Asthma - Alternative Medicine, Coping and Support

Alternative medicine

There's some evidence that certain alternative treatments may help with asthma symptoms. However, keep in mind that these treatments are not a replacement for medical treatment — especially if you have severe asthma. Talk to your doctor before taking any herbs or supplements, as some may interact with medications you take. While some alternative remedies are used for asthma, in most cases more research is needed to see how well they work and to measure the extent of possible side effects. Alternative asthma treatments include:

• Breathing techniques. Examples include the Buteyko breathing technique, the Papworth method, and yoga breathing (pranayama). These exercises may reduce the amount of medication you need to keep your asthma symptoms under control. Yoga classes increase fitness and reduce stress, which may help with asthma as well.
• Acupuncture. This technique involves placing very thin needles at strategic points on your body. It's safe and generally painless.
• Relaxation techniques. Techniques such as meditation, biofeedback, hypnosis and progressive muscle relaxation may help with asthma by reducing tension and stress.
• Herbal remedies. A few herbal remedies that have shown some promise in treating asthma symptoms include butterbur, dried ivy and ginkgo extract. Blends of different types of herbs are commonly used in traditional Chinese, Indian and Japanese medicine. However, more studies are needed to determine how well herbal remedies and preparations work for asthma.
• Omega-3 fatty acids. Found in fish, flaxseed and other foods, these healthy oils may reduce the inflammation that leads to asthma symptoms. They also appear to have a number of other health benefits.
• Homeopathy. Homeopathy aims to stimulate the body's self-healing response using very small doses of substances that cause symptoms. In the case of asthma, homeopathic remedies are made from substances that generally trigger an asthmatic reaction, such as pollen or weeds. There's still not enough clear evidence to determine if homeopathy helps treat asthma caused by allergies.

Coping and support

Asthma can be challenging and stressful. You may sometimes become frustrated, angry or depressed because you need to cut back on your usual activities to avoid environmental triggers. You may also feel hampered or embarrassed by the symptoms of the disease and by complicated management routines. Children in particular may be reluctant to use an inhaler in front of their peers. 

But asthma doesn't have to be a limiting condition. The best way to overcome anxiety and a feeling of helplessness is to understand your condition and take control of your treatment. Here are some suggestions that may help:

• Pace yourself. Take breaks between tasks and avoid activities that make your symptoms worse.
• Make a daily to-do list. This may help you avoid feeling overwhelmed. Reward yourself for accomplishing simple goals.
• Talk to others with your condition. Chat rooms and message boards on the Internet or support groups in your area can connect you with people facing similar challenges and let you know you're not alone.
• If your child has asthma, be encouraging. Focus attention on the things your child can do, not on the things he or she can't. Involve teachers, school nurses, coaches, friends and relatives in helping your child manage asthma.

Prevention

Working together, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks.

• Follow your asthma action plan. With your doctor and health care team, write a detailed plan for taking medications and managing an asthma attack. Then be sure to follow your plan. Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life in general.
• Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.
• Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak airflow with a home peak flow meter.
• Identify and treat attacks early. If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to control your symptoms. When your peak flow measurements decrease and alert you to an impending attack, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don't improve, get medical help as directed in your action plan.
• Take your medication as prescribed. Just because your asthma seems to be improving, don't change anything without first talking to your doctor. It's a good idea to bring your medications with you to each doctor visit, so your doctor can double-check that you're using your medications correctly and taking the right dose.
• Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your quick-relief inhaler such as albuterol, your asthma isn't under control. See your doctor about adjusting your treatment.

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Source: Mayo Foundation for Medical Education and Research

Asthma - Treatments and drugs

Prevention and long-term control is the key to preventing asthma attacks. Treatment usually involves learning to recognize your triggers and taking steps to avoid them, and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler such as albuterol. 

Medications

 
The right medications for you depend on a number of things, including your age, your symptoms, your asthma triggers and what seems to work best to keep your asthma under control. Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, medications to treat specific allergies are needed. 

Long-term control medications

 
In most cases, these medications need to be taken every day. Types of long-term control medications include:

• Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex), flunisolide (Aerobid), beclomethasone (Qvar) and others. They are the most commonly prescribed type of long-term asthma medication. You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use.
• Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR). They help prevent asthma symptoms for up to 24 hours. In rare cases, these medications have been linked to psychological reactions such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction.
• Long-acting beta agonists (LABAs). These inhaled medications include salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer). LABAs open the airways and reduce inflammation. However, they've been linked to severe asthma attacks. LABAs should be taken only in combination with an inhaled corticosteroid.
• Combination inhalers such as fluticasone and salmeterol (Advair Diskus) and budesonide and formoterol (Symbicort). These medications contain a LABA along with a corticosteroid. Like other LABA medications, these medications may increase your risk of having a severe asthma attack.
• Theophylline. This is a daily pill that helps keep the airways open (bronchodilator). Theophylline (Theo-24, Elixophyllin, others) relaxes the muscles around the airways to make breathing easier. It's not used as often now as in past years.

Quick-relief medications

 
Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it. Types of quick-relief medications include:

• Short-acting beta agonists. These inhaled, quick-relief bronchodilators can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and pirbuterol (Maxair Autohaler). These medications act within minutes, and effects last several hours.
• Ipratropium (Atrovent). Your doctor might prescribe this inhaled medication for immediate relief of your symptoms. Like other bronchodilators, ipratropium relaxes the airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks.
• Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. They can cause serious side effects when used long term, so they're used only on a short-term basis to treat severe asthma symptoms.

Treatment for allergy-induced asthma

 
If your asthma is triggered or worsened by allergies, you may benefit from allergy treatment as well. Allergy treatments include:

• Allergy shots (immunotherapy). Immunotherapy injections are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your immune system reaction to specific allergens.
• Omalizumab (Xolair). This medication is specifically for people who have allergies and severe asthma. It acts by altering the immune system. Omalizumab is delivered by injection every two to four weeks.
• Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn and ipratropium nasal sprays.

Don't rely on quick-relief medications

 
Long-term asthma control medications — such as inhaled corticosteroids — are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack.

If you do have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler very often. Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication. 

Bronchial thermoplasty

 
This treatment is used for severe asthma that doesn't improve with inhaled corticosteroids or other long-term asthma medications. Generally done in three outpatient visits, bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and may reduce asthma attacks. Bronchial thermoplasty isn't widely available. More research is needed to determine whether the benefits of this treatment outweigh the possible risks and potential side effects. 

Treatment by severity for better control: A stepwise approach

 
Treatment based on asthma control can help you manage your asthma. Asthma treatment should be flexible and based on changes in symptoms, which should be assessed thoroughly each time you see your doctor. Then, treatment can be adjusted accordingly. For example, if your asthma is well controlled, your doctor may prescribe less medicine. If your asthma is not well controlled or getting worse, your doctor may increase your medication and recommend more frequent visits. 

Asthma action plan

 
Work with your doctor to create an asthma action plan that outlines in writing when to take certain medications, or when to increase or decrease the dose of your medications based on your symptoms. Your asthma action plan should also list your triggers and the steps you need to take to avoid them. Your asthma plan may also involve tracking your asthma symptoms or using a peak flow meter on a regular basis to monitor how well your treatment is controlling your asthma.

Lifestyle and home remedies

Although many people with asthma rely on medications to prevent and relieve symptoms, you can do several things on your own to maintain your health and lessen the possibility of asthma attacks.

Avoid your triggers

 
Taking steps to reduce your exposure to things that trigger asthma symptoms is a key part of asthma control. Here are some things that may help:

• Use your air conditioner. Air conditioning reduces the amount of airborne pollen from trees, grasses and weeds that finds its way indoors. Air conditioning also lowers indoor humidity and can reduce your exposure to dust mites. If you don't have air conditioning, try to keep your windows closed during pollen season.

• Decontaminate your decor. Minimize dust that may worsen nighttime symptoms by replacing certain items in your bedroom. For example, encase pillows, mattresses and box springs in dust-proof covers. Remove carpeting and install hardwood or linoleum flooring. Use washable curtains and blinds.

• Maintain optimal humidity. If you live in a damp climate, talk to your doctor about using a dehumidifier.

• Keep indoor air clean. Have a utility company check your air conditioner and furnace once a year. Change the filters in your furnace and air conditioner according to the manufacturer's instructions. Also consider installing a small-particle filter in your ventilation system. If you use a humidifier, change the water daily.

• Reduce pet dander. If you're allergic to dander, avoid pets with fur or feathers. Having pets regularly bathed or groomed also may reduce the amount of dander in your surroundings.

• Clean regularly. Clean your home at least once a week. If you're likely to stir up dust, wear a mask or have someone else do the cleaning.

• If it's cold out, cover your face. If your asthma is worsened by cold, dry air, wearing a face mask can help.

Stay healthy

 
Taking care of yourself and treating other conditions linked to asthma will help keep your symptoms under control. A few things you can do include:

• Get regular exercise. Having asthma doesn't mean you have to be less active. Treatment can prevent asthma attacks and control symptoms during activity. Regular exercise can strengthen your heart and lungs, which helps relieve asthma symptoms. Keep in mind that exercising in cold weather may trigger asthma symptoms. If you do exercise in cold temperatures, wear a face mask to warm the air you breathe.

• Maintain a healthy weight. Being overweight can worsen asthma symptoms, and it puts you at higher risk of other health problems.

• Eat fruits and vegetables. Eating plenty of fruits and vegetables may increase lung function and reduce asthma symptoms. These foods are rich in protective nutrients (antioxidants) that boost the immune system.

• Control heartburn and gastroesophageal reflux disease (GERD). It's possible that the acid reflux that causes heartburn may damage lung airways and worsen asthma symptoms. If you have frequent or constant heartburn, talk to your doctor about treatment options. You may need treatment for GERD before your asthma symptoms improve.

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Asthma - Complication, Test and Diagnosis

Complications

Asthma may cause a number of complications, including:

• Symptoms that interfere with sleep, work or recreational activities
• Sick days from work or school during asthma flare-ups
• Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe
• Emergency room visits and hospitalizations for severe asthma attacks
• Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, when you call to set up an appointment, you may be referred immediately to an allergist, pulmonologist or other specialist.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do
 

These steps can help you make the most of your appointment:

• Write down any symptoms you're having, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Note when your symptoms bother you most — for example, if your symptoms tend to get worse at certain times of the day; during certain seasons; or when you're exposed to cold air, pollen or other triggers.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For asthma, some basic questions to ask your doctor include:

• Is asthma the most likely cause of my breathing problems?
• Other than the most likely cause, what are other possible causes for my symptoms?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What's the best treatment?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor
 

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• What exactly are your symptoms?
• When did you first notice your symptoms?
• How severe are your symptoms?
• Do you have breathing problems most of the time, or only at certain times or in certain situations?
• Do you have allergies, such as atopic dermatitis or hay fever?
• What, if anything, appears to worsen your symptoms?
• What, if anything, seems to improve your symptoms?
• Do allergies or asthma run in your family?
• Do you have any chronic health problems?

Tests and diagnosis

Diagnosing asthma can be difficult. Signs and symptoms can range from mild to severe and are often similar to those of other conditions, including emphysema, early congestive heart failure or vocal cord problems. Children often develop temporary breathing conditions that have symptoms similar to asthma. For example, it can be hard to tell asthma from wheezy bronchitis, pneumonia or reactive airway disease.

In order to rule out other possible conditions, your doctor will do a physical exam and ask you questions about your signs and symptoms and about any other health problems. You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe.

Tests to measure lung function include:

• Spirometry. This test measures the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
• Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and deal with low peak flow readings.

Lung function tests often are done before and after taking a bronchodilator (brong-koh-DIE-lay-tur) such as albuterol to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma.

Other tests to diagnose asthma include:

• Methacholine challenge. If you have asthma, inhaling a known asthma trigger called methacholine will cause mild constriction of your airways. If you react to the trigger, you likely have asthma. This test may be used if your initial lung function test is normal.
• Nitric oxide test. This test is sometimes used to diagnose and monitor asthma. It measures the amount of a gas called nitric oxide you have in your breath. If your airways are inflamed — a sign of asthma — you may have higher than normal nitric oxide levels. This test isn't widely available.

How asthma is classified

 
To classify your asthma severity, your doctor will consider your answers to questions about symptoms (such as how often you have asthma attacks and how bad they are), along with the results of your physical exam and diagnostic tests. Determining the severity level of your asthma will help your doctor choose the best treatment for you. Asthma severity often changes over time, requiring an adjustment to treatment. 

 

Asthma is classified into four general categories: 

Asthma classification	Signs and symptoms
Mild intermittent	Mild symptoms up to two days a week and up to two nights a month
Mild persistent	Symptoms more than twice a week, but no more than once in a single day
Moderate persistent	Symptoms once a day and more than one night a week
Severe persistent	Symptoms throughout the day on most days and frequently at night

 

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Asthma - Symptom and Causes

When you have asthma, your airways narrow and swell. They produce extra mucus, and breathing becomes difficult. The most common asthma signs and symptoms are coughing, wheezing and shortness of breath. For some people, asthma symptoms are a minor nuisance. For others, they're a major problem that interferes with daily activities. If you have severe asthma, you may be at risk of a life-threatening asthma attack. 

Asthma can't be cured, but its symptoms can be controlled. Treatments include taking steps to avoid your particular asthma triggers, using long-term control medications to prevent flare-ups and using a quick-relief inhaler to control symptoms once they start. Because asthma changes over time, you'll work with your doctor to track your signs and symptoms and adjust treatment as needed.

Symptoms

Asthma symptoms range from minor to severe and vary from person to person. You may have mild symptoms and asthma attacks may be infrequent. Between asthma flare-ups you may feel normal and have no trouble breathing. You may have symptoms primarily at night, during exercise or when you're exposed to specific triggers. Or you may have asthma symptoms all the time. Asthma signs and symptoms include:

• Shortness of breath
• Chest tightness or pain
• Trouble sleeping caused by shortness of breath, coughing or wheezing
• An audible whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
• Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu

Signs that your asthma is probably getting worse include:

• More frequent and bothersome asthma signs and symptoms
• Increasing difficulty breathing (this can be measured by a peak flow meter, a simple device used to check how well your lungs are working)
• An increasingly frequent need to use a quick-relief inhaler

For some people, asthma symptoms flare up in certain situations:

• Exercise-induced asthma occurs during exercise. For many people, exercise-induced asthma is worse when the air is cold and dry.
• Occupational asthma is asthma that's caused or worsened by breathing in a workplace irritant such as chemical fumes, gases or dust.
• Allergy-induced asthma. Some people have asthma symptoms that are triggered by particular allergens, such as pet dander, cockroaches or pollen.

When to see a doctor
These key circumstances may lead you to talk to your doctor about asthma:

• If you think you have asthma. If you have frequent coughing that lasts more than a few days or any other signs or symptoms of asthma, see your doctor. Treating asthma early, especially in children, may prevent long-term lung damage and help keep the condition from worsening over time.
• To monitor your asthma after diagnosis. If you know you have asthma, work with your doctor to keep it under control. Good long-term asthma control not only helps you feel better on a daily basis, but also can prevent a life-threatening asthma attack.
• If your asthma symptoms get worse. Contact your doctor right away if your medication doesn't seem to ease your symptoms or you need to use your quick-relief inhaler more and more often. Don't try to solve the problem by taking more medication without consulting your doctor. Overusing asthma medication can cause side effects and may even make your asthma worse.
• To review your treatment. Asthma changes over time. Meet with your doctor on a regular basis to discuss your symptoms and make any needed adjustments to your treatment.

When to seek emergency treatment

 
Severe asthma attacks can be life-threatening. Work with your doctor ahead of time to determine what to do when your signs and symptoms worsen — and when you need emergency treatment. If your quick-relief medications don't relieve symptoms of a severe asthma attack, seek emergency help right away. Signs of an asthma emergency include:

• Rapid worsening of shortness of breath or wheezing
• No improvement even after using a quick-relief inhaler such as albuterol
• Shortness of breath when you are doing minimal physical activity

Causes

It isn't clear why some people get asthma and others don't, but it's probably due to a combination of environmental and genetic (inherited) factors.

Asthma triggers are different from person to person. Exposure to a number of different allergens and irritants can trigger signs and symptoms of asthma, including:

• Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
• Respiratory infections, such as the common cold
• Physical activity (exercise-induced asthma)
• Cold air
• Air pollutants and irritants, such as smoke
• Certain medications, including beta blockers, aspirin and other nonsteroidal anti-inflammatory drugs
• Strong emotions and stress
• Sulfites, preservatives added to some types of foods and beverages
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat
• Menstrual cycle in some women
• Allergic reactions to some foods, such as peanuts or shellfish

Risk factors

Asthma is common, affecting millions of adults and children. A growing number of people are diagnosed with the condition each year, but it isn't clear why. A number of factors are thought to increase your chances of developing asthma. These include:

• Having a blood relative (such as a parent or sibling) with asthma
• Having an allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)
• Being overweight
• Being a smoker
• Exposure to secondhand smoke
• Having a mother who smoked while pregnant
• Exposure to exhaust fumes or other types of pollution
• Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing
• Low birth weight

Exposure to allergens, exposure to certain germs, and having some types of bacterial or viral infections may also be risk factors. However, more research is needed to determine what role they may play in developing asthma. 

 Next - Complications

Bloodless Medicine - Benefits and risks

The risks and benefits of bloodless methods -- compared to traditional medicine -- have not been well studied. The main benefit of bloodless medicine is that it allows people to avoid potential blood reactions and contaminants, and to follow certain religious beliefs. It also helps address blood supply issues. However, it is possible that bloodless medicine may provide a variety of other benefits, including fewer transfusion-associated complications, such as lung injuries. 

All of these possibilities are being studied, but the evidence is preliminary.

Keep in mind that ALL patients undergoing any type of surgery -- whether bloodless or conventional -- face certain risks. There may be additional risks specific to you and your personal medical condition and history. Your individual risk and benefit ratio should be reviewed specifically with your physicians as you consider the medical options available to you.

Bloodless medicine, however, has some unique considerations. 

When blood is lost -- but not replaced

In taking a bloodless approach, your health care team will strive to limit the possibility of heavy bleeding (hemorrhage). However, no surgical techniques or bloodless strategies can completely prevent the possibility of all bleeding. If an unforeseen circumstance results in major bleeding, and you have declined the use of blood donor products, you could experience serious blood loss that may need to be replaced to prevent organ injury or death. It is important that this unfortunate outcome be discussed in advance, so that you may guarantee that your wishes are followed. 

In the rare event that this occurs during elective surgery, the complications that you'll experience depend on the amount of blood lost, the speed with which the blood is lost, and your baseline level of health. Healthy adults can usually lose up to 20% of their normal blood volume without suffering permanent damage. If the blood loss occurs slowly over time, a loss greater than 20% of normal blood volume may be tolerated without permanent effects. 

However, severe blood loss can cause life-threatening complications such as low blood pressure, changes in the acidity of your blood, and decreased oxygen supply, resulting in damage to vital organs. 

Depending upon the specific type of therapy or procedures employed, there may be other increased risks. For example, using some hemostatic agents may have side effects; aprotinin is associated with allergic reactions, and aminocaproic acid may cause blood clots or a condition called disseminated intravascular coagulation. 

Discuss your options

If you are considering bloodless surgery, make sure that you understand the basic risks that accompany the particular procedure you'll be undergoing, discuss your unique personal risk factors with your health care team, and ask for help weighing the risks and benefits of using bloodless techniques.

Adapted from: Penn Medicine

Why people choose bloodless medicine

Traditionally, surgeons and other doctors have used blood transfusions (donated or banked blood, usually from another person) for a variety of medical situations. For example, people would have received blood transfusions if they had lost a great deal of blood during a surgical procedure, childbirth, or a serious injury. 

The rationale behind giving blood transfusions has always been to maintain a certain level of hemoglobin in your blood. Hemoglobin is a component of red blood cells, and it is responsible for carrying oxygen throughout your body. Low hemoglobin levels mean that less oxygen is being delivered to your tissues and organs. This has been thought to increase your risk of infection, slow your body's ability to heal, and cause tissue and organ damage

Proponents of bloodless medicine are re-examining the threshold level of hemoglobin necessary for good health and healing. They believe that patients can do well at lower hemoglobin levels than previously believed safe. And some proponents believe that the risks of a blood transfusion can, at times, outweigh the risks of low hemoglobin. 

Bloodless medicine may be chosen for a variety of reasons. Some of the most common are described below.

Religious convictions

If you belong to certain religious groups, most notably the Jehovah's Witnesses, your religious beliefs may state that you should not accept blood transfusions. Jehovah's Witnesses believe blood "stands for life... has special significance... and should not be misused." Their ethical principles state that blood should not be removed from the body and stored, nor taken in by another person. Therefore, Witnesses do not accept blood products containing plasma, red blood cells, white blood cells, and platelets -- which are sometimes referred to as major blood fractions. 

Clotting factors, albumin, growth factors, and immunoglobulins are sometimes referred to as minor blood fractions. If you are a Jehovah's Witness, whether or not you can accept treatment with a minor blood fraction may be considered an individual "matter of conscience." 

Concern about infections in the blood supply

In the early 1980s, a number of hemophiliacs contracted HIV through blood transfusions. Since then, public concern about infections transmitted through blood transfusions has increased. 

A variety of infectious agents have been discovered in the nation's blood supply, including:

• Hepatitis A, B, and C
• Malaria
• Syphilis
• Cytomegalovirus
• Herpesviruses
• Epstein-Barr virus
• Creutzfeldt-Jacob virus (which causes the human form of "mad cow" disease)
• West Nile virus

Potential donors can be screened, and donor blood tested and discarded, if found to contain some of these viruses.

Still, new viruses are regularly discovered in donor blood, requiring that new blood testing and screening procedures be put into place. 

Other complications from blood transfusions

While infections are certainly the most "in-the-news" complications, there are other medical risks of receiving blood transfusions. Everybody has a specific blood type, which refers to the biochemical markers located on their red blood cells. If you accidentally receive a transfusion of the wrong blood type, you can have a severe and even life-threatening reaction. Errors in blood typing do sometimes occur, prompting some people to prefer bloodless techniques over traditional transfusion medicine. 

Even if you get the right blood type from a donor, you could still undergo an allergic-type reaction to the transfusion because of other factors in the blood. 

A dwindling blood supply and rare blood types

As policies to cut down on infectious contamination of donor blood are instituted, more and more people are prohibited from donating. The donor pool continues to shrink, and the nation's blood supply has been steadily declining. Further, the cost of giving blood to patients has increased, due in part to the variety of tests to which donor blood must be subjected. If you have a rare blood type, it may be especially difficult to locate the kind of blood you need -- meaning that bloodless medical techniques may be crucial to your care.

 Adapted from: Penn Medicine

Bloodless Medicine

The term "bloodless medicine" refers to a variety of techniques that allow a patient to be treated without blood transfusions. This means that the patient does not receive any major blood products that have been stored or provided by donors. 

You may wish to request bloodless medicine techniques if you are scheduled to undergo a surgical procedure. In addition, some of these techniques can be applied to patients who have suffered traumatic injuries.

Bloodless techniques may be performed before, during, and after your surgery, and may include a combination of diet, medication, surgical techniques, and other strategies. Some of the common goals are to:

• Boost your red blood cell count prior to surgery
• Monitor and optimize oxygen delivery during surgery
• Avoid blood loss during surgery
• Collect and reuse your own blood during surgery

Bloodless medicine is growing

The practice of bloodless medicine is growing by leaps and bounds. In early 1990, you would have been able to choose from only a small number of medical centers providing bloodless health care. By 1996, you could have chosen from about 76 centers.

Today, more than 100 American medical centers are known for providing bloodless care, and even more centers are exploring the technologies and practices that will make such care a regular option for interested patients. Overall, health care practitioners are making efforts to avoid the use of blood products whenever possible, even in centers that do not specifically focus on bloodless medicine. 

The components of blood

 

To better understand the issues surrounding bloodless medicine, it's important to have a basic understanding of blood. In a given sample of your blood, more than half of the sample is made up of a watery substance called plasma, which contains proteins, immune cells, clotting factors, and various salts.

About half of the sample is made up of red blood cells, which contain oxygen-carrying hemoglobin. Less than 1% of the sample is made up of white blood cells (infection-fighting cells) and platelets (sticky little cell fragments that are involved in helping the blood clot).

Adapted from:  Penn Medicine

Epilepsy - Fact File

Epilepsy is a disorder that results from the generation of electrical signals inside the brain, causing recurring seizures. Seizure symptoms vary. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others have full-fledged convulsions. 

About one in 100 people in the United States will experience an unprovoked seizure in their lifetime. However, a solitary seizure doesn't mean you have epilepsy. At least two unprovoked seizures are required for an epilepsy diagnosis. 

Even mild seizures may require treatment, because they can be dangerous during activities like driving or swimming. Treatment — which generally includes medications and sometimes surgery — usually eliminates or reduces the frequency and intensity of seizures. Many children with epilepsy even outgrow the condition with age.

Symptoms

Because epilepsy is caused by abnormal activity in brain cells, seizures can affect any process your brain coordinates. A seizure can produce:

• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Complete loss of consciousness

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Doctors classify seizures as either partial or generalized, based on how the abnormal brain activity begins. In some cases, seizures can begin as partial and then become generalized.

Partial seizures
When seizures appear to result from abnormal activity in just one part of the brain, they're called partial or focal seizures. These seizures fall into two categories.

• Simple partial seizures. These seizures don't result in loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of part of the body, such as an arm or leg, and spontaneous sensory symptoms such as tingling, vertigo and flashing lights.
• Complex partial seizures. These seizures alter consciousness, causing you to lose awareness for a period of time. Complex partial seizures often result in staring and nonpurposeful movements — such as hand rubbing, twitching, chewing, swallowing or walking in circles.

Generalized seizures
Seizures that seem to involve all of the brain are called generalized seizures. Four types of generalized seizures exist.

• Absence seizures (also called petit mal). These seizures are characterized by staring and subtle body movement, and can cause a brief loss of consciousness.
• Myoclonic seizures. These seizures usually appear as sudden jerks or twitches of your arms and legs.
• Atonic seizures. Also known as drop attacks, these seizures cause you to lose normal muscle tone and suddenly collapse or fall down.
• Tonic-clonic seizures (also called grand mal). The most intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking, and loss of bladder control.

When to see a doctor
Seek medical advice if you experience a seizure for the first time. Also, seek immediate medical help if any of the following occurs.

• The seizure lasts more than five minutes.
• Breathing or consciousness does not return after the seizure stops.
• A second seizure follows immediately.
• You're pregnant.
• You have diabetes.
• You've injured yourself during the seizure.

Causes

Epilepsy has no identifiable cause in about half of those who have the condition. In the other half, the condition may be traced to various factors.

• Genetic influence. Some types of epilepsy, which are categorized by your type of seizure, run in families, making it likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, though it's estimated that up to 500 genes could be tied to the condition. For some, genes are only part of the cause, perhaps by making a person more susceptible to environmental conditions that trigger seizures.
• Head trauma sustained during a car accident or other traumatic injury can cause epilepsy.
• Medical disorders. Events like strokes or heart attacks that result in damage to the brain also can cause epilepsy. Stroke is responsible for up to one half of epilepsy cases in those over age 65.
• Dementia is a leading cause of epilepsy among older adults.
• Diseases like meningitis, AIDS and viral encephalitis can cause epilepsy.
• Prenatal injury. Fetuses are susceptible to brain damage caused by an infection in the mother, poor nutrition or oxygen deficiencies. This can lead to cerebral palsy in the child. About 20 percent of seizures in children are associated with cerebral palsy or other neurological abnormalities.
• Developmental disorders. Epilepsy can be associated with other developmental disorders, such as autism and Down syndrome.

Risk factors

Certain factors may increase your risk of epilepsy.

• Your age. The onset of epilepsy is most common during early childhood and after age 65, but the condition can occur at any age.
• Your sex. Men are slightly more at risk of developing epilepsy than are women.
• A family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.
• Head injuries. These injuries are responsible for many cases of epilepsy. You can reduce your risk by always wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.
• Stroke and other vascular diseases. These can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of such diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet and exercising regularly.
• Brain infections. Infections like meningitis, which causes an inflammation in the brain or spinal cord, can increase your risk of epilepsy.
• Prolonged seizures in childhood. High fevers in childhood can sometimes be associated with prolonged seizures and subsequent epilepsy later in life, particularly for those with a family history of epilepsy.

Complications

Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.

• Falling. If you fall during a seizure, you can injure your head or break a bone.
• Drowning. If you have epilepsy, you're more than 15 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.
• Car accidents. A seizure that causes either loss of awareness or control can be dangerous if you're driving a car or operating other equipment. Many states have driver's licensing restrictions related to your ability to control seizures and impose a minimum amount of time that you've been seizure-free — ranging from three months to two years — before you're allowed to drive.
• Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you're considering becoming pregnant, talk to your doctor. Most women with epilepsy can become pregnant and have a healthy baby. You'll need to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It's very important that you work with your doctor to plan your pregnancy.

Other life-threatening complications from epilepsy are uncommon, but do occur.

• Status epilepticus. This condition occurs if you're in a state of continuous seizure activity lasting more than five minutes or you have frequent recurrent seizures without regaining consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
• Sudden unexplained death in epilepsy (SUDEP). People with poorly controlled epilepsy also have a small risk of sudden unexplained death. Overall, less than one in 1,000 people with epilepsy die from SUDEP, but it's more common among people whose seizures aren't controlled by treatment. The risk of SUDEP is particularly elevated when generalized tonic-clonic seizures are frequent.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a specialist, like a neurologist or a doctor called an epileptologist, who specializes in treating epilepsy.

Because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Keep a detailed seizure calendar. Each time a seizure occurs, write down the time, the type of seizure it was and how long it lasted. Also make note of any unusual circumstances, such as increased stress, menstruation or other events that might trigger seizure activity. Seek input from people who may observe your seizures — including family, friends and co-workers — so that you can record information you may not know.
• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements that you're taking.
• Take a family member or friend along. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot. Also, because you may not be aware of everything that happens when you are having a seizure, your doctor may want to ask questions of someone who has witnessed them.
• Write down questions to ask your doctor.

Preparing a list of questions in advance will help you make the most of your time with your doctor. List your questions from most important to least important in case time runs out. For epilepsy, some basic questions to ask your doctor include:

• What is likely causing my seizures?
• Are there other possible causes?
• What kinds of tests do I need?
• Is my epilepsy likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• How can I ensure that I don't hurt myself if I have another seizure?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
 

Your doctor is likely to ask you a number of questions:

• When did you first begin experiencing seizures?
• Do your seizures seem to be triggered by certain events or conditions?
• Do you have similar sensations just before the onset of a seizure?
• Have your seizures been frequent or occasional?
• What symptoms do you have when you experience a seizure?
• What, if anything, seems to improve your seizures?
• What, if anything, appears to worsen your seizures?

What you can do in the meantime
 

Certain conditions and activities can trigger seizures, so it is best to:

• Avoid excessive alcohol consumption
• Avoid nicotine and recreational drug usage
• Get enough sleep
• Reduce stress

Also, it is important to start keeping a log of your seizures before you visit your doctor.

Tests and diagnosis

Your doctor may use a number of tests to diagnose epilepsy, from neurological exams to imaging techniques like MRI scans.

• Neurological and behavioral exam. Your doctor may want to test your motor abilities, behavior and intellectual capacity to see how the seizures are affecting you.
• Blood tests. Your doctor may take a blood sample to check for signs of infections, lead poisoning, anemia or diabetes, which can cause seizures.

Your doctor may also suggest tests to detect abnormalities within the brain. These include:

• Neuropsychological tests. This group of tests includes IQ, memory and speech assessments, which help doctors pinpoint where the seizures are originating. This type of testing is routinely done before epilepsy surgery.
• Electroencephalogram (EEG). This is the most common test to diagnose epilepsy. An EEG records the electrical activity of your brain via electrodes affixed to your scalp. If you have epilepsy, it's common to have changes in your normal pattern of brain waves, even when you're not having a seizure. Your doctor may want to monitor you on video while conducting an EEG of you awake or asleep in hopes of recording the seizure to see what kind of seizures you're having. Sometimes your doctor will have to do something to provoke a seizure while you're being tested, such as asking you to sleep very little the night before.
• Computerized tomography (CT). You might be given a CT scan if you go to an emergency room for an initial seizure, because it's generally a readily available test. CT machines use a type of X-ray equipment to obtain cross-sectional images of your brain and skull. CT scans can reveal abnormalities in the brain that might be causing your seizures, including tumors, bleeding and cysts.
• Magnetic resonance imaging (MRI). An MRI provides much the same type of information as a CT scan, but in far greater detail. MRIs use radio waves and a strong magnetic field to produce detailed images of your brain. MRIs can reveal brain abnormalities that could be causing your seizures.
• Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors generally use an fMRI before surgery to identify the exact locations of critical functions, like speech, so that surgeons don't injure those places while operating.
• Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities.
• Single-photon emission computerized tomography (SPECT). This type of test is used primarily if you've had an MRI and EEG that didn't pinpoint the location in your brain where the seizures are originating. A SPECT test uses a small amount of low-dose radioactive material that's injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures.

Treatments and drugs

Doctors generally start by treating epilepsy with medication. If that doesn't work, they may propose surgery or another type of treatment. 

Medication
 

Most people with epilepsy can become seizure-free by using a single anti-epileptic drug. Others can decrease the frequency and intensity of their seizures. More than half the children with medication-controlled epilepsy can eventually stop medications and live a seizure-free life. Many adults also can discontinue medication after two or more years without seizures.

Finding the right medication and dosage can be complex. Your doctor likely will first prescribe a single drug at a relatively low dosage, and may increase the dosage gradually until your seizures are well controlled. If you've tried two or more seizure medications without success, your doctor may recommend trying a combination of two drugs.

All anti-seizure medications have some side effects. Mild side effects include:

• Fatigue
• Dizziness
• Weight gain
• Loss of bone density
• Skin rashes
• Loss of coordination
• Speech problems

More severe but rare side effects include:

• Depression
• Suicidal thoughts and behaviors
• Severe rash
• Inflammation of certain organs, such as your pancreas

To achieve the best seizure control possible with medication:

• Take medications exactly as prescribed.
• Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.
• Never stop taking your medication without talking to your doctor.
• Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts or unusual changes in your mood or behaviors.

Half of all people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies.

Surgery
 

Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that doesn't interfere with vital functions like speech, language or hearing. In these types of surgeries, your doctor removes the area of the brain that is causing the seizures.

If your seizures originate in a part of your brain that can't be removed, your doctor may recommend a different sort of surgery where surgeons make a series of cuts in your brain. These cuts are designed to prevent seizures from spreading to other parts of the brain.

Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages. In some cases, surgery for epilepsy can cause complications such as permanently altering your cognitive abilities. Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering.

Therapies

• Vagus nerve stimulation. This therapy involves a device called a vagus nerve stimulator that's implanted underneath the skin of your chest like a pacemaker. Wires from the stimulator are wrapped around the vagus nerve in your neck. The battery-powered device delivers short bursts of electrical energy to the brain through the vagus nerve. It's not clear how this inhibits seizures, but the device can reduce seizures by 30 to 40 percent. Most people still need to take anti-epileptic medication. Side effects of vagus nerve stimulation include hoarseness, throat pain, coughing, shortness of breath, tingling and muscle pain.
• Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by maintaining a strict diet that's high in fats and low in carbohydrates. This diet, called a ketogenic diet, causes the body to break down fats instead of carbohydrates for energy. Some children can go off the ketogenic diet after a few years and remain seizure-free.
  Consult a doctor if you or your child is considering a ketogenic diet. It's important to make sure that a child doesn't become malnourished when taking the diet. Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies, and buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if use of the diet is properly and medically supervised.
  

Lifestyle and home remedies

Understanding your condition can help you control it.

• Take your medication correctly. Don't take it upon yourself to adjust your dosage levels. Instead, talk to your doctor if you feel something should be changed.
• Get enough sleep. Sleep deprivation is a powerful trigger of seizures. Be sure to get adequate rest every night.
• Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly.

In addition, make healthy life choices such as managing stress, limiting alcoholic beverages and avoiding cigarettes.

Coping and support

Uncontrolled seizures and their effect on your life may at times feel overwhelming or lead to depression. It's important not to let epilepsy constrain you. You can still live an active, social life. To help cope:

• Educate yourself and your friends and family about epilepsy so they understand the condition.
• Try to ignore negative reactions from people. It helps to learn about epilepsy so you know the facts as opposed to misconceptions about the disease. And try to keep your sense of humor.
• Live as independently as possible. This means continuing to work, if possible. If you can't drive because of your seizures, investigate public transportation options near you.
• Find a doctor you like and with whom you feel comfortable.
• Try not to constantly worry about having a seizure.

If your seizures are so severe that you can't work outside your home, there are still ways to feel productive and connected to people. These include:

• Work from home by developing a special skill, like computer programming.
• Develop or participate in hobbies, and connect over the Internet with other people who are interested in the same things.
• Work to develop friends and have contact with other people.

Let people you work and live with know the correct way to handle a seizure in case they're with you when you have one. This includes:

• Gently roll the person onto one side.
• Put something soft under his or her head.
• Loosen tight neckwear.
• Don't try to put your fingers or anything else in the person's mouth. No one has ever "swallowed" his or her tongue during a seizure — it's physically impossible.
• Don't try to restrain someone having a seizure.
• Don't attempt to rouse the person by shouting at or shaking him or her.
• If the person is moving, clear away dangerous objects.
• Stay with the person until medical personnel arrive.
• Observe the person closely so that you can provide details on what happened.
• Time the seizures with your watch.
• Keep calm and reassure others nearby

Adapted from:  Mayo Foundation for Medical Education and Research