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The Pharmacist Answers Podcast

Updated 5 days ago

Health & Fitness
Science
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Have a question for the pharmacist? Get your answers here! Clear explanations about complicated medical topics that anyone can understand.

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Have a question for the pharmacist? Get your answers here! Clear explanations about complicated medical topics that anyone can understand.

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Best weekly hand curated episodes for learning

Cover image of The Pharmacist Answers Podcast

The Pharmacist Answers Podcast

Latest release on Jun 17, 2020

Best weekly hand curated episodes for learning

The Best Episodes Ranked Using User Listens

Updated by OwlTail 5 days ago

Rank #1: Episode 113 - Dysphagia

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Dysphagia Basics

Having difficulty swallowing or the inability to swallow is known as dysphagia.

Symptoms of dysphagia include:

  • Pain while swallowing
  • The sensation of food stuck in the throat or chest
  • Drooling
  • Hoarseness
  • Regurgitation
  • Reflux
  • Unexpected weight loss
  • Choking, coughing, or gagging when swallowing
  • Taking tiny bites
Dysphagia by Phase

There are several conditions that can affect each phase of the swallowing process.

Oral Phase

Dysphagia during the oral phase, or voluntary phase, can be caused by neurological conditions like Multiple Sclerosis, Muscular Dystrophy, advanced Parkinson's.  Brain damage caused by trauma or stroke can also cause trouble swallowing in adults.

Dysphagia in Kids

Babies start out nursing or feeding through a bottle and their swallowing mechanism is reversed.  A reverse swallow is when the tongue is thrust forward or out of the mouth to open the throat and allow food or drink down the esophagus.  As children learn to eat solid food and drink from a cup, the swallowing procedure changes. Children can also have trouble swallowing, but the root causes are completely different.  Premature birth, low birth weight, cleft lip or palate, and tongue or lip ties can lead to swallowing issues if not corrected with therapy.  These issues can cause swallowing issues with the reverse mechanism as well as make it difficult to convert to a regular swallow.  Children with low muscle tone are also more likely to stick with the reverse swallow because it is easier.

Pharyngeal Phase

Pharyngeal diverticula are pouches that form in the mucous membrane above the esophagus.  These pouches can collect food particles that don't get swallowed.  This can cause bad breath, as well as coughing, and constant throat-clearing because it feels like something is stuck in the throat.

Esophageal Phase

There are several swallowing issues that stem from the esophagus and esophageal phase.

  • Achalasia is an issue where the sphincter that opens into the stomach doesn't relax to allow food to pass through.  This can cause pressure in the chest and may possibly lead to regurgitation if it persists.
  • Diffuse spasms happen when the peristalsis rhythm of the esophagus muscles is poorly coordinated.
  • Stricture is also known as a narrowed esophagus.  It can be a result of injury and scarring from GERD.
  • An esophageal ring is when a thin area of the lower esophagus is narrowed.  This is also a result of scar tissue from chronic GERD.  The scar tissue from acid damage tends to be less flexible which can cause pain.
  • Eosinophilic esophagitis is the overpopulation of eosinophils in the esophageal lining due to food allergies.  Eosinophils are a type of white blood cells that show up in very specific situations - parasitic infections, cancer, or allergies.
Dysphagia Risk

The risk of dysphagia increases with age, mostly because the risk of the conditions that cause dysphagia increases with age as well.  And while dysphagia can be very uncomfortable, the biggest concern is with the risk of aspiration, or breathing food or drink into the lungs, that leads to pneumonia.

Call Back

Swallowing Muscle Tone discussion - Accordion in Your Brain

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Music Credits: Up In My Jam (All Of A Sudden) by - Kubbi https://soundcloud.com/kubbiCreative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 http://creativecommons.org/licenses/b...Music provided by Audio Library https://youtu.be/tDexBj46oNI

Jan 29 2018

24mins

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Rank #2: Episode 63 - Brain Bleeds

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Your brain is held inside your skull by a tri-layer membrane called the meninges.  These membranes and all the other structures in your brain are nourished by blood vessels, and different circumstances will make these vessels at risk of rupturing.

*ALL BRAIN BLEEDS REQUIRE MEDICAL ATTENTION!* 

Brain bleeds are classified based on the membrane they are closest to.  They can be caused by physiological malformations, stroke or aneurism from age or disease, or trauma.

From the outside in
  • Extracranial bleed: (extra = external; cranial = cranium = skull bones), between your skin and your skull.  Doesn’t affect your brain, there is more room for it to stretch.
  • Intracranial bleed: (intra = internal); bleeds inside the skull increase the intracranial pressure and requires medical intervention.  Main goal is to reduce intracranial pressure so brain cells aren’t pressed on and damaged.
    • Epidural (yep, that place they put the anesthesia for women having babies, except it’s in the spinal cord): Epi = above, Dural = Dura mater, that topmost, durable layer of the meninges.  Between the skull and the dura mater.
    • Subdural: Sub = under; blood leaks in between the dura mater and the arachnoid mater, which are normally in close contact, so the separation causes pain.
    • Subarachnoid: under the arachnoid mater. Normally, under the arachnoid layer is the subarachnoid space which contain cerebral spinal fluid (CSF).  People who have had a subarachnoid bleed and survived, describe hearing a “thunderclap”.  Officially called a “thunderclap headache”.  It’s like they can hear the blood vessel pop and experience extreme pain all over their head all at once.  Described as “the worst headache of my entire life”.  Because the pia mater under the subarachnoid space lays directly on top of the brain cells and follows all the grooves and wrinkles of the brain, this type of bleed will require emergent attention and possible surgery.
  • Intracerebral: cerebral = cerebrum, the main part of your brain
  • Intraparenchymal: Parenchyma = organ tissue, means it’s right up against the brain cells
  • Intraventricular: Ventricles = pockets inside the brain that make, hold, and reabsorb CSF.  The deepest part of the brain.
*ALL BRAIN BLEEDS REQUIRE MEDICAL ATTENTION!*  Connect with me

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Sep 19 2016

12mins

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Rank #3: Special Episode #3: Meds & Blood Sugar

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People with chronic diseases don’t get holidays or vacations from their medication.

4 ways medication can affect blood sugar Type of medication

The goal of the medication that people with diabetes take is to lower blood sugar - either by increasing insulin sensitivity, encouraging the pancreas to make more insulin, or to replace insulin that’s not naturally made anymore.  Metformin is like insulin’s wingman; it helps make the cells ready for insulin when it comes by.  So usually these medications (including insulin) will lower blood glucose no matter if you eat or not.

Timing of medication

Most of the medications should not be taken if a meal is going to be skipped.

Dose of medication

The more sugar you eat, the more insulin you need.  The higher the blood sugar level, the higher the dose is needed.  It needs to stay proportional.  Any form of sugar you eat gets turns into glucose, the complexity of the sugar determines how fast it raises your blood sugar.  Even diabetics are at risk for hypoglycemia.  If one little thing gets out of whack, it can cause a drop in blood sugar and require a “rescue”.  Favorite hypoglycemia rescue “go to” is orange juice (lots of simple sugars).  Regular soda can be used, as well as hard candy or glucose tablets.  NO DIET SODA - artificial sweeteners do not affect sugar enough.  High blood sugar can cause coma, lower blood sugar can cause coma.  Bottom line: Coma is bad.

Interaction with medication

Fluoroquinolones can causes changes in blood sugar control and require a person to check their levels and adjust their medicines more often.  Steroids can also cause blood sugar to be more uncontrolled - this is true for acute (short term) use or chronic (long term - like autoimmune diseases) use.  Beta blockers used for blood pressure control can mask the symptoms of low blood sugar because the symptoms are very similar.  Symptoms of low blood pressure:  tiredness, weakness, dizziness, shakiness, inability to focus.  The only way to know which one you’re experiencing is to check your blood sugar and your blood pressure.

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute!

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Sep 14 2016

18mins

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Rank #4: Episode 91 - Ear Anatomy

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Ear Basics

The auricle is the part of the ears you can see. It is made of cartilage (flexible tissue that doesn't have a large blood supply).  Everything else requires a tool for the doctor to see inside.  And the doctor can only see to the ear drum.  The stuff behind the ear drum isn't visible because of the membrane that blocks it.  The middle and inner ear are surrounded by your head bones.

Science of Sound

Sound is created when the air around us is compressed and then expands.  They move away from the source in circles (think radar or sonar or throwing a pebble in a pond).

The ear canal directs the sound waves towards the ear drum.

Sound gets translated in 2 main ways
  1. Identify the sound
  2. Identify if the sound has meaning
Inside Your Ears

The ear drum (tympanic membrane) vibrates according to the intensity of the sound and trigger the Hammer-Anvil-Stirrup cascade.

  • The ear drum vibrates the handle of the Hammer (Malus bone - yes, it's a real bone).
  • The Hammer bangs on the Anvil (Incus bone).  
  • The Anvil has a tail that is connected to the Stirrup (Stapes bone).
  • The Stirrup looks like the spurs on the back of boots.  It is connected to a membrane on the Cochlea and works like a plunger.

All of these bones are surrounded by air and the pressure is controlled by the Eustachian tube.  This is the access point for ear infections or congestion due to allergies or a cold.

The Cochlea is a bone full of fluid and lined with hairs and shaped like a spiraled sea shell.  The hairs pick up different frequencies of sound (sound wave frequency determines pitch).  If certain levels of hairs get damaged, then you will not be able to hear pitches in that range anymore.  If you unrolled the cochlea, it would be laid out low pitch to high pitch like a piano.  And these hairs are connected to the auditory nerves and turn sound signals into electrical signal to send it to your brain.

Semicircular canals of the cochlea are little bone chambers full of fluid and they control balance.  This works like a leveling bubble to help you stay upright.  If it becomes dysfunctional, then it may trigger vertigo.

The middle ear (the area behind the ear drum) is where most of the trouble happens - whether allergies causing stopped up ears, or colds leading to ear infections.

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

May 01 2017

19mins

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Rank #5: Episode 92 - Ear Issues

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PSA:  Please don't stick things in your ear any larger than your elbow...and that includes your finger.

Review

Outer ear = the part that you can touch Middle ear = the area being the ear drum Inner ear = the cochlea and area responsible for your balance

3 common ear problems
  • Ear infections (otitis media)
  • Vertigo (and motion sickness)
  • Tinnitus (ringing in your ear)
Callback

*Ear wax

Ear Infections

The area behind your ear drum has air in it and that pressure is equalized through the eustachian tube.  If that area gets fluid in it, that fluid can grow bacteria and that leads to infection.  The natural motion of opening and closing your jaw helps massage the eustachian tubes and moves air in and out (like when you fly or drive in the mountains and you chew gum or yawn).

Cold and allergies can be the source of the fluid build up that leads to ear infection.  You may have decreased hearing, pain, decreased balance - infection can require antibiotics.

Vertigo

This is the sensation of spinning, dizziness, being off balance The semi-circular canals are responsible for your balance.  If it get sloshed too much, or doesn't level out exactly right, then the signals sent to the brain may translate to being off balance even though your body is upright.  The signal confusion is what can lead to nausea (it's not actually happening in your stomach - at least not until you vomit!) The fluid moving around in these canals are why kids can induce dizziness when they spin around in circles (think about the clothes in your washer during the spin cycle - they get pushed to the outside). Medications  for vertigo are the same as some medications for nausea - plus they have drowsy side effects, so maybe you just sleep it off. There are many suspected causes, but nothing definite or proven.

Tinnitus

Defined as ringing, buzzing, roaring, whooshing sound when nothing is actually making that noise. Causes: hearing loss (either due to aging or exposure to loud noises); high blood pressure (pulsating); medications One theory: the hairs in the cochlea are damaged so those frequencies of sound (usually high pitched sounds) can't be picked up anymore; the brain fills in the gaps with "made up sound".  This is NOT PROVEN! High blood pressure can cause you to hear the blood pulsing through the blood vessels in your ears.

Medications that causing ringing in the ears
  • Aspirin (acute over-use)
  • Aminoglycosides (i.e. Gentamicin = antibiotic) - it has a small therapeutic window, too much can lead to ear damage, it stopped in time, permanent ear damage can be avoided
  • Quinine = usually asked for to help leg cramps, also medically prescribed to prevent malaria.  Can only be readily consumed by drinking tonic water.

Flavonoids are put in vitamins and advertised to help tinnitus.  Flavonoids are phytonutrients (nutrients you get from plants).  These nutrients can't grow the hairs back in the cochlea.  Most of the vitamins and nutrients in the flavonoid vitamins have anti-oxidative properties, but I doubt that tinnitus is a major oxidation problem.

Audience Question Can being slapped over time cause ringing in the ears?
  • Being bopped in the face and head can probably cause permanent damage to the structures on the inside and outside of your head.  Being hit in the side of the head can cause pressure build-up in the ear where the air causes the ear drum to rupture (like "boxing" the ears).
  • Slaps to the face (like "you jerk!" kind of slaps) don't usually cause ear problems, but punches or slaps to the side of the head near or on the ears can possibly cause damage.

Prevent ear problems: be nice to your ears!

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

May 08 2017

31mins

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Rank #6: Episode 94 - Nose Anatomy

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Nose Basics

Your nose is responsible for breathing and smelling.  These things work better when it isn't stopped up.

The part of your nose that you can see and touch is cartilage covered in skin.  There is bone above it, beside your nose, below it, and right in the middle (inside your head).  Part of the cartilage is stiff and hold shape, other parts of cartilage are soft for flexibility.

The nasal root (the bone that extends between your eyes) connected to the bridge of your nose (which is made of cartilage).  The tip is also called the lobe.  The wings are on each side of your nose that you can flare.  The nostrils is actually the holes.

There are 4 main sinus cavities
  1. Frontal sinuses = in your forehead, between your eyebrows
  2. Maxillary sinuses = run under your eyes, behind your cheeks
  3. Ethmoid sinus = right between your eyes, in the middle of your head, connected to your tear ducts
  4. Sphenoid sinus = under your sphenoid bone (in the middle of your head)

The sinus cavities are lined with mucous membranes that keep them moist and have lots of blood flow to them.  Their job is to warm and moisten the air you breathe in your nose before it goes into the lungs.  Your lungs don't like cold air.

Mouth breathing is not very efficient. This is true in athletics as well as sleep.   But breathing out through your mouth can be useful because you can get a large amount of air out rather quickly and the lungs empty better.

You have a fast-flow and a slow-flow nostril - this has to help you perceive smell.  Sometimes almost as good as dogs.

The cartilage of your ears and nose never stop growing through your life.

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

May 22 2017

20mins

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Rank #7: Episode 65 - White matter vs Grey matter

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Basic Brain Biology

Your brain is made of cells.  Those cells are called neurons.  Neurons transmit signals in the form of electricity (aka .positive and negative charges).  One end of a neuron will build a signal or charge, and once it reaches a certain threshold, then a signal is send down the axons.

Most of the cells in your body touch and transmit signals and pass chemicals through their membranes.  Neurons do not touch.  The terminals of one will get really really close to the dendrites of another.

They're really good at the telephone game - mostly because the body tries to minimize the number of neurons involved in passing a signal.

Axons are coated in myelin.  Myelin insulates the axon that helps the signal being sent travel faster, and prevents it from getting lost to something else touching it.  You want the signal to have to same strength when it reaches its destination as it did when it left its source.

Parts of a neuron

Dendrites: receives signals from previous neuron Cell body: contains the nucleus and creates and translates signals Axon: the "wire" that transmits signals Terminals: sends signals to the next neuron

Grey matter - cell bodies, dendrites, and terminals White matter - axons wrapped in myelin

Grey matter - information storage and translation White matter - information transmission

Brain: grey matter is on the outside, white matter is on the inside Spinal cord:  grey matter is on the inside, white matter is on the outside.

PS.  Grey?  Gray?  IDK!!!

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Oct 03 2016

18mins

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Rank #8: Episode 112 - Swallowing

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The 3 Phases of Swallowing Oral Phase

This phase includes chewing and saliva mixing with the food to form a bolus (a little glob of mashed up food). Then the tongue moves the bolus towards the back of the mouth.  The tongue starts by pressing against the hard palate behind the front teeth.  Then the sides of the tongue raise up to also press against the hard palate inside the teeth.  At this point, the bolus has nowhere to go except towards the back of the throat.

Pharyngeal Phase

The vocal folds in the larynx close to keep food out. The larynx also moves up as the epiglottis covers it to seal off the airway. Then the soft palate and uvula move up and close off the nasal passage  So now there is only one way out.

Esophageal Phase

The bolus moves into the esophagus (because it is the only open path). The esophageal muscles contract from top to bottom (this waving, rhythmic muscle movement is called peristalsis) to push the bolus into the stomach.

Swallowing Reflex

There are sensory receptors in the pharynx and tongue that receive touch signals.  When they are touched by a bolus, the signals are sent to the brain stem and the return signal results in involuntary and automatic movements of the larynx and epiglottis.  This is a good thing since swallowing is a very rhythmic process and you want food and drink to continue going in the correct direction.

This reflex cannot be triggered by sticking your finger in your throat.  You are more likely to trigger a gag reflex that way.  The voluntary steps of swallowing must be initiated before the involuntary portion of the process takes over.

Weird Swallowing Scenarios How do you swallow with your mouth open?

At the dentist, you are usually laying in the chair on your back and facing the ceiling.  There are at least three tools and two hands in your mouth.  Things in your mouth trigger saliva production.  Also, generally one of the tools the dentist is using is emitting water.  The natural reflex when you have to hold your mouth open for a long time is to bring the back of the tongue and the soft palate together.  This seals off the throat and allows you to still breathe through your nose.  The liquid in your mouth plus gravity creates a puddle at the seal of your tongue and soft palate.  Because the touch sensors to trigger your swallowing reflex are also in this area, it is likely you begin to panic because if they don't hurry and use the suctioning straw to remove the liquid, you're going to swallow!

Do you swallow in your sleep?

A study was done to find that the only times you swallow while sleeping is during arousal and during REM.  My logical deduction regarding why is that when you're aroused or in one of the more shallow phases of sleep, that is when you can voluntarily move - roll over, adjust the bedding, and swallow.  During REM sleep, most people will experience sleep paralysis, so whatever exciting things are happening in their brain, the body is not likely to act it out.  Because the brain cannot tell if a dream is real or imaginary, the feeling solicited can trigger hormones secretions and saliva production. Increased saliva, just like in the dentist scenario, can trigger swallowing.

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Music Credits: Up In My Jam (All Of A Sudden) by - Kubbi https://soundcloud.com/kubbiCreative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 http://creativecommons.org/licenses/b...Music provided by Audio Library https://youtu.be/tDexBj46oNI

Jan 22 2018

26mins

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Rank #9: Episode 90 - Allergy Testing Experience

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Allergy Basics

Anaphylaxis = an out of control allergic reaction that can be life-threatening if medical treatment is not sought immediately EpiPens are a first-step self-treatment in the case of a major allergic reaction or anaphylaxis.

My Allergy Testing Experience

I got 33 injections!!

Allergy testing started with a serum test as a baseline - just to see how strongly my histamine reaction was.

The injections are sub-dermal (under the dermis layer of the skin).  It's the same level if injection that a TB skin test is done (to see if you've been exposed to tuberculosis).

The next step was a prick-test or scratch test - these plastic claw things that poke down in my forearms.  This test required me to sit completely still for 20 minutes.  COMPLETE TORTURE!

Numbers 1-20 are plants (trees, grasses, flowers).  C = cat. D = dog (Good news - I'm not allergic to dogs!) M = skin mites (don't think about this one too hard). CL = cockroaches.  The other letters are household and common molds.

The skin pricks on my forearm was a preliminary test to determine how much serum she was going to inject of each in my upper arms. The mites injection hurt the worse of all of them, but i had minimal reaction.

Slowest tattoo EVAR!

My Results

One of my higher reactions was to Fescue (this is the type of grass that Ken grows on the farm as hay to feed the cows!) The one the nurse was most concerned about was Cocklebur.

They didn't want me to wash the mold markings off until I go in for a delayed reading a few days later.

The next step that they prefer you do is allergy shots - 2 years of weekly injections of what you're allergic to in hopes to desensitize you to those triggers.  NOPE!  Not doing it!

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Apr 24 2017

16mins

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Rank #10: Episode 67 - Where has all the grey matter gone?

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Grey matter - neuron cell bodies that create and translate messages White matter - myelin-covered axons that transmits the messages across the brain

Conditions that affect grey matter
  1. Dementia - memory starts to fail with age (due to the death of brain cells).  Newest formed memories get lost first (Last In First Out), and it progresses until the vital functions are lost.
  2. Alzheimer's - similar results as dementia, different cause.
  3. Bipolar - there is not a clear explanation, but the grey matter of someone who exhibits bipolar symptoms looks different on a brain scan from the grey matter of someone who doesn't.
  4. Amnesia - can be because the cells holding the information or memories have been injured or killed due to injury, or because the wires that would send the messages for recall have been damaged.  This can be caused by head injuries.  In traumatic experiences, amnesia is a self-preserving mechanism.
  5. Lewy- body dementia - a type of dementia that manifests in Parkinson's disease.  As a neuron cell dies, it fills up with protein and blocks message transmission.  These large clumps of protein-filled cells will show on a brain scan.  These buildups can lead to hallucinations - visual or auditory.  Also, affects memories, just like typical dementia does.
  6. Schizophrenia - stereotypical symptoms can be caused by changes in grey matter, but not the same as protein build-up.  And still a lot unknown about why.

Your brain cells do not reproduce and replenish the way other cells (like your skin) do.  We do know that the brain can create new cells, but it is a very slow process that requires very specific conditions to be present.  But the new growth of brain cells is not fast enough to slow or reverse a disease.

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Oct 17 2016

14mins

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Rank #11: Episode 96 - Nose Issues

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Nose issues that cause your breathing to fail
  • Congestion from allergies, viruses, or infections.
  • Deviated septum - the septum (the bone that separates the nasal cavity and divides your nostrils) can get crooked and change the size and access of the nostrils or nasal cavity.  Can be from trauma, or may gradually get crooked from chronic pressure.
  • Turbinate Hypertrophy - over-growth of tissue covering the turbinates (tissue-covered bones that add warmth and moisture to the air you breathe). This can lead to snoring.  May be treated by steroid nasal sprays or surgery to remove extra tissue.
  • Nasal Polyps - uneven overgrowth of mucus membranes (symptoms may be runny nose, post-nasal drip, stuffiness).  They are not cancerous.  Treated by snipping them out.
  • Sinus cancer - a single growing tumor that causes bulging, either around the eye, face, or mouth.
Nose issues that cause your smelling to fail
  • Age
  • Deviated septum (see above)
  • Polyps (see above)
  • Chronic sinus infections - the smelling sensors are inflamed or covered with mucus so much that they become damaged or less sensitive.
  • Smoking - smoke and toxins can damage smelling receptors in your nose.  Also, the receptors become so clogged up with smoke and tobacco molecules that there's no room for other molecules to be detected.  This can be temporary or permanent.
Nosebleeds
  • In kids, this is usually from trauma (either bumps and bonks or picking).  Can also be caused by dry air in the wintertime (use vaseline in the nostrils).
  •  In adults, can be from hypertension (high blood pressure) or chronic use of blood thinners.

PSA: Treatment for a nosebleed:  DO NOT tip your head backwards!!!!!  It makes you swallow that blood!  THAT'S GROSS!!  Proper treatment:  pinch the nose and tip the head forward.  This allows a clot to form and clots stop the bleeding.

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Jun 05 2017

23mins

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Rank #12: Episode 88 - Eye Conditions 4

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Eye Conditions (not) in ABC Order Dry eye

48% of Americans over age 18 complain of dry eyes.  Caused by environment, genetics, health conditions, eye procedures, medications.

There are 2 reasons for dry eye:
  1. Inflammation blocks the free flow of fluid through the eye.
  2. Tear duct insufficiency - the ducts and glands don't produce adequate moisture for the eye (can be solved by a tear duct stent)

If a medication dries up another part of your body, then it has the potential to dry out your eyes (antihistamines, medications for overactive bladder) - these medications can also lead to constipation. Many of the common diseases that many Americans deal with can cause dry eye - hypertension (high blood pressure), diabetes, obesity.

They light from electronic devices tricks your eyes into not blinking as often, therefore your eyes can dry out more easily (blinking is your eyes' remoisturizing process).  The solution is to give your eyes long breaks from electronic light , especially late at night before sleeping.

Air conditions in hotels can make your eyes feel dry because they work to remove excess humidity from the air.

Hormones, whether in pregnancy, menopause, or during the use of prescription birth control products, can cause changes in the moisture content of your eyes.

The Solution: eye drops (either OTC or Rx)

Presbyopia

It means "old or elderly vision". Presby = elders Presbyterian church = the church's decision-maker was a group of people called Elders

This seems to happen somewhere around age 40.  The lens of your eye loses some of its flexibility.  The lens has to be really curved to see up close, and then flattens out a bit to see far away.  So, if the flexibility decreases, it means it can't curve up enough to clearly see things up close.

The solution: wear reading glasses.

Stye

It's an infected oil duct or hair follicle.  Looks like a zit.  DO NOT TRY TO POP A STYE LIKE A ZIT!!  They will usually clear out on their own in 6-7 days.  Not too troublesome other than being sore, swollen, and not pleasant to look at.

The Solution: warm compress for 15-20 min, then take a shower or wash your face, then leave it alone!  Can use drops or an ointment to help lubricate the eye.  Worst cases will require antibiotic drops or ointment from the doctor.

Corneal dystrophy

A genetic condition that causes the accumulation of protein material build up in the layers of the cornea (recap: cornea = the very front layer of your eye that starts to focus the light into the eye).  If this fluid gets cloudy with junk, then your vision gets blurry. No other symptoms really except worsening vision.  A surgical procedure can be used to clear out the cloudy liquid, but no cure.

This can lead to corneal erosion (where the layers of the cornea begin to separate = painful). Corneal erosion has to be corrected by surgery.  Erosion can also be a result of eye injury - either instant trauma or more gradual like an unhealed corneal abrasion (which can lead to ulceration and eventually erosion).

Take care of your eyes and treat them nicely!

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Apr 10 2017

25mins

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Rank #13: Episode 64 - Meningitis

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Basics

Meningitis = inflammation of meninges

Generalized symptoms:  fever, headache, stiff neck, light sensitivity, confusion, lethargy, 

4 types of infectious meningitis
  1. Bacterial - we have a vaccine for that! 3-7 days; spreads in close communities (like college dorms).  Spreads through prolonged contact.  Confirmed through spinal tap and cerebrospinal fluid culture
  2. Viral - most common type; can be caused by lots of viruses: enterovirus, mumps, measles, flu, west nile.  7-10 days.  This is why I believe in vaccines!
  3. Fungal - not contagious; most common in patient with suppressed immune systems or secondary from surgery.
  4. Parasitic - Rare yet fatal.  Amoeba enters through nose from warm contaminated fresh water sources or pool, even hot springs (warm up to 115* F).  Only 31 cases in the 10 years between 2002 and 2012.  Destroys brain tissue ~ 5 days. 

Non-infectious causes:  Surgery, injury, lupus, cancer

The most important thing is that all of this be monitored by a doctor - ALWAYS!!

2 quick tests for meningitis

Kernig’s sign

Brudzinski’s sign

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Oct 03 2016

28mins

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Rank #14: Episode 87 - Eye Conditions 3

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Eye Conditions in (not) ABC Order

If something happens to your eyes that makes you want to ask the pharmacist if you should go to the doctor, the answer will most likely be "yes, go see a doctor."  Even at emergency rooms, they will treat you and make you comfortable but always tell you to follow up with your eye doctor.

Photopsias

This is seeing things that aren't really there, the visual cortex translates other sensations as "sight".

  • Floaters: "shadows" that float around in your field of vision.  They *can* be a sign of a detaching retina, but that is usually not the case.  They are normal for most people. Inside your eyeball is a gel, called vitreous gel.  Throughout your life, that gel begins to liquify.  As it turns to liquid, it may have other bits of gel still floating in that liquid.  And you see "shadows" because they block light from reaching your retina.  Floaters may worsen with dehydration or exhaustion.  If you try to focus on them, they "float" away.
  • Flashes: "seeing stars" - when the vitreous gel/liquid combo gets shook up and sloshed around (i.e. head trauma).  You can also get "flashes" with Digitalis toxicity (Digoxin is a medication derived from the Foxglove plant and developed for arrhythmias.)  This is a medication that the doctor will test your levels for to make sure toxicity doesn't happen.
  • Waves: looks like radiating heat; caused by spasms of the blood vessels in your eyes.  This may be one explanation of the "aura" that comes before a migraine.  If it happens and no headache follows, it's caused an "ocular migraine".
Glaucoma

It is the 2nd leading cause of blindness in the US and around the world.  Glaucoma is known for increased pressure in your eyes.  The fluid around the eyes typically have adequate drainage so nutrients can flow in and waste can flow out.  If that drainage becomes inadequate, the pressure builds up and it can put pressure on the optic nerve (the nerve that connects from the retina to the brain).  It starts with decreasing peripheral vision, and can become "tunnel vision" where a person can only see right in the middle of their field of vision. Medications are eye drops that control pressure and help open up drainage pathways as much as possible.  It doesn't hurt, and it takes a while for the decreased peripheral vision to be noticeable.  It's not reversible, but it can be slowed with medication.  Eye doctors have a way to check the pressure in your eyes each time you get your eyes checked.

(Macular Degeneration is the #1 cause of blindness in the US, Cataract is the #1 cause of blindness worldwide).  

Nystagmus

Pronounced nigh-stag-mus.  It is the involuntary rapid eye movement side to side.  Caused by a neurological issue, either related to the eye muscles and nerves or the inner ear (one cause a vertigo).  The shaking seems to be worse when a person looks straight at something or someone.  For someone dealing with nystagmus, they usually discover they can tilt or turn their head to make their eyes slightly off center where the shaking wills stop - this is called a "null point".  Strengthening eye muscles can help the shaking, but it still worsens with exhaustion or stress.

This can be a result of a stroke, multiple sclerosis (autoimmune).  Dilantin is a medication for seizures, and is another medication that has to be regularly measured because too much can cause temporary nystagmus.

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Apr 03 2017

28mins

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Rank #15: Episode 86 - Eye Conditions 2

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Eye Conditions in ABC order Color blindness

It doesn't mean that someone sees the world in black and white. It's technically labeled as Red-Green color blindness, which means the world is seen in shades of yellow. The cones in your eyes (a certain shaped cells in your retina) are built to pick up different wavelengths of  light (think ROYGBV).  So the cones that would pick up reds and greens are absent or broken. Found to be a Y-chromosome trait, so it is more prevalent in males. Rarely Blue-yellow color blindness is a thing.

Conjunctivitis

pink eye = inflammation of the conjunctiva conjunctiva = the layer that covers your whole eye

3 types:
  1. Viral: itching, watering, burning, light sensitivity, very contagious, lasts ~ 7 days
  2. Bacterial: green/brown discharge (aka "goo"), foreign-body sensation, contagious, can cause damage if untreated, requires antibiotic drop
  3. Allergic: triggered by allergens, histamine reaction, can accompany a larger, more general allergy reaction, anti-histamine eye drops can help
Corneal abrasion

A scratched or injured cornea.  Symptoms include redness, watering, light sensitivity, foreign-body sensation Can be dramatic or traumatic like being hit in the face or eye by something, or something as simple as rubbing an itchy eye or getting something out of their eye. * If you end up with something in your eye, the best option is to flush it out with water or saline Bacteria on your hands or the thing that scratched your eye can lead to a deeper infection, but most of the time, if you use caution, it will heal itself rather quickly.

**Solution for light sensitivity:  wear sunglasses at night

Detached retina

When the retina detaches from the back of the eye.  Sounds awful but it doesn't hurt.  The retina a web of nerves in the back of your eye that sends signals to the brain.

Closing curtain sensation is where part of the view of vision will become shadowed as the retina detaches gradually from one side to the other.  Floaters also show up if this is happening. (All floaters ARE NOT related to the retina.)

Sudden detachment can be caused by head injuries or sudden intra-ocular pressure drops (the fluid pressure inside your eyeball).  This sudden detachment is experienced as a flash of light and then sudden darkness.  Sudden or gradual detachment requires immediate medical attention and can be repaired with surgery and medical intervention. Diabetic retinopathy do to chronic damage can lead to retina detachment.  *The risk of retina detachment occurring after an eye procedure (lasik surgery or cataracts surgery) is skewed for people with severe nearsightedness, possibly due to a genetic disposition of having a shorter retina.

Audience Question

Safe to use allergy eye drops long-term? Answer:  Sure!  The only problem is that chronic use can lead to your body not responding to the same med over and over as well.  So, to avoid this, swap between drops and allergy tabs - based on if you're experiencing "eye only" allergies or a wider allergy response that involves the sinuses too.

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Mar 27 2017

29mins

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Rank #16: Episode 66 - Wrinkly Brain

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Brain Basics

All brains are wrinkly.  Wrinkles in your brain are a good thing.  Wrinkles are biology’s way of maximizing surface area while conserving space.

The plateaus of the brain are called gyri (or a gyrus).

The smaller, sunken in wrinkles are called sulci (or a sulcus).  Sunken in sulci - that’s how I remember it.

The larger canyons of the brain are called fissures.  These are the groves that separate the hemispheres and the lobes of the brain.

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Oct 12 2016

6mins

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Rank #17: Episdoe 95 - Smell

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Smell Basics

Air goes in your nose and flows over the smell sensors.

Your nose and sinus cavities act as a resonating chamber for your voice.  That's why you sound funny when you hold your nose or when your nose is stopped up from a cold or allergies.  This is important in talking and singing.

What makes something smell?

Volatile molecules evaporate at normal temperatures and pressures, so actually molecules of the thing are in the air and available to go in your nose.  Don't think about this too hard....

The smelling sensors are on the roof of the nasal cavity --> olfactory receptors (olfactory is the fancy word for smelling).  The molecules fit into the receptors like a key in a key hole.  Our brain likes to categorize things, and so certain compounds have similar structures and get lumped together ("smells like eggs" but you know it's not real eggs).

The olfactory receptors send the signals to the olfactory bulb (which is the area in the brain that translates all the smells and allows you to identify a smell).  It's not a very long trip....

The olfactory bulb is a part of the limbic system (the emotion center).  this is why smell is more strongly connected to emotions and memory - even stronger than sight and sound.

Smell Tidbits

If you go to the perfume counter at a department stores, you'll find that they all start smelling the same.  The perfume department will have coffee beans because it helps clean out the receptors.

Coffee-scented, caffeinated perfume <-- free idea!!

Inflammation and mucus congestion blocked off the receptors.

No concrete evidence of why pregnant women get a "super smeller" during pregnancy.

One rogue molecule won't make you smell something.

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

May 29 2017

16mins

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Rank #18: Special Episode #4: Life & Blood Sugar

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For someone with diabetes, everything they do in life affects their blood sugar.  They could be eating 100% right and taking their medicine 100% right, and something would cause the blood sugar to be off.

Exercise

It is well-accepted that exercise is good for you.  Your body will store extra sugar as a large molecule called Glycogen.  Imagine a line of kindergarteners hold hands trying to make it through the museum, Glycogen is just a bunch of glucoses holding hands.  When you’re not eating, your body will snip off a glucose at a time as it needs it.  The liver stores and directs the glycogen most of the time.  Your skeletal muscles also store some glycogen, because when they do work (i.e. exercise), it takes too long for the liver to snip off glucose from glycogen and send it to them.  

After exercise, the body replenishes the muscles’ glycogen stores.  This can cause the blood sugar level to drop, for someone with diabetes, this can be dangerous because they can’t “untake” medicine.  When protein and carbohydrates are eaten together, before or after exercise, the blood sugar changes can happen more slowly - the nutrient absorption in the gut causes a “traffic jam” of sorts.

Sleep

Certain metabolism processes happen only when you sleep.    Some people with diabetes wake up with really high blood sugar, others wake up with really low blood sugar.  Sleep is not restful and restorative if the blood sugar is out of balance, but also if sleep is not restful, then blood sugar levels can be jacked up - not just in the morning, but for the rest of the day.

Stress

The hormones that are triggered by stress - even something as basic as adrenaline, can cause the body to respond to insulin and glucose differently.  

Sickness

Your body is going to responds things differently when the immune system is in high gear - that includes insulin, glucose, the food you eat.  An infection requires an antibiotic because you are infected with a bacteria.  Bacteria are living organisms.  Living organisms consume energy sources and produce waste.  This can affect the sugar levels in your bloodstream.  You’re immune system doing work also burns sugar.

Allergies

Works about the same as sickness.  Your immune system is actively trying to protect you from something (allergens) and so it responds differently.

Smoking

If you smoke, STOP!  The nicotine and other chemicals make you more resistant to insulin.  This is most troublesome in Type 2 Diabetes.

Hormones

Especially for women, hormone cycles can affect sensitivity to insulin differently during different times of the month.  Adrenaline can override almost any response to any previous hormone response.

Life is hard

Life with diabetes is super hard.  Diabetes and other chronic diseases are silent and it doesn’t show on the outside at first sight.  Extend grace, extend compassion.

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute!

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Sep 22 2016

19mins

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Rank #19: Episode 111 - Tonsillectomy

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What is a Tonsillectomy?

A Tonsillectomy is a surgical procedure to remove the tonsils.  Tonsil - immune system tissue in the back of the throat.  -Ectomy = to remove something from the body.

Removing the tonsils may be required if chronic tonsilitis is a problem.  Chronic tonsilitis is defined as multiple infections in a row or an infection lasting 3 months or longer.  Severe snoring and sleep apnea may be another reason to remove the tonsils, for the purpose of opening up the airway.

Adenoids

Adenoids are another set of immune system glands in the back of the nasal cavity.  They can also swell during infections and interfere with breathing.  Depending on the severity of the infections or the risk of sleep apnea, these may also be removed in the same or a similar procedure.

Tonsillectomy Methods

Since general anesthesia is used in all methods to remove the tonsils, no eating is allowed before the procedure.  They also recommend no NSAIDs (non-steroidal anti-inflammatory drugs) are to be used before and after due to their ability to thin the blood and increase the risk of bleeding.  In general, a tonsillectomy will take between 30 and 60 minutes.  Recovery time afterward is estimated to be about two weeks.

  1. Scalpel This is the old school method of using a very sharp surgical knife to cut out the tonsil.  This method has the highest risk of bleeding.
  2. Cauterization This method involves a hot knife that separates the tonsil tissue from the throat.  The heat also closes off the blood vessels so bleeding is not as severe.  A downside is that the tissue has been burned, so I imagine the pain after this method is more severe.
  3. Ultrasonic Vibration Ultrasonic waves are sound waves that have a higher frequency than the human ear hears.  The waves cause a very rapid vibration and the energy of those waves is what causes the tissue to separate as well as the blood vessels to clot.  This is the newest method developed and seems to have the least bleeding and pain.
After the Tonsillectomy

The side effects of a tonsillectomy include swelling of the throat, as well as the face and jaw, bleeding, and infection.  To avoid the bleeding and infection, it is important to follow all the instructions given for the recovery period.  Because of the swelling, cold foods like ice cream and popsicles are popular because cold things reduce swelling.  Popsicles can also help with hydration because swallowing bigger sips or gulps of water can be painful the first few days.  Hot foods are not recommended because the heat can increase the pain or reinjure the surgical site.  And while ice cream is the most popular post-tonsillectomy food, any soft, non-abrasive foods are fine to eat.

Why do adults have more issues than kids?

Kids heal faster because they are still growing and developing.  Kids also have smaller body parts than adults - the tonsils are smaller and the blood vessels are smaller.  Smaller blood vessels clot and heal faster than larger ones.  This is even true between the different sized blood vessels in your own body.  And a factor no one wants to admit: adults are terrible at following directions and truly resting after a surgery or procedure.  Rest is the best thing for a healing body of any age or size.

Strep Carriers

Generally, when we think of severe tonsilitis that leads to a tonsillectomy, we think of strep throat.  A carrier is someone who carries the germ around with them but does not get sick from the germ (pertussis is another example). In 1998, a study found that 5-15% of school-aged children were asymptomatic carriers of strep.  This means they tested positive on a strep swab but had no symptoms of being sick.  This causes concern because it means that you can be sick with something else that causes vague symptoms like fever and sore throat but because the strep test is positive, antibiotics are prescribed when they might not be necessary (meaning that you were sick from a virus).  This study showed that providers and caregivers were unaware of the number of unnecessary antibiotics they were prescribing.

Strep is eradicated from a carrier by an extensive treatment of antibiotics, or by removing the tonsils from the carrying family member as well as the tonsils of the chronically sick family member. #tonsillectomyforeveryone

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851340/ Callback

Facebook Memory: Episode 74 Sleep Hygiene All About Sleep

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Jan 08 2018

30mins

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Rank #20: Episode 110 - Tonsils

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Tonsils Basics

Your tonsils can be found in the back of your throat.  You can open your mouth and look in the mirror and see them on each side of your mouth behind your teeth and tongue.  You can also feel them below your earlobes and behind your jaw bone.

Tonsils are composed of lymph tissue since they are a part of your lymph system.  They store white blood cells that help you fight off infection.  Their activation during sickness is why they swell and get sore. 

They are covered with the same mucosal membrane as the rest of the inside of your mouth.  This mucosa layer has pits and crevices called crypts.  These crypts increase the surface area of the mucosa that comes in contact with the lymph tissue and allows more opportunity for infectious material to be directly accessed by the immune system.

Infectious Tonsil Issues

Tonsillitis is the inflammation of the tonsils.  It can be classified as acute or chronic.  Acute tonsillitis is directly related to a viral or bacterial infection.  Chronic tonsillitis can be either a persistent, long-lasting infection or multiple consecutive acute episodes that can appear to be one long sickness.

Swollen tonsils can cause simple activities such as swallowing, talking, and breathing very painful.  You can see your swollen tonsils when you look in the mirror.  They will appear red or possibly blistered.

Mono, an infection caused in adolescents and adults by the Epstein-Barr virus, cause severe swelling in all the lymph nodes, including the tonsils.  This is one of the situations where your tonsils will be so inflamed, you can see the swelling on the outside of your face and neck.  Because such a large portion of your lymph system is involved, including your spleen, this is a serious sickness.

Strep throat is probably the first infection you think about when you think of swollen tonsils.  The bacteria, streptococcus, infect the lining of the tonsils and throat.  This is why the doctor will swab your tonsils when they're testing for strep.

Non-Infectious Tonsil Issues

A non-infectious reason the tonsils will be large is a condition caused hypertrophic tonsils.  The tonsil tissue and/or mucosa overgrow and become oversized without any infection or immune activation being involved.  Overgrown tonsil tissue can lead to snoring or sleep apnea, and that's bad.

Another non-infectious issue with your tonsils is called tonsilloliths or tonsil stones.  These stones happen when dead bacteria or food debris gets stuck in the crypts and they become calcified.  They cause a sensation many describe as a crumb stuck in your throat.   They can become quite large and can interfere with swallowing and eustachian tube function.  Because the eustachian tubes run from your eardrum into your throat, if the tonsil is swollen enough, it may close off the tube to the ear and cause ear pressure/pain.  Some tonsil stones are large enough to be visible and may have to be manually removed.  Lastly, due to the composition of the stones (dead bacteria and old food), frequent tonsil stones can be the cause of bad breath.

There's no way to prevent tonsil stones 100%.  Good oral hygiene can certainly help reduce the frequency of stones, and can also help remove them quickly if they occur.  The most common way of trying to remove a tonsil stone involve coughing, clearing your throat, or hissing.  All three of these ways produce vibrations in the lining of the throat and mouth.  So along with the exhalation of these methods, hopefully, the result is the stone coming out of the tonsil and out of your mouth.

PSA:  Please DO NOT scratch your tonsils with your fingernails to remove a tonsil stone!

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Music Credits: Up In My Jam (All Of A Sudden) by - Kubbi https://soundcloud.com/kubbiCreative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 http://creativecommons.org/licenses/b...Music provided by Audio Library https://youtu.be/tDexBj46oNI

Dec 11 2017

21mins

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