Chronic Obstructive Pulmonary Disease: (Irreversible and progressive inflammation in the lungs causing chronic airflow obstruction)
- Chronic Bronchitis "Blue Bloater" (described below)
- Emphysema "Pink Puffer" (described below)
- Different than Asthma because Asthma can be reversible!
- Asthma is reversible & useually seen in childhood
- Asthma risk factors include:
- Family history of Asthma
- Smoking parents
- History of RSV Bronchiolitis
- COPD is chronic and irreversible
- Seen in adults 35 and older
- COPD risk factors include:
- Cigarette smoking,
- Environmental or occupational pollutant exposure
Recurrent respiratory infections
80% of COPD cases are attributed to tobacco abuse
- COPD incidence in the U.S.: 15 million patients (5% of the U.S. population)
- COPD results in 126,000 deaths per year in U.S. (4th leading cause of death)
- Direct medical cost is $29.5 billion per year
- Recurrent wheezing
- Productive cough
- Chest tightness
- Animal fur & feathers
- Dust mites // mold // smoke
- Weather changes
- Environmental & Occupational irritants
- Triggers --> inflammation --> tightening of the airways
--> shortness of breath // wheezing
- If untreated, exacerbation espisodes --> Acute respiratory distress
--> Respiratory failure
- Industrial waste
- Use of coal & carbon based fuels
- Inadequate environmental health regulations
- Tobacco abuse
- Increased longevity
- Poor access to care
- 80% of COPD cases are caused by tobacco abuse alone
- Tobacco use is the most preventable causes of cancer & death in the U.S.
- Causes 434,000 deaths per year in the U.S.
- Direct medical costs of tobacco abuse nears $50 billion per year
The Electronic Cigarette:
- Regulated by the FDA as a tobacco product since 2016
- 80% of users have the misconception that vaping is harmless
- Popular among "Middle School" & "High School" students (1 of 9 High School students // 1 in 30 Middle School students)
Chronic Bronchitis "Blue Bloaters":
- Irriversible inflammation occurs in the bronchial tubes
- Patient will have chronic cough with thick mucus
- Patient is usually obese & presents with cyanosis (bluish or greyish coloring of skin, nails, lips or around the eyes)
- Usually occurs in smokers after 10-12 years of smoking
Emphysema "Pink Puffers":
- Irreversible inflammation occurs in the avioli where gas exchange occurs
- Patient is usually very thin & presents with exertional dyspnea
- Cough can be dry or with scant sputum production
- Patient has prolonged expiration & breathes through pierced lips
- Short // Long acting maintenance medications
- Nebulizer treatments
- Combination of both short & long acting maintenance medications
Treatments during exacerbation:
- Steroid injections // Breathing treatments // Oral Steroids // Antibiotics // Oxygen therapy
- Pulmonary Rehab // Home Oxygen // Lung Transplant Surgery
- Smoking cessation
- Avoid irritants
- Flu and Pneumonia vaccines
- Take your medications as directed
- Avoid prolonged exposure to the AC and have your AC inspected.
- Follow up with your doctor regularly!
Dr. Amine Chahbouni
Hypertension (High Blood Pressure)
Hypertension is common and affects 30% of US adults and 65% of persons 60-69 years of age.
What is a Normal Blood Pressure?
- < 120/80 Normal
- 120-129/80 Elevated
- 130-139/80-89 Stage 1 Hypertension
- 140/90 Stage 2 Hypertension
- 95% of all Hypertension is idiopathic (arising spontaneously or for which the cause is unknown)
- Alcohol, salt, pain, stress and obesity
- Cardiovascular: Aortic regurgitation, Aortic coarctation
- Renal: Renal artery stenosis, polycystic kidneys
- Endocrine: Cushing's, Conn's, Pheochromocytoma, hyperthyroidism
- Medications: Oral contraceptives, NSAID's, glucocorticoids, phyenylephrine
- Obstructive sleep apnea
- Dizziness, recurring headaches, nosebleeds and shortness of breath
- Weight Loss
- Heart Healthy Diet
- Increased Physical Activity, Excersize Program
- Decrease Sodium Intake
- Decrease Alcohol
- Stop Smoking
- Decrease Fat Intake to Decrease Risk of Coronary Artery Disease
- Decrease Stress
- Primary prevention for adults with an estimated 10-year risk of atherosclerotic CVD of 10% or more and average BP > 130/80
- Secondary prevention of recurrent cardiovascular events in patienbts with CVD and average BP > 130/80
- Thiazide Diuretics (HCTZ)
- Calcium Channel Blockers (Amlodipine)
- ACE Inhibitors (Lisinopril)
- ARBs (Losartan)
- Target BP < 130/80
- Lifestyle Modifications
- Stage 2 HTN Will Likely Need 2 Medications
- Follow up every month and titrate medications until target, then every 3-6 months
Dr. Jose Dalprat
Shingles (Herpes Zoster)
Since the chickenpox virus causes shingles, you cannot develop shingles unless you have had a previous infection of chickenpox (typically as a child). As we age, our ability to fight infection is weakened, which allows the dormant virus to activate an outbreak. An outbreak typically starts with a sensation of burning pain or tingling, along a horizontal line from your back to your front, followed by a rash of red blisters, which burst and crust over. Although the entire outbreak typically lasts less than a month, the pain can persist for a long time, which is called post herpetic neuralgia.
Although you typically cannot get shingles from someone else, your may get chickenpox with close contact with an infected person if you have never had chickenpox. However, the rash and pain that follow can be treated with medications. The rash can be treated with antiviral medications, such as acyclovir (if started within the first 3 days, which is why it is important to see your doctor quickly). The medication may speed recovery and reduce the chance that your pain will last. If your pain persists after the rash heals, called post herpetic neuralgia, your doctor may prescribe additional medications such a Lyrica® (pregabalin) or Neurontin® (gabapentin). Additional measures include: acetaminophen (Tylenol®) for pain, cool, moist washcloths on the rash, rest, and avoid irritating the rash with clothes or bed sheets. Things to call your doctor about include: worsening pain or fever, changes in your thinking or reasoning, blisters near the eye or pain in the eyes or blisters that have become more redden or drain yellowish fluid which may indicate infection.
Lastly, a preventive measure if your have never had chickenpox is available for people over 60 is a vaccine called Zostavax®, which may lessen or prevent the attack, but cannot reduce the shingles attack after it has started. Additionally, you can help prevent attacks by maintaining good general health, diet, rest, and reducing stress.
Dr. Michael Roach
Don’t Be Afraid to Exercise
People of all ages and physical conditions benefit from exercise and physical activity. Exercise and physical activity are among the healthiest things you can do for yourself. Older adults that are reluctant to exercise may fear that exercise will be too strenuous, or that physical activity will harm them.
Physical activity can help you control your weight; improve conditions such as diabetes, high blood pressure, heart disease, arthritis and depression. Improving your fitness ability also helps you perform your daily activities. Exercise 3-5 times a week can significantly reduce the risk of chronic disease and loss of mobility.
Starting a fitness program may be one of the best things you can do to increase your physical activity. The key is to start slowly and build gradually as ability and strength improve. Most important is simply to start now.
Dr. Jamshid Maleki
The doctors and nurses are trained professionals in health care maintenance and preventative medicine, such as annual gynecological exams, school physicals, pre-employment exams, STD screening, contraception management, immunizations, tuberculosis screening, and post cancer health care. We are located in La Mirada, CA. Call today (562) 902-3000.