Please enjoy these articles written by Cottage Hospital's own healthcare professionals.
Headaches & Migraines
October 11, 2021, by Jamie L. Wagner, APRN, AGPCCP-BC
There are over 150 types of headaches, all of which can be broken down into 2 main groups: primary and secondary headache disorders.
A Primary headache disorder is when the headache is not caused by an underlying disease or condition. Many people worry that the pain they are feeling in their heads means something is wrong with their brains. The brain itself cannot feel pain. The pain experienced usually comes from inflammation surrounding nerves, blood vessels, or muscles in and around the neck and head. Examples of primary headache disorders include but are not limited to: migraines, tension-type headaches, and trigeminal autonomic cephalgias.
Secondary headaches are caused by another condition triggering the same areas in the head and neck. Often warning signs of more serious systemic disease such as infections, aneurysms, elevated blood pressure, or brain tumors, can be more serious than primary type headaches.
Primary Headache: Migraines In the United States, there are more than 26 million migraine sufferers, with statistically higher rates in women than men. Migraine symptoms can vary depending on the type. Of the many types, migraines with aura and without aura are the two most common. Migraines without aura typically have specific features and associated symptoms. They can be diagnosed to a varying degree when attacks last between 4 and 72 hours, are generally located to one side of the head (but can occur on both), have a pulsating or throbbing quality, be aggravated by physical activity, associated nausea, and/or vomiting, and light and/or sound sensitivity.
Migraine with aura is characterized by neurological symptoms that usually precede or accompany the headache. These usually consist of visual and/or sensory symptoms (tingling, blind spots, flashes or zigzags of light, tunnel vision) and/or speech/language symptoms (slurred, mumbling speech, trouble finding words). To complicate matters more there are even some types of migraines with aura that have minimal or no preceding headache at all, meaning a person can see zigzagging or flashes of light in their field of vision, but have either a very small headache or no headache at all. This can be very confusing, particularly when it occurs for the very first time. Some patients will also have what is called a prodromal phase, where they can experience symptoms hours or days before headache onset. Alternatively, similar symptoms occur during apostdromal phase, after the headache has resolved. These symptoms can include depression, cravings for particular foods, repetitive yawning, fatigue, neck stiffness, or pain.
Triggers Migraines, whether with or without aura, can be life-altering. Whether they occur frequently or occasionally they can make it hard cognitively to function, limit your socialization, and also affect your mental health. I am aware that many people do not like to take medication, if you can find a triggering factor for your migraine and eliminate it, you may be able to avoid medications. For instance, some triggers are dietary such as red wine, chocolate, aged cheese, cured meats and artificial sweeteners. Keeping a food diary along with a headache diary can help with discovering triggers and allow the opportunity to avoid them and migraines altogether.
Skipping meals and allowing blood sugar drops can be a common trigger. Eating small meals throughout the day can help avoid those triggering drops. Dehydration can also be a trigger, this is easily avoidable by drinking enough water. Regular sleep schedules and exercise routines are also associated with less frequent migraine headaches.
Stress and depression can manifest physically with symptoms like a headache, talking to someone you trust (family, friends, clergyman, or therapist) can help. Stress treatments include mind and body activities such as Yoga, meditation, or walking outdoors.
Caffeine can be helpful for migraines, but like pain-relieving medications (Tylenol, NSAIDs, narcotics), its overuse can trigger headaches. This reaction causes rebound headaches stemming from withdrawal. This can become a cycle, a patient takes medication to relieve the headache, and then as the medication wears off it triggers a headache, so medication is taken again and so on.
When to seek treatment If logging and tracking headaches do not lead to any known triggers, seeking treatment may be the next step. It is good to see your healthcare professional about a headache if it is occurring 5 or more times a month and/or you have concerns about associated symptoms. Headaches that are new or unusual for you and are associated with symptoms such as fever, weakness, vision loss, double vision, or confusion warrant an emergency room visit and could be a sign of a secondary type of headache.
Treatment There are many treatment options available to choose from. Speaking with your provider about any other health conditions or concerns you have can be helpful in the selection of a headache prevention medication. Preventative medication is generally recommended when you suffer from 5 or more headaches a month. Headache preventative treatment, often dependent on the type, can be taken either daily, monthly, or quarterly. Preventative medication should reduce the monthly frequency, sometimes to the point they are rare yearly occurrences. When headaches breakthrough preventative treatment or you suffer from less than 5 migraines a month, abortive therapy may be a more appropriate option. Abortive headache medications are taken episodically to treat acute migraine headaches and can include over-the-counter or prescription options.
This article has been a very small glimpse at certain types of headaches. If you ever have concerns or want to know more about if what you are experiencing is normal or if you are tired of your life being limited due to headache pain, it is best to seek out a medical professional to discuss what is going on and what options you may have. Remember if you are limiting the way you are living due to headache pain this is a problem that can usually be improved
Dietary Approaches to Stop Hypertension (dASH) & Stroke Prevention
May 24, 2021, by Sharon Anderson, RDN, LD
May is stroke awareness month. Did you know that there is action you can take to prevent a stroke by adopting healthy eating habits?
One of the leading causes of stroke is high blood pressure. Following the DASH eating plan may help to reduce the risk of having a stroke as it has been clinically proven to lower blood pressure. In addition to lowering blood pressure, the DASH eating plan may also help to reduce stroke-causing plaque in the arteries due to its high level of antioxidants and low levels of saturated fat.
The DASH eating plan is focused on vegetables and fruit-a total of 8 to 10 servings per day of the two groups combined. The DASH eating plan recommends smaller amounts of animal proteins, such as chicken and beef for example, and a higher proportion of protein from plant foods such as legumes and seeds. The DASH eating plan encourages whole grains and healthy fats (olive oil, avocado, canola oil etc.) as well. Including up to three servings daily of low-fat and non-fat dairy foods has also been shown to help with blood pressure management.
By following the DASH eating plan, you will lower your sodium intake to about 1500 mg to 2300 mg per day compared to the more typical 3500 mg sodium in an American diet. The DASH studies showed that the lower the sodium intake, the more beneficial the DASH was to lower stroke risk.
A recommendation to help get started with the DASH eating plan would be to fill half of your plate with non-starchy vegetables such as greens, carrots, beets, tomatoes etc. Fill one quarter of the plate with a starchy food such as whole wheat pasta, brown rice, or sweet potato and fill the other one quarter of the plate with protein such as chicken, fish or beans.
As always with any dietary change, make small steps each week to lead up to your goal of thoroughly adopting the DASH eating plan.
For more information on DASH including recipes and meal plans, visit https://www.nhlbi.nih.gov/health-topics/dash-eating-plan.
Resources:
- Harvard Health Publishing, Harvard Medical School; Dash diet may help lower stroke risk, November 2020
- https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
Nutrition & autism Spectrum Disorders
April 23, 2021 by Sharon Anderson, RDN, LD
April is autism awareness month. Autism Spectrum Disorder (ASD) is a developmental and neurological condition that particularly affects people in the areas of social interaction and communication. According to the CDC, approximately 1 in every 54 American children have a diagnosis of autism, with four times as many girls than boys. People with ASD often have repetitive behaviors as well as sensitivities to textures and smells. These characteristics of ASD can make food choices difficult for these people, as well as may lead to health concerns.
In order to help a loved one with nutritional challenges related to ASD, here are some tips:
- For “picky eaters” or selective eaters, identify what tastes, colors, smells, and textures are the biggest barrier to a healthy eating plan. Begin introducing problem area foods or food groups, well before the child with ASD eats them at home in their kitchen. Bring the child to the store to pick out a new food. Together, decide how to prepare the new food. It’s ok if the child won’t eat the food the first time it is prepared for them. The process of “getting to know” the new food is more important. One day, they may surprise you and actually eat it!
- Mealtimes can actually be over-stimulating to a child with ASD and thus they may not be able to focus on eating. To reduce stimulation, develop a mealtime routine including the time of day, where to sit etc. If bright lights are difficult, dim the lights or use candle light.
- Consider a special diet. Although, controlled scientific studies have not shown any improvement in ASD symptoms with a special diet, such as gluten free and/or casein-free, that doesn’t mean there isn’t anecdotal evidence from families who have tried these diets.
A registered dietitian nutritionist (RDN) can help you with meal planning, meal strategies, and any questions or concerns you may have about your child’s nutritional health.
References:
Autismspeaks.org
Eatright.org/ASD and diet.q
National Nutrition Month 2021
March 5, 2021 by Sharon Anderson, RDN, LD
National Nutrition Month is observed every March to highlight the importance of good nutrition throughout the lifecycle. The second Wednesday of March is Registered Dietitian’s Day, which is an annual celebration of the dedication of RDN (Registered Dietitian Nutritionists) as the leading advocates to promote health through sound nutrition. This year, Registered Dietitian’s Day is March 10th.
The theme for National Nutrition Month (NNM) in 2021 is “Personalize Your Plate”. The Academy of Nutrition and Dietetics recommends that people adjust their eating habits depending on their stage of life.
For example, people in their teens and 20 should focus on bone building which means many calcium rich foods like low-fat dairy milk and yogurt or non-dairy sources such as beans, leafy greens and salmon.
Those who are in their 20s to 30 can really be focusing on nutrition to reduce risk of chronic disease like obesity, diabetes, and heart disease. A diet rich in vegetables, fruits, low-fat dairy, plant proteins and fats, and fish has been proven to reduce or prevent chronic disease.
In the 30 to 40 age range, disease preventing nutrition should continue to be a focus as well as making sure to get good sources of anti-oxidants for cancer prevention and more graceful aging.
People aged 40 to 50 have to be sure to incorporate regular physical activity into their healthy-eating lifestyle, as the body’s hormones are fluctuating and weight gain is common if nothing is done to off-set the decrease in metabolism.
For those aged 60 and over, it is very important to get sufficient protein as the rate of muscle loss is greatest in this population and protein foods will help rebuild muscle. Good sources of protein include, fish, leant meats, eggs, beans, tofu, and nuts.
So, no matter what your age, your specific nutritional needs, or nutrition goals are, be sure to consult with a Registered Dietitian Nutritionist to help you formulate your very own nutrition care plan.
Resources:
The Academy of Nutrition and Dietetics, 2021.
Febrary is American Heart Month
February 8, 2021 by Sharon Anderson, Regisered Dietitian
American Heart Month is a time the nation turns its attention to keeping families and communities free from heart disease, the number one cause of death for people in the United States. We often hear about eating “right” for the heart and making sure you get at least 150 minutes of physical activity per week. This article is going to focus on a leading cause of heart disease that I think many people may not take into consideration. How much do you sit? Not how much do you move and engage in moderate intensity physical activity and not how many vegetables do you eat daily. How much do you sit on a typical day?
Studies show that people who sit for ten hours or more per day are more likely to have a heart attack or stroke than those who sit for five or fewer hours per day. These studies have also shown that sitting for more than ten hours per day diminishes the health benefits of being physically active. It doesn’t eliminate it, but someone who stands for five hours or less daily and is physically active is healthier than someone who is also physically active but sits for ten hours or more daily.
These findings are not to say that we have to be running around or doing jumping jacks nineteen hours of the day! We simply just need to take breaks from sitting throughout the day. Here are some ideas on how to do that.
- If you have a desk job, get up from your chair hourly and take a walk around your office, march in place, or take a quick walk around the building. Perhaps we should all consider having standing desks in our workplace.
- If you tend to be active during the day, but love to come home and “Netflix and chill”, pause the movie every hour. Get up and do jumping jacks, walk the dog, or run up and down the stairs in your house.
- Take a few short walks daily such as after meals. Research show walking after a meal lowers blood sugars, which ultimately reduces risk of heart disease.
- Do whatever works for you! The goal is to be standing more and sitting less during your waking hours.
Happy heart month. I hope to see you just standing around.
References: www.health.harvard.edu/heart-health , www.heart.org
Action Plans, Not Resolutions, for the new year
January 1, 2021 by Sharon Anderson, Registered Dietitian
How many of us have made lofty New Year’s resolutions time and again, for them just to be broken within the first few weeks of the year?
The problem with these resolutions many times is that they are long term goals without a plan on how to achieve it.
For example, “I am going to lose 25 lbs. this year.” On January 1st, you stop all sweets, eat only vegetables (when previously you were eating maybe one vegetable per day), and you use the treadmill that you haven’t used in five years, for an hour and a half. January 2nd rolls around and you’re starving because you’ve only had vegetables for a day, so you pick at the leftover holiday treats, but you promise yourself you will do the treadmill for 2 hours to make up for it. January 3rd arrives and you are so sore from overworking your body that you can barely move, so you won’t be using the treadmill today and there is an office party in the afternoon, so you’ll just start working on weight loss next week.
Do you see where this is going? In order to reach our goals, we need a set of action plans to reach these goals. The endpoint (I’m going to lose 25 lbs. this year) is the overarching goal. Here are some examples of developing action plans towards a goal:
In the first week of the year, I am going to replace one starchy food with green leafy vegetables every day. If that action is achieved successfully, then make another action plan.
In the second week of the year, I am going to clean off the treadmill and move it to the living room so I can watch television while I exercise. Who knows? You may even use the treadmill in the second week, but if you just achieve the action you set out you are still successful and more likely to keep working towards your goal.
In the third week of the year, I am going to use the treadmill for 30 minutes before work on Monday, Wednesday, and Friday. I am also going to continue with my increase in green leafy vegetables and I am going to cut the amount of sugar in my coffee by 75%. And so on. You may just notice that by February 1st, you’ve lost 3 pounds. If you lose 3 pounds each month of the year, that’s 36 pounds by the end of the year.
Good luck! You got this, whatever “this” is. May 2021 be full of health, happiness, gratitude, and kindness.
The Lowdown on CT
December 23, 2020 by Elizabeth Paterson, Director of Radiology
CT stands for Computed Tomography. CT is an x-ray machine that rotates around a patient lying on a table and acquires hundreds or thousands of cross-sectional images in just a few seconds.
CT was invented in the early 70’s and became widely available in the clinical setting by 1980 but had very limited uses. It was dedicated to head imaging only and took an hour or more to acquire a full head CT. Now we can scan a whole head in about 10 seconds. During its 30-40-year history, CT has made great advances in image quality and speed as well as reduction in radiation exposure. As CT scan times have gotten faster, more anatomy can be scanned in less time. Faster scanning helps to eliminate artifacts from patient motion such as breathing or the motion of the heart beating. CT exams are now quicker and more patient-friendly than ever before. Tremendous research and development have been made to provide excellent image quality for diagnostic confidence at the lowest possible x-ray dose.
As previously mentioned, CT is a cross-sectional exam, meaning it takes images of the body in slices. If you picture the body as a loaf of bread, each image is a slice of the loaf. We view the images looking from head to foot. X-ray is a 2D image and CT produces 2D images as well, however they can be reconstructed into 3D images with software that can highlight different parts of the body depending on what you’re looking at. X-ray is most specific to skeletal concerns and certain pathologies such as pneumonia, whereas CT is best for more internal structures of the body i.e. liver, colon, bladder. Although CT is a very quick exam, it is significantly more radiation exposure than an x-ray exam. So the ordering physician needs to carefully weigh the risks and benefits.
Radiation dose is a significant concern in CT and it varies greatly depending on what type of CT you get. A head CT is far less radiation than an Abdomen/Pelvis scan simply because you’re scanning a much smaller region of the body and the scan time is less. To put it in perspective a Head CT is approximately 2mSv which is equal to about 8 months of natural background radiation. An Abdominal or Pelvic CT is 10mSv or 3 years of background radiation exposure. A chest x-ray is 0.1mSv or 10 days of exposure.
The problem with radiation is it has cumulative effects over time. Radiation, although you can’t see or feel it, can have long term effects on our cells. Radiation may have one of three biological effects, with distinct outcomes for living cells: (1) injured or damaged cells repair themselves, resulting in no residual damage; (2) cells die, much like millions of body cells do every day, being replaced through normal biological processes; or (3) cells incorrectly repair themselves, resulting in a biophysical change. Problems arise when the cells are incorrectly repaired and years down the road can become cancer. Children and young adults are most sensitive to radiation since their cells are actively and rapidly changing and dividing to support growth and development. Certain cells in adults are more sensitive than others such as the gonads and thyroid. For certain x-ray exams we can shield these body areas but this is more difficult in CT because the radiation comes from all directions and we can’t shield an area that is part of the scan.
Cottage Hospital has a Siemens Somatom Definition 20 slice scanner. That means in a single revolution of the x-ray tube around the patient, it acquires 20 images. Some of the features of this particular scanner include radiation dose reduction software called SAFIRE and CARE Dose 4D which optimizes the technical factors to balance quality imaging with low doses. It has a fairly large bore and table to accommodate larger patients up to 550lbs, has a wide range of settings to accommodate pediatric patients, and optimized protocols for contrast enhanced studies, and it is fully customizable and upgradeable.
The Radiology Department is very excited to announce we will be upgrading our CT scanner in January 2021! We will be upgrading to 64 slice which means the machine will acquire 64 images in a single rotation rather than 20. This translates to faster scan time, more accurate scans when timing with contrast, and even less radiation dose.
Environmental Services During COVID-19
December 7, 2020 by Laurie A Fellows, Director of Environmental Services CESE/ CHWC
Environmental Services plays an instrumental role in keeping the facility clean and safe. We pride ourselves in ensuring a sanitized environment that promotes healing and well-being. Though the current pandemic presents additional considerations for our specially trained group, we are well prepared to address all environmental needs that come our way. What is the Cottage Hospital Environmental Services Department doing to help combat Covid-19 within our facility?
We follow guidance closely from the Center for Disease Control and Prevention (CDC). Our staff wears (PPE) Personal Protective Equipment: masks, gloves, and other PPE as deemed appropriate for cleaning in the current environment. All rooms, corridors, and bathrooms are cleaned and disinfected daily; special attention is paid to high touch surfaces.
We follow the CDC’s guidance for air exchanges before entering a room in question. Once adequate air exchange has occurred, our team begins by removing any cubicle curtains from the area and then proceeds with disinfecting every surface from top to bottom. This process ensures the room is germ free for the next patient. We follow recommendations set forth by the Environmental Protection Agency (EPA) on approved chemicals for the disinfecting of all surfaces here at the hospital.
To prevent cross-contamination, cleaning equipment is disinfected after every use. A flat mop system is used for floor cleaning with mop heads being changed after every room. In addition, all soiled laundry is sent out to be decontaminated and cleaned by a laundry company. Clean linen is wrapped in cellophane and returned to us for use.
Our team would like to remind you there are things you can do to help keep yourself and those around you safe…wear a mask, wash your hands, and practice social distancing.
Anti-Inflammatory Foods
March 2019 — By: Brandy Helm, CDM, CFPP and Diane Hawkins RD,LD, CDE
If you are one of the many Americans who has battled or is at risk for cancer, heart disease, diabetes, arthritis, depression or Alzheimer’s disease, you may benefit from an anti-inflammatory diet. Regarded as a healthy diet, an anti-inflammatory diet is intended to prevent or reduce chronic inflammation which has been linked to these conditions. Researchers suggest that an ideal diet to prevent inflammation would contain the following guidelines: plenty of veggies and fruits; good sources of omega 3-fatty acids, such as fish or walnuts; whole grains, such as brown rice and bulgur; lean proteins and plant based proteins, such as beans and nuts. To enhance the flavor of your healthy diet and obtain other nutritional benefits, you can add a variety of spices to your meals, such as garlic and turmeric.
Food that should be kept to a minimum include red meat, full fat dairy, saturated fats and trans fats. To help reduce chronic inflammation, avoid highly processed foods, fried foods and anything excessively sweet. Sweets are often easy to overeat and, in addition to weight gain, can cause inflammation. The anti-inflammatory diet, along with appropriate exercise, has been considered to be a steadfast approach to stress and pain management. To seek medical nutrition therapy regarding a healthy diet, please contact Cottage Hospital’s Registered Dietitian for an appointment at 603-747-9723.
Influenza, referred to as the flu, and the common cold share many of the same symptoms.
February 2019 — By: Maria Ryan, PhD, APRN, Cottage Hospital Chief Executive Officer
The flu and the common cold are caused by viruses. You cannot take an antibiotic for either as these are not bacterial infections.
You may get a stuffy nose, sneezing and sore throat with both. Typically, a common cold comes on gradually whereas the flu symptoms happen abruptly. A common cold may last up to 10 or 14 days whereas the flu is less time.
Fever, body aches and chills are more associated with the flu.
I have heard people describe vomiting and diarrhea as the flu. These symptoms are not from influenza but can be in conjunction or a complication of influenza.
Influenza is a serious condition and leads to greater than 80,000 deaths per year. One of the most serious complications of the flu is a bacterial infection of the lungs called pneumonia, which can be treated with antibiotics.
Each year scientist try to predict what type of influenza may occur the following year and they make a vaccine. The vaccine does not always work but it is the best avenue to try to prevent the flu as well as minimizing exposure and frequent hand washing. These viruses are spread by droplet nuclei. This means when someone coughs or sneezes the virus is spread through the air. It is important to wear a mask if you have these symptoms and you are in the general public.
Your provider may prescribe an antiviral medication within the first 48 hours of symptoms/diagnosis of influenza. This antiviral medication does not cure it but can shorten the duration of the virus.
Just because they are caused by a virus it does not mean you are not sick and you don’t feel miserable. You can treat symptoms with Tylenol or Motrin for fever and body aches. Drink plenty of fluids and get plenty of rest!
Avoid people who are showing symptoms of a cold or influenza!
For more information, contact: Dhaniele Duffy | 603-747-9707
Health Matters is a health related column provided by the staff of Cottage Hospital. If you would like to see a certain topic covered, please call 603.747.9707 or email [email protected].
Cottage Hospital is a community hospital, located in Woodsville, NH. The hospital has been serving the Upper Connecticut River Valley of New Hampshire and Vermont for over 115 years with a broad range of services.