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Month: April 2019

Have a piercing migraine? Get an ear piercing! (? or maybe not…)

Have a piercing migraine? Get an ear piercing! (? or maybe not…)

If you haven’t heard of a Daith piercing, you are not alone.  That is the proper name for an earring that is placed through that little triangle of cartilage that sits in the front middle of the entrance to our ear canal.

Whether this is fashionable or not is almost as debatable as whether or not it can help headaches.  There is a large community of migraine sufferers out there who swear that having a Daith piercing has cured or significantly ameliorated their chronic headaches, but just as many people exist who report no abatement in their symptoms.

The idea behind why it may work is rooted in acupuncture/acupressure, since the tragus (that little cartilaginous area) is a known pressure point target in those techniques.  One of the early advocates of this piercing (Dr. Will Foster) believed that having a piercing there provided constant pressure and therefore constant relief/effect on the correlating body systems.

Many people’s migraines correlate with GI symptoms (i.e. food triggers or association with stomachaches) and since that spot relates to digestive organs, it would seem to follow that it could help those select patients, but certainly not all migraines have a GI corollary and that may be one reason for the disparity in the effectiveness of this piercing.  The thing most neurologists would tell you though, is that there is NO evidence or research to back up the claim that a piercing can cure a headache, and most docs would warn against getting one, especially since that specific spot on the ear can take quite a while to heal, and is one of the most common sites to get infected.  That being said, if you are already planning on getting one and happen to be a migraine sufferer, there is a chance that you may get an unexpected side benefit other than the aesthetic.

If you aren’t into body jewelry but are still interested in non-pharmacologic treatments, other options include Botox, acupuncture, massage, biofeedback, cognitive behavioral therapy, chiropractic spinal manipulation, yoga, tai chi, and hypnotherapy.  If you have tried all of that already, and have gone through med after med, then you may be a candidate for surgery.  Yes surgery, for a headache.  MISON and MIGONE are only two of the recent surgeries being utilized for treatment of refractory migraines, but they certainly are not for everyone, and a typically a last resort.  Talk to your neurologist for more information.

Dear Dr. K: I’ve been taking fish oil for years, but just showed up “+” to cod on my allergy testing form. Do I need to stop taking it?

Dear Dr. K: I’ve been taking fish oil for years, but just showed up “+” to cod on my allergy testing form. Do I need to stop taking it?

The short answer is NO.  First off, a single plus sign on your testing form represents the mildest of reactions; more of a potential sensitivity than a truly clinically significant allergy (especially if all your other fish and shellfish were negative across the board).  Secondly, even if you did have major atopic complications due to fish or shellfish, those should not translate to fish OIL, since all allergens, by definition, are (molecular-structurally-speaking), proteinaceous.  Fish oil’s name says it all, it is an OIL, which is a fat, not a protein.  High quality fish oil products should and will be devoid of proteins.  However, when you start bargain shopping and settle for those made under less stringent manufacturing regulations, you can end up with less pure, more contaminated capsules, which may contain not only some tiny modicum of fish protein, but also other fillers which may be allergenic or irritating.

Now for the longer answer:  Even though you should be able to safely take high quality fish oil products, why would you?

The debate over omega 3’s and fish oil has been an exceedingly murky and highly contentious area in medicine for the past decade or so.  In 1999, a famous study showed that patients taking omega 3’s were 10% less likely to get heart attacks, strokes, or die from cardiovascular disease, so for years PCP’s and cardiologists were putting everyone on them.  However, since then, a myriad of studies has come out with varied and conflicting results.  One of the most well known was in 2012 where the highly respected JAMA showed no reduction in MI, stroke or death.  The problem with many articles is that they focused on patients with established CVS disease, who were often taking potential confounding prescriptions, and many used what critics stipulate were subtherapeutic doses of the study drug.  Finally, in 2018, the “VITAL” study came out which looked at healthy subjects.  They found that a gram of Lovaza was effective as a primary prevention for heart attacks – but not for stroke, cancer, or all causes of cardiovascular death.  So, what are you to do with all this gobblygook data?  Even the most recent critical review on the topic from March 2019 hedges a little in their recommendations, saying that better studies need to be done in order to confidently advise patients, but for now, given the fact that omega 3’s pose little risk and have few adverse effects, but great (or as some argue, proven) benefits, they won’t discourage their use in healthy subjects, and they (and the AHA) still advise certain high risk patients to continue supplementation.

The bottom line?  The jury’s still out on if and how much fish oil is needed for cardiovascular health (and even further away from settling the debate over its use for inflammatory, neurologic, and psychiatric conditions), but since it probably won’t hurt, there’s no harm in trying it (other than to your wallet).

The one area everyone is in firm agreement on is that ensuring sufficient daily omega 3 intake, whether through diet and/or supplementation is essential in pregnancy.

Got a Sweet Tooth?

Got a Sweet Tooth?

Maybe not. If you are someone who used to crave salty snacks but recently have found yourself salivating at the thought of a Hershey’s bar, it may not be just a sweet tooth, but in fact, a real medical problem.

Chocolate cravings specifically can often be a sign of Hypomagnesemia, since the Cacao plant is one of nature’s biggest magnesium sources.  You may also find yourself craving sweets if you are lacking phosphorus, sulphur, chromium, or tryptophan (although it is quite uncommon to see deficiencies of the latter in the Western world).

More common deficiencies include calcium, which can manifest as cravings for cheese or soda and fizzy drinks and iron, which can present as cravings for red meat, coffee or black tea, or ice (a condition known as Pica).

There are many reasons for people to become deficient in certain vitamins or minerals.  One of the biggest factors is the generally poor Western diet, which for a lot of people tends to include too much processed fast food, and not enough leafy greens, crisp veggies, or juicy fruits.  Other factors that can lead to an imbalance in nutrients are kidney disease, liver disease, malabsorption from the GI tract, or various side effects of medications.  These tend to increase in prevalence as we get older, but any of these reasons can affect people of all ages, so if you find yourself all of a sudden craving food you never used to care for, it may be a good idea to check in with your primary care doctor to get some of your levels checked.  (Or take a pregnancy test…pickles anyone?)

Q – Tips: “tastes like chicken”

Q – Tips: “tastes like chicken”

The journal “Pediatrics” recently reported cases of severe (anaphylactic) food allergy to crocodile meat in children known to be allergic to chicken.  Chicken and crocodile share a common protein called a-parvalbumin that can lead to the cross-reactive allergy.  Maybe there is some truth to the old expression “tastes like chicken”.

Q – Tips: Nitric Oxide

Q – Tips: Nitric Oxide

Nitric oxide has recently been found to be an effective therapy for people with “atypical TB” known as Mycobacterium abscessus.  The inhaled nitric oxide gas is an alternative to having to take an oral therapy of three different antibiotics.

Q – Tips: Primatine Mist

Q – Tips: Primatine Mist

The FDA has approved the return of Primatine Mist to OTC (over the counter) availability after its removal in 2011.  Many medical organizations, including the American Thoracic Society, have concerns about its misuse which can lead to asthmatic deaths.  It contains aerosolized epinephrine which can serve as a rescue medication but does not act as a controlling medicine for the asthmatic condition.  Also, pure epinephrine has potential to be a cardiac irritant.