowly or too fast or with an irregular rhythm. Some can stop pumping blood to the body -- this causes SCA.

What are the risk factors for SCA?

By far the biggest risk factor for the development of SCA is Coronary heart disease (CHD). Most people suffering from SCA have some degree of coronary heart disease; however, many people don't know they have CHD until a SCA event occurs. In many cases, it is "silent" meaning that it exhibits no signs or symptoms and goes undetected by health professionals. In many cases, victims have "silent" (undiagnosed) heart attacks prior to a SCA event. Patients who suffer a "silent" heart attack - also known as a Myocardial infarction (MI) - show none of the common symptoms associated with a heart attack.

Other risk factors include: 1) A personal history of arrhythmias [such as Atrial fibrillation (A-Fib)]; 2) A personal or family history of SCA or inherited disorders that put you at risk for experiencing an arrhythimias; 3) Substance abuse; 4) Heart attack; or 5) Heart failure.

Screening and prevention of SCA

Ways to prevent death from SCA are dependent on several factors: 1) The person already suffers from Sudden Cardiac Arrest; 2) The person has never had Sudden Cardiac Arrest, but is at an elevated risk for it; and 3) The person has never had Sudden Cardiac Arrest and has no known risk factors for developing it.

For people who have survived Sudden Cardiac Arrest

People who have previously experienced SCA are at a great risk of it happening again. Research has shown that surgical implantation of a Implantable cardioverter defibrillator (ICD) [pictured at right] reduces that chance of the patient dying from a second SCA. It is surgically placed under the skin in either the chest or abdomen and has wires that connect to the chambers of the heart. If a dangerous rhythm is detected, it will deliver a shock that will return the heart to a normal sinus rhythm.

For people at risk for a first occurrence of Sudden Cardiac Arrest

Persons with severe coronary heart disease (CHD) are at a higher risk for SCA -- particularly if they have already had a heart attack. Your doctor might prescribe a Beta blocker to aid in lowering your risk for SCA. They might also prescribe a statin drug for patients who have: A) Diabetes; B) Heart disease (or a previous stroke); or C) High LDL ("bad") cholesterol levels.

For people with no known risk for Sudden Cardiac Arrest

CHD appears to be the cause of SCA in most adults. It is also major risk factor in the development of angina pectoris (chest pain and/or discomfort). It can also contribute to the occurrence of heart attack and other related problems.

For additional information:

What is Coronary Heart Disease?

What is sudden cardiac arrest?

What is Celiac's disease?

Dedicated to my dear friend and "adopted sister" Hope Welker

Celiac's disease is a serious autoimmune disorder which can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestines. It's estimated that 2 1/2 million people (bolded emphasis added) in the United States alone are undiagnosed and at risk for long-term health complications.

What causes Celiac's disease?

When a person with Celiac's disease ingests gluten (which is barley, rye, and wheat) their body mounts an autoimmune response that attacks the small intestines (see image at the top of the page). These (autoimmune) attack result in damage to the villi, finger-like projections which line the small intestine and promote nutrient absorption. This damage leads to nutrients not being properly absorbed into the body.

Celiac's disease is hereditary in nature meaning that it runs in families. People with a first-degree relative with Celiac's disease (meaning a parent, child, or sibling) have a 1 in 10 risk of developing Celiac's disease. (Bolded emphasis added) 

What are the longterm health effects?

Celiac's can develop at any age after people begin foods and medications that contain gluten. Left untreated, it can result in other immune disorders Types 1 diabetes, multiple sclerosis (MS), dermatitis herpetiformis (an itchy skin rash), anemia, osteoporosis, infertility, and miscarriage. Interestingly, in recent years, different neurological disorders have been diagnosed in patient's suffering from Celiac's disease. In some patients, this may be an initial manifestation leading to the initial diagnosis and recognition of the problem be the result of Celiac's. Some of these neurological disorders might be the result of micronutrient malabsorption - particularly vitamins - while others may share an immune-mediated etiology.

How is it treated?

Currently, the only treatment for Celiac's is lifelong adherence to a strict gluten-free diet. This means they MUST (Bolded emphasis added) avoid foods that contain barley, rye, or wheat. Consuming even small amounts of these (such as crumbs on a cutting board) can result in damage to the small intestine.

My sources:

Neurological disorders in adult celiac disease

What is Celiac's disease

Homemade zip lines can be dangerous!

Professionally installed and maintained, a zip line can be fun and good exercise . . .but improperly installed they can be potentially dangerous and cause serious injury. One west Georgia family learned this first hand when their daughter dropped six feet into the Little Talapoosa River when the homemade zip line she was on broke. That in itself would have been traumatic enough, but Aimee Copeland also suffered a laceration to her left calf that required two-dozen staples to close. Sadly, the story doesn't end happily there -- but takes a deadly turn as she developed an almost always fatal complication known as Necrotizing fasciitis (or NF for short) a rare, flesh-eating virus that can easily travel across the fascial plane. I won't dwell on the condition but, just know, Aimee Copeland is alive today because of excellent medical treatment on the part of the Joseph M. Still Burn Unit in Augusta, Georgia  (JMS Burn Center)  and God's grace!

Aimee's accident points out the danger of a home-made zip line. These lines - whether they be made of rope or heavy-guage wire - are subject to great stress and can easily snap if they are not properly installed and/or maintained. As a matter of fact, when I first read of Aimee's accident, I was under the impression that her injury was the result of being cut by the breaking zip line; it wasn't until I read a follow-up article the next day that I understood that she was injured by the fall. I joint Aimee's fellow psychology majors at West Georgia College in asking that, while it's okay to enjoy a zip line, please leave the construction and maintenance of them to the professionals!

-- Walter

Get well soon Aimee!

Societal attitudes towards developmental disabilities

Take a look at the picture before you read any further. What is your attitude toward the young lady in the wheelchair? Chances are that you might feel a little sorry for her because she's in a wheelchair. That's okay . . . at least, I would hope, you don't see her as incapable or incompetent because of her situation which is known as a developmental disability. This term - developmental disability - is used to describe a life-long disability which is attributable to mental and/or physical (or a combination of both) impairments which are manifested prior to age 18. Frequently this term is used to describe someone who suffers from mental retardantion, cerebral palsy, autism spectrum disorder, various genetic and chromosomal disorders (such as Down syndrome and Fragile X syndrome) and Fetal Alcohol Spectrum disorder. The sad part, as I alluded to above, is the fact that many people see a person who is developmentally disabled as being incapable or incompetent of handling their own affairs. This is simply not true!

Throughout history, people with developmental disabilities - and people with disabilities in general - have been viewed as incapable and/ot incompetent in their ability to make decisions. It wasn't until the Enlightenment in Europe (circa 16th century), that this opinion began to change and, even then, it was a slow and painful process. Until this time, care and asylum for a person with a developmental disability was provided largely by their family or by the church (in monasteries and other religious communities) and focused on the basic physical needs of food, shelter, and clothing. For the most part, the prevailing attitude viewed them as either the dimwitted yokel or potentially dangerous (such as demonic possession for a person with epilepsy) .

The movement toward individualism in the 18th and 19th centuries, coupled with opportunities afforded by the Industrial Revolution, lead to housing and care using the asylum model. Persons with a developmental disability were either placed by, or removed from, their families - usually in infancy - and housed in large institutions. Some of these provided a very rudimentary level of education such as distinguishing between colors, and basic word recognition. But, for the most part, they continued to concentrate solely on the provision of basic needs. Conditions in these facilites varied widely, however, the support provided was generally non-individualized with aberrant behavior and low levels of economic productivity regarded as a "burden to society". Heavy sedation and assembly line methods of support (such as 'birdfeeding' and cattle herding) were the norm and the medical model of disability prevailed. Services were provided based on the relative ease to the provider instead of being based on the needs of the person requiring service.

Although major strides have been made in the treatment provided to individuals with developmental disabilities, it can be argued that we still have a very long way to go before people with such disabilities are seen as full citizens of society. Person Centered Planning and Person Centered Approaches address the continuing labelling and exclusion of "socially devalued people", such as those with developmental disabilities. Rather than focusing on what such people can't do, it emphasizes as being someone with capacities and gifts . . .all they need to achieve this is a little support!

Until next time . . .

Lets talk about sleep apnea

What is sleep apnea?

I'm one of the thousands of people who suffered from sleep apnea and require a Constant Positive Airway Pressure (CPAP) machine to keep my airway open while I sleep. But, if you're like me, you might wonder exactly it is. Simply put, it can be caused by: 1) interruption of breathing due to lack of effort known as central sleep apnea; 2) interruption of breathing due to a physical blockage despite respiratory effort known as obstructive sleep apnea; or 3 a combination of the two known as mixed sleep apnea.

Sleep apnea is a condition where a person is a sleep disorder that is characterized by abnormal pauses in breathing and/or instance of abnormally low breathing during sleep. Each of the pauses is known as an apnea which can last anywhere from a few seconds to several minutes and can occur anywhere from five (5) times to thirty (30) times (or more) an hour. In most cases the person suffering from the apnea(s) or hypopnea (low breathing) is rarely aware of it. The symptoms associated with sleep apnea can continue for years - or possibly even decades - without being identified. As a result, a person suffering from the condition becomes accustomed to the daytime sleepiness and fatigue that result from the sleep loss.

My situation

For years, I had been getting up in the morning feeling almost as tired as when I went to bed six to eight hours earlier. I finally got tired of being tired and asked my doctor to refer me to a Pulmonologist who could assess my situation and refer me for a sleep study - known as a polysomnogram - if he thought it was needed. It wasn't until after Dr. Akbik (my pulmonologist) referred me for the initial study that I realized just how bad my apnea was.  I stop breathing - on average - 38.5 times an hour and kick my legs - due to restless leg syndrome -  an average of 24 times an hour. No wonder I stayed tired all of the time!

Armed with this knowledge, Dr. Akbik knew my treatment would involve two phases: 1) treating the restless leg syndrome; and 2) having me titrated (Explanation of titration) for a C-PAP machine that would prevent me from having apneas when I slept. The difference it would make was obvious the night of the second sleep study. That night, when I used a C-PAP for the first time, I had no episodes of apnea and my oxygen saturation remained at a healthy 96 percent!

In conclusion, if you snore, I encourage you to speak to your doctor and see if he/she thinks you could be suffering from sleep apnea. You'll be glad that you did!

-- WL