Saturday, November 12, 2016

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations in contrast to just feeling tired? This refers to your usual way in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation.
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

Situation Chance of dozing
Sitting and reading __________
Watching TV __________
Sitting inactive in a public place (eg, a theater or meeting) __________
As passenger in a car for an hour without break __________
Lying down to rest during the day when circumstances permit __________
Sitting and talking to someone __________
Sitting quietly after lunch without alcohol __________
In a car, while stopped for a few minutes in traffic __________

Scores 10 or above suggest Excessive Daytime Sleepiness. 


STOP-Bang questionnaire

Do you snore loudly (loud enough to be heard through closed doors, or your bed partner elbows you for snoring at night)?
Do you often feel tired, fatigued, or sleepy during the daytime (such as falling asleep during driving)?
Has anyone observed you stop breathing or choking/gasping during your sleep?
Do you have or are being treated for high blood pressure?
Body mass index?
Is your BMI more than 35 kg/m2?
Are you older than 50 years old?
Neck size large? (measured around Adam's apple)
For male, is your shirt collar 17 inches or larger?
For female, is your shirt collar 16 inches or larger?
Gender = Male?

Scoring criteria*:
Low risk of OSA: Yes to 0 to 2 questions
Intermediate risk of OSA: Yes to 3 to 4 questions
High risk of OSA: Yes to 5 to 8 questions

Sunday, May 24, 2009

Acupuncture; Does It Work?

Acupuncture is derived from Latin words "acus", meaning, needle and "punctura", meaning, penetration. Acupuncture was originated in China approximately 2000 years ago and is one of the oldest medical procedures in the world.

The traditional theory of Acupuncture involves qi, yin and yang, and the Five Elements.

There are number of physiologic models that have been proposed to explain the effects of acupuncture.

Proposed conditions with possible efficacy include:
  • Chronic Pain
  • Postoperative nausea and vomiting
  • Chemotherapy induced nausea
  • Acute pain including dental pain
  • Headache
  • Hypertension

Although there are difficulties in studying acupuncture, the best randomized trials suggest that acupuncture and sham acupuncture have similar efficacy. Given this, much or all of the effect of acupuncture may be related to the placebo effect.

Acupuncture is generally, very safe; as long as appropriate sterile techniques are followed.

In patient with chronic pain, both acupuncture and sham acupuncture appear to have much greater efficacy than when patients are left untreated. So patients with unavailability of safe alternatives with Chronic pain or other conditions may benefit from a trial of acupuncture.

Sunday, May 10, 2009

Fish Oil: Good Stuff but Use Caution!

Fish oils are Omega-3 fatty acids. The fish oils are important for the production of nerve tissue, hormones, and cellular membrances.

These fats have anti-inflamatory activity, help lower high blood pressure, reduce elevated cholesterol and triglycerides, prevent atheroscleratic plaque formation, and improve skin conditions such as eczema and psoriasis.

Thus can indirectly help prevent heart attack, stroke and peripheral artery disease.

High doses may cause gastrointestinal upset, loose stools, and nausea.

Use with caution in individuals with diabetes or in those who may be predisposed to hypoglycemia; may alter glucose regulation. Effects of drugs like insulin and oral hypoglycemics may be potentiated. Blood sugars should be closely monitored and medications adjusted. This should be done under supervision of a healthcare providers.

Again, use with caution in individuals on antihypertensive agents. Fish oils can lower blood pressure and may have additive affect.

Patients with Diabetes and/or Hypertension might need less medicines to control their diseases.

Fatty acids are contraindicated in individuals with active bleeding eg, peptic ulcer and intracranial bleed. Use with caution in individuals with history of bleeding, bleeding disorders, or in individuals taking Warfarin, aspirin, Aleve, ibuprofen, motrin or like, or antiplatelet agents like ticlopidine, clopodogrel or plavix.

Discontinue use of fish oils at least 14 days prior to dental or surgical procedures.

Drug interactions theoretically with anticoagulants, warfarin, ASA, NSAIDS, Plavix, Antiplatelet agents, insulin, oral hypoglycemics, and antihypertensives.

Easy way to remember is to know fish oils can reduce blood sugars and blood pressures and can cause bleeding. Use Caution and always include your physician in your decision to take these or any other alternative medications.

Saturday, May 9, 2009

Avoiding the Flu ?

You have more control than you think.

Wash your hands with soap and water often or clean with an alcohol based hand cleaner.

Use tissue or arm to cover your mouth and nose to sneeze or cough.

Remind those who feel ill to see the doctor and stay home.

Get vaccinated against the flu.

Tamiflu is affective if started within 48 to 72 hours of symptoms.

Symptoms include nasal congestion, runny nose, sore throat, body aches, and fever.

The H1N1 influenza (Swine Flu) may be sticking around!