Hay fever

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Hay fever is a fairly common problem with one in five people being affected by it, and there's no known cure! Put simply, the grass pollen is the gamete of the grass and is trying to mate with the lining of your nose and eyes: and neither your nose nor eyes are very pleased with the idea and consequently react to the promiscuous pollen!


The problems is that if you suffer from hay fever, then this happens every year and every time your neighbour decides to cut his lawn. So, apart from closing your windows and hoping that you can reduce the volume of pollen trying to inflame your nostrils and irritate your conjunctiva, then you may have to rely on symptom control to make life more comfortable. This would include

• Nasal steroid sprays
• Non sedating anti-histamines
• Very short term nasal decongestants
• Others such as intra-nasal Cromolyn sprays: Singulair

For those who are looking for longer term solutions for their children, then there is the choice of "Immuno-therpay" in the form of weekly subcutaneous injections or sub-lingual drops for three to five years! And getting little children to have weekly "shots" is a big ask for most parents. 

Sublingual - under the tongue - therapy has been around for a long time and up until now been a weekly treatment, in season and out of season. But there may be some relief to this regime as according to an article in the September issue of Pediatric Allergy and Immunology the therapy may not have to be all year round, at least not after the first year. 

The researcher found that in the first year, continuous therapy was 20% better than the coseasonal therapy - therapy given before and during the hayfever season. In the following years however, both therapies produced similar results. This isn't a cure, but should make life a little more comfortable, less intrusive and less expensive for all concerned. Talk to your treating doctor about it. 

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Good news for female coffee drinkers

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I recently wrote an article on the multiple health benefits of physical activity: according recent research, coffee may be chasing exercise in the health benefits stakes!

A Harvard School of Public Health researcher has just released data following a group of 50,000 women over 10 years and found that those who drink 2 to 3 cups of coffee a day had a 15% decrease in the risk of depression. For those who drank 4 cups per day the rate was 20% risk reduction!

As usual, there are still questions to be asked. As the results were "observational" and not "double blind" studies, the results will be good for promoting further debate and research, but not good for basing Public Health standards on. Also, the group were women with an average age of 63, so there is no data on the weaker sex! They will, no doubt, sip on their red wine and hope that they have chosen the right beverage for them.
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Faith in good health

Tweet Here's a report that probably wont make it to the front pages of most newspapers. It's a literature review on the impact of spirituality/religiosity on mortality, and comparing it with other health interventions.

What the researchers from Sao Paolo in Brazil did was to identify 25 well recognized Health interventions and then performed a Medline review for these interventions for the years 1994 to 2009: they then did a similar review for studies on religiosity and spirituality  for the same period. They came up with 28 meta analyses and found that people with a higher religiosity/spirituality had an 18% reduction in mortality. This was better than 60% of the other Health initiatives.

To put this into context, having a religious or spiritual belief is as effective as taking a Statin or aspirin for heart disease, and is more effective than having airbags in cars or undergoing colo-rectal screening for bowel cancer.

Whilst I have no doubt that this report will not convince those who find it hard to "believe" that science is more than a well informed mystery, it certainly does put some hard facts behind the idea that we could all do with a little more "faith" sometimes!

It's a bugs life!

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Ever had the feeling that you shouldn't have done something really dopey? Well, when it comes to decision making, you may not be in as complete control as you thought you were. And that brilliant immune system of ours that's supposed to detect and delete all those germs that threaten our existence: has the "enemy" infiltrated it and is it quietly controlling how it functions?

The answer to both those questions is literally under the microscope, and the particular microscope of Prof Eric Denkers, a Veterinary Immunologist in the USA. He's been studying a ubiquitous germ called Toxoplasmosis gondii, that he charmingly describes as "..an especially promiscuous parasite", and which infects all warm blooded animals and most of the human population. Most of the time is quietly co-habits with its host organism, living peacefully within muscle or brain cells. However, if the host's immune system is deficient, then it can cause serious problems.

But it also has the ability to alter brain chemistry with jaw dropping results! In rats, for instance, it alters their brains activity in such a away as to make them fearless of cats - not a particularly smart move - as the cats always win and eat the infected rats allowing the Toxoplasmosis to enter and live in its favoured breeding ground, the intestine of the cat!

But it's influence on the immune system that has attracted Dr Denkers attention. In the past it was thought that Toxoplasmosis just sealed itself off from the surrounding environment and lay dormant. Now it appears that it actually modulates the immune cells ability to release a chemical known as a Cytokine, and which is the key to creating an inflammatory response. Too many Cytokines are not good for Toxoplasmosis as they attract more immune cells and that may lead to eradication of the organism. Too little Cytokines and the body's survival could be threatened from other infective organisms. It appears that Toxoplasmosis plays the immune system like a violin!

The up-side to all this is that this research is revealing how the immune system operates and the various "chemical signaling" systems that it uses in order to control and contain infection, and this will lead to new treatment options in the future.

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Hallucinations, vegetables and memories.

Tweet I was "grazing" through Medscape the other day - it's one of my online medical education resources - and came across the following case presentation: "A 12-year-old boy presented for psychiatric evaluation. He was referred by his school nurse because he had been describing complex visual hallucinations to his classmates. He reported seeing cartoonlike scenes of zucchini dressed like cowboys shooting at each other and eggplants dressed like clowns engaged in slapstick and acrobatic activities. He knows that these visions are not real and finds them mildly amusing and somewhat entertaining rather than threatening. He has had the visions intermittently, several times daily, over the past 3 months. The visions are purely visual and not accompanied by music, voices, or other sounds."

My mind went back to student days when I was attached to a psychiatric hospital and one of the patients was building a 12ft carrot for some reason that I now forget! But it reminded me that hallucinations happen, and when you first meet someone who is having them, you are almost convinced that they might be telling the truth! One long distance truck driver I looked after was overdoing the "uppers and downers" and was admitted to our small country hospital with hallucinations. When I visited him, he pointed out the window to the little men who were running along the telegraph wires and some were even riding small bicycles: I found myself looking out the window to see if I could see them too!

According to the authors at Medscape: "Hallucinations or perceptions in the absence of identifiable external stimuli are thought to reflect psychosis and underlying serious psychopathology. Hallucinations in children may reflect normal development or response to psychosocial stress, but it is important to rule out an underlying physical illness as well as to evaluate for psychiatric conditions."

The young lad at the beginning of this piece was found to have a small benign lesion in his brain that was removed at surgery and ended his hallucinations. His story had a happy ending, but many others suffer from life long psychoses that require medication and for them, life is not so funny.

Chondroitin Suplhate gives a helping hand!

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Our hands are amazing structures: works of art really. They have the ability to perform amazingly fine work, and yet when clenched into a fist, can bludgeon a man to death! For most of us though, they fulfill our need to grip, squeeze, hold and manipulate objects without ever having to think about them. Until, that is, they start to malfunction at which point we suddenly realize how precious normally functioning hands are.

Inflammatory arthritis affects many joints of the body and the hand is one of the more common sites that it can flare in. Generally speaking there is no "cure" for the problem, but relief can be found from divers treatments:

• Simple analgesia such as paracetamol
• NSAIDs
• Steroid joint injections
• Disease modifying medications for those with Rheumatoid Arthritis

The "market" for alternative treatments is fairly healthy too with promoters offering, amongst other things,  copper bracelets and magnets to help sufferers cope with their pains and morning stiffness.

One of the alternative therapies - Chondroitin Sulphate - has just been found to help in reducing pain in inflammatory arthritis of the hand, which is good news indeed. But before you scour the Net for your supple of Chondroitin Sulphate for your painful hands, here are a few more points to consider:

• It took 3 months of treatment before its beneficial effects appeared: NSAIDs work almost immediately.
• The size of the trail was relatively small and would need a much larger trial to confirm the findings.
• It had no significant impact on morning stiffness of the hands.
• It did not improve the grip strength in the hands.
• Chondroitin Sulphate is generally well tolerated but does have a mild anti-coagulant effect so sohuld be used with care by those already on "blood thinners".

But bearing all that in mind, if I had stiff painful hands and was looking for an extra 10% of relief, I'd be searching the Net right now!

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Shoulders - you're 'armless without them!

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Being a rugby tragic, I was both despondent and delighted with Australia's loss to Ireland at the weekend. Despondent, because the Aussies played without much passion and delighted because the "young bride" is .. Irish! Reading all the comments in this mornings papers, I was concerned that injuries are already starting to play their part in the competition, and in particular, the Australian Captain was reported as having an MRI on a suspected shoulder injury, which thankfully, is not thought to be serious.

The shoulder joint is a very mobile, and inherently an unstable joint between the Humerus - which is the bone of the upper arm - and the Scapular, or shoulder blade. Together they form a part of the Shoulder Girdle along with the Clavicle - or collar bone - that also articulates with the Scapular, but is also relatively unstable though far less mobile than the "humero-scapular" joint. The purpose of the Shoulder Girdle is to provide a support and brace for the arm as it carries out it's various essential functions to feed and forage for the rest of the body.

The shoulder joint allows the arm to move in many directions and there are muscles attached that provide the power and dexterity to achieve such movements. As I sit here typing I am aware that most of the activity in my shoulder muscles is occurring in the pectoral muscles, which are tending to pull my shoulders forwards in a "hunched" fashion. In fact, I am pretty sure that the muscles that are intended to pull my shoulders back must be fairly flimsy by now, as most of the work I perform these days is in front of me,  and unless I consciously think about it, my shoulder posture has become .... "rounded", to use polite terminology!

Also, as a callow youth, I too indulged in contact sport and can remember injuring both shoulders as a result: put past injury together with current poor posture and the result can be pain, limitation of movement and even the need for surgery. Luckily for me, after such surgery to one shoulder some years ago, I met a physiotherapist - Justin Barich - who gave me some fairly basic points on posture and some exercises to do for the rest of my life, that have helped me avoid having to undergo surgery on the other injured shoulder, because, believe me, shoulder surgery can be very, very painful!

The moral to this tale: respect and protect your shoulders, and if you do need advice on how to maintain good balance in your shoulder muscles, then talk to someone who has the right experience and that, for me, is an accredited sports physiotherapist.

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