Spring Blossoms Spell Sneezing, Itching for Allergy Sufferers

With the Asthma and Allergy Foundation of America’s (AAFA) recent release of its 2013 Spring Allergy Capital list, Rochester won 37^th place on the list of  “the 100 most challenging places to live with allergies” during the spring and fall seasons. The report takes into consideration pollen counts, the use of allergy medications (both over-the-counter and prescription), and number of board-certified allergists per patient.

With the warmer spring weather soon upon us—signaling plants to start budding and trees to pollinate—we can expect hay fever (or seasonal allergic rhinitis ) to be right on its heels. What’s an allergy sufferer to do? To learn more about managing runny noses, congestion, sneezing, itchy and watery eyes, we spoke to allergist Dr. Carolina Marcus.

Scripts: Is there any way to avoid exposure to pollen this spring?

Marcus: Indeed, there are several smart, simple things you can do.

First, when it’s hot out, use an air conditioner as opposed to cracking windows or propping open doors. You really want to keep them shut as much as possible, to limit the amount of pollen entering your home and car. You can also plan to avoid outdoor activities or exercise early in the day, instead engaging in these activities in the afternoon or evening, since tree pollen is heaviest in the morning and tends to dissipate as the day goes on. You might also consider taking a shower and wash your hair—even if it’s just with water— before bedtime. This helps rid your hair and scalp of accumulated pollen that could otherwise end up on your pillow, where you can inhale it. By that same token, wash your clothing frequently, and don’t go to bed in the same clothes you wore during the day.

Scripts: That’s all great, practical advice. But what about medications—can you highlight some options?

Marcus: Over-the-counter antihistamines can be very helpful. Loratadine, cetirizine and fexofenadine are long-acting antihistamines that can help alleviate itchy eyes and a runny nose. But for nasal congestion, the single most effective treatment is a nasal glucocorticoid spray, which you secure by prescription. You should ask your doctor if you think you might benefit from this kind of medication.

Scripts: And how can I pinpoint the exact cause/s of my troubles?

Marcus: You have to engage a specialist. Consultation with an allergist can help you identify specific triggers and manage your symptoms and/or asthma. In some cases, allergy shots might be the best therapeutic option. Talk to your primary care doctor if you think you might benefit from working with an allergy specialist. It’s really important that you communicate your symptoms and concerns to all of your caregivers, regularly, so that they can best care for you as a team.

Here’s to a happy and healthy allergy season!

Carolina Z. Marcus, M.D., is an assistant professor of Immunology at the University of Rochester Medical Center. Her clinical interests focus on the education of her patients and their families, as well as the community at large, on asthma, atopic dermatitis and allergies. Dr. Marcus has a particular interest in food allergy awareness and education.

Want an appointment? Dr. Marcus sees patients at URMC’s Allergy and Immunology Clinic, 400 Red Creek Drive, Rochester, NY 14623. Learn more by calling (585) 486-0147.

Simple Prevention Steps Keep Athletes in Game, Off Bench

When it comes to sports, there’s big pressure on players—even ones who’ve barely just learned to tie their laces—to be bold, play hard, and make bleacher fans proud.

But at what cost? How hard is training too hard? How can you tell when you’re crossing the line, setting yourself up for short- and long-term—maybe even lifelong—pain? Whether you coach a little league team or are gearing up to tackle your first 5K, read on. We’ve talked with sports medicine expert Dr. Mike Maloney on the basics of avoiding athletic injuries, no matter what your sport.

Scripts: When it comes to injury prevention, are there fundamentals that every athlete should perform religiously before training/competing?

Maloney: Recommendations vary dramatically by sport, so I want to point you to really terrific resource—the “Stop Sports Injuries” website, sponsored by the American Orthopaedic Society for Sports Medicine. It’s a goldmine for coaches, trainers and athletes alike, serving up guidelines tailored to your team’s type of play, the unique pitfalls you might meet, and suggested steps you might take to avoid them.

More broadly, though, are basics we all can stick to. Like a proper warm-up and gentle stretching to loosen muscles and get blood flowing. You should also be intentional about taking time to rest—perhaps exercising alternate muscle groups each day, giving your body adequate chance to rebuild and recover.

Investing in the right, properly fitted protective gear—such as pads (neck, shoulder, elbow, etc.), helmets, mouthpieces, face guards, protective cups, eyewear—is important too. So is a supportive shoe, built for the stress inherent in your type of exercise. And of course, you can actively head off heat injury by drinking plenty of fluids before, during and after practice or play, wearing light, breathable clothing, and avoiding outdoor practice during periods of high heat or humidity.

Scripts: How do you know when you’re working too hard?

Maloney: Pain. It’s the body’s built-in alarm system, letting us know to stop and slow down.

Unfortunately, all too often young athletes fear that speaking up about troublesome symptoms might cost them their prized place on the team. There’s heavy social and psychological pressure to “be tough,” hide their injuries, and play through the pain. But that only ultimately makes things worse, and in extreme cases, can damage joints for a lifetime. I’d urge any athlete to keep the big picture—not just the next game—in mind, letting the right coach or trainer know if they’re uncomfortable, are hurting, or sense that their range of mobility is restricted. It takes courage, but it’s essential to voice these concerns.

Scripts: Are there some key injuries that spell death to a sports career?

Again, it depends on the sport. But some of the most devastating injuries we see are torn ACLs (anterior cruciate ligaments), a type of knee injury that can spell trouble (and the bench) for many young athletes—even leading to long-term disability from osteoarthritis (a painful joint condition). More than 50,000 debilitating ACL injuries occur annually in female athletes at the high school and college level. It can take between six to 12 months to return to a sport after ACL reconstruction; some sufferers may experience continuing knee symptoms that limit their participation.

Overuse injuries (in the form of stress fractures, shin splints, and tendonitis ) can develop when athletes boost the frequency, duration, intensity, or resistance of training too quickly—putting undue stress on a particular part of the body. Again, rest is really important. But sometime even that’s not enough; in more serious cases, treatment and medical intervention might be necessary.

Finally, concussions concern us. Research continues to evolve, most recently implicating repeated blows to the head with long-term brain trauma, and even dementia in later life.  We can’t exaggerate the importance of protective helmets and gear.

Scripts: So, what’s the bottom line?

Maloney: I think the overarching message is to train smart, sticking with a conditioning program that emphasizes fitness, strength, flexibility and endurance. Remember, we have one body to age with. It’s so important that we respect it, listen to it. The power of proper nutrition, rest, and prudent training cannot be overstated.

Want To Learn More about Injury Prevention—From a Local Olympian?

On Saturday, March 23, Olympic pole vaulter Jenn Suhr, who brought home the gold medal from the Summer 2012 games in London, will be the featured speaker at a free URMC Orthopaedics and Rehabilitation seminar. A graduate of Roberts Wesleyan College who makes her home in Churchville, Suhr will sign autographs and  share her Olympic experiences—and discuss the steps she takes personally to prevent injuries.

Dr. Michael D. Maloney, chief of URMC Sports Medicine and professor in the Department of Orthopaedics and Rehabilitation, will kick off the activities at 1 p.m. with a discussion about injury prevention and the proper steps that all athletes, whether middle and high school students or adults, should take to avoid injuries. Maloney’s medical practice is broad, including reconstructive surgery of the knee, shoulder, and elbow, and arthroscopy of the knee, shoulder, and elbow for patients of all ages in the Rochester region and beyond. He serves at team physician for the Rochester Red Wings, along with area college sports teams.

For more information on the free community event or to RSVP, please call (585) 275-8762 or e-mail ortho-info@urmc.rochester.edu.

More about URMC Sports Medicine

URMC Sports Medicine, the only medical practice in the nine-county region dedicated solely to sports medicine, offers the latest in medical and surgical care to prevent, evaluate, treat, and rehabilitate injuries for both recreational and competitive athletes of all ages. Its physicians are fellowship-trained sports medicine primary care physicians and orthopaedic surgeons who work together with physical therapists and athletic trainers to give complete medical care. For an appointment, call 585-275-5321.

Lace Up the Tennis Shoes: Running Linked to Lower Risk for Psoriasis

Ten million Americans.

That’s the number of people living with psoriasis, an autoimmune disease that leaves sufferers with irritated, red, flaky patches of skin. It can appear suddenly or gradually, with severity varying from person to person – some get only a few scaly patches on their elbows and knees, while others develop them all over their body. While psoriasis is not contagious, it seems to be passed down through families.

According to URMC dermatologist Dr. Francisco Tausk, psoriasis is more than just skin deep – it’s often tied to arthritis, and can greatly increase one’s risk for heart disease, diabetes, bowel disease and depression. The good news? Just last week, a new study found that vigorous exercise might help reduce the risk of psoriasis for U.S. women.  Given most people’s inclination to be outside and active in the summer months, we checked in with Dr. Tausk to see if this is one more reason for women (and possibly, men) to make sure they hit the running trails or bike paths during the sunny season.

Scripts: As a physician treating psoriasis patients every day, is this finding –that vigorous exercise is associated with a reduced risk of the disease in women – surprising? 

Tausk:  Well, this study is certainly interesting, because it’s the first to pinpoint a behavior that reduces one’s risk for psoriasis. We never could have inferred this in our clinic alone; drawing these sorts of conclusions requires a study with a large number of subjects who are followed over time. This particular study included 86,655 U.S. female nurses who reported whether they had ever been diagnosed as having psoriasis and who completed several detailed physical activity questionnaires between 1991 and 2001.

I suspect further studies will show that exercise also reduces the severity of the disease in people who already have it – and that may be even more exciting.

Scripts: What exactly makes up vigorous physical activity – does going for a brisk walk count? Or is it more like swimming or running? And how much time do people have to spend exercising to get this benefit?

Tausk: The study used a detailed formula to decide when exercise is considered “vigorous”  – but, in practice, vigorous exercise is any activity that significantly boosts the heart rate and maintains it for around 30 to 40 minutes.

The study suggests 105 minutes of running, or 180 minutes of swimming or playing tennis a week is associated with a 25 to 30 percent reduced risk of psoriasis (compared with not participating in any vigorous exercise). That’s a significant reduction.  And what’s further encouraging, this amount of vigorous activity is more or less equal to the current U.S. Department of Health and Human Services recommendation for greater health benefits.

Unfortunately, just walking – while a great health habit – was not linked with a reduced risk of psoriasis in this study.

Scripts: What is it about exercise that might keep psoriasis at bay?

Tausk: We don’t really know. We do know that psoriasis is linked to obesity, diabetes, hypertension, arthritis and depression.  People who regularly engage in vigorous exercise would probably avoid these other conditions. Also, exercise has an antioxidant effect that may help people ward off psoriasis.

The bottom line:  A healthier lifestyle will always be beneficial. Physical activity has been associated with a decreased risk of a whole host of conditions, ranging from type 2 diabetes and heart disease to breast and colon cancer. More research is needed, but psoriasis may eventually be added to this list.

Scripts: What about men – could this finding apply to guys as well?

Tausk: I don’t see why not. By design, men were not assessed in this study because the authors used data from the Nurses’ Health Study, in which the participants were all women.

Scripts: This study focuses on reducing the risk of psoriasis, but let’s switch gears and talk about people who already have the condition. What is your advice for their getting the best possible care?

Tausk: First, it’s important that patients with psoriasis of the skin be assessed for joint involvement, since psoriatic arthritis – a form of arthritis that affects some people who have psoriasis – requires a more aggressive treatment regimen because it can eventually severely impair joint function. At our Psoriasis Center here at the Medical Center, patients are seen simultaneously by a dermatologist who specializes in psoriasis, and a rheumatologist (a doctor who deals with clinical problems involving joints) who specializes in psoriatic arthritis. Although these visits take longer, they represent the best possible coordination of care.

During these visits we also address other conditions sometimes found in psoriasis patients, like depression and psychological and emotional disorders. We have a psychiatrist right in the clinic to support patients who need it.

Finally, we offer patients the chance to participate in clinical trials. One example is a study called the Mindfulness Based Stress Reduction study, which provides instruction in this stress-relieving intervention and evaluates if it helps alleviate the symptoms of psoriasis.

Scripts: Your clinic sounds like a true one-stop shop for patients with psoriasis.

Tausk: Yes, we really embrace a holistic, team-based approach. We feel it’s the only way to truly understand each patient and to find the best possible treatment. Ours is one of the very few centers in the country entirely dedicated to the treatment of psoriasis, psoriatic arthritis and related conditions.

For more information about URMC’s Psoriasis Center, patients and family members can call (585) 487-1400 or visit http://www.urmc.rochester.edu/dermatology/psoriasis/.

To Grandmother’s (Dangerous?) House We Go

Later this week, holiday travels will draw families together for sumptuous feasts, giggles, gift exchanges and more.

And with so many loved ones milling about – crowding kitchens, sipping wine and getting caught up in the holiday cheer – it’s not uncommon the littlest guests to sneak off and find their way into trouble.

“We see too many toddlers suffer injuries while visiting grandparents, or while at holiday gatherings where their parents are otherwise distracted,” says Dr. Anne Brayer, an emergency department pediatrician at the University of Rochester Medical Center, who also co-directs the local Injury Free Coalition for Kids chapter.

So, how do you keep curious little fingers from finding danger – especially in a non-child-proofed home? Brayer offers the following tips:

• Before settling into the fun with friends and family, quickly scan the room that youngsters are in. Don’t let the munchkins toddle off without having made sure there are no open outlets, electric cords, or easy-to-swallow items in reach. Also pay special attention to pointy-edged coffee tables, wall corners that jut out, or any other sharp objects an infant could bump her head on – and watch out for kitchens, bathrooms, and other cabinets that might hold cleaning supplies.
• Don’t leave children without an adult. Well-meaning cousins or other grade-school-aged friends might not recognize potentially risky situations. What’s more, they often get so carried away in amusing one another, they forget to make babies’ and toddlers’ safety their first priority.
• Monitor a child’s interaction with pets. Little ones might be tempted to grab Fluffy’s tail, or even try to climb Fido, causing some pets to lash out. “Dog bites are especially problematic this time of year, since many dogs who aren’t used to toddlers horsing around the house,” Dr. Brayer warns. Even subdued pets can easily knock over little ones.

Remember, no one wants to spoil a holiday with a trip to the emergency room (or worse, carry the guilt of having a little guest injured at their house!) – so while it may seem cumbersome to pay extra attention to youngsters and prepare the house for their arrival, make the effort! It’s time well-spent.

Wishing you a most safe and happy holiday season!

Scripts will not publish next week, but returns Wednesday, Jan. 4. Happy New Year!

Mushrooming: Diabetes Rates Double in Just Three Decades

Startling new statistics published just weeks ago in the journal The Lancet suggest that nearly 350 million adults worldwide now have diabetes.

Still not fazed? Consider this: That count is more than double what it was in 1980.

And, while it’s clear that a now-global obesity epidemic is in large part fueling the phenomenon, there’s so much more at play – for instance, a little thing called genetics. Case in point: While more than 25 percent of the population is obese in more than two-thirds of all U.S. states, only about 8 percent of Americans are diabetic. So, clearly, while maintaining a healthy weight is a really important part of delaying or avoiding diabetes,  it’s not the whole story. (Just to shake things up some more, here’s another fact to chew on: As many as 20 percent of persons with type 2 diabetes are not overweight. You can read more popular diabetes myths here.)

To gain better insight into this often misunderstood disease – its various types, the causes and symptoms, and the heavy burden it places on persons living with it (from both fiscal and quality-of-life standpoints) – we spoke with URMC expert and endocrinologist Dr. Steve Wittlin.

In the clip below, he offers a crash course in diabetes.

Want to know more about the diabetes care available through URMC? Click here to learn about the spectrum of services offered by our team of endocrinologists, nurse practitioners, nutritionists, and nationally certified diabetes educators.

Freckle, Mole, or More? This Weekend, Free Skin Checks Offer Peace of Mind

A few blistering, lobster-red sunburns as a kid. Fair skin, light eyes, sprinkled with a hearty helping of freckles. A family history of melanoma.

When it comes to protecting your skin from cancer, you can’t be too safe. By far the most common of all cancers, skin cancer can be dangerous – especially melanoma, a kind of skin cancer arising of pigment-producing cells called melanocytes. While melanoma accounts for less than 5 percent of skin cancer cases, it causes a large majority of skin cancer deaths.

Luckily, skin cancer is almost always curable if caught early. But how can you discern between a normal, healthy mole and one that’s cause for concern? In the clip below, you can hear URMC dermatologist Dr. Marc Brown discuss skin cancer, the importance of practicing “safe sun,” and some tips to help you identify suspicious moles at home.

What’s more, if you’re in Rochester, you can be proactive about your skin health this weekend by stopping by Strong Memorial Hospital’s Free Skin Cancer Screening Clinic between 9 a.m. and 1 p.m. this Saturday, May 7. No registration is required; take the Silver Elevators to the 2^nd floor to find the Dermatology Suite. Each screening takes about five to ten minutes and offers a written report of findings. Information on skin cancer, including prevention tips, will be available.

For more information about the free detection clinic, contact the Dermatology Department at (585) 275-3871.

The annual screening event is sponsored by the American Academy of Dermatology, Rochester Dermatologic Society, and URMC’s Department of Dermatology.

Dr. Brown specializes in the diagnosis, treatment and prevention of skin cancers. In addition to performing Mohs surgery on more than 1,200 patients a year, he also runs a multidisciplinary melanoma group practice.

Big HIV Prevention Study Halted, but Experts Won’t ‘Throw in the Towel’

HIV-1 virions (green) can be seen on the surface of a lymphocyte. Image courtesy of the CDCs Public Health Image Library.

One of the most critical fronts in the war against AIDS is staving off future HIV infections. The challenge can be especially daunting within the most vulnerable populations – like African communities where women are sometimes subjected to sexual relations against their wills.

In fact, this particular population forms the study group for one of the most recently attempted prevention trials. Eager to arm these women with strategies to protect themselves, scientists recruited 1,900 female volunteers spread across Kenya, South Africa and Tanzania to help test if a daily pill (emtricitabine and tenofovir disoproxil fumarate, known by the brand name Truvada) could keep the virus in check. (In theory, the drug works not by stopping the virus from penetrating cells, but rather, by keeping viruses from turning the cells into all-out virus replication factories.)

Last week’s headlines, unfortunately, said early data shows that women taking the drug fared no better than those assigned a sugar pill.

Even so, experts like URMC’s Dr. Amneris Luque warn that a handful of similar prior studies are simply too encouraging for us to completely “throw in the towel” this time around.

Other confounding factors could be at play in this most recent trial, she warns. For instance, if women in the study didn’t take their pills vigilantly, that could explain the inefficacy. Or, Luque said, perhaps this has more to do with that fact that gel-type therapies applied directly to the vaginal/cervical area may do a better job of checking the virus than do mere pills.

To hear more of Dr. Luque’s insights  on the halted study, watch the clip below.

Amneris Luque, M.D., associate professor of Medicine at the University of Rochester Medical Center, serves as medical director for URMC’s AIDS Clinic. Under Luque’s leadership since 1994, the clinic has been designated by the New York State Department of Health as a “Center of Excellence” for more than two decades.

To learn more about HIV research underway at URMC, click here.

It’s February: Love Your Heart

Make no mistake: while the stereotypical heart attack victim in the movies might be male, heart disease is an equal opportunity killer. In fact, it’s the number one cause of death among women 20 and older, killing almost one every minute.

The good news? Research shows that, even if saddled with a family history of the disease, there are steps each of us can take to become more heart-healthy. Simple things — like following a proper diet, keeping active, not smoking, not drinking excessively, and partnering with a primary care doctor to monitor cholesterol, blood sugar, blood pressure and weight — can go a long way in lowering one’s risk for a heart attack or stroke.

So, in light of February being American Heart Month, we’ve tapped Dr. Gladys Velarde, director of our Strong Women’s Heart Program, to give a few quick tips (for everyone, and then especially for women) for maintaining for a healthier heart.

To hear her advice, watch the clip below.

Curious how the Women’s Heart Program is making a difference for patients here in Rochester? Click here.

Shoveling: Tips to Help You Fight the Fluffy Stuff

With Thanksgiving festivities around the corner, it’s time to face the cold, hard facts: Mr. Snow Miser could start fiddling with the thermostat at any moment.

Luckily, those wee-morning driveway shoveling duties don’t have to be back-breaking – so long as we pace ourselves, practice smart body mechanics, and know when to call it quits.

To learn more about how we can shovel safely — and how we can avoid a trip to a back-pain specialist — we spoke with senior physical therapist Joe Griseta, who shares this sage advice:

• Don’t buy a shovel just because it’s on sale. Shovels aren’t one-size-fits-all; you have to consider the construction. Is it made of plastic or metal? (Metal, while durable, lends extra weight to the chore.) Is the blade right-sized for you? (Too big, and you won’t be able to easily hoist the load.) Is the shaft short enough for you to comfortably grip both the handle on one end, and close by the blade on the other? If not, look for something shorter.

• Don’t wait for the storm to pass. We know the cliché (“it’s like shoveling in a snowstorm!”), but it’s actually worthwhile to work in a few spurts as the snow falls. Don’t hold off until there’s too much to manage, or you’ll risk staining your heart and your back.

• Don’t “warm up” with a cup of coffee. Shoveling is a vigorous activity, and caffeine is a stimulant – so don’t mix the two. You don’t want your heart beating any harder than it has to, so stick with a glass of water.

• Treat shoveling as a sport. This may sound funny, but take a few minutes to warm up by walking in place and doing some stretches. Focus on breathing deeply. Hydrate. Dress in layers (so that you can peel them off easily if you start to overheat). And just like running, here’s a quick test to know if you’re working too hard: see if you can carry a conversation at the same time. If you can’t talk and shovel simultaneously, slow your pace.

Want more tips? Just watch the clip below. Want to learn more about our Physical Medicine and Rehabilitation programs? Click here.