The following are random notes involving newer and important medical issues that are coming up more and more in my practice.

• The treatment of anaphylaxis is often "too little, too late", with sometimes fatal consequences.  Of course, a susceptible person should always carry an Epi-Pen or other source of immediate access to epinephrine.  And he or she should not be afraid to self-administer it when a generalized reaction is developing...rather be afraid of not using it.  If administered, the person should then go directly to the nearest hospital or urgent care center for further medical attention.  But the epidemic of obesity has resulted in cases where the usual needle length will not administer the epinephrin intra-muscularly, where it should go.  Also, one dose may not be enough to get you to the hospital.  Epi-Pen now comes in two dose sets.  Please talk to your doctor about these issues.  And remember, epinephrine is not used enough even in emergency rooms; you may have to educate the ER doctor in your behalf.
• Obstructive Sleep Apnea continues to exist in nearly epidemic form out there, often diagnosed only after the heart attack, after the stroke, or after the third auto accident.  In children, especially in those who snore, it is most often caused by large tonsils and adenoids and is cured by their removal.  Otherwise, the child may under-perform in school and be mis-diagnosed with ADHD; he or she may be considered a discipline problem; he may actually lose brain function due to prolonged lack of oxygen during sleep; or he may go into heart failure.   All avoidable by thinking about the diagnosis and following up with an overnight sleep study.  Please see our Category offering on this subject.
• Bronchial Asthma that occurs more than twice weekly and requires medication at those times requires a comprehensive diagnosis, including evaluation of underlying allergic factors.  Asthma of such severity should be treated with...among other things...inhaled steroids.  In most cases, such a patient should also receive Allergy Immunotherapy, since this is the only form of treatment that works to reverse the underlying immune mechanism causing the Asthma over a three to five year period of treatment.  (The anti-IgE antibody Omalazubab works only so long as it continues to be administered and for a few months after cessation of use).
• Severe Bronchial Asthma that is "steroid-resistant" is a special problem.  It can sometimes be resolved by switching from Prednisone or Prednisolone to Dexamethasone (or to Celestone, if it ever returns to the market).  In addition, it has been reported recently that low Vitamine D stores can pre-dispose to steroid-resistant Asthma...and that restoration of adequate Vitamine D stores (to higher than traditional levels) may reverse the resistance.
• In fact, in the last few years low levels of 25-OH Vitamine D have been found with increasing frequency, for a variety of reasons, and this may be the reason for a multiplicity of complaints centering around chronic muscle and joint pains.  Easily diagnosed, and easily treated.  But first it must be thought of.  "Call your doctor".
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