Health Connection - February 2020

Author: Ellen Doxey & Daniel Sadowski

What You Should Know About Coronavirus

At MarinHealth Medical Center, we maintain a calm and constant state of readiness regarding potentially lethal airborne transmitted infectious diseases. Infrequently, we diagnose those diseases and treat infected patients. We have been monitoring the “Novel Coronavirus 2019 (2019-nCoV)" situation carefully. On February 11, the World Health Organization officially named the virus COVID-19. We are in close contact with Marin County Public Health about this fluid situation.

At baseline, our emergency department routinely screens patients for recent travel history. We also have initiated appropriate travel screening in our outpatient clinics. As of Thursday, February 13, MarinHealth has not encountered anyone who meets the Centers for Disease Control and Prevention (CDC) criterion for testing for COVID-19. However, to assuage fears, we are prepared to triage, evaluate and care for such patients at this time. Anyone looking for additional background on this particular virus can visit the CDC website.

If you have had recent travel to China or are in close contact with someone who has, AND you develop cold virus symptoms, please contact your health care provider by phone prior to going to a health care facility.

As with every winter, it's an especially good time to cover your cough and sanitize hands. If you develop a cold, it's likely a cold virus, such as rhinovirus or respiratory syncytial virus. If you have fever, body aches, cough, and feel “wiped out” all of sudden, you probably have influenza. Your doctor can prescribe antiviral medications that are safe, shorten disease symptoms and prevent spread to loved ones.

It's not too late to get an influenza vaccination this year. To put these viral illnesses in perspective, the CDC estimates that for the 2019-2020 season, there have been at least 22 million flu illnesses, including 210,000 hospitalizations and 12,000 deaths in the U.S.

Caregiver Burnout: Prevention Starts with Self-Care

One out of every three U.S. adults is a caregiver to a family member. The work can be physically and psychologically draining, and caregivers may find themselves experiencing cascading emotions, from impatience and resentment, to guilt and remorse, to isolation and hopelessness.

If you are a caregiver, chances are you also work outside of the home. This can provide respite and independence, but also leave you overwhelmed and struggling to keep up with responsibilities. If you feel like you need a break, or your caregiving responsibilities will be short term, ask your human resource department about options for unpaid leave. You may be eligible to take up to 12 weeks of unpaid leave under the federal Family and Medical Leave Act.

Whether you are a full- or part-time caregiver, burnout can be a very serious problem. It can take its toll on your health, your emotions, and your relationships. It’s essential that you know the signs so you can give yourself the care and attention you deserve.

Common Signs of Caregiver Burnout

  • Feeling chronically worried or overwhelmed
  • Anxiety, sadness, depression
  • Tiredness and lack of energy
  • Getting too much or too little sleep
  • Significant weight loss or gain
  • Being irritable or quick to anger
  • New or worsening health problems
  • Trouble concentrating and forgetfulness
  • Feeling resentful, powerless, or trapped
  • Feeling helpless or hopeless
  • Drinking, smoking, overeating or abusing prescription medications
  • Neglecting responsibilities at home or at work
  • Losing interest in activities or topics you once enjoyed
  • Having trouble relaxing, even when you take time off
  • Frequent headaches, aches and pains
  • Catching every bug that’s going around
  • Neglecting your own needs and not taking care of yourself

This assessment from the American Medical Association can help you understand how being a caregiver is impacting your health.

There’s no getting around it: caring for a loved one is stressful. However, there are things you can do to stay healthy and hopeful and avoid succumbing to caregiver burnout.

1. Pay attention to your health

Keep up with your annual checkups, screenings, and immunizations (including your flu shot). Tell your doctor you're a caregiver and discuss the physical and emotional challenges of that responsibility. Eat a healthy diet, drink lots of water, and try not to resort to sugar or caffeine for a quick boost. Find a way to exercise five times a week, for at least 30 minutes. Stress can put you at higher risk for diabetes, hypertension, and heart disease. It’s a good idea to practice a relaxation technique like yoga, deep breathing, or mindful meditation.

2. Maintain positive relationships

Talk with your closest friends and family members, especially those who can provide a sympathetic ear – even if it’s only on the phone. It’s okay to unburden yourself from time to time. Limit your interactions with negative or critical people or those who are unwilling to listen.

3. Pamper yourself

When it comes to boosting your spirits, little luxuries can make a big difference. Go out for ice cream or a movie. Get a professional massage or a back rub from a loved one. Get a manicure. Take a nature walk, bike ride, or long hot bath.

4. Hold on to your hobbies

Make time for your favorite activities, whether it’s reading, painting, woodworking, cooking, or playing with the dog.

5. Laugh

There’s truth to the cliché that laughter is the best medicine. It’s an excellent way to combat stress. Try to find humor in the little things, and remember that it’s okay to laugh – even when your situation if serious. Read an amusing book, watch a funny movie, or schedule time to hang out with your favorite witty friend.

6. Speak up and get help

You deserve a break. Ask a friend or relative to fill in occasionally so you can take some me-time. Consider hiring in-home help if possible. Look into structured options such as in-home respite care, adult care centers, or short term nursing homes. Lighten your load with specific services such as meal delivery, house cleaning, or transportation.

7. Simplify your communications

Keeping extended family up to date on their loved one’s conditioncan be exhausting and time consuming. Websites like CaringBridge or PostHope let you post updates for everyone privately and simultaneously.

8. Join a support group

Whether online or in person, talking to other caregivers is a great way to get sympathy, support, and advice. Not only will you be able to get help, you will have the opportunity to help others. In-person local groups are a great way to find understanding new friends and discover local resources. There are support groups available for general caregivers, as well as for people caring for someone with a specific condition such as cancer, brain injury, or Alzheimer’s.

Not sure where to start? Check out some of these resources to find the help and support you need:

Fighting Lung Cancer: News from the Frontlines

By Alex S. Metzger, MD

Every 2.3 minutes, another American is diagnosed with lung cancer – the second most common cancer in the US. While the majority of these cancers are found in smokers, 10% of lung cancers occur in people who have never smoked. While smoking is an obvious risk factor for lung cancer, others include:

  • Being around second hand smoke, which increases cancer risk by as much as 40%
  • Chronic marijuana smoking
  • Exposure to asbestos, radon, certain environmental carcinogens, and/or air pollution
  • A family history of lung cancer (Research is being conducted into several inherited genetic mutations believed to increase the risk of lung cancer)

One of the major challenges in the treatment of lung cancer is that the symptoms – chronic cough, coughing up blood, shortness of breath, chest pain, hoarseness, weight loss, headache, bone pain – don’t usually appear until the cancer has progressed to an advanced stage. In order to detect lung cancer in the earlier, more treatable stages, some hospitals, including MarinHealth Medical Center, have begun offering low-dose CT screening for early stage lung cancer. You may qualify for a screening if:

  • You are between 50 and 75
  • You have quit smoking within the past 15 years
  • You have a 30 “pack year” history (To calculate your pack years, multiply the number of packs of cigarettes smoked per day by the number of years you have smoked. For example, 1 pack-year is equal to smoking 20 cigarettes a day for 1 year, or 40 cigarettes a day for six months)

Medicare and private insurance will both cover the cost of a screening for qualified individuals who are referred by their healthcare provider.

The treatment of lung cancer depends on the type of cancer and the stage at which it is diagnosed. There are two basic types of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Strongly associated with smoking, SCLC is fast growing, aggressive and accounts for 20% of lung cancers. The remaining 80% are NSCLC and, while smoking remains a strong risk factor, these cancers can also occur in non-smokers.

For stage 1 or 2 lung cancer, surgery is a treatment of choice to remove the cancer before it spreads. Once the cancer has progressed to stage 3, which involves lymph nodes in the chest, treatment will involve multiple modalities including radiation, sometimes chemotherapy and surgery.

Targeted therapies and immunotherapies are changing how we treat lung cancer. Genetic testing is now routinely used to screen for specific mutations that can be treated with medications by targeting proteins involved with tumor growth. Beyond targeted therapies, immunotherapy is now being routinely used to treat advanced lung cancer. These therapies can “unmask” tumor cells from the immune system and allow one’s own immune system to fight the cancer.

Emerging therapies are not the only good news in the field of lung cancer. Between 2011 and 2015, rates of new lung cancers dropped by 3% a year in men and 1.5% a year in women. With approximately 1.3 million smokers quitting each year, lung cancer rates should continue to decrease.

Rather than give up smoking, some people are switching to dangerous new nicotine delivery systems: e-cigarettes and vape pens. Vaping simply substitutes one unhealthy habit for another. There is already more than enough data to know that vaping tobacco or marijuana can be dangerous – and even deadly. As of January 14, 2020, the CDC reports a total of 2,668 people hospitalized with e-cigarette or vaping associated lung injury (EVALI). Sixty deaths have been confirmed across 27 states and the District of Columbia.

Smoking is a challenging addiction to break, but more and more people are quitting for good. Many excellent smoking cessation programs are available, including the one MarinHealth offers through our Integrative Wellness Center. The highest success rates are achieved through a combination of a smoking cessation program and prescription medications to reduce nicotine cravings.

Dr. Metzger specializes in hematology and oncology, and is Board Certified in Hematology and Medical Oncology

Heart Health for Young Adults

By Brian G. Keeffe, MD

People do not often think about their heart health in their teens and 20s. They assume that conditions like high blood pressure, high cholesterol, diabetes or sleep apnea do not manifest until later in life. However, many of these conditions can develop much sooner than people think. Helping people maintain their heart health over time and starting at a young age is the goal of the emerging preventive cardiology specialty.

When we think about heart disease in young people, we tend to focus on sudden high-profile deaths of young athletes. This can be due to a variety of conditions, the most common in the United States being hypertrophic cardiomyopathy (HCM). HCM tends to go undiagnosed because it is usually asymptomatic. Hypertrophic cardiomyopathy and some of the other conditions that can lead to sudden cardiac death in young people often do not have symptoms prior to the life ending event. However, anyone experiencing symptoms such as shortness of breath, chest pain or heart palpitations should discuss them with their doctor immediately.

Heart disease (the buildup of plaque in arteries) is the number one cause of death in the United States for all people. From a young age, we should be thinking about our risk factors for developing heart disease. For starters, it’s essential to know your risk factors, including:

  • Family history of heart disease
  • Hypertension
  • High cholesterol
  • Diabetes
  • Obesity
  • Sleep apnea, which can even occur in young adults
  • Smoking
  • Stress, which elevates heart disease risk over time by causing the body to release adrenaline and cortisol
  • Excessive alcohol consumption and binge drinking (alcohol is a direct heart toxin)
  • Sedentary lifestyle

A routine screening or a checkup with your doctor can help look at your risk for heart disease. Prevention of cardiovascular disease should be addressed in young people with a pediatrician or adult physician seeing a young adult. The goal is to prevent the development of atherosclerosis (heart disease) in later life. This includes assessment of tobacco exposure, weight status, physical activity, dietary assessment, blood pressure, fasting glucose, and fasting cholesterol.

Before your next checkup, you can make lifestyle changes that will help preserve your heart health over time.

  • Exercise. Try to be physically active for at least 30 minutes, five times a week. If you are interested in evaluating or enhancing your performance, consider making an appointment at MarinHealth’s Cardiovascular Performance Center. This innovative program can help you train more effectively for competitive sports, evaluate your exercise performance, or simply improve your metabolic health.
  • Maintain a healthy diet, controlling your intake of sugar and fats.
  • Avoid soda and other sugary drinks. Excess sugar consumption can set you on the path to type 2 diabetes.
  • Reduce your caffeine intake to 400 milligrams a day – the equivalent of a 12-ounce cup of coffee.
  • Limit your alcohol consumption. Moderate alcohol use is generally defined as one drink a day for women and up to two drinks a day for men.
  • Don’t skimp on sleep. The National Sleep Foundation recommends 7-9 hours for adults ages 18-65.
  • Stop smoking immediately. MarinHealth offers a smoking cessation program that can help you quit for good.

Remember, no matter how young you are or how healthy you feel, don’t skip that annual checkup. Follow your doctor’s advice to stay healthy – and stay young at heart.

Dr. Keeffe is a MarinHealth cardiologist specializing in preventive cardiology, cardiac CT imaging, and the cardiovascular benefits of exercise.

A Word About GERD

Indigestion. Heartburn. Sour stomach. Acid reflux. Whatever you call that unpleasant burning feeling, it’s something we all experience from time to time.

When you swallow a bite of food, cells in your stomach prepare for digestion by producing acid. Food passes from your esophagus to your stomach through the lower esophageal sphincter, or LES. Normally, the LES relaxes to let food into the stomach while preventing a backwash (reflux) of acid back into the esophagus. If acid washes back up through the LES, it causes that burning sensation in the walls of your esophagus. While everyone has an occasional case of heartburn, you should talk to your doctor if your symptoms are frequent, severe or wake you up in the middle of the night. You could be suffering from gastroesophageal reflux disease, or GERD.

Common Symptoms of GERD

The degree of severity of GERD depends on how often you experience reflux, how much acid washes back up, and how long it stays in your esophagus. People diagnosed with GERD experience one or more of these symptoms:

  • Heartburn, usually after eating
  • Chest pain
  • Difficulty swallowing
  • Burping and regurgitating bits of food or sour liquid
  • Feeling like there is a lump in your throat
  • Nighttime acid reflux, which may include a chronic cough, laryngitis and sleep disturbances

Risk Factors for GERD

Some people are more likely than others to develop GERD. Risk factors include:

  • Having a hiatal hernia, which may decrease the amount of pressure the LES needs to maintain the anti-reflux barrier
  • Obesity
  • A tendency to secrete too much stomach acid
  • A family history of acid reflux and GERD
  • Pregnancy
  • Sclerodoma
  • Delayed stomach emptying, or Gastroparesis, a disorder that slows or stops the movement of food from the stomach to the small intestine

Tips for Avoiding Reflux

There are some lifestyle measures you can take to reduce the incidence and severity of your heartburn. Make a point of avoiding the following:

  • Caffeine
  • Chocolate
  • Onions
  • Peppermint
  • Carbonated beverages
  • High fat and fried foods
  • Alcohol
  • Citrus and tomato products
  • Smoking – another reason to quit!

Use gravity to help your digestive system do its work. Sit up straight while eating and avoid lying flat for a couple of hours after a meal. Better yet, stand up and walk around to get your gastric juices flowing in the right direction. Avoid eating less than 3 hours before bed. If you experience heartburn at night, try raising the head of your bed 6 inches so you are sleeping on an incline.

Managing GERD

Left untreated, GERD can eventually cause damage to the esophagus and lead to complications such as pain, open sores, or difficulty swallowing. Fortunately, GERD can usually be managed through a combination of medication and lifestyle changes. A variety of over the counter and prescription medications are available to treat GERD. Antacids, or acid blockers, neutralize the stomach acid. Another class of drugs, such as Zantac, reduces acid production in the stomach. Proton Pump Inhibitors, or PPIs, block acid production in the stomach and also help heal the esophagus. Talk to your doctor about your GERD issues, and together you can find the right course of treatment for keeping symptoms in check. Find a doctor, here.