Health Features

Ask the Specialists

I always have had seasonal allergies. This year has been worse than ever, but I really don’t like to take medicine. Is there another therapy you recommend?

seasonal allergies 
Dr. Hamsa Subramanian, allergist and immunologist
Signature Medical Group
Some allergy patients say they don’t like to take medications because they worry about ingredients like steroids or side effects such as drowsiness. Unlike some other health conditions, prevention doesn’t lead to a cure because you often can’t escape what causes your allergies. Researchers think symptoms are increasing because ozone levels, rising temperatures and smog contribute to high pollen concentrations. My first advice for people with symptoms affecting quality of life is to see a physician and follow his or her instructions. This especially includes patients with allergy-related conditions like asthma, insomnia, headaches, sinus infections and ear problems.

A number of medications are known to be safe and effective, but those who still don’t want to take them may find allergy injections a good alternative. The first year of therapy can be time consuming because you have to build up the dose weekly in the beginning, then switch to every two, three and then four weeks. But after treatment, many people only need medication occasionally and some can wean off of it altogether.

Patients also can try changing their habits and surroundings to reduce the effects of allergies. It’s not a perfect solution to the problem, but it may help. Try grooming household pets often, and keep them out of the bedroom. Keep windows closed, wear sunglasses when outdoors, use artificial tears, and stay informed about pollen counts. Pollen levels tend to be lowest before dawn, in the evening and after rain showers, so plan your outdoor exercise and activities accordingly.

An honest conversation with your doctor is the most important part of the plan. A good allergist will listen to the patient’s concerns, dispel any misconceptions and create a treatment plan to fit the person’s lifestyle and preferences.

I am in my 40s and have noticed that occasionally, I become disoriented and turn the wrong direction or misplace things. I am concerned; my mother developed dementia in her 70s. What tests do you advise, if any?

neuropsychology
Andrew Menatti, Ph.D., clinical neuropsychologist
St. Louis Center for Cognitive Health
In my practice, I often see patients with questions like this. I wouldn’t be concerned about dementia or testing in your 40s; neurodegenerative disease isn’t generally problematic until your 70s or 80s.

With that said, many people your age become concerned if they can’t focus or remember things as well as they used to. That’s very common. It’s important to realize that as magnificent as our brains are, they are far from being perfect storage vessels. They have a lot to process! In the days of early cave-dwellers, people hunted, picked berries and did the same simple things all of the time; their lives were not cognitively demanding. Now, however, we multitask with phones and computers and have to be in several different places each day.

In some ways, it seems that modern life has outpaced the brain’s capacity to stay on top of things, but there are techniques we can use to stay on track. It’s an issue of organization and knowing what factors affect your memory. My first question to patients in their 40s is: How organized are you? Do you use a calendar, smartphone, to-do lists and GPS to help you stay on track? If not, put those aids in place. Do you have major drama or stress in your life? Are you only getting a couple of hours of sleep at night? These factors can affect your thought processes as well, which means you have less thinking power to keep track of car keys and highway exits. It’s a good idea to ask a family member—someone who will be objective with you—if you have seemed more forgetful lately. If so, you may want to talk with your doctor.

Use these suggestions first, and if problems persist, your doctor can order testing for neurological disease later. If you undergo tests and the results are normal, that’s good news; now you have baseline data for doctors to look at if issues arise 20 or 30 years from now.

My father is 75 and had bypass surgery when he was 70. I am 42 and wondering if I should have a heart screening. If so, what tests should I have, and what will they show?

cardiac health 
Dr. Michael Lim, cardiologist
SLUCare Physician Group
This is always a good question to ask. With heart health, there always are opportunities to avoid following the same paths as our predecessors; it’s all about being proactive on your own behalf. The disease process that leads to heart attacks generally happens over many years with the accumulation of cholesterol and buildup of plaque in the coronary arteries. It may even start in your 20s and progress slowly, so you shouldn’t wait until your 50s or 60s to give it some thought.

It’s a great idea to talk with a cardiologist about your family’s history and your own health. Things that increase risk include high blood pressure, diabetes, smoking, high cholesterol and lack of exercise. Look at the history of these things in first-degree relatives.

Human nature often makes us want to test everything, but if you have no symptoms that suggest narrowing of the arteries, tests actually may not be helpful. They don’t always lead doctors to the ‘pot of gold’ and should only be done selectively. A well-known example is that of TV commentator Tim Russert. He had a stress test right before the heart attack that took his life, but it didn’t show anything major. That’s the conundrum of testing procedures; having a lot of them done doesn’t mean you are better off than if you only have them performed selectively.

If your 10-year risk of heart problems is low, doctors can suggest proactive methods like improving your diet and sticking to an exercise regimen. If your 10-year risk is intermediate or high, we can work on lowering blood pressure, controlling diabetes and bringing cholesterol down. If you are concerned because a relative has had heart problems, don’t be afraid to ask your doctor whether testing is needed. We are great coaches and want you to have the best chance at good health.

I deal with depression on a daily basis and haven’t found any medication that really seems to help. What does TMS (transcranial magnetic stimulation) therapy involve, and how long would treatments last for a long-term solution?

depression and tms
Kim Mercille, RN, founder and CEO
TMS Therapy Centers of Saint Louis
Depression, a debilitating condition, affects more than 16 million American adults and about 20 percent of adolescents, and suicide is the third most common cause of death in people ages 10 to 24. Not included in these statistics are all of those who suffer silently for a variety of reasons. TMS therapy was approved by the FDA in 2008 and offers an effective alternative to conventional therapies like antidepressants. Most major insurance carriers and Medicare cover the treatment for adults who haven’t benefited from medication.

TMS is a noninvasive, highly safe, outpatient therapy that takes about 20 minutes, doesn’t require sedation or surgery, and doesn’t cause any systemic side effects. The patient is seated, and the system delivers pulsed magnetic fields to stimulate specific neurons in the brain. After repeated stimulation, the nerve cells begin to ‘wake up’ and produce chemicals called neurotransmitters that are thought to be lacking in people with depression. Patients receive treatment five days a week for about six weeks. It’s not a permanent cure, but results can last up to two years. About 84 percent of patients receive significant benefits, and more than 74 percent achieve remission for a period of time. Maintenance therapy sessions may be required if symptoms begin to reappear.

Alternatives like TMS are important because many people have treatment-resistant depression that does not respond well to antidepressants. These patients battle persistent sadness, sleep problems, fatigue, low energy and suicidal thoughts despite trying multiple medications. Over the years, antidepressants actually have become less effective and sometimes they even make symptoms worse, but they used to be the only option. TMS is an important solution that improves quality of life and saves patients’ lives.

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