health

Multi-Generational Households Must Remain Vigilant

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 28th, 2020

Dear Doctor: Our family -- ages 66, 59, 27 and 22 -- lives in one household. We’ve been working from home and keeping socially distant since the start of the pandemic. Now the younger members wish to resume outside employment. How do we safely manage their return to work?

Dear Reader: The challenge in multi-generational households like yours is keeping the older members safe. The answer lies in the basic precautions we’ve learned to take during this pandemic, along with an added layer of vigilance and awareness. We may sound like a broken record by now, but that means wear a mask, maintain distance from people outside of your household and be consistent about washing your hands. We tell our patients to assume that each time they leave their homes, they will encounter someone infected with the coronavirus, and to behave accordingly. Considering the spiking infections across the nation at this time, that’s not an exaggeration.

When it comes to the younger people spending time outside the family bubble, you’re talking about an increased level of risk. Any risks they take outside of the home, they bring home with them. While in the workplace, they need to wear a good mask at all times, and continue social distancing as much as possible. The fabric of a mask not only limits the distance someone’s breath will travel, it also provides a physical barrier that can protect the wearer as well. That’s important because we now know that some transmission of the coronavirus is airborne. We also know that some individuals can be infected with the virus but have either no symptoms or symptoms that are quite mild. They’re lucky enough not to feel sick, but, unfortunately, they are still able to pass the virus along to other people, who may become quite ill.

Physical distancing remains important. Studies have made a connection between viral load, which is the concentration of virus someone is exposed to, and the severity of subsequent infection. The further away you stand from someone, the less their exhaled breath can reach you. When combined with a mask, social distancing can measurably reduce your risk of coming into contact with the virus. And, because viral particles can also be carried via droplets that land and persist on surfaces, washing or sanitizing your hands, as well as high-touch surfaces, remains important.

Your family should discuss their comfort with risk, then decide the steps to take to address it. This can include no physical contact, sequestering in different parts of the home and even wearing masks in each other’s presence. Ventilation is important, so if your climate allows, keep windows and doors open, and spend time together outdoors. Remain alert for COVID-19 symptoms, which include fever, chills, exhaustion, difficulty breathing, headache, gastric upset and sudden loss of taste or smell. If someone begins to feel unwell, or has contact with an infected source, they should isolate from the rest of the family immediately to prevent spread. If you follow these measures and don’t let your guard down, the risk of infection and transmission will remain low.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

health

Dad's Diabetes Causes Painful Peripheral Neuropathy in Feet

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 25th, 2020

Dear Doctor: My dad is 65 years old and has Type 2 diabetes. He recently developed pain in his feet, which his doctor says is peripheral neuropathy. What is that, and what treatments are available?

Dear Reader: Neuropathy is a condition in which the nervous system malfunctions due to either disease or some kind of damage. The addition of the word "peripheral" means the problem lies in the vast and complex network of nerves that serves the body.

The peripheral nervous system collects and sends vital sensory information to the central nervous system, which is made up of the brain and the spinal cord. When you drop that hot frying pan handle, break into a sweat on a hot day or keep your balance with your eyes closed, that's all thanks to information your peripheral nervous system has sent to your brain.

It's estimated that 20 million people in the United States experience some kind of peripheral neuropathy. Sometimes the damage is limited to a single nerve, but most often the condition affects groups of nerves. Symptoms include numbness, twitching, throbbing or tingling, burning sensations, problems with balance, or skin sensitivity so acute that ordinary stimuli, like the touch of a shirt on bare skin, are interpreted as pain.

When the motor nerves are affected, peripheral neuropathy causes muscle weakness and can often lead to the loss of muscle mass. If the nerves that serve the organs or glands are involved, it can result in impaired digestion, perspiration, urination or sexual function. At its most extreme, peripheral neuropathy causes breathing difficulties, or leads to organ failure. Fortunately, this is rare.

Diabetes is the most common cause of peripheral neuropathy. Other factors include infections such as shingles or the Epstein-Barr virus, certain kidney disorders, vitamin deficiencies, physical damage, cancers that press on or infiltrate nerve fibers, or autoimmune diseases that cause the body to attack its own tissues. Exposure to toxic industrial and environmental substances such as lead, arsenic or pesticides as well as medical agents like chemotherapy drugs can also lead to the condition. So can heavy alcohol consumption.

Your father's symptoms began in his feet, which is common among people with diabetes. He may also experience numbness, a decrease in foot and ankle reflexes, trouble with balance and coordination, and an increase in foot problems like ulcers and infections. This is due to tissue damage resulting from chronic high blood glucose levels, as well as decreased circulation, which occurs because diabetes causes the blood vessels in the foot and leg to become stiff and grow narrow.

Treatment for your father's condition will focus on two things -- carefully controlling his diabetes to prevent further nerve damage, and giving him relief from the existing pain. Mild pain often responds to over-the-counter NSAIDs. Medications like antidepressants, anticonvulsants and narcotics are used for chronic pain. Procedures like electrical nerve stimulation have shown promise. Physical therapy and specialized footwear can also help.

Pain treatment is often most effective when there's an ongoing dialogue. Be sure your dad shares all his symptoms with his doctor, and follows up with regular progress reports.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

health

A Mid-Afternoon Nap Is One of Life's Great Pleasures

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 23rd, 2020

Dear Doctor: My Type A husband, who naturally falls asleep for about 25 minutes on weekend afternoons, complains that he's wasting time when he does so. How do I explain to him the benefits of napping?

Dear Reader: Millions of people throughout the world take a daily nap. In many cultures the afternoon sleep break is built right into everyday life. Businesses close shop and everyone heads home for lunch and a bit of shut-eye.

Here in the goal-oriented United States, though, napping carries a bit of stigma. It sounds as though your husband has internalized that feeling, which is too bad because you're correct -- a daytime nap is often a good thing.

Studies show that napping does more than just reduce fatigue. It can elevate your mood, improve productivity and make it easier for you to learn and retain new information.

However -- and this is where things get a bit tricky -- not all naps are equally beneficial. It turns out that what time you nap and how long that nap lasts make a difference.

A nap as brief as 10 minutes and up to 30 minutes can leave you feeling energized. Sleep much longer than half an hour and chances increase that you'll wake in a mental fog. The reason for all this is that sleep is quite complex. Not only are there several different stages of sleep, they occur in distinct cycles.

When you first drift off, you move from light sleep, from which you can awaken easily, into stages of ever-deeper sleep. Your brain waves and even your brain chemistry change. It becomes progressively more difficult to awaken. People in the stage known as "deep sleep" show no muscle or eye movement.

The other stage of sleep is known as REM sleep, which is short for "rapid eye movement." This is the cycle during which you dream, and in which the brain registers significant electrical and chemical activity. Fall short on REM sleep and it's quite possible you'll wind up feeling cranky or irritable.

Which leads us back to the question of optimal napping.

First -- what time to close your eyes. Sleep experts agree that mid-afternoon is optimal. Your body clock is naturally primed for a break, and it's far enough away from bedtime so as to not interfere with your night sleep.

Next, the reason why a brief nap feels best.

It takes about 90 minutes for your body (and brain) to go through a complete sleep cycle. Sleep too little and you've barely grazed the surface of light sleep. Sleep too long and you're swimming up from the groggy depths of deep sleep. Aim for 20 to 30 minutes, which puts you into the earliest stages of REM sleep and lets you wake up easily, feeling refreshed.

For the best naps, choose a location that's dark and quiet. Lying down results in better sleep than sitting or reclining. Setting an alarm will let you relax into your nap and assure that you'll wake up before deep sleep takes hold.

When you wake up, take a moment to stretch and take a few deep breaths. And enjoy. A good nap is one of life's real pleasures.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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