Saturday, July 16, 2016

How is POTS Diagnosed?

How is POTS Diagnosed?


Detailed questioning of the patient is the key to accurate diagnosis.  Physical examination and appropriate investigations are also important. Other causes of symptoms need to be considered and identified.
Patients are usually diagnosed by a cardiologist, neurologist or medicine for the elderly consultant.
To be given a diagnosis of POTS, a person needs to have:
  • A sustained increase in heart rate of greater than 30 beats per minute within 10 minutes of standing
  • Those aged 12-19 years require an increase of at least 40 beats per minute
  • These criteria may not apply to those with a low heart rate when resting
  • There is usually no drop in blood pressure on standing

Investigations

It may be necessary for patients to have some or all of the tests below.

Electrocardiography (ECG)
An ECG is performed to rule out any heart problems that may cause symptoms similar to those found in POTS.

The Active Stand Test
The active stand test can be used to diagnose PoTS. Under careful supervision, heart rate and blood pressure are measured after resting lying down, then immediately upon standing and after 2, 5 and 10 minutes. This test may bring on symptoms of PoTS and some people may faint.
Tilt Test

Symptoms can be debilitating, ranging from mild to severe and varying from day to day.

POTS symptoms

  • Dizziness or pre-syncope (almost fainting).
  • Syncope (fainting).
  • Palpitation (awareness of heartbeat).
  • Headaches - orthostatic headaches (due to upright posture)/migraine.
  • Brain fog (difficulty in thinking).
  • Tiredness.
  • Sense of anxiety.
  • Shakiness.
  • Visual problems (greying, tunnel or glare).
  • Gut problems (nausea, diarrhoea, pain).
  • Sweating.
  • Chest pain.
  • Poor sleep.
  • Purplish discolouration of skin due to blood pooling in hands and feet.
  • Bladder problems.


Triggers that can worsen POTS

  • Excess heat.
  • After eating - especially refined carbohydrate: sugar, white flour etc.
  • Standing up quickly.
  • Dehydration.
  • Time of day (especially rising after wakening).
  • Menstrual period.
  • Deconditioning or prolonged bed rest.
  • Alcohol (as it dilates blood vessels).
  • Inappropriately excessive exercise.
  • Temporarily during illness such as viral infections or after operations.*

Tuesday, July 12, 2016

Can Anti-Inflammatory Therapies be Effective in Treatment of Epilepsy

Epilepsy, Seizures, and Inflammation: Role of 

the C-C Motif Ligand 2 Chemokine


Here is the abstract from a study published in DNA and Cell Biology. 
The whole study examining the impact of treating inflammation-induced seizures is available for free download until August 06, 2016 at the link below. -JR


ABSTRACT:

Epilepsy is a chronic disorder characterized by spontaneous recurrent seizures. Several lines of evidence demonstrate that inflammatory processes within the brain parenchyma contribute to recurrence and precipitation of seizures. In both epileptic patients and animal models, seizures upregulate inflammatory mediators, which in turn may enhance brain excitability. We recently showed that the C-C motif ligand 2 (CCL2) chemokine (also known as monocyte chemoattractant protein-1 [MCP-1]) mediates the seizure-promoting effects of inflammation. Systemic inflammatory challenge in chronically epileptic mice markedly enhanced seizure frequency and upregulated CCL2 expression in the brain. Selective pharmacological blockade of CCL2 synthesis or C-C chemokine receptor type 2 (CCR2) significantly suppressed inflammation-induced seizures. These results have important implications for the development of novel anticonvulsant therapies: drugs interfering with CCL2 signaling are used clinically for several human disorders and might be redirected for use in pharmacoresistant epilepsy. Here we review the role of CCL2/CCR2 signaling in linking systemic inflammation with seizure susceptibility and discuss some open questions that arise from our recent studies.

Monday, July 11, 2016

How to Get Your Brain--and Body--Out of Bed Every Morning



11 Tips That Will Help You Wake Up Every Morning

Effective tips to crank yourself up in the morning from pre-bed routines to morning of practices- JR.

By: Toria Sheffield via Bustle Lifestyle

1. Don't Hit Snooze. 2. Try a Burst of Cold Water. 3. Don't Drink Coffee Right Away. 4. Keep Your Alarm on The Other Side of The Room. 5. Invest in An Alarm Lamp. 6. Get an Alarm App. 7. Set Your Intentions. 8. Try Melatonin. 9. Train Yourself Gradually. 10. Move. 11. Limit Screen Time Before Bed.

Saturday, July 09, 2016

Optimal infant sleep habits may help prevent childhood obesity

"When parents keep babies up longer, they just sleep less". 

"the babies in the bedtime techniques group gaining weight more slowly than the control group, and less likely to be overweight by age one"- JR

Healthy infant sleep habits may help prevent childhood obesity
Perfect Baby (free image labeled for reuse. Not a patient)

-Review of research published in JAMA Pediatrics discussing the importance of regulating an infant's sleep schedule. -JR

US research out this week suggests that teaching parents techniques to help encourage healthy sleep habits in their children could help to prevent obesity. The new study, conducted by Penn State College of Medicine researchers, could lead to a new intervention technique to help tackle the growing levels of obesity worldwide.
The team studied the use of the intervention using data from the INSIGHT study (Intervention Nurses Start Infants Growing on Healthy Trajectories), a longitudinal trial study which looks at how responsive parenting intervention can prevent obesity.
A total of 291 mother and baby pairs were recruited, with the mothers randomly assigned to one of two groups.
One group was given obesity prevention education that covered sleep-related behaviours, bedtime routines, improving sleep duration and avoiding feeding and rocking to sleep. The other group, a control, were given safety education about preventing sudden infant death syndrome.
The study showed that the infants of parents who had learned the bedtime techniques went to bed earlier, had a more consistent bedtime routine, and slept for longer than the infants whose parents had been given safety education.
The infants were also more likely to self-soothe to sleep without being fed, and were less likely to be fed back to sleep when they awoke during the night.
And at nine months, infants who both self-soothed and went to bed by 8 p.m. slept for on average 80 minutes longer or more than those whose bedtimes were after 8 p.m. and did not self-soothe.
In addition, the team saw that the intervention also had a positive effect on obesity as well as sleep, with the babies in the bedtime techniques group gaining weight more slowly than the control group, and less likely to be overweight by age one.

Misconceptions about infant sleep
Commenting on the findings lead author Ian M. Paul had this advice for parents, “A lot of parents try to keep their babies up longer, thinking that then they’ll sleep longer at night and they won’t wake up. We found that’s not true. When parents keep babies up longer, they just sleep less.”
“If you want your baby to sleep longer and better, put them to sleep earlier. Regardless of what time you put babies to sleep, they wake overnight. If we don’t set the expectation that they’re going to be picked up and fed, they learn to soothe themselves back to sleep.”
In addition to helping prevent obesity, better sleep habits also have added health benefits for both parents and children, with lack of sleep previously shown to have a negative effect on a child’s development and parents’ psychological well-being.

Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ


The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.
Study Parameters
Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.
"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."
Advice for Parents
(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ

The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.
Study Parameters
Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.
"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."
Advice for Parents
(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

Friday, July 08, 2016

Could a baby have a seizure? Review the signs and what you can do...

Signs of Seizures in Babies





Is your baby having a seizure? Find out the signs of seizures in babies and what to do if your child has one.

Signs of Seizures in Babies

  • Febrile seizures. Your baby may roll her eyes, and her limbs may either stiffen or twitch and jerk. Up to 4 out of every 100 children age 6 months to 5 years have one of these seizures, which are triggered by high fevers, usually above 102°.
  • Infantile spasms. This rare type of seizure occurs during an infant's first year (typically between 4 and 8 months). Your baby may bend forward or arch her back as her arms and legs stiffen. These spasms tend to occur when a child is waking up or going to sleep, or after a feeding. Infants can have hundreds of these seizures a day.
  • Focal seizures. Your baby may sweat, vomit, become pale, and experience spasms or rigidity in one muscle group, such as fingers, arms, or legs. You may also observe gagging, lip smacking, screaming, crying, and loss of consciousness.
  • Absence (petit mal) seizures. Your baby appears to be staring into space or daydreaming. She may blink rapidly or appear to be chewing. These episodes typically last less than 30 seconds and may occur several times a day.
  • Atonic (drop attack) seizures. Your baby experiences a sudden loss of muscle tone that makes her go limp and unresponsive. Her head may drop suddenly, or if she is crawling or walking she might fall to the floor.
  • Tonic seizures. Parts of your baby's body (arms, legs) or her entire body suddenly stiffen.
  • Myoclonic seizures. A group of muscles, usually in the baby's neck, shoulders, or upper arms, starts to jerk. These seizures usually occur in clusters, several times a day and several days in a row.

    What to do if Your Baby Has a Seizure

    See your pediatrician if you think your baby is having seizures. "If possible, take a video of the episode on your smartphone to show to your doctor," suggests Dr. Hartman, who is also a member of the American Academy of Pediatrics' (AAP) Section on Neurology. It's important to pay attention to these things:
      • How long the seizure lasts
      • Where the seizure started (arms, legs, eyes) and whether it spread to other body parts
      • What the movement looked like (staring, jerking, stiffening)
      • What your baby was doing right before the episode (waking up, eating)