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“最近的研究已經著眼於即使在嚴重的哮喘患者中也能很好地控制哮喘的能力。如果我們能夠做到這一點,則人們應該能夠進行任何水平的鍛煉。他們應該能夠上班不要錯過幾天,就像上學一樣。說實話,只要哮喘得到控制,天空就是極限。”<br />-溫德爾&middot;里士滿(Wendell Richmond)博士<br />有時,您可能會感到自己患有疾病。事實是,許多哮喘病患者都有相同的令人沮喪的症狀和情緒過山車。聽取其他HealthTalk哮喘教育網絡成員的意見,並分享您自己有關哮喘如何影響您的生活質量的故事。尋找解決方案來應對和控制這種潛在危險但通常可以控制的疾病。<br />該程序由HealthTalk製作,並通過Genentech和Novartis的無限制教育資助進行贊助。<br />播音員:歡迎觀看此HealthTalk網絡廣播。在開始之前,我們提醒您,本網絡廣播中表達的觀點僅是我們客人的觀點。他們不一定是HealthTalk,我們的讚助者或任何外部組織的觀點。而且,一如既往,請諮詢您自己的醫師以獲取最適合您的醫療建議。<br />瑞克&middot;特納(Rick Turner):工作日缺勤,缺勤,去醫院旅行-如果這些情況是您日常生活的一部分,那麼您的哮喘很可能無法控制。今晚,我們將研究哮喘對患者生活的真正影響,我們將提供應對和控制疾病的解決方案。<br /><br />我們很高興能與兩位醫療專業人員在一起,他們致力於幫助哮喘患者控制疾病。首先,我想向您介紹Wendell Richmond博士,他是伊利諾伊州Oakbrook的Oakbrook過敏症專科醫師。今晚在奧克布魯克過敏症專家的陪同下,在我們的座談會上還有註冊護士唐娜&middot;斯塔薩克(Donna Staszak)。<br />現在,我希望您認識Carol Mersman。卡羅爾是一名哮喘患者。她是芝加哥地區的居民,她很樂意今晚加入我們。謝謝你在這裡,卡羅爾。<br />卡羅爾&middot;梅斯曼(Carol Mersman):謝謝您邀請我。<br />瑞克(Rick):您是如何第一次得知自己患有哮喘的?<br />卡羅爾:我10歲時父母帶我去了兒科醫生。我會花時間在有動物的朋友家中,然後我會喘息和打噴嚏回家,他們終於意識到他們需要為此做些事情。<br />瑞克:他們立刻意識到這是哮喘嗎?<br />卡羅爾:不,他們沒有。他們認為那隻是過敏。去醫生做了幾次診斷。<br />瑞克(Rick):您已經生活了很多年。您知道什麼觸發了您的攻擊嗎?<br />卡羅爾:是的,我願意-豚草,香煙煙霧和寵物皮屑。<br />瑞克(Rick):我相信這些年來一直有高潮和低潮,可能對您來說是治療哮喘的好方法。您是否想與我們分享一個特別低的時刻?<br />卡羅爾:絕對低點是我岳父家的平安夜。他們有兩隻小狗和一棵活的聖誕樹。參觀他們的房子後,我將去急診室,所以那不是一個有趣的經歷。<br />瑞克:總的來說,卡羅爾,您如何說哮喘影響了您的生活質量?<br />卡羅爾:我真的限制自己只能和動物在一起在朋友的房子裡,在樹木或豚草季節也要在外面。<br />里克:你避免運動嗎?<br />卡羅爾(Carol):是的,我會[避免運動],因為我會一直呼吸困難。<br />瑞克(Rick):多年來,請給我們一連串的治療方法。<br />卡羅爾:我的兒科醫生讓我服用Theo-Dur(茶鹼),還有Ventolin(albuterol)。他們當然嘗試了普米克[布地奈德],賽文特[沙美特羅],因他莫爾[cromolyn]和潑尼松。<br />瑞克(Rick):卡羅爾,現在告訴我們您目前的治療計劃以及它如何為您服務。<br />Carol:我目前的治療計劃是我服用的是最低劑量的Advair 100 [沙美特羅/氟替卡松]。我也每月一次使用Xolair [omalizumab]。效果很好。我根本不使用沙丁胺醇。運行的很棒[ly]。<br />瑞克:今天的生活質量如何?與五年前相比。<br />卡羅爾:我什至都不知道自己得了這種病,除了我每月服用Xolair注射一次之外。我什至沒有意識到我患有哮喘。<br />里克:我很高興一切都為您工作,很高興您今晚與我們在一起。<br />卡羅爾:謝謝你。<br />里克:現在讓我們回到里士滿博士。聽卡羅爾的經驗,您認為這是您在實踐中所見到的典型患者嗎?<br />G.溫德爾&middot;里士滿博士:是的,我想這可能很典型。當然,哮喘是一種頻譜疾病,從輕度到嚴重到像Carol一樣嚴重。但是,我認為對於那些疾病較為持久的人來說,這並不是我們所聽到的異常。<br />瑞克(Rick):像卡羅爾(Carol)一樣,每個過敏的人都有自己的觸發因素,他或她自己的免疫系統實際上會對反應過度。我們已經提到過一些常見的誘因,使過敏性哮喘的人特別容易感染:例如動物皮屑,塵蟎,黴菌暴露。為什麼對於過敏性哮喘患者來說,確定其個人觸發因素很重要?<br />里士滿博士:我認為一旦他們了解了自己的個人觸發因素,便希望他們能夠避免這些事情。正如Carol所建議的那樣,其中某些事情很難避免。實際上,如果它們是季節性問題或家庭參與,有時會很困難。但是,理想情況下,我們可以避免這種情況,如果不能避免的話,也許我們可以採取一種稍有不同的方法來治療,這可能會減少這些症狀的發生頻率和嚴重程度。<br />瑞克(Rick):在弄清一個人的個人觸發因素是什麼時,您該怎麼做?<br />里士滿博士:有幾種不同的方法。當然,歷史非常重要。我們花費大量時間記錄病史,希望有一段相當詳細的病史來了解觸發因素是什麼-基本上,患者教醫師是因為他們了解病史。<br />一旦我們從發生的事情的歷史中獲得了一個想法,那麼我們當然可以看看過敏原是否是一個因素。然後,我們來看看試圖確定哪些過敏原是有問題的。<br />瑞克:你怎麼做到的?<br />里士滿博士:那是在尋找在某些情況下識別對樹木,草木,房屋灰塵,蟑螂等東西的過敏抗體的能力。可以通過皮膚測試[或]進行血液測試[完成]。<br />瑞克(Rick):今晚,我們將聽到哮喘患者面對的一些常見情況和症狀的例子。當我們談論如何避免人為觸發時,通常是在家裡談論迴避策略,即您可以控制的環境。但是,在戶外,您可能沒有太多控制權。里士滿博士和唐娜(Donna),請回复此案例研究,探討季節性觸發因素。<br />案例歷史1:我患有中度哮喘,而我的誘因是花粉和黴菌。在春季和濕度高的時候,我會更多地使用救援吸入器。在春季和夏季如何控制哮喘?<br />里士滿博士:如果我們有一個個人擁有這種類型的暴露,我們希望減少暴露量。這可以通過幾種不同的方式來完成。顯然,第一件事是患者了解問題所在,然後嘗試避免該問題。我們可以通過空調來做到這一點。空調有很大幫助。我認為修改我們的治療方法會有所幫助。<br />里克:在我們找您之前,唐娜,我想听聽卡羅爾的意見,看看她在避免季節性因素方面是否有個人經驗。<br />卡羅爾:當我要計劃外面的一天時,就像里士滿博士所說的那樣,我會增加藥物治療。我會額外噴鼻,以防止自己患有哮喘或過敏發作。<br />里克:唐娜,你還要加些什麼?<br />唐娜:我們與一些患者討論過的其中一項有用的事情是將花粉放在外面。不要把它帶到室內。 [嘗試]晚上睡前洗頭。做兩次。花粉不要放在枕頭上。每周可能要多洗一次枕頭套。其中一些可以幫助您。通常,只有您的動物,如果您家中有任何動物,這些動物也會攜帶很多皮屑,因此它們也會將過敏原也帶進去。他們正在將其移至家具,枕頭和地毯上。您只需要真正地監視實際上有多少外部進入,特別是在高峰時段。服藥前。即使您不想,也請在旺季時每天服用藥物。很多人不想每天都吃藥,但是您確實需要。<br />瑞克(Rick):地理因素也會影響個人觸發因素。我們的下一個案例研究質疑,搬到該國的其他地區是否可以改善一個人的哮喘症狀。<br />案例研究2:我的女兒在太平洋西北地區長大,現在住在拉斯維加斯地區。自搬遷以來,她的哮喘病似乎更嚴重了。她可以在某個地方逃脫季節性誘因嗎?<br />里克(Rick):現在,最初,我很驚訝聽到這一消息,因為我認為西北太平洋地區的花粉會更多。 [當您搬到沙漠時,情況應該有所改善,但情況恰恰相反。<br />里士滿博士:我認為這就是我們當今所看到的東西。 [說] 40年前的30年,我們會說:“好吧,向西南移動,情況將會變得更好。”我認為我們已經看到每個人都向西南遷移。不幸的是,他們帶來了所有的植物。花粉在下方的問題經常和這裡的一樣多。人們已經進口了豚草以及該地區的其他所有東西。如今你可以去哪裡?好吧,我會告訴人們我想成為的地方,您可以想像您在夏威夷群島中,而您在太平洋一側,隨風飄揚。那是一個很棒的地方。<br />里克:聽起來對我很好。<br />里士滿博士:海風吹拂,您可能會選擇北極或南極,但除此之外,您確實會遇到麻煩。我認為這種情況還提出了另一點。遺傳上易變態的個體易患過敏。患有過敏症的人會隨著時間的推移而看到過敏症的變化。因此,如果您從位置A移到位置B,通常的建議是,在該位置移動的三年內,您將開始對該區域的那些花粉產生症狀。您永遠無法完全逃脫,因為從基因上講,您已經獲得了變態反應的天賦。<br />里克:唐娜,你想添加什麼嗎?<br /><br /><br />唐娜:我認為患者會這樣說,尤其是在他們快退休的時候,``我能去的最好的地方在哪裡,所以我不必處理我現在一直在處理的事情?''我認為,沒有地方只是患者教育。最終,您將對德克薩斯州的風滾草過敏。沒關係同樣,它可以控制疾病,即使您感覺良好也可以繼續使用這些藥物。它在這裡與您同在,它將繼續存在。<br />里克:哮喘患者的另一個難題是寵物。我敢肯定你在辦公室裡已經談論過很多。讓我們聽聽下一個案例研究,並讓我們的小組回應。<br />案例研究3:我的狗是我最嚴重的哮喘病誘因之一。我真的很喜歡服藥,但我對皮屑仍然很敏感。除了捨棄我的狗,我還能做其他什麼嗎?<br />里士滿博士:菲多(Fido)使這個人生病了。正確的答案是,您應該猜出來,是那隻狗移到克利夫蘭,而她留在這兒。<br />里克:那還短嗎?<br />里士滿博士:我會告訴患者,當然,他們看著我,只是搖了搖頭說:``那不會發生。如果我們知道寵物會造成問題,那麼我們希望將該寵物排除在我們花費大部分時間的一個區域之外。那是臥室,因為如果您每天睡八個小時,那是一天在一個區域中的三分之一。顯然,設法使臥室盡可能不帶寵物是一個明顯的優勢。然後我們進入一個問題:“我應該洗寵物嗎?”這似乎減少了來自這種特殊寵物的過敏原數量嗎?研究表明,事實上,洗寵物可以減少過敏原的數量。研究表明,實際上,您可能至少需要每周至少洗一次寵物,才能使其最有效。<br />瑞克:洗貓嗎?<br />里士滿博士:用爪子洗貓是非常困難的。那將是困難的。當然,另一件事是“嗯,我應該買空氣淨化器嗎?有什麼幫助嗎?”我們經常聽到這個問題。不錯,是的,有些空氣淨化器,實際上大多數空氣淨化器都會減少寵物的數量,無論是貓,狗還是友善的豚鼠,都會減少空氣中的這種過敏原。<br />里克(Rick):(唐娜)[您有什麼要補充的東西要處理的寵物嗎?<br />唐娜:我們都想控制住自己,所以我認為他們只需要更頻繁地抽真空,最好是讓別人抽真空,這可能會更好。今天出現的新型真空吸塵器系統對患者也有幫助,無袋吸塵器會更好。並且,當然,讓寵物不在他們的區域內[會有所幫助]。<br />瑞克(Rick):超過2000萬美國人患有哮喘病,但研究表明,許多哮喘病患者可以做更多的事情來控制自己的疾病並減輕症狀。今晚我們已經提到控制很多次了。里士滿醫生,請為我們定義控制哮喘的意義。<br />里士滿博士:有五個領域可以確定控制權。第一,我們要確保個人沒有症狀,或者盡可能沒有哮喘的症狀。第二個方法是減少病情加重的頻率-您多久患一次哮喘[症狀]。我們不會惡化或很少惡化。活動級別-活動級別,實際上是您的社交活動級別還是運動活動級別-應該是正常的。我們不希望看到任何人受到哮喘的任何限制,我認為這是非常重要的一點。不幸的是,人們常常會藉口說:“我得了哮喘。我不應該參加活動。”<br />我認為,盡可能少地使用急救藥物也是重要的一點。我們希望擁有相對正常或接近正常的肺功能數據。最後,患者的心臟附近和親愛的東西是他們希望使用某種非常安全且耐受性良好的藥物。<br />里克:整夜睡覺的問題-當您受到控制時,這有多重要?<br />里士滿博士:這是非常好的一點。當個體的哮喘惡化時,他們的主要問題之一就是他們會在深夜醒來。如果哮喘得到很好的控制,那就永遠不要醒來。<br />里克:關於養寵物,我們問的問題是哮喘控制了你或反之。從某種意義上講,如果您是因為哮喘而避免養寵物,那對您來說是正確的,對嗎?<br />里士滿博士:[完全正確。<br />瑞克(Rick):我知道當哮喘得到控制時,患者實際上不應以任何方式受到限制。儘管患有哮喘可以達到什麼目的?<br />里士滿博士:我認為最近的研究已經考察了即使是在嚴重的哮喘患者中,也能非常好地控制他們的哮喘的能力。如果我們能夠做到這一點,那麼個人應該可以在任何水平上鍛煉。他們應該能夠上班,並且不會錯過工作日,這與學校一樣。坦白說,只要您的哮喘病得到控制,天空就是極限。<br />瑞克(Rick):當然,我們已經看過哮喘運動員的電視廣告。<br />里士滿博士:世界上最快的女人曾經是哮喘病。這表明,如果您控制了哮喘,那麼哮喘將無法控制您。<br />瑞克(Rick):有不同種類的哮喘藥物。長期控製藥物(例如吸入皮質類固醇)與速釋藥物(例如沙丁胺醇)之間有何區別?<br />里士滿醫生:定義為沙丁胺醇,它是一種速效藥物。理想情況下,它會在三到五分鐘內迅速改善症狀。效果持續時間為兩到六個小時之間。沙丁胺醇不會做的是治療氣道內的炎症。 Albuterol是一種速效藥物。它不是長期藥物。並不是要真正治療症狀更持久的人。<br />長期控製藥物是可以減輕氣道壁內炎症的藥物。同樣,這對於具有更持久症狀的個體來說非常重要。這些藥物會長期改變您的病程,並有望預防哮喘引起的長期不良事件。<br />瑞克(Rick):醫生,請給我們一些哮喘藥物的不同分類。我們提到了皮質類固醇,[還有]支氣管擴張劑,白三烯修飾劑,IgE阻滯劑。給我們介紹一下我們在這裡要處理的內容。<br />里士滿博士:白三烯修飾劑-目前最廣為人知的藥物是Singulair [montelukast]。 Singulair抑制該特定分子與其受體結合併引起明顯的支氣管收縮。 Singulair通過不同於吸入糖皮質激素的機制來治療哮喘。其他藥物包括[cromolyn鈉或nedocromil,商標名稱Intal或Tilade]。這些特殊的藥物非常有效,非常安全,可能不像吸入的皮質類固醇激素那樣有效。那些記得舊的Theo-Dur或茶鹼化合物的人,這些是我在70年代和80年代接受培訓的東西,是主要的藥物。 [這是一種有效的治療哮喘的藥物,正如我們在過去幾十年中看到的那樣,但是再次證明,它的抗炎作用不如吸入皮質類固醇強。抗IgE分子是較新的治療方法之一,是我們現在可以使用的更具創新性的方法之一。 IgE在引起哮喘中非常重要,如果我們減少IgE的量,我們將減少患哮喘的可能性。<br />我想提到另一個領域,有時它不被認為是一種經典的治療劑,即過敏針。事實證明,隨著時間的推移,過敏鏡頭會降低小兒人群患哮喘的可能性。它不是哮喘的直接治療方法,但會降低許多人的症狀發生頻率和嚴重程度。<br />瑞克:列治文博士,如果您能使用我們所有的這些類別的藥物,請觸摸一下它們適合誰以及需要關注的一些副作用。<br />里士滿博士:幸運的是,這些藥物大多數都適合幾乎所有人。如今,我們開始看到這種藥物已被批准用於兒科人群。在小兒人群中非常合適的吸入糖皮質激素一直是人們關注的問題。小兒人群中的其他藥物可能是[cromolyn鈉或Intal品牌的藥物],該藥物吸收不良,非常有效,副作用最小。使用沙丁胺醇的[短效]β-激動劑在該人群中非常安全。關鍵是我們必須控制氣道炎症以長期保持健康。<br />瑞克(Rick):您提到的最後一種藥物之一是IgE阻斷劑Xolair [omalizumab] [是]品牌名稱。對於誰合適?<br />里士滿博士:Xolair目前可指示中度至重度[過敏]哮喘患者-在我們所說的經典治療方法中未獲得巨大成功的患者,未對這些方法做出適當反應的患者沙丁胺醇,後來被吸入更具侵略性的吸入性糖皮質激素的個體,他們沒有足夠的反應。並不是說他們沒有反應,而是[他們沒有]足夠的反應,或者在服用這種藥物時哮喘發作頻繁。<br />瑞克(Rick):讓我們談談定期正確地服藥的重要性。您如何幫助在服藥後遇到困難的患者?<br />里士滿博士:這是一個非常困難的問題。順應性是治療哮喘的首要問題。我認為,如果我們看一下已經有10多年曆史的國家指南,那麼數據在許多不同的研究中都表明,如果患者是依從性的,那麼如果您只是遵從性,則超過80%的個人,將對哮喘有非常好的控制。合規性是一件大事。我們現在遇到的問題是,有些人不想服藥或在服藥方面遇到問題。<br />我認為隨著人們對藥物,醫生或醫療保健提供者的副作用的教育程度提高,我們需要教會他們這些藥物是安全的,以了解該藥物的問題所在,以便他們可以注意這些問題,預測這些問題或隨著他們的進行,意識到藥物治療不是大問題。<br />瑞克(Rick):唐娜,您如何與患者合作以確保他們從治療中獲得最大收益?<br />唐娜:我認為最重要的事情之一是,只要我們能夠在辦公室就診時與病人坐下來,就是要確保他們了解他們每年需要被哮喘診治三到四次。哮喘是不會消失的疾病。他們可能會感覺好些-他們仍應繼續服用藥物。將藥物放在家裡的某個地方,以使它們不會忘記[是一種好習慣]。今天大多數人都很輕鬆。充其量是每天兩次的藥物。將[您的藥物]放在廚房的桌子上。把它放在浴室裡。在您離開家之前,就寢之前,將其作為日常衛生的一部分。定期去看醫生,帶著您的問題和疑慮到醫生辦公室去。<br />里士滿博士:我認為作為醫生,我們要做的關鍵一件事是提供書面行動計劃。人們會經常出門在辦公室-他們不知道藥物是什麼。他們不了解用藥的目的,而且醫生常常太忙[並且]不花時間寫下一些東西,說:“好吧,這就是你要做的。這就是貝蒂&middot;克羅克(Betty Crocker)如果您遵循貝蒂&middot;克羅克(Betty Crocker)的食譜來治療哮喘,您可能會做得很好。”<br />瑞克(Rick):唐娜(Donna),回到您身邊,當孩子在依從性問題上患有哮喘時,會有特殊的挑戰嗎?<br />唐娜:我認為這取決於孩子的年齡(可能是這樣)。當然,對於年幼的孩子,父母會給孩子服藥,孩子會服用。這是非常觀察到的,這不是問題。隨著他們的年齡增長到他們的青春期,尤其是他們的青少年時期,尤其是他們的青少年時期,我們需要不斷提醒他們這種疾病永遠存在。服藥後,您就不會因為[哮喘]而生病。您將不會進入急診室。<br />只需每天將藥物作為控制者。您不想在哮喘發作時控制哮喘,這有點晚了。您必須繼續處理相同的問題。除了隨身攜帶沙丁胺醇外,大多數人還會告訴您是否正在使用長期的皮質類固醇激素,他們甚至不需要它。但是他們應該擁有它,而且我認為今天的恥辱程度不那麼高。我認為很多學生都在學校裡接他們。我們只是試圖保持重複並重複同樣的事情。<br />里克:我希望里士滿博士和唐娜都對我們為您提供的更多假設性案例研究做出回應,這是一名哮喘病患者的母親。<br />案例研究4:我有一個12歲的孩子,患有中度持續性哮喘。他已經被多次口服類固醇激素治療。我們應該注意哪些長期副作用?<br />里士滿博士: [https://linkagogo.trade/story.php?title=%EF%BB%BF%EF%BC%86%EF%BC%83x27%E8%83%96%E5%BB%9A%E5%B8%AB%EF%BC%86%EF%BC%83x27%E5%92%8C%E7%B3%96%E5%B0%BF%E7%97%85-%E8%81%B7%E6%A5%AD%E7%97%85-#discuss HoMan] 。在相對較短的時間內,這可能是一個重要因素。在進行的過程中,我們將看到個人具有所謂的庫欣格oid面孔(也稱為月球面孔)-由於類固醇的緣故,這是一張相當圓的面孔。對於曾經使用類固醇的人來說,這可能會很麻煩,而且看起來與以前不太一樣。在那之後的較長一段時間內,我們必須考慮其他事項:白內障,有時會增加青光眼的風險,血糖增加,這再次是一個令人擔憂的問題,不一定每個人都會患糖尿病,大多數人會這樣做不。但是,再次,如果您患有糖尿病,那將是一個主要問題。我們必須時刻關注膽固醇水平的上升。最近的數據表明,長期服用類固醇的人患冠狀動脈疾病的風險可能會增加,如果存在這種關聯的話,膽固醇水平可能會升高。適當劑量的皮質類固醇會降低骨密度。在兒科人群中,關注的問題之一是骨骼的生長。約翰尼會成為西雅圖超音速隊的6'5“大前鋒嗎?這始終是一個主要問題。那些是我們期望長期服用類固醇的人中可能會遇到的一些主要異常情況。<br />里克:我們還有另一個案例研究副作用。<br />案例研究5:我的哮喘從小就很嚴重,但現在已經中等了。藥物Advair [沙美特羅/氟替卡松]對我來說效果很好,但是儘管遵循這封信的指示,但不幸的是我發展出了喉炎和鵝口瘡。遭受這些副作用六個月的苦難使我對新藥有些不滿。這是對其中含有類固醇的藥物的常見反應嗎?<br />里士滿博士:這是一個常見的不良事件,是喉炎或醫學術語是聲衰,他們只是失去了一點聲音。當然,這是相對常見的。我要說的是那些曾經服用過糖皮質激素的人,這種失聲不是很普遍,但毫無疑問,我們確實看到了某些影響,是的,我們可以看到這一點。他提到的Advair藥物,根據我的經驗,這也是我的經驗,似乎比其他吸入性糖皮質激素,Pulmicort [budesonide],Azmacort [triamcinolone]的使用頻率要高。 Advair也是如此。與所有這些藥物一樣,Advair是一種非常有效的藥物。但是,偶爾,我們會看到這種異常。<br />里克:他提到的鵝口瘡怎麼辦?<br />里士滿博士:鵝口瘡是一個非常普遍的問題。我們使用的藥物劑量越高,鵝口瘡的可能性就越大。鵝口瘡是咽後部的念珠菌感染。當您看一下喉嚨的後部時,看起來好像一點奶酪在您的喉嚨後部,不會消失。它通常取決於吸入的皮質類固醇的劑量。口服類固醇同時服用吸入類固醇的個體患鵝口瘡的風險增加。在服用較高劑量吸入糖皮質激素的同時服用抗生素的人經常會增加患鵝口瘡的風險。患有葡萄糖耐受不良的糖尿病患者患鵝口瘡的風險會增加。所以鵝口瘡可能是個問題。<br />里克:卡羅爾,我想知道您是否有一些副作用的生活經歷,例如我們剛剛聽到的描述以及人們如何應對它們。<br />卡羅爾(Carol):當我剛開始使用Advair時,我也幾次畫眉,但是我並沒有像我想像的那樣跟隨它。我不會像里士滿博士告訴我那樣沖洗和吐痰。一旦我開始更好地遵循指示,便沒有問題了。<br />瑞克(Rick):當生活條件改變時,哮喘的治療方法也應改變。醫生,請對此案例進行回應。<br />案例研究6:我在第二次懷孕的前三個月中。我有一些哮喘病症狀,如容易疲勞和呼吸急促。有時我在晚上或清晨咳嗽時醒來。我有兩個問題。在產前檢查,哮喘病專家或婦產科醫生中應該找誰?對於我的女性而言,哪種哮喘治療對她安全?<br />里士滿博士:第一個問題,她應該看誰?答案是她應該看到兩者。我認為,如今的婦產科醫生一定會與哮喘專科醫生攜手合作-與肺科醫生,過敏症醫生並照顧懷孕的人。這是一個重要的相互作用,這將有助於照顧孕婦的哮喘病。<br />藥物,這很有趣。某人懷孕時有很多事情要做。問題是,我們平常用於治療非孕婦哮喘的藥物是否在懷孕期間安全?在這個時間點上,答案是肯定的。不管實際上他們是否懷孕,我們都將在哮喘患者中使用相同的藥物。在懷孕期間,胎兒體內的氧氣含量遠低於母親。如果您患有哮喘的急性加重症,那麼胎兒會感到更多。因此,在哮喘發作期間,胎兒的潛在風險實際上甚至比母親更高。在這個時候,我們將向所有人使用的建議將在哮喘的懷孕個體中貫徹。<br />對於症狀較輕的人,[我們將討論]使用短效沙丁胺醇吸入器。對於症狀持續較持久的人,我們將開始討論吸入皮質類固醇的使用。毫無疑問,這種好處明顯超過了懷孕期間使用該藥物的任何風險。<br />唐娜:我認為女人對此總是非常謹慎。有時候,我們會在懷孕前從女性人群中得到一個問題-我應該停止服用藥物嗎?這可能是當今最重要的問題。如果他們打算懷孕,[答案是]否。您需要保持控制。您需要保持真實水平。我們不想加重病情。當您試圖進入懷孕狀態時,您不想生病。他們只想重申所有信息。通常情況下,它們是相同的信息,並且她們在OB / GYN或他們的家庭醫生甚至是兒科醫生那裡都在聽到,因為許多女性在懷孕前也尋求過兒科醫生的意見。<br />Rick:&nbsp;We've spent a lot of time talking about asthma medications and some avoidance strategies. Now let's spend some more time talking about other factors that can contribute to poor asthma management and how we can avoid these pitfalls. Our next case study looks at a patient who has been in denial about their asthma.<br />Case Study #7: When I was first diagnosed with asthma, I wouldn't accept that there was anything wrong with me, and I refused to take my medication. Most of the time, I was fine anyway. Then I ended up in the hospital. The doctors told me I nearly died. I didn't even know you could die from asthma. I think it's time to take this disease more seriously. What are the next steps I should take to educate myself?<br />Rick:&nbsp;Can you die from asthma?<br />Dr. Richmond:&nbsp;Absolutely, you can die from asthma. Unfortunately, we have seen that happening up till the mid-1990s, which was absolutely amazing. From the '60s on, there was an increased risk of death even though we were doing better taking care of individuals with asthma. Unfortunately, Chicago tends to be one of those areas where we see more asthma deaths than most anywhere else in the country for reasons that are being studied at this point in time.<br />Rick: So what does this individual need to do?<br />Dr. Richmond:&nbsp;I think he's done a major thing. I think he's realized that it's time now to get serious about taking care of his asthma. I think that that in this particular situation, education is going to be the major thing. I think that if he begins to understand what asthma is, what the process is that is causing his asthma to become worse, whether in fact it is allergens, whether it's viral infections, which is a very common cause of asthma exacerbations. I think that right now he is of the understanding that he's going to need to take a medication every day. I like to make one very important point: People think that you have to have bad asthma to die. It's very clear that you can find individuals with mild asthma, and they can die from their asthma. People can have acute exacerbations of their asthma and not be appropriately cared for, and any level of asthma can be a death-defying episode.<br />Rick:&nbsp;That's sobering to hear. For some people, exercise is an asthma trigger. See if we can get you to respond to the following situation.<br />Case Study #8:Two of the things that I love to do best - hiking and biking - leave me short of breath. I have tried using my albuterol inhaler before, but it seems to make no difference.我能做什麼?<br />Dr. Richmond:&nbsp;Without a doubt, an individual with asthma, if their asthma is not well-controlled, exercise will routinely do it. There's certainly this subgroup of individuals who have exercise-induced asthma, which does not have a severe connotation to it at all - only occurs with exercise. This is a case that's a little bit more disturbing to me because this individual is using their albuterol inhaler. A good 94 to 95 percent of individuals, if they use an albuterol inhaler before exercise, will be able to curb their asthma if they simply have exercise-induced symptoms. If this individual has more persistent symptoms, then unfortunately an albuterol inhaler still should be of some benefit. He would need to be seen. I think the severity of his asthma would have to be better identified. There are other medications which will help out in this situation. Right now, classically, leukotriene modifiers, Singulair [montelukast], has been shown to be very effective in exercise-induced symptoms.<br />Donna:&nbsp;I think also if they are only taking albuterol, I would wonder if they've been followed properly. Pulmonary function testing, the patient comes in and does a breathing test at least once a year to see where they are at in terms of their disease, is a great comparison for a physician and the patient. It's a visual tool that they can use to actually monitor and track how they are doing, and they can look at that and say, &quot;But I don't feel that bad.&quot; And that's because they are not in control. Again, office visits, communication with the patient and constant teaching for them [are good practices].<br />Dr. Richmond: Exercise-induced asthma has become a very popular phrase for individuals nowadays, especially the pediatric population. A recent study just took a look at a group of individuals who had exercised-induced breathing problems. It turns out that a proportion of these individuals, generally 35 to 40 percent had exercise-induced asthma. Other individuals simply had exercise-induced dyspnea, which is just shortness of breath, [that] could be from a lack of conditioning or other problems. Again, not everything that wheezes is asthma, and not all asthma wheezes. We are seeing a lot of individuals with exercise-induced vocal cord dysfunction where there is nothing wrong inside the chest. It is a problem in the upper airway that individuals are having trouble getting air into their lungs. It's a problem at the vocal cord level, and, again, it would not be expected to respond appropriately to albuterol. We need to use these subtle clues as clinicians to understand if this person has asthma or has a combination of something else.<br />Rick:&nbsp;We've touched on exercise a couple times tonight, but let's address it directly. Used to be the thinking was that if you had asthma, that was a reason to avoid exercise. What's the thinking today?<br />Dr. Richmond:&nbsp;I think the thinking today is just the opposite. As an individual who takes care of asthma, my goal is to have that person treated with appropriate medications so that they can exercise at any level that they would so choose. If they have the ability to be an Olympic athlete, they should be able to go out and do that and be a world champion.<br />Donna:&nbsp;I think that that's true today. I think that years ago, you saw patients, particularly small children, who were held back because their disease got out of control if they ran around the playground too much or if they joined the baseball team, or [if] they ever ran track. But today, we as parents and as health providers want to see children more involved and more active for various reasons, and we shouldn't shy away from it. We should work together with the physician, the pediatrician, allergist, pulmonologist, to make sure that the child with asthma or even exercise-induced bronchospasm can certainly perform their activity.<br />Rick:&nbsp;As we just heard, exercise is a realistic possibility for people whose asthma is under control. Let's start our audience questions.<br />Stephanie:&nbsp;I want to ask a question about exercise-induced asthma. I'm a triathlete. I have [been] training for my first race about five months. My trainer said that I should carry my albuterol with me during the course of the event. It's a half-mile swim, 12-mile bike ride and 3-mile run. Obviously, with the bike and the run, it's a little more practical, but I just wanted to know what else you might recommend since it would be hard to swim with an inhaler attached to you.謝謝。<br />Dr. Richmond:&nbsp;That's a very good point. Congratulations on doing that. I think that's wonderful. Fortunately, if you use the albuterol ahead of time, in theory, you should be able to get a good two hours out of it and maybe even longer than that. What's interesting is we run into these problems of individuals where we might need to use longer-acting medications. In that situation, we have a couple different choices, maybe even three different choices. The first choice is using a long-acting beta-agonist. Those are available nowadays, and one of them being Serevent [salmeterol], the other one being Foradil, which are two brand names. Foradil [formoterol] has a relatively rapid onset of action within generally three to five minutes with the duration of effect somewhere around 12 hours. Again, Serevent has a little longer onset of action about 48 minutes, but again, will last about 12 hours. Some individuals, for exercise-induced symptoms, will use that. Again, a very good medication for exercise induced symptoms is a leukotriene modifier - Singulair being the classic medication nowadays. Now, again, that does not have a rapid onset of action. Generally, it will take about 24 hours before we see much of anything from this medication. But, again, that would have a much longer duration of effect. Those would be certainly two considerations, and some individuals who have more persistent symptoms other than simply exercise-induced symptoms we will then put them on inhaled steroids with a long-acting beta-agonist, something like Advair, at this point.<br />Rick:&nbsp;We're going to start with an e-mail question first tonight from Frank in Norfolk, Virginia who e-mailed us this question, &quot;Is it true that Xolair's effectiveness increases the longer you use it?&quot;<br />Dr. Richmond:&nbsp;Xolair [omalizumab] is anti-IgE antibody. The data has shown at this point in time that we need to administer Xolair over approximately four to six months to see if, in fact, there is an effect. Will things progressively improve? We have seen, in our experience, in our group here that over that first year that we will see some improvement. Usually, the slope of the curve of improvement will be very steep, at least initially, within that first six-month period of time. It will then begin to flatten off, but, again, we'll continue to see some improvement over time.<br />Rick:&nbsp;Carol, did you want to comment on your experience with Xolair?<br />Carol:&nbsp;I just had my 23rd shot today, and my medication level has decreased significantly since I first started. I notice the difference starting at month three. I definitely see a difference.<br />Rick:&nbsp;I'm sure we did touch on this earlier, but let's talk about how Xolair is administered.<br />Dr. Richmond: Xolair, it is an antibody against IgE. It is an injectable medication. It is not intravenous. It is simply going to be an injection into the muscle. It's given in either every two to four weeks intervals. At this point in time, the recommendations are to be given within the physician's office. I think that what we will see over time, that might change with it being shown to be extremely safe medication.<br />Rick:&nbsp;Next, we have an e-mail from Janet in California who writes, &quot;I've been diagnosed with asthma and COPD. How do I know which problem I'm having when I have an episode?&quot;<br />Dr. Richmond:&nbsp;COPD is chronic obstructive pulmonary disease, most classically associated with individuals who have smoked. Amazingly, up to a fourth of adult asthmatics continue to smoke. So we do see some overlap in COPD. Now, is COPD, simply from smokers? No, we can have COPD from other respiratory trauma whether it be some individuals inhaling organic dusts, other different types of things. But again, that's going to be the classic precipitating factor for COPD. It's a difficult thing because there are individuals who have a wheezy COPD and there are individuals who have asthma and COPD. Fortunately, the therapy is going to be about the same. For individuals who have a wheezy episode, whether that's COPD or asthma, nowadays, it's going to be initially a short-acting beta-agonist. In some individuals with COPD and asthma, that a second medication will be added on called [ipratropium bromide] which has better effect with individuals with COPD than asthmatics. This is a medication which goes by the name of Combivent, it's a combination of albuterol plus [ipratropium bromide]. How would we figure this out? I think number the one thing is to have a measure of one's breathing and that measure is usually going to be a peak flow meter. That peak flow meter would give us a clue whether in fact the breathing problems are abnormal. It would simply say, you've got something that is causing you to wheeze, and that should be treated. I'm not so sure that it's critical that we figure out if it's asthma or COPD. It's just critical to see if you've got something that can be treated and reversed by one of these medications.<br />Rick:&nbsp;Next, [we'll go] to our live audience here in Chicago.<br />Mike:&nbsp;I just wanted to ask what effect cigarette smoking had on asthma, for any of the panel.<br />Dr. Richmond: As we all know, if you take a lung function after we hit about 30 years of age, we see a gradual decline in our lung function. That's just normal. If you take a look at asthmatics, even well-controlled asthmatics, their fall in lung function will have a little steeper curve than will even normal non-asthmatics. Well-controlled asthmatics will do better. If you take a look at people with smoking or COPD, that fall is even more precipitous. If you would choose to continue to smoke and have asthma, that is the worst fall as far as losing your lung function over a much shorter period of time. That is a very, potentially lethal combination in your long-term prognosis.<br />Rick:&nbsp;As to the issue of smoke, I wonder have studies been done on this topic regarding direct smoke from the smoker and second-hand smoke?<br />Dr. Richmond:&nbsp;It's a big issue. There is no doubt that second-hand smoke is a major factor. We see that in the pediatric population. That is one of the major factors in pediatric asthma. Interestingly enough, it's not so much paternal smoking, it is maternal smoking, which has been clearly correlated with worsening pediatric asthma. I guess we could suggest that mom's going to be around more than dad and if mom's sitting there smoking, that airway irritation and bronchial constriction from cigarette smoke can be a major factor. But that is one of the major problems in pediatric asthma.<br />Greg:&nbsp;I'd like to tie maybe two issues that you brought up: one is coughing. I would say maybe once or twice a week I get into very bad coughing jags. That really disturbs me and worries me. I hurt from the coughing. Also, sometimes [I] wake between one and five in the morning. I'm taking Singulair [montelukast] and Advair [salmeterol/fluticasone]. I've been doing [my treatment] pretty religiously. I wondered if you had any suggestions.<br />Rick:&nbsp;And do you wake coughing?<br />Greg:&nbsp;Sometimes I do.<br />Dr. Richmond:&nbsp;Is this coughing associated with chest tightness and shortness of breath?<br />Greg:&nbsp;Yes.<br />Dr. Richmond:&nbsp;Nocturnal cough is an important problem that we see pretty regularly. Certainly cough can be a manifestation of asthma, without a doubt. We can see cough from other different phenomenon. We can see it from allergies. We can see it from post-nasal drip. We can see it in individuals as the presenting manifestation of recurring sinus disease. That, generally, is going to be pretty easy to figure out by history and from your symptoms.<br />Another important point, which again, is becoming much more prominent, at least prominently known in the last five to 10 years, is gastro-esophageal reflux [GERD] as a common cause of nocturnal cough and also increasing asthma. Those are some of the things we would think about. Now, if we go back and say, you've got nocturnal cough and you're taking Singulair, a leukotriene modifier, and an anti-inflammatory, that being your Advair, and things are not well-controlled, then we would want to sit down, we'd want to take a better look at your pulmonary functions. Get some breathing tests and see where that is. At that point, there would be, perhaps, an alteration in either the medication or the dose of medication you're on at this point in time.<br />Rick:&nbsp;I'm curious, does everyone with asthma cough, doctor?<br />Dr. Richmond:&nbsp;The vast majority of individuals who have asthma will cough. There is this phenomenon known as cough-equivalent asthma where the only manifestation of asthma is a cough. You don't have individuals who will wheeze. You'll not have them waking up with tightness. People with cough-equivalent asthma, generally it's not going to be a severe asthma, it's going to be milder asthma. I think one of the things that's interesting is yes, asthma can cause cough, but other different things that will potentiate asthma can cause cough that being gastro-esophageal reflux disease [GERD], which has always got to be considered, sinus disease and allergy.<br />Christian:&nbsp;Does the use of Azmacort [triamcinolone] affect glaucoma?<br />Dr. Richmond:&nbsp;The use of corticosteroids will increase intraocular pressure - glaucoma [which is] increasing pressure in the eye. When we give individuals oral steroids, frequently they'll go see their doctor because their vision is a little bit blurry. Most often, the ophthalmologist will say, &quot;When you're off the steroids, come back, and we'll see if there's a problem then.&quot; Generally, the inhaled corticosteroids do not increase intraocular pressure at doses that are prescribed. There's no doubt that if we take a look at increasing inhaled doses at high dose, inhaled corticosteroids, that we can see systemic side effects, and we can certainly see cataracts and increase in intraocular pressure. But that would be [seen] at very high doses of inhaled corticosteroids.<br />Lydia:&nbsp;I read somewhere that asthmatics often develop dermatitis. I have a spot on my wrist, and it's like hives. It sort of pops up, and it'll go away, and it'll pop up again. I'm wondering if there is a correlation.<br />Dr. Richmond:&nbsp;There are certain conditions that are associated with asthma - one of which is atopic dermatitis. We generally will see that in the pediatric population. Atopic dermatitis, atopic eczema is a risk factor for asthma in the pediatric population. Usually, eczema in adults is not associated with that. This particular lesion, if it's a hivelike lesion, it's itchy, has a duration of less than 24 hours and if the skin is normal once that lesion goes away, then it sounds like a hive. I would suggest that it would be two independent processes going on here. You would have hives, and you would have asthma. Occasionally, people will have allergy exacerbations of both their asthma and hives. People who are walking around a dog and the dog licks them, and they get a hive, and then they wheeze. But, again, that's two different shock tissues being involved. I think the question here is what is the chronicity of this thing on your wrist? Is it something that has been there for a good long time, and does it clear rather rapidly? If it fails to clear rapidly, then I think it's time for the dermatologist to take a good look at it.<br />Joan:&nbsp;You mentioned tonight two important points. You in your practice you find that getting people to take medication on a regular basis has been an issue, and also that people can die from asthma whether they are diagnosed with mild or severe [asthma]. I have a two-part question here based on that article that was in the New England Journal of Medicine in regards to studies being done about people with mild asthma, of getting off their medications. There's no difference whether they've taken their medications or not, they've been fine. As an asthmatic, reading an article like this, my first question would be, can a person who has originally been diagnosed with mild asthma develop into a severe asthmatic whether they take medication or not? Also, reading this article, is it a form of playing a Russian roulette with our lives if we follow some advice like this?<br />Dr. Richmond:&nbsp;Those are very good questions. Let me do the first question, and then I will talk about this article ever so briefly and let people who have not read it, give you a little bit more information on it. Can an individual go from mild to severe asthma?是。 Can individuals with mild asthma die from mild asthma? Again, mild asthma, as defined by having symptoms less than two times a week, having nocturnal awakening less than two times a month, using an albuterol inhaler refilling it less than two times a year, so that would be an individual who has rare symptoms. Can those people die? Yes, as I've suggested before, that people can run into a situation where they have acute asthma and die from that. We see it in the paper not infrequently here in Chicago. You can certainly progress. There is no doubt about that. We think that most individuals who are going to die from asthma are individuals who have more persistent disease, and that usually is going to be the case. Individuals who have asthma, they know they have asthma. They fail to take care of it appropriately. That is, they go to the emergency room regularly for their primary care, and once they leave the emergency room they take the medicine until it runs out, and then they are back on their own. And within a matter of weeks or so, they are back in the emergency room.<br />The article was published in the New England Journal [of Medicine]. It looked at intermittent use of inhaled corticosteroids versus daily use of corticosteroids asking the question &quot;Are people well-controlled? Are their symptoms well-controlled?&quot; It is a very interesting article - a very controversial article at this point in time, it does toss a wrench into the works. We take a look at individuals with asthma, and we want to decrease long-term persistent disease. We do not want to have any abnormalities in people's lungs when they get to be 95 years of age. When I first started teaching [patients about] asthma 30 years ago, I would tell patients when they walked in that if you died at 120, and I looked at your lungs at 120, your lungs would be absolutely normal if you had asthma, no matter what degree. That teaching is now no longer correct. It's very obvious that individuals with asthma will have changes in their airway. Airway remodeling is associated with airway inflammation. We do not know why people have airway remodeling. What we do know is that if we try to decrease airway inflammation, that we will decrease some airway remodeling. Therefore, we will have individuals who are more responsive. What is the long-term side effect of airway remodeling? You are not going to have nearly as responsive reversible airway disease. When you have a remodeled airway, it's going to be less responsive to therapy, in theory. So that's not what we want to do. I think that this particular [thing] is interesting because it raises the question, yes, can you be symptomatically controlled fairly well with intermittent use? And, again, a lot of people do that. The question that I think has to arise is, is what's that going to mean in the long-term with some individuals? And, again, this was a relatively short duration study. What is the long-term morbidity, that is, the side effects and mortality of this approach going to be? We have sort of an idea about that already because we've seen that asthma and deaths have increased when people use things intermittently.<br />Rick:&nbsp;Heidi from Dayton, Ohio, sent us this question. &quot;There is so much I gave up when I developed asthma: scuba diving, making pottery, etc. Now that my asthma is under control, how can I tell if it's safe to resume my hobbies?&quot;<br />Dr. Richmond:&nbsp;It's actually an interesting question because of the scuba question. As far as pottery making, if in fact you're doing extremely well, you can resume that right off the bat. Scuba and asthma - it's an area that 30 years ago, if you had asthma, you would be told not to scuba without doubt. As a result of airway abnormalities that individuals can have acute exacerbations when they are at depth, and occasionally people can blow a little of these air blebs, little alveoli and have a pneumothorax [air between the lung and the chest wall], potentially, obviously walking down the street would be a problem. But if you're 30 feet under water, you're going to have big problems.<br />Duke [University] has studied scuba diving and asthma, and they have a research center that looks at this regularly. [http://digitalxiaomi.com/story.php?title=%EF%BB%BF%E5%80%96%E5%AD%98%E8%80%85%E5%B0%8D%E6%96%B0%E7%9A%84%E5%89%8D%E5%88%97%E8%85%BA%E7%99%8C%E7%AF%A9%E6%9F%A5%E7%88%AD%E8%AD%B0%E6%9C%89%E5%8F%8D%E6%87%89 好man] will require that if they will allow you to dive, to show that you have normal airway function on medication, that you have not had a recent exacerbation of your asthma, certainly within a two-week period of time and in that, ideally, a pre-dive pulmonary function has been shown to be normal. If you are a scuba diver and your asthma is absolutely under excellent control, and I must underline the word excellent, anything less than excellent, [and] I would be a bit concerned about diving.<br />Rick:&nbsp;[We have a question from] Melanie in Minneapolis, Minnesota who wrote, &quot;Can having asthma make you feel fatigued?&quot;<br />Carol:&nbsp;When my asthma was not in control, I was tired all the time. I did not want to do anything at all. But now that it's in control, I do not have the fatigue at all.<br />Dr. Richmond:&nbsp;Absolutely. I couldn't say it any better. It can cause significant fatigue, and as Carol suggested, once it's under good control, you should be normal. The question is, is this asthma or not? A cause of fatigue can be asthma, but again the most common complaint of anybody walking into any doctor's office, any doctor - whether it be an allergist, immunologist, a primary care doctor, a gynecologist - is fatigue.<br /><br /><br />Rick:&nbsp;Dr. Richmond, if there's one single piece of practical advice you could give people to help them better control their asthma, what would it be?<br />Dr. Richmond:&nbsp;I think they need to educate themselves. Nowadays with the Internet, I think you can certainly educate yourself about what asthma is, about the medications that are available and realize if you've got something more than an intermittent wheeze, that you need something more than just an albuterol inhaler.<br />Rick:&nbsp;Donna Staszak, in your opinion, what is the best thing asthma patients can do to take control of their disease?<br />Donna:&nbsp;I think don't just make those doctors' appointments. Get to those doctors' appointments and come to those appointments prepared. Three or four times a year, come with your questions, come with your concerns, come with a diary of days that weren't so good and what surrounded them. Let the doctor know how things are working, what can you do better, make the most of those visits. Stay in contact with your healthcare provider.<br />Rick:&nbsp;Carol, what advice would you have for fellow asthma patients out there who maybe want to get better control?<br />Carol:&nbsp;[I recommend] having a good relationship with your doctor and be willing to try new medications. If it wasn't for Dr. Richmond telling me to try new things, the Advair and the Xolair, I wouldn't have the control of my asthma as I do now.<br />Rick:&nbsp;Dr. Wendell Richmond, registered nurse Donna Staszak and patient advocate Carol Mersman, thank you all for joining us tonight.<br />From all of us at HealthTalk, I'm Rick Turner.祝您和家人身體健康。 Good night.<br /><br />
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Revision as of 01:39, 14 January 2021

The sciatic nerve may be the longest nerve within your own system, a passing between both tendons, ligaments, tendons, and ligaments. In the event the plantar nerve becomes swollen it might lead to distress, which may radiate the rear part of the leg together with the very best way in your whole foot. It might appear to be a niggly stiffness, or even perhaps a sharp aggravation, but in any event, it should not be ignored. Studies to sciatica reveal that females, broadly speaking, believe that the neurological illness at more portions in their human anatomy compared to just women.

After preparing for the next marathon, then I had been introduced into the joys of peripheral nervewracking. A serious, sharp pain in my nose, at first recognized like a jet tear, which simply failed to go off. A few times, it would feel fine, other times, so that I felt just as though my leg might provide much in any moment for a very simple speed.



Through working with muscle massager , I came across physical workout routines to provide assist. I heard just how to glue out the guts and also maintain on the top of tightness in my own spine once again to lower the frequency of flareups. Nevertheless, as curative massage firearms and percussive remedy turned into a favorite assist to improve healing from the conducting entire world," it failed to happen well before I had been googling,"'is just a Theragun heal plantar nerve illness'.

How can the Theragun and therapeutic massage therapy aid plantar nerve vexation?
By using a Theragun may help rehydrate using the annoyance, releasing pressure, and improving blood circulation to list a couple. The percussive movement of this Theragun eases the muscle cells surrounding the sciatic nerve and also helps spark the blood pressure at the bowels pathways.

That is going to be the greatest regions to use that the Theragun should you are afflicted from plantar nerve-wracking pain, or nerve pain that travels down the thighs?
Care for alongside it by that you're feeling ache to focus to both back, calves, and hamstrings to get a single minute per - if either side your own body experience pain, then cure both sides. Our Therabody program contains an superb detail by detail Sciatica protocol which isn't difficult to take a look at together together, particularly in the event that you have got just one among our Bluetooth-enabled devices - the Theragun professional, elite, along with chief. I formulated the app protocols, in order our customers/clients/patients may possibly feel as if they'd an appointment together with me everytime they utilize their Theragun apparatus and they know ways exactly to find the most rewards from each and every therapy. During this kind of program, additionally, you'll get tips for added elements of your human body that'll support with most of the current handling of these muscle tissues you're predicated on, additionally together side attachment and grip suggestion.

As stated above, the back, hamstrings, and hamstrings would be the very best regions to concentrate on. Be cautious when using pressure into the peripheral nervewracking, particularly across the piriformis muscle mass building. Your instincts will say to care for the plantar nerve right, however really don't. Work around the spot, and then sweep the rectal nerve wracking. No tension is necessary.

Observing Theragun Guru to receive a small number of months, I'd say that the percussive therapy has a beneficial effect on my nerve disorder, however, did significantly more conventional therapy out from this physiotherapist. If you may spend it and additionally in addition, you want to decrease the time spent performing physio, afterward the Theragun is still still a fantastic option, however, it is only a single resolution.