• Is Sleep Apnea Making You a

    Morning Zombie?

    Do you wake up feeling like a zombie? Do you have trouble keeping your eyes open at work or school, or even while driving? You might be one of the 12 million-plus Americans feeling the effects of a disorder known as sleep apnea. Even though you may be getting to bed at a reasonable hour and assuming you’re getting a normal night’s sleep, sleep apnea can subtly interrupt the quality of your sleep, making you feel tired and lethargic in the morning. Sleep apnea has many other affects on the body, but this is certainly one of the most recognizable symptoms of a disorder you may not even be aware you have.

    Serious Consequences of Sleep Apnea

    Most people don’t know they have obstructive sleep apnea, usually caused when the soft tissue in the back of the throat collapses when sleeping, says Patrick J. Strollo, Jr., MD, medical director of the UPMC Sleep Medicine Center. That leads to a drop in oxygen levels, prompting the brain to send a surge of adrenalin signaling the person to wake and take a deep breath. That kick-start also leads to a spike in blood pressure.

    According to the National Institutes of Health, this common disorder causes breathing pauses while you sleep. These pauses can last a few seconds, or even minutes — as often as 30 times, or more, an hour.

    “It’s a burden on the cardiovascular system and affects the quality of your rest,” says Dr. Strollo. Left untreated, sleep apnea can lead to serious health problems and even cause deadly accidents.

    10 Signs You Might Have Sleep Apnea

    Not everyone who snores has sleep apnea, but it is a major clue. Since sleep apnea only occurs during sleep, a family member or bed partner might be the first to notice.

    Common signs and symptoms include:

    • Loud and chronic snoring — sometimes with pauses.
    • Choking or gasping following pauses
    • Feeling tired or sleepy, even after sleeping all night
    • Waking up with a very sore or dry throat
    • Daytime sleepiness, or lack of energy
    • Morning headaches
    • Restless sleep, waking up during the night, or insomnia
    • Trouble concentrating or problems with learning and memory
    • Depression and irritability
    • Sexual dysfunction

    Consult your primary care physician or family doctor if you’ve experienced any of these symptoms. If left untreated, sleep apnea can have serious consequences on your waking life and your health. For more information, visit the UPMC Sleep Medicine Center online or call 412-692-2880.

    Read More
  • What You Need to Know About

    Ebola

    Thomas Eric Duncan became the first casualty of the disease on U.S. soil. Duncan was exposed to the disease in Liberia before returning to the U.S. He died in a Dallas hospital on October 8, 2014, after being treated for the disease. By the time Duncan began an experimental treatment, his case of Ebola was too far advanced to respond. A deeper look at Duncan’s case shows that it is actually harder to catch Ebola than most Americans may believe.

    Sunday, October 19 marked the completion of the 21-day incubation period that health officials observed, monitoring individuals who Duncan had been in close contact with since his return to the U.S. October 20 marks a full month since he took several flights from Monrovia, the capital city of Liberia.

    To date, and as expected since he was not contagious at the time, no one on Duncan’s flight has fallen ill. Duncan’s family and fiancé – whom he lived with while he was experiencing the symptoms of Ebola,such as sweats, a fever, and vomiting – have not shown signs of the disease either and have been declared free of the virus.

    In addition to Duncan’s family having been given a clean bill of health, a Texas health worker who was traveling aboard a cruise ship in the Caribbean also tested negative for the disease. Once she and her husband had been tested for Ebola, they were given clearance to drive home. The remaining 4,000 vacationers on the ship were also allowed to leave a few hours after pulling back into port.

    Amesh Adalja, MD, an infectious disease specialist at UPMC and a senior associate at the UPMC Center for Health Security, says the risk of it spreading in the U.S. is very low because it can only be transmitted under specific conditions.

    Ebola is a deadly disease, it’s a scary disease, but it’s not very contagious. It doesn’t spread through the air; it only spreads through intimate contact with blood or body fluids,” says Dr. Adalja.

    “It is far less contagious than the flu — a respiratory virus easily spread by sneezing and coughing. Also, Ebola is only contagious when a person has symptoms. With the flu, a person is contagious the day before symptoms appear.”

    Although the risk of Ebola spreading is low, the Centers for Disease Control and Prevention (CDC) and other agencies have taken steps to prevent that from happening in this country. That includes increased airport screenings before and after entering the United States from Ebola-affected countries. In addition, the CDC has issued Level 3 travel warnings urging U.S. residents to avoid nonessential travel to Guinea, Liberia, and Sierra Leone in West Africa. The West African nations of Nigeria and Senegal have recently been declared Ebola-free. The country has not registered any new cases of Ebola in 41 days.

    Protocols also have been established to ensure health care facilities are prepared to properly detect and handle the disease. UPMC facilities are ready, says Dr. Adalja. Each hospital in our system has comprehensive and detailed action plans in place.

    “We know how to stop the spread of Ebola. But it’s crucial for hospitals to prepare in advance,” he says. “UPMC has easily accessible protocols from the moment a patient arrives in the Emergency Department through their hospital stay — how we screen that person, how we isolate that person, how we test for it, who we communicate with — it’s all laid out.”

    About the 2014 Epidemic

    According to the CDC, the 2014 outbreak is the largest in history and the first documented appearance in West Africa. About half the people who contracted the virus have died. In the U.S., the Texas patient who had recently traveled from Liberia died on Oct. 8.

    Ebola Facts

    • A person infected with Ebola is not contagious until symptoms appear.
    • Symptoms of Ebola may appear anywhere from two to 21 days after exposure, but the average is eight to 10 days.
    • Early symptoms include:

    o Fever (higher than 101.5° F)

    o Headache

    o Diarrhea

    o Vomiting

    o Stomach pain

    o Muscle pain

    o Unexplained bleeding or bruising

    How Ebola Spreads

    Ebola is spread through direct contact with:

    • Blood and body fluids (urine, feces, saliva, vomit, sweat, and semen) from a person sick with the disease; and
    • Items contaminated by blood or body fluids from an infected patient, like needles, medical equipment, clothing, or bedding.

    Are You at Risk?

    If you’ve traveled to an area with an outbreak, or had close contact with someone sick with the disease, you may be at risk. The CDC recommends that you:

    • Check for signs and symptoms for 21 days.
    • Take your temperature every morning and evening.
    • Call your doctor — even if you do not have symptoms — to evaluate your exposure level and consult with public health authorities to determine if any actions are needed.
    • Continue normal activities, including going to work, while you are symptom-free.

    If You Get Sick after Travel to an At-Risk Area

    • Get medical care immediately if you develop a fever (higher than 101.5° F).
    • Alert your doctor about your recent travel to West Africa, or contact with a person sick with Ebola, and symptoms before you go to a doctor’s office or emergency department. Calling ahead will help the doctor or emergency department care for you — and protect others.

    Updated 10/21/2014 

    Read More
  • Recipe: Homemade

    Pumpkin Spice Latte

    Fall is finally here and we are officially excited about EVERYTHING pumpkin! Instead of buying the famous coffeehouse drink, skip out on the saturated fat, carbohydrates, and sugars by crafting your own version of the pumpkin spice latte in the kitchen. You may be used to waiting in a long line for this tasty treat, so you’ll be pleasantly surprised to find you can whip up this recipe in half the time. Better yet, this version uses real pumpkin, not syrup! Pumpkin is low in fat and calories, and also packs a healthy dose of antioxidants, vitamin A and vitamin C, as well as iron. Pumpkin is also a great dietary source of fiber.

    So, save yourself some calories, money, and time spent in line by adopting this version of a fall favorite!

    Pumpkin Spiced Latte

    Ingredients

    2 cups skim milk

    2 tablespoons canned pumpkin

    2 tablespoons Stevia

    2 tablespoons vanilla extract

    1/2 teaspoon pumpkin pie spice

    1/2 cup hot brewed coffee

    Whipped cream, pumpkin pie spice and ground nutmeg, optional

    Directions

    Combine milk, sugar, and pumpkin in a small pan over medium heat until steaming.

    Remove heat, stir in pumpkin pie spice and vanilla

    Transfer the mixture to a blender. Process for 15 seconds or until foamy

    Pour into two mugs, add ¼ cup coffee

    Top with whipped cream and a pinch of pumpkin spice

    Nutritional Facts

    1-1/4 cups (calculated without whipped cream) equals 307 calories, 0 g fat (5 g saturated fat), 33 mg cholesterol, 346 mg sodium, 39 g carbohydrate, 1 g fiber, 22 g protein

    Do you have any favorite healthy fall recipes you enjoy with seasonal fruits and vegetables? Share them with us in the comments!

    Read More
  • Infographic:

    Colors of the Eye

    From the famous lines of beloved songs to the stories of ancient legends, eye color has captivated audiences throughout time. The origins and genetic makeup associated with eye color makes the color of one’s eye more complex than a simple collection of aesthetic traits, however. Genes and pigment concentrations are two important factors in determining eye color. Some eye colors are more rare than others and can be linked to genetics or family origins and heritage.

    Hannah Scanga, MS, a genetic counselor at the UPMC Eye Center, explains, “The two primary genes that influence the color of the eye, primarily brown and blue eyes, are OCA2 and HERC2. Additional genes influence other eye colors and specific variations, including green or hazel eyes and gold rings.” The scale of eye color from most to least common is brown, blue, hazel, green, and silver.

    According to Ellen Mitchell, MD, “Concentrations of the pigment melanin in the iris of the eye is the primary determinant of eye color. Higher amounts of melanin lead to darker colors while lower amounts result in lighter eye colors.” Dr. Mitchell continues, “The pigment lipochrome also plays a role in determining eye color, specifically green eyes.”

    Eye color can also change due to factors like pupil size, emotions, and age. However, if these changes are drastic or only occur in one eye this may indicate a medical condition and you should discuss symptoms with a doctor.Eye Color Infographic

    Are you still curious about some of the fascinating facts behind blue (green, or brown) eyes? Visit the UPMC Eye Center website to learn more about the latest breakthroughs in the field of optometry and the different eye conditions we treat. Call 1-800-446-3797 to schedule an appointment today.

    Read More
  • 5 Ramen Noodle

    “Health Hacks”

    It’s that time of year again. The time when college students flock back to campus, ready to ace their tests, reunite with friends, and feast on the infamously unhealthy Ramen Noodles. Unfortunately, the beloved college-food was the subject of a recent health study, which linked it to series health issues. Even more disheartening? These issues were gender specific. Women who ate the noodles at least twice per week saw a 68 percent increase in their risk of cardiometabolic syndrome, while men saw no notable difference in their risk. But with all-nighters and deadlines looming, it’s not easy to toss the prepackaged delicacy into the trash for good. So what’s a busy college kid to do?

    Leslie Bonci, director of sports nutrition at UPMC Center for Sports Medicine, commented on the story and assured students that it doesn’t take much effort to make Ramen healthier. So next time late-night hunger strikes, try these simple steps to save your wallet and your health:

    Ramen Graphic

    1. Ditch the Seasoning

    The sky-high sodium content is the biggest health issue, so try adding flavor another way! Use water or broth and flavor it with garlic, ginger, herbs, chili, or sesame oil.

    2. Add Veggies

    If you live on campus, grab some vegetables from the salad bar to use in your Ramen. Otherwise, break out the frozen veggies to give your noodles an extra kick of nutrients!

    3. Pack in the Protein

    Chicken, shrimp, tuna, tofu, grilled salmon, eggs…the list goes on! Any protein you choose will make your Ramen healthier and keep you feeling full longer than Ramen alone.

    4. Use your Leftovers

    Have extra food from last night’s dinner? Combine it with ramen noodles (sans seasoning) for a delicious reworking that makes you forget you’re eating leftovers.

    5. Go Dry

    Cook the noodles, drain, and lightly toss in your favorite dressing or sauce! Think low-sodium soy sauce, Italian dressing, vinaigrette, or teriyaki sauce.

    6. Get Creative

    There are dozens (if not hundreds) of Ramen recipes for you to try. There are even Ramen Noodle cookbooks! So don’t settle for boring noodles, spice it up with a creative recipe.

    Eating habits tend to change when entering college mode, as campus life warrants an active and hectic lifestyle. Quick, convenient and unhealthy meals often take center stage, landing healthy eating and cooking in the bleachers. When you’re looking to get creative with regular old Ramen, check out some of our health hacks. Think of it as teaching an old dog new tricks, but this time you’re the dog and the tricks are disguised as noodles. Bring your dorm room dining to a new level while also becoming more conscious of the ingredients your putting in your body!

    How do you make your Ramen healthier? Share your ideas below!

    Read More

Pulmonary Hypertension Q&A

by Pulmonary Hypertension

Ask the Expert: M. Patricia George, MD

Question: What are the different types of lung disease?

Answer: Lung disease is a huge category that includes many diseases. One simplified way to think about the different types of diseases is by where in the lung they target. For example, there are diseases that attack the airways (the tubes in the lungs) such as COPD, asthma and bronchiectasis.

Then there are diseases that affect the lung tissue such as pulmonary fibrosis, coal miner’s lung. There are also diseases that affect the blood vessels such as pulmonary hypertension or pulmonary embolism (blood clot in the lungs).

And then there are diseases that can affect multiple parts of the lung, such as sarcoidosis which can affect the tissue or the airways or blood vessels. And lung cancers can come from different areas of the lung depending on the type of cancer.

Question: What do healthy lungs do that those with lung disease don’t?

Answer: Healthy lungs are responsible for respiration – the process of getting oxygen into our bodies and also getting rid of carbon dioxide. Our bodies need oxygen for cells to be happy and function properly.

We breathe nearly 25,000 times per day, and normally this all happens in a very efficient manner – so efficient and automatic that we are not usually aware of it. That is until we have lung disease. Lungs can become diseases in different ways that affect how this process happens, but in general when lungs become impaired in their function, this process requires more energy and effort.

Examples would be an asthmatic who becomes short of breath and very uncomfortable from narrowed and inflamed airways, or a patient with a serious pneumonia who has an infection that is filling the air spaces and not allowing this process to happen efficiently.

Question: How can I decrease my chances of lung disease?

Answer: Don’t smoke, or if you smoke cigarettes, quit. This is the number one step to decreasing chances of lung disease – especially COPD and lung cancer. Avoid second hand smoke.

Test your home for radon (while cigarette smoking is by far the greatest risk factor for developing lung cancer, radon is the second leading cause of lung cancer in the United States). Avoid working with asbestos (and if your job requires it wear protective equipment) and protect yourself from dust and chemical fumes. Talk to your doctor about whether influenza and pneumococcal vaccinations are appropriate for you.

Question: If someone has pulmonary arterial hypertension (PAH) because of a Congenital Heart Defect and Bi-directional Shunting, is it possible they could also have PH because of Lung Agenesis/Hypoplasia or Restrictive Lung Disease?

Answer: Thank you for your question. Pulmonary hypertension can definitely be complicated, and can be due to a combination of causes.

And while congenital heart defect is likely the biggest contributor, there have been reports of pulmonary hypertension in approximately 19 percent of cases of unilateral agenesis of the lung (though it is more common in agenesis with someone who also has a left-to-right shunt) (Capuani et al. 1982). And yes, restrictive lung disease can contribute to PH as well.

Question: I am 72 years old, and I had Asthma as early as I can remember. In 2008, after frequent admission to the hospital without success of medications, I was then diagnosed with pulmonary hypertension. Do you think I had PH after all these years, or is it possible the Asthma turned into PH?

Answer: It is unlikely that asthma would “turn into” PH. What may be the case is that you have two lung conditions, or as you suggest, that your symptoms were in fact due to PH.

Without the details of your case I cannot comment specifically on whether either of these is true (or another explanation altogether). However I will say that it is not uncommon that PH goes undiagnosed for years before the correct diagnosis is made.

That is one reason we are working so hard to raise awareness about the disease – to physicians and non-physicians alike. The Pulmonary Hypertension Association has been leading this campaign called Sometimes It’s PH.

Question: The doctors told me I have PH about a month ago, and they said it was mild. I’m very scared and on no medication right now. I have another echo In June, and I currently feel okay and am still going about life. What is in my future with this?

Answer: Thank you for sharing your question and what you are feeling right now about having a new diagnosis – and undoubtedly a lot of questions that come with it – is completely understandable and overwhelming.

The good news is you “feel ok” and that they said it was mild, but the next steps I would recommend are discussing with your physician more about pulmonary hypertension. Ask them what the next steps are and whether you need more testing or to see a PH specialist (even if only for a second opinion). Also, there is a lot of good information (and not so good) info on the internet about PH (as well as other lung diseases).

I highly recommend going to the Pulmonary Hypertension Association website. This is a fantastic organization that can provide you resources both online as well as connect you with people who live with PH and can support you in this. You are not alone.

Question: I was diagnosed with IPAH last year and right heart failure which caused three heart attacks. I was really sick all winter but the summer before as I kept my normal walking and physical activities I didn’t have to be admitted. I did nothing in the winter but stay home doing nothing so I was hospitalized five times. I started my walking and am currently doing three miles a day without excretion keeping my Oximeter on and monitoring my HR. Will physical activities cause my PAH to get worse?

Thank you for your question and sharing your story. I’m sorry to hear you had a rough winter. It certainly was a rough (and long) one for all of us, especially those with respiratory conditions. In general, I am a big advocate of exercise when PAH is well-treated and the patient is seeing a PH specialist regularly.

Many PAH physicians agree that not only is exercise not harmful but that it may even be beneficial. That said, it is always important to talk to your PH specialist before starting an exercise program of any kind, and it is important to not exercise beyond the point where you have symptoms (light-headedness, chest pain, severe shortness of breath).

In patients who are starting out, pulmonary rehabilitation programs can be helpful in teaching safe limits of exercise as well as well-rounded programs. Plus, when you can do it, exercise is a part of actively taking an element of quality of life back. Good luck!

Question: I have PH and was diagnosed month ago. I also have sleep apnea. My doctor said I have a mild case. What is this disease outlook?

Answer: Although I do not have the details of your case to be able to talk to you about overall outlook, I will make a general statement to say that if you have mild PH, talking to your doctor about possible treatments as well as current risk factors that can make it worse would be helpful.

One such risk factor is sleep apnea. If you have untreated sleep apnea, which has been associated with pulmonary hypertension, treating it may help your condition. I recommend talking to your primary doctor and sleep doctor about this. Good luck.

Question: For those that are newly diagnosed with PH, how does a physician know which drug will be the best fit fit their patient when they determine they are in fact dealing with PAH.

Answer: After making that first step of establishing the diagnosis, of course the next challenge is deciding which treatment options are best to start.

When a PH doctor makes a diagnosis of PAH – pulmonary arterial hypertension – which means high blood pressure in the lungs due to a disease of the arteries in the lungs, the doctor also assesses other aspects of the patient’s case.

How sick is the patient at this moment and how have they felt recently? Is there involvement of the right side of the heart in their disease? Do they have any underlying heart or lung disease or blood clots? Have they been on any therapies before?

These are some of the questions that a PH doctor will try to answer before initiating therapies, as different treatments help depending on the pateint’s whole condition.

Question: My doctor’s philosophy is to wait for transplant until the last possible minute. Other doctors I’ve seen think it’s time now. What markers should be used to decide when it’s time?

Answer: In general, when patients are getting worse despite medical therapy, and there seem to not be other options available, it is a reasonable time to at least consider lung transplant. As a transplant physician, I would rather evaluate someone too soon (and if the patient is too healthy for transplant, hold off on listing and just follow them over time in the event that they worsen) rather than too late in the disease (when it becomes more difficult to try to address any medical or other problems that increase a patient’s risk for transplant).

Earlier evaluation allows the patient and family to learn more about transplant from the center, and address any concerns that may arise in the evaluation process.

Question: Could scarring from pneumonia be a reason for interstitial lung disease?

Answer: There are many forms of interstitial lung disease (ILD) (diseases that affect the lung’s structural tissue as opposed to diseases of the airways like COPD or asthma). And there are many known causes of ILD.

While I would not necessarily attribute ILD to scarring from a focal bacterial pneumonia, it is believed that lingering active infections or chronic ongoing infections may contribute to developing ILD.

Question: What are the factors that prevent you from being listed for lung transplant?

Answer: As for factors that prevent one from getting a lung transplant, this is also a complicated question, and varies based on transplant centers. But active smoking or active substance abuse, not going to the doctor or taking medications as prescribed are major “red flags.”

There are other factors that – depending on severity – may prevent one from getting a lung transplant such as other serious medical conditions (severe irreparable heart disease, kidney or liver failure, sepsis), but it is best to talk to a transplant center about the individual patient to explore whether transplant is an option.

At our center we definitely evaluate patients on an individualized basis as everyone is unique. So while I cannot tell you current life expectancy after lung transplant, I can give you the median survival data from the latest data from the International Society for Heart and Lung Transplantation.

In patients transplanted from 2004-2011 is a median survival of 6.1years. This means that at 6.1 years after transplant, 50% of recipients are still alive. This is not life expectancy per se, as we don’t really have good mathematical models to predict life expectancy after transplant.

Comments

comments

About Pulmonary Hypertension

The UPMC Division of Pulmonary, Allergy, and Critical Care Medicine is among the nation’s leaders in treating chronic lung conditions. As part of the one of the world’s leading lung transplant centers – with more than 1,400 lung and combined heart-lung transplants performed – our pulmonologists offer expert transplant evaluation for patients with life-threatening lung conditions. Through our disorder-specific specialty clinics, our physicians see and treat patients with a wide variety of respiratory conditions.