Archive for January 2015

(Not so) Good Old Pneumonia

“I’ve just been coughing up a little bit of junk … kind of sore in the chest when I do cough. I’ve got a bit of fever too. But overall I’m just really tired the last couple of days and winded when I go up the stairs. You think my smoking is finally catching up with me?” My mid-30’s patient turned out to have pneumonia affecting both sides of her lungs and proving somewhat slow in responding to antibiotics.

So what exactly is pneumonia?  Let’s start with what it’s not: a ton of what we see in a primary care office, especially this time of year, is in the category of upper respiratory infections (URI’s), and they’re usually viral.  An acute URI is a contagious infection of your upper respiratory tract which includes the nose, throat, larynx, and bronchial tubes. The common cold is the most well-known URI. Other types of URI’s include sinusitis, pharyngitis (throat infections), epiglottitis, and bronchitis.

Pneumonia on the other hand, is a lower respiratory infection.  It’s an infection of the lung itself, and can be either bacterial or viral.  In the United States, pneumonia causes more disease and death than any other infection.  Worldwide these infections cause a greater burden of disease than HIV infection, malaria, cancer, or heart attacks.  More than 3 million cases occur each year in the U.S. Pneumonia is more common during the winter months and in colder climates and often follows a viral URI which knocks down a person’s defenses.

In terms of its symptoms, pneumonia can be very similar to a bronchitis with coughing, fever, possibly some chest discomfort and shortness of breath, especially with exertion.  Some types of pneumonia have lots of sputum production (coughing up mucous) while others can have a dry cough.  Likewise, some will have a very high fever while others can have only low-grade or even no noticeable fever at all.

The substantial variation of symptoms is partly dependent on the particular bacteria or virus causing the infection and partly on the person who has the pneumonia.  For example, the elderly often don’t mount much of a fever response with pneumonia.  This variation of symptoms and substantial crossover with URI symptoms is also why we always like to get a good listen to the lungs of a patient with cough and other respiratory symptoms.  Often the lung exam will tell us if pneumonia is the problem.  The breath sounds of someone with a typical URI are usually pretty normal, while pneumonia often has crackles and wheezes coming from the infected parts of the lung.

In general, viral pneumonias more often have a dry cough while many (but not all) bacterial pneumonias have a productive cough with thick sputum.  Of course antibiotics only help the bacterial pneumonias.  That being said, over my course of some 30 years of practicing medicine, I have seen a steady increase in the resistance of bacteria to antibiotics.  The case we opened this article with is fairly typical in that we had to change antibiotics once and the improvement has been slow and steady, not fast and dramatic.

This growing resistance to antibiotics is part of the rationale for recommending pneumonia vaccines to appropriate individuals.  If you can be immunized against ever catching at least some of these pneumonias, it beats getting the pneumonia and then hoping it’s not resistant to multiple antibiotics.  There are currently two different pneumonia vaccines which are given from infancy all the way up to the elderly.  Your physician can let you know if you are in a category where one or both would be helpful.

If you end up still catching pneumonia, the majority can be treated outside of the hospital.  Mostly those who are very young, very old, have a lot of other health problems, or have an unusually severe case of pneumonia need to be treated in the hospital.

But here’s hoping you avoid pneumonia all-together and by some miracle even the URI’s that are moving like a tidal wave through our area.  You’ll help that with some old-fashioned preventives: good hydration, hand-washing, fruits and veggies, adequate rest, vaccination, aerobic exercise (really does improve immunity), and of course, not smoking.


Anxiety and Panic

Did you see I was in the ER last week?  I’d been shopping at Walmart and started getting all short of breath, chest pressure, heart pounding… I was sure I was having a heart attack.  But they did the work-up, drew some blood, did an EKG, even put me on a treadmill… all totally normal.  They said they thought I’d had a panic attack.  My life isn’t that stressful; why the heck should I be having a panic attack?  Am I going to have another?  That was embarrassing! And terrifying!”

That little description by twenty-something David pulls together some of the symptoms and feelings experienced by someone having a panic attack.  Panic disorder is one of the twelve or so recognized anxiety disorders.  Anxiety disorders are considered the most common mental disorders by the medical establishment with over 40 million Americans suffering from them.

Panic disorder is a type of anxiety disorder in which a person has repeated attacks of intense fear that something bad will happen. The cause is unknown but it is a bit more common if it runs in your family.  Panic disorder is twice as common in women as in men. Usually symptoms begin before age 25, but sometimes not until mid-30s. Even children can have panic disorder.

Panic attacks begin rather suddenly and symptoms usually reach a peak in about 10 minutes and then may last up to an hour or so.  To fit the criteria, a panic attack will include at least 4 of the following symptoms:palpitations, sweating, trembling or shaking, shortness of breath, feeling of choking, chest pain or discomfort, nausea or abdominal distress, dizziness or lightheadedness, feelings of detachment or unreality, fear of losing control or going crazy, fear of dying, numbness or tingling, chills or hot flashes.  Clearly not a very pleasant list of symptoms to experience.

Also at least one of the attacks is followed by one month or more of either persistent concern about having additional attacks or worry about the consequences of another attack (like going crazy or really having a heart attack), or a significant change of behavior related to the attacks.

So these are unpredictable, frightening, embarrassing episodes that sometimes cause folks to more and more pull back from their normal activities.  Some people end up barely able to leave the house.

Well, what can you do about them?  While there is no quick cure for these, there is quite a lot that can help.  See your doctor about them and he or she can first make sure your symptoms aren’t from something else like heart disease, thyroid disease or one of few other mimickers. If your symptoms really do seem to be pointing to panic disorder, there are several treatment choices.  Certain types of counseling can help you deal with these and keep you from slowly restricting your life.

In addition, there are meds that can treat you at the moment of the attack, although these are somewhat limited as they take a bit longer to get into your system than you would like at that moment.  There are other meds that, when taken regularly, can help prevent the attacks altogether, or at least reduce them.

All this often takes some patience as one approach doesn’t fit everybody.  But it’s worth the effort to keep this frightening but non-deadly specter from shrinking the boundaries of your life.  In reality, it takes some courage to fight panic.


Butternut Squash Soup

Cozy up with this delicious winter soup!

Butternut Squash Soup
Recipe type: Soup
Serves: 5-6
  • 1 medium to large butternut or other winter squash (between 3 and 4 pounds)
  • 3 tablespoons butter, unsalted (Kerrygold recommended)
  • 2 large leeks, white part only cleaned thoroughly and chopped (you could substitute one onion for the leeks if you prefer)
  • 4 teaspoons fresh ginger, peeled and minced
  • 5 cups chicken stock or broth
  • ½ cup heavy whipping cream
  • ¼ teaspoon salt (if using salted store-bought chicken broth then taste the soup before adding any salt)
  • Optional: Chopped pistachio nuts and/or fresh sage leaves for garnish
  1. Heat the oven to 400 degrees F.
  2. Slice the squash in half long ways and scoop out the seeds. Place the squash cut side down on a baking sheet. If you line the baking sheet with foil or parchment paper the clean up will be easier.
  3. Bake for 30 – 45 minutes or until the thick part of the squash can easily be pierced with a fork. Let cool then scoop out the pulp and discard the skin. (Note: This step can be done in advance)
  4. In a large soup pot over medium-low heat, melt the butter. Add the chopped leeks and ginger. Cook for 5 – 8 minutes until tender, but not browned.
  5. Add the squash pulp to the pot along with the 5 cups of chicken stock. Bring to a simmer and cook, stirring and breaking up the squash with the back of your spoon, for 10 – 15 minutes.
  6. Puree the soup either with a hand immersion blender or in a counter top blender. I highly recommend a hand immersion blender if you like to make soups because you’ll end up with a lot fewer dirty dishes.
  7. After the soup has been pureed, stir in the cream and salt (to taste).
  8. Ladle into soup bowls and serve warm topped with chopped sage and pistachios.
  9. Refrigerate or freeze the leftovers.



Fruits and Veggies

So I started this challenge  with my family (me, hubby, 2 1st grade girls, 10 month old) this week to cut out processed foods in 14 weeks.

Week 1: Eat a minimum of two different fruits or vegetables (preferably organic) with every breakfast, lunch, and dinner meal.

Variety of fresh fruit and vegetables

We are on day 2 and not perfect but this is what we have done so far and I like to be transparent with my patients.  I like to share this to show you that at Trinity, we are working to practice what we preach.

Day 1:

B- turkey sausage with onion, red bell peppers, eggs. Kids ate additional banana, apple, or orange.

L- “Annie’s” brand mac and cheese with nitrite free hot dogs, apple with natural peanut butter, baby carrots with ranch

D- Grilled cheddar cheese, bacon*, and green apple sandwhich (on whole wheat bread) from the “100 days of real food” cook book, carrots with ranch, green beans. (** by the way, if you have never baked bacon in the oven, it is the bomb! Preheat to 400. Lay a wire cookie rack on top of baking sheet and then lay out bacon on the wire. Bake for ~20 min. No flipping or burning (the bacon or yourself) and you can feed your 10 month old or do other things while it bakes away).  If you have leftovers, save in fridge and reheat for breakfast the next day.

Day 2:

B- smoothie- banana, strawberry, plain greek yogurt, whey protein powder, unsweetened almond milk, water

L- spinach salad with berries, mandarin oranges, parmesan, chicken and poppyseed dressing, grilled bell peppers and zucchini, brownie :) (Our friends at Brown Bag make it easy to get your fruit and veggies in.

D-  Bacon Apple Crockpot Chicken and frozen green beans or broccoli steamed (whatever I find in the freezer at home).


We have successfully made it 2 days!! I haven’t gone organic on my fruits and veggies yet. I am going to do some more research here and will let you know what I find out.


How do you like to get your fruits and veggies in? Do you buy organic?  Do you want to do this challenge with us?