Dr. D and Becky answer listeners questions about both themselves and medical topics.

COPD is chronic obstructive pulmonary disease (also called chronic obstructive lung disease) It is the 4th leading cause of death in the US. Anatomy Lungs composed of airways that branch smaller and smaller like a tree and end in tiny air sacks called alveoli where oxygen and carbon dioxide are exchanged. When we breathe, air moves in and out of our lungs, delivering oxygen and giving off carbon dioxide. COPD results in obstruction of this air flow. COPD has 2 categories, chronic bronchitis and emphysema. Chronic bronchitis is caused by inflammation, mucous production and stiffening of the airways. Common symptoms are productive cough, congestion, wheezing and shortness of breath with exertion. Emphysema is caused by destruction of the air sacs where oxygen and carbon dioxide exchange occurs. This leads to shortness of breath, air hunger, weight loss and chronic fatigue. Smoking is the leading cause of COPD although there are some other minor causes. Chronic uncontrolled asthma can lead to COPD and there is a genetic enzyme (alph 1 antitrypsin) deficiency that leads to lung tissue destruction and emphysema. Smoking damage is estimated in “pack years”. 1 pack year is one pack daily for one year. Increased pack years increases the risk of developing COPD. It is very important to diagnose COPD correctly because there are other diseases that can cause similar symptoms and treatments might be different. Testing for COPD might include pulmonary function testing, xrays, CT scans and tests to rule out or diagnose other problems. Treatment for COPD is aimed at managing symptoms. It is very important to stop smoking. Inhaled medications help open airways and decrease inflammation. Once damage has occurred, it cannot be repaired, but lung function can improve. Please stop smoking and don’t start. Help loved ones quit, but they have to be ready. It is important to have end of life discussions if your family is facing issues with COPD.

Vitamin supplements are not necessary for the general population if eating a well balanced diet.  Most health issues associated with vitamin deficiency can be solved with a well balanced diet.

Some conditions such as Crohn's and Celiac disease can cause problems with the absorption of vitamins.  Restrictive diets, including vegan, may limit intake of some essential vitamins, especially B12.  Advancing age may also be a factor in limiting vitamin absorption.  Talk to your personal physician if you are concerned about the need for vitamin supplementation. 

Liver is a prime source of multiple vitamins.

There are several causes of vitamin D deficiency, including decreased intake from vitamin D rich sources like milk, decreased absorption, and reduced sun exposure. 

Individuals at risk for vitamin B12 deficiency include those on a restrictive diet like vegan and those post gastric or bariatric surgery.  They should receive oral vitamin B12 supplements. 

Folic acid supplementation is recommended in pregnancy, but not for the general population unless at risk.  Risk factors for folate deficiency include malnutrition, chronic alcohol use, chronic hemolytic anemia.  Those individuals should receive folic acid supplementation.

Most infants should have an iron supplement while breastfeeding.  Children will also get the proper nutrients from a well balanced diet.  

Calcium and vitamin D supplements can be helpful in reducing the risk of osteoporosis.  Talk to you personal physician for specific recommendations to meet your needs.

https://www.fda.gov/consumers/consumer-updates/fortify-your-knowledge-about-vitamins

Dr. D and Becky share personal colonoscopy experiences.  

Diabetes is the 7th leading cause of death

1.5 million new cases diagnosed every year

30 million people with diabetes, about 7.5 million don’t know they have it

84 million with pre diabetes

327 billion dollars in diabetes care in 2017

Diabetes is a chronic disease whose hallmark is elevated blood glucose (sugar) above normal.

Normal fasting blood glucose values for diabetes are 70-100

Pre diabetes 101-125

Diabetes greater than 126

Type I diabetes is usually early or childhood onset, we did not talk about this, we will save it for a later episode.

Type II diabetes is also called late or adult onset because it usually is diagnosed in middle age

It is associated with insulin resistance. Insulin is a hormone made in and secreted from the pancreas and is responsible for keeping blood glucose in a normal range. Insulin resistance is a state in which the cells of the body become resistant to the effects of insulin, making it harder for the glucose to get from the blood to the inside of the cells of the body where it is needed. This results in higher blood glucose levels which leads to all of the complications of diabetes.

Risk factors for Type II diabetes include obesity, family history, hispanic or African American decent. There are others, these are most common.

Symptoms of diabetes are not common early in the disease.  As it progresses and blood sugar gets higher symptoms can include excessive urination and thirst, recurrent urinary tract infections (UTI), recurrent yeast infections, fatigue, weight loss. Interesting note, when these symptoms occur, the urine has excess sugar and before lab testing was available, doctors would taste urine to see if it was sweet.

Consequences of untreated or poorly controlled diabetes include cardiovascular disease, heart attack, strokes, peripheral arterial disease which can lead to poor wound healing and amputation, blindness, kidney disease, neuropathy. These consequences are related to the damage that long term high glucose levels cause in small blood vessels which then leads to end organ failure.

There is no cure for diabetes so management is very important to prevent the above problems. Management strategies include lifestyle changes like healthy diet that includes low sugar intake and adequate exercise. Dietitians and diabetic educators play a vital role here. Medications are very important. It is important to check blood sugar regularly and keep follow up appointments with your doctor. Please follow doctors advice.

Very useful resources can be found at www.diabetes.org

Cold and upper respiratory infection mean the same thing. It is caused by different respiratory viruses that cause sore throat, cough, nasal drainage and congestion, low fever and mild body aches. It will usually last about a week and gradually gets better after 3-4 days. This does not require antibiotics for treatment.  A slight cough may persist for two or three weeks with a cold.

Flu is caused by influenza virus and has similar symptoms to a cold, but the symptoms start more suddenly and is associated with high fevers, severe body aches and fatigue. You feel awful, worst cold ever. Antibiotics don’t treat this but there is treatment available that might shorten the length of illness and decrease symptoms. There are some people who need to be treated, but it must start within the first one to two days.

Sore throats are usually caused by viruses and don’t require antibiotics unless it is strep throat. This needs to be treated with antibiotics to prevent certain complications.

Sinus infections and ear infections are usually caused by viruses. If a bacterial source is suspected based on length of illness or symptoms, antibiotics are needed.

If symptoms last 7-10 days, get worse or there is a second illness that presents (getting better then suddenly get worse) this might be an indication for further evaluation and treatment.

See your doctor if:

You are worried it is worse than a cold (it is still probably a cold and does not need antibiotics)

Early, if you think you have the flu and would need to be treated.

If you were getting better, then got sicker

Fever more than 3 days

Very young or old are more susceptible to serious infection

Inappropriate use of antibiotics leads to antibacterial resistance strains of bacteria, possible serious adverse reactions, c.diff infections, and the perception that antibiotics are necessary when they are not.

To help prevent and stop the spread of colds and flu:  wash your hands, stay home if you have the flu, cover your cough and sneeze, and wash your hands again.  Also, get your flu shot.