A study published in the January issue of the Journal of the American Geriatrics Society finds that geriatricians are less likely than general internists (doctors whose specialty is internal medicine) to prescribe potentially inappropriate medications (PIMS) to older adults. For the study, researchers from the American Board of Internal Medicine compared annual PIM prescribing rates between 2,815 outpatient geriatricians and general internists. PIM prescribing was defined as prescribing drugs flagged as potentially inappropriate in the American Geriatrics Society Beers Criteria® guideline. Compared with general internists, geriatricians were about 17 percent less likely to prescribe a PIM and about 3 percent more likely to prescribe an appropriate alternative drug. Whether you are seeing a geriatrician or a general internist, take the precaution of scheduling regular medication reviews so that you can make sure the drugs you take are safe and still needed.

Patient Error Affects Accuracy of In-Home Colorectal Cancer Tests

When it comes to colorectal cancer screening, many Americans are turning to stool-based tests they can do in the privacy of their own homes. But a recent UT Southwestern Medical Center study suggests that the completed tests often cannot be processed, mostly due to patient error. The study (Cancer Epidemiology, Biomarkers & Prevention, Feb. 1) looked at in-home stool tests submitted by 56,980 people, ages 50 to 74. The analysis showed that more than 10 percent of samples could not be processed in the laboratory (double the 5 percent recommended threshold set by the U.S. Multi-Society Task Force on Colorectal Cancer). Inadequate specimen collection (51 percent), incomplete labeling (27 percent), age of specimen (13 percent), and broken or leaking containers (8 percent) were the primary causes of failed tests. If you opt for a stool test to screen for colorectal cancer, be sure you know exactly how to take the sample, label it, and submit it for testing. See our cover article and Q&A on the back page for more on colorectal cancer screening.

Pulmonary Rehabilitation Inaccessible for Many

If you have chronic obstructive pulmonary disease (COPD), your doctor may have recommended you attend a pulmonary rehabilitation program. Such programs incorporate exercise and education about strategies that can help people with COPD and other chronic respiratory illnesses better manage their illness. But a new Yale University-led study reveals that pulmonary rehabilitation is difficult for millions of people to access. The analysis found that more than 14 million Americans must travel more than an hour for access to their nearest program. The researchers also uncovered racial disparities in access—for example, nearly 30 percent of the American Indian and Alaska Native population lives more than an hour away from the closest program. Long commutes to access this type of care are physically taxing and may require traveling with multiple oxygen tanks. The study was published in JAMA Network Open, Feb. 5.

Music Benefits Brain Health

Engaging in music is associated with better brain health in older age, according to a study from the University of Exeter, UK. The study (International Journal of Geriatric Psychiatry, Jan. 10) looked at data from 1,000 people, mean age 67. The research team compared the participants’ musical experience and lifetime musical exposure to their cognitive test results. The analysis showed that playing a musical instrument—particularly the piano— is linked to improved memory and the ability to solve complex tasks (known as executive function). Continuing to play into later life provided even greater benefit. Singing also was linked to better brain health, although this may partly be due to the social factor involved in being part of a choir or other singing group. Previous research has shown that music-based group activities can relieve agitation and depression, and boost attention in people living with dementia.

The post Newsbriefs: Risky Medications, Accuracy of In-Home Colorectal Cancer Tests, Pulmonary Rehabilitation, Music Benefits Brain Health appeared first on University Health News.

What Happens in COPD

Air travels to and through your lungs through a system of bronchial tubes that repeatedly branch off into smaller and smaller tubes, the smallest of which are known as bronchioles. The latter culminate in microscopic thin-walled air sacs called alveoli. When you inhale air, the alveoli expand, and when you exhale, they deflate. Alveoli are surrounded by capillaries (the smallest blood vessels in the body). Normally, oxygen in the air you inhale transfers from the alveoli to these capillaries, where it is absorbed into red blood cells. At the same time, a waste gas called carbon dioxide is transferred from the capillaries to the alveoli and expelled when you exhale. However, COPD impedes this process.

COPD typically is characterized by two underlying conditions: chronic bronchitis and emphysema, which may occur singly or jointly. In some cases, asthma also may play a role. “Chronic bronchitis causes the bronchioles to become inflamed and blocked with mucus,” Dr. Schachter explains. “As a result of this obstruction, air is trapped in the alveoli, making breathing more difficult. Emphysema damages the alveoli, reducing their ability to exchange oxygen for carbon dioxide.” Asthma also causes narrowing of the airways. While the narrowing usually can be reversed with medications, in some cases it cannot and may contribute to COPD.

Complications Are Common

COPD symptoms include shortness of breath, along with a chronic cough. You also may experience chronic headaches as carbon dioxide accumulates in your blood. In advanced COPD, the heart has to work harder to pump blood through the lungs, and heart failure can result. Some studies also associate COPD with an increased risk for cognitive impairment, dementia, and depression. Because COPD weakens the immune system, people with COPD are vulnerable to shingles, a reactivation of the chickenpox virus that produces a painful rash and can cause lasting nerve damage.

Are You at Risk?

COPD is most common in people ages 40 and older who are long-term heavy smokers. “Women appear to be more susceptible than men are to the effects of smoking, and more likely to require hospitalization for COPD,” Dr. Schachter notes. But smoking isn’t the only source of toxic substances that are harmful to lung tissue. The very air you breathe carries microscopic particles from vehicle exhaust, and studies have shown that people who live close to major roads and are exposed to automobile exhaust for many years are more likely to develop COPD. “Moreover, depending on your home’s fuel source and the area where you live, you may breathe in fine particulate matter from the burning of fossil fuels and wildfires,” Dr. Schachter adds. Studies have linked obesity with impaired lung function that may lead to COPD, and research also suggests that the condition may be more likely in people who consume excess alcohol.

Drugs Make Breathing Easier

Having a chronic cough and coughing up sputum for no identifiable reason, such as a cold or flu, is not normal. If you experience these symptoms, see a doctor. “While lung damage due to COPD is permanent, early treatment with medications can slow the rate of deterioration, help prevent complications, and improve your quality of life by making it easier to exercise and go about daily life without running out of breath,” Dr. Schachter says.

Two types of drugs are used to treat COPD: bronchodilators, which expand airways, and anti-inflammatory drugs, which reduce inflammation in the lungs. “The drugs are delivered through inhalers to ensure maximal effects in the airways where they are needed and reduce their effects on the rest of the body,” says Dr. Schachter. Inhalers can be tricky to use, so if you are having difficulty tell your doctor. He or she may suggest using a spacer or a nebulizer. A spacer is a short tube that is placed between the mouthpiece of the inhaler and your mouth. It allows the medication to be inhaled more slowly and deeply. A nebulizer is a machine that turns the liquid form of a drug into a fine mist that can be inhaled through a mask. “If the oxygen delivered to your blood is reduced, you also may need oxygen therapy,” Dr. Schachter adds. Oxygen therapy is delivered via nasal tubes and maintains the body’s oxygen level, helping to reduce stress on the heart.

Pulmonary Rehabilitation Helps

Studies show that people with COPD who participate in a pulmonary rehabilitation program typically have less shortness of breath, can exercise longer, enjoy a better quality of life, and are hospitalized less often. Exercise is a major component of such programs, but they also include nutrition counseling, smoking cessation tips, and helpful breathing strategies. Many programs offer music therapy, which provides added benefit. People who take part in music therapy that includes playing wind instruments or singing show greater improvements in shortness of breath, fatigue, and depression than people who participate in standard pulmonary rehabilitation programs. “Most pulmonary rehabilitation programs last six weeks or longer, and participants meet two or three times a week,” Dr. Schachter notes. “Continuing the exercises at home after completing a program may provide additional benefits.”

Many medical centers across the country offer pulmonary rehabilitation. If your physician does not refer you to a program, the organization Live Better with Pulmonary Rehab (www.livebetter.org) provides a searchable online directory of pulmonary rehabilitation programs nationwide. Medicare covers pulmonary rehabilitation for people with moderate to very severe COPD; however, you will pay 20 percent of the cost if the program is conducted in a physician’s office, rather than in a hospital. Pulmonary rehabilitation is not covered for people with mild to moderate COPD.

Keep in mind that the flu, pneumonia, COVID-19, and respiratory syncytial virus can be deadly for people with COPD. You can best protect yourself by following the vaccination schedule recommended by the Centers for Disease Control and Prevention. If you are in any doubt about getting a vaccine, consult your doctor.

Know What to Do About Exacerbations

If your symptoms suddenly worsen and breathing becomes even more difficult, you may be experiencing an exacerbation. “These acute periods usually are caused by rising levels of inflammation in the lungs due to viruses or inhaled irritants, and can accelerate the loss of lung function,” Dr. Schacter says. Symptoms include increasing shortness of breath accompanied by wheezing, chest tightness, increased cough, increased sputum production, a change in the color of sputum, and fever.

Dr. Schachter adds that it is a good idea to prepare in advance for exacerbations. “Ask your doctor what measures you should take if you notice any signs that one may be imminent, and what symptoms warrant a call to the doctor or a trip to the emergency room,” he advises.

The post What You Need to Know About COPD appeared first on University Health News.

The test to which you refer can be purchased online and requires approval by a telehealth doctor; you then attend a local lab to provide a blood sample.

The test is marketed as an option for people who have memory issues and/or a family history of Alzheimer’s disease (AD). You are in the latter category—however, I have reservations about the test. The test measures two forms of an abnormal brain protein called amyloid-beta (A-beta) in the blood—Abeta 42 and A-beta 40—and provides an A-beta 42/40 ratio. Some research suggests that the ratio may help identify who is at risk of developing AD. However, the test has not undergone long-term large-scale testing, so it is unclear if it has any useful predictive value. An important thing to keep in mind here is that we don’t know for sure whether A-beta causes AD—many older adults with high levels of the protein in their brains remain cognitively normal until death. If you were to get the test and the results gave cause for concern, this likely would result in significant anxiety, possibly unnecessarily. Moreover, the test is not approved by the U.S. Food & Drug Administration.

If you are set on getting tested, I recommend you ask your doctor to refer you to a specialized memory clinic where a comprehensive evaluation can be carried out using a range of tests. Should the results be positive, these clinics also have trained counselors to provide emotional support, discuss treatment options with you, and help you formulate a plan for your future care.

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

I am able to manage my gastroesophageal reflux disease with lifestyle approaches, but is it true that it raises the risk of esophageal cancer?

Several studies have shown that people who have gastroesophageal reflux disease (GERD) are more likely to develop esophageal cancer, with older men most vulnerable. GERD results in digestive acid leaking out of the stomach into the lower esophagus (the muscular tube that links the back of the throat to the stomach). The cells that form the inner lining of the stomach are protected against the corrosive properties of digestive acid by a layer of mucus, but the cells that line the esophagus do not have this safeguard. If GERD is not well controlled, long-term exposure to the acid may inflame the lining of the esophagus (a condition known as esophagitis), and the cells may develop mutations that lead to cancer. All that said, a recent large study (BMJ, Sept. 13, 2023) suggests that the risk of esophageal cancer in most people with GERD may have been overstated. The Swedish study tracked about 485,000 people for up to 31 years and found that the risk was elevated only in people who had evidence of esophagitis. The takeaway is that you shouldn’t panic about the link between these conditions, particularly if your GERD symptoms are well controlled.

Brijen J. Shah, MD

Gastroenterology

I use an inhaler to manage COPD, but I recently read that inhalers raise the risk of fractures. Should I stop using mine?

A recent large study review suggested that using an inhaler containing a corticosteroid drug may increase the risk of fractures. The mechanism underlying the association is unclear; however, studies have shown that oral corticosteroids—which often are taken to help control chronic obstructive pulmonary disease (COPD)—can have serious effects on bone if given for a prolonged course. Inhaled corticosteroids have been associated with similar findings in many publications, although with a much lower incidence, presumably because of lesser systemic absorption.

Your letter does not clarify what the active ingredient is in your inhaler, but many of these devices don’t contain a corticosteroid. If you are unsure whether yours does, are worried about your treatment regimen, or are in a high-risk category for bone fracture (for example, you are age 65 or older, or have severe COPD), ask your pulmonologist if a different medication is advisable.

E. Neil Schachter, MD

Pulmonary Medicine

The post Ask the Experts: Blood Test for Alzheimer’s; GERD and Esophageal Cancer; COPD Inhalers and Fracture Risk appeared first on University Health News.

A: Checking oxygen saturation is often called the “fifth vital sign.” Along with temperature, blood pressure, pulse, and respiration rate, this important piece of data helps us gain insight into your health. By measuring the amount of light that passes through your fingertip, a pulse oximeter can estimate how much oxygen is being carried by your red blood cells, which reflects how well your lungs are working. When we breathe in air, our lungs transmit oxygen into tiny blood vessels called capillaries. In turn, these capillaries send oxygen-rich blood to the heart, which then pumps it through arteries to the rest of the body. Our organs need a constant supply of oxygen to work properly. When the ability of the lungs to transport oxygen into the blood is impaired, blood oxygen saturation declines, potentially putting our organs in danger. A normal oxygen saturation level is 97-100%, but older adults typically have lower levels than younger adults. For people over age 70, a normal oxygen level may be about 95%, which is acceptable.

Low oxygen saturation may occur for a number of reasons including COVID or other infections of the lungs (such as pneumonia), a possible blood clot that travels to the lung, heart disease, sleep apnea and long-term lung conditions like COPD, asthma, or lung cancer. Low oxygen saturation also can be caused by medications that suppress breathing, such as opioid drugs. During the recent COVID-19 pandemic many people purchased over-the-counter (OTC) pulse oximeters to check their oxygen saturation because it became commonly known that a low oxygen saturation could be a sign of a COVID infection. The Food and Drug Administration (FDA) became alarmed about the use of OTC devices and issued a safety communication to doctors and consumers. The FDA warned that OTC pulse oximeters might not be accurate, especially in certain people. These devices might not be accurate in people with dark skin, cold skin, thick skin, or poor circulation. They might also be affected by nail polish, dirty nails, or artificial fingernails.

— Susan Leonard, MD, Geriatric Medicine, UCLA Healthy Years Editor-in-Chief,

The post Oxygen Saturation Levels appeared first on University Health News.

Flu

Did you get your flu shot this year? Many people ignore the annual public health advisory to get a flu shot, even though the Centers for Disease Control and Prevention (CDC) recommend a seasonal influenza vaccine for almost everyone. Some say they don’t get the vaccine because it’s not 100 percent effective. It is true that the flu vaccine does not prevent all cases of the flu, but if you do get the flu and you’ve been vaccinated, it can mean the difference between recuperating on your couch and requiring hospitalization for severe symptoms and complications. “The flu vaccine is very effective at preventing severe cases of flu. Each year, a majority of patients hospitalized for flu didn’t have the flu vaccine,” says Keith Roach, MD, associate professor of clinical medicine at Weill Cornell Medicine.

That’s right—all too often people think vaccines are all about preventing illness, when in fact a critical part of their job is reducing the seriousness of the illness they aim to prevent. Vaccines are an important aspect of preventive medicine. However, because various medical conditions and lifestyle choices can affect whether certain vaccines are safe for you, don’t hesitate to ask your doctor for guidance.

Here’s a summary of what you need to know about the most important vaccines.

COVID-19

As with other vaccine-preventable diseases, you are best protected from COVID-19 when you stay up to date with the recommended vaccinations. Everyone (6 years and older) should get one updated Pfizer-BioNTech or Moderna COVID-19 vaccine, regardless of whether they’ve received any original COVID-19 vaccines. Some people may get additional doses of COVID-19 vaccines: For instance, people ages 65 and older may get one additional dose of the vaccine four or more months after the first updated vaccine. Talk to your health-care provider about additional updated doses.

Pneumonia

The pneumococcal vaccine is recommended for everyone ages 65 and older. The vaccine comes in two parts: First, a dose of PCV13 (Prevnar 13) is given, followed a year later by a dose of PSV23 (Pneumovax23). However, people with certain medical conditions are advised to get vaccinated at a younger age. These conditions include those that compromise the immune system, such as leukemia, lymphoma, Hodgkin’s disease, and some other types of cancer, HIV, treatment with drugs that suppress the immune system, such as chemotherapy, and conditions such as diabetes, alcoholism, being a current smoker, chronic obstructive pulmonary disease (COPD), emphysema, and asthma, chronic liver disease, and chronic renal (kidney) failure.

Shingles

In 2017, a new shingles vaccine, Shingrix, was approved by the U.S. Food and Drug Administration. This vaccine is given in two doses, two to six months apart, and is recommended for all adults ages 50 and older. Preventing shingles is important, since possible complications from shingles include long-term postherpetic neuralgia, vision loss (if shingles occurs in or around your eye), and neurological problems that include balance and hearing difficulties. Remember that even if you have had shingles, you can get it again. Also, even if you previously got the Zostavax vaccine for shingles, you are advised to get the Shingrix vaccine.

First RSV Vaccine

The most recent vaccination to be approved by the FDA is the respiratory syncytial virus (RSV) vaccine. It is indicated for preventing lower respiratory tract infections in adults ages 60 and over. The CDC recommends a single dose of the RSV vaccine for people in this age group who decide with their health-care provider that the vaccine would benefit them.

Chickenpox

If you’ve never had chickenpox or received the chickenpox vaccine, you should consider getting vaccinated. Although chickenpox is thought of as a childhood disease, adults can also get the virus, and elderly adults and those with compromised immune systems are at higher risk of serious complications. The two-shot vaccine (given at least 28 days apart) is especially recommended for anyone who provides health-care for someone with a weakened immune system or who lives or works in a nursing home or similar environment.

Where to Get Vaccinated

You may be able to get your vaccines from your primary care physician. However, it may be more convenient and less costly to get your vaccines at your local pharmacy.

The post Stay Up to Date with Vaccines to Protect Your Health appeared first on University Health News.

Unfortunately, the list of potentially serious side effects has also mounted, and patients need to be aware of these possibilities when weighing the risks against the benefits of steroid drugs.

Steroids Treat Inflammation

“Patients take steroids for a variety of inflammatory conditions, including rheumatoid arthritis (inflammation of the joints), colitis and Crohn’s disease (the bowel), asthma and chronic obstructive pulmonary disease (lungs), and eczema and psoriasis (the skin),” explains Linda Russell, MD, a rheumatologist at the Weill Cornell-affiliated Hospital for Special Surgery and assistant professor at Weill Cornell Medicine. Other conditions frequently treated with steroids include allergies, hay fever, lupus, vasculitis, multiple sclerosis, and tendinitis.

Steroid Drugs and Delivery Methods

The terms “steroids,” “corticosteroids,” and “glucocorticoids” are different names commonly used to describe the same class of drugs, which include cortisone, hydrocortisone, prednisone, and prednisolone (see What You Should Know for more names of steroid drugs).

Steroid drugs are available in several different forms; the form your doctor prescribes is based on the source or cause of inflammation. Topical forms of steroids come in creams, sprays, and lotions and are used to treat skin conditions. Steroids can be injected into an inflamed joint or into the spine (an epidural). Steroid drugs used to treat asthma, allergies, and chronic obstructive pulmonary disease (COPD) are delivered via inhalers or nasal sprays. And some steroids are taken orally in pill form. Generally speaking, the lowest dose is best, and local administration (a knee or shoulder injection, for example), is preferable to systemic (affecting the whole body) delivery via pills or epidural injection.

Possible Side Effects

Not everyone experiences side effects, but they can occur. Using a low-dose, over-the-counter topical cream for bug bites and minor rashes is essentially safe, says Dr. Russell. However, recent research suggests that topical and inhaled steroid drugs may be linked with a higher risk of bone fractures and osteoporosis than previously recognized. And concerns about side effects rise with a systemic disease such as rheumatoid arthritis, which may require frequent dosing with high-potency steroids.

Some side effects include depressed or anxious mood, fluid retention (typically in the form of swollen ankles), dizziness, headache, insomnia, thinning skin, and weight gain.

More serious side effects linked with higher-dosage and/or longer-term steroid use include bone thinning that may result in osteoporosis, cataracts, glaucoma, high blood pressure, type 2 diabetes, and, rarely, avascular necrosis (bone collapse caused by insufficient blood supply to the bones). These side effects often may be present without manifesting any outward signs, so they may have already caused some damage before they are detected.

However, Dr. Russell says there’s no need for excessive worry or concern if you are treated occasionally with steroids for a condition like poison ivy or bronchitis.

“If you take a steroid once a year, the side effects will probably be minimal,” she explains. “If you start taking them once a month, or if you take them daily for more than two weeks, then you’re more likely to experience side effects.”

Explore Other Treatment Options

When considering steroid drugs, you and your doctor also need to think about alternatives. For example, in the case of rheumatoid arthritis, Dr. Russell says that physicians now try to use steroids only if the patient is experiencing a flare-up of symptoms. For asthma, physicians usually start with nonsteroidal medications, such as Singulair or Ventolin. Then, if the patient requires steroids, they use inhalers rather than oral steroids.

“For all conditions, always explore what nonsteroidal medications are available,” advises Dr. Russell.

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Instead, it’s the collection of anecdotal reports about possible side effects that cause pharmaceutical companies to include various complications among the drug’s “adverse effects.” Most drugs carry a toll-free number—usually to the Food and Drug Administration—on their labels for consumers to report serious side effects.

But determining whether new-onset depression or another mood-related side effect is absolutely attributable to starting a new medication can be a challenge for individuals and their healthcare providers, explains Gregory Fricchione, MD, Associate Chief of Psychiatry at Massachusetts General Hospital and Director of the Benson-Henry Institute for Mind Body Medicine. “There are so many variables at work when trying to discover why someone feels depressed contemporaneously with starting a new medication,” Dr. Fricchione says. For example, are the person’s expectations of a negative treatment outcome triggering mood changes—an example of the so-called “nocebo effect?” Or did the person have depression before starting the medication and is now simply more acutely aware of symptoms?

Adding to the challenge is that some legitimate medication side effects may lead to symptoms that mimic a mood disorder. Fatigue, for example, is a common side effect for many medications, including beta blockers. But a person experiencing fatigue may appear to be disinterested, tired, and having low mood and low energy—all common signs of depression. “Beta blockers really speak to the complexity of trying understand how a patient might be experiencing certain side effects,” says Dr. Fricchione.

Managing Side Effects

Of course, many medications really do trigger mood-related side effects that often need to be managed. Corticosteroids, such as prednisone, are widely used medications to treat inflammatory conditions ranging from asthma and chronic obstructive pulmonary disease (COPD) to lupus and rheumatoid arthritis.

Dr. Fricchione notes that some of the more common side effects of steroids are elated mood, difficulty sleeping, and other signs often associated with mania. “Some people taking steroids have manic episodes to the point where they need treatment,” he says, adding that the side effects can be so severe that individuals have delusions and perceptual changes.

But simply stopping steroid usage in those cases can also be harmful, as removing the drugs from the system can trigger depression. Your doctor instead might prescribe atypical antipsychotic medications to treat the mania, Dr. Fricchione says, adding that a gradual reduction in steroid dosage can help ease any further complications if the steroids are no longer needed or if another treatment may be an option.

Antidepressants can also sometimes cause mania, leading to what is known as medication-induced bipolar disorder. In these situations, and others in which a medication has caused a serious mood-related response, a mood-stabilizing medication can sometimes restore healthy mood regulation.

Dr. Fricchione explains that managing these and other side effects requires a very personalized approach to medicine. Your doctor can’t predict exactly how you will respond to a particular medication at a particular dosage.

Understand the Risks

Side effects, like mood swings, can often be experienced more acutely in older adults. “Their ability to metabolize drugs isn’t the same as when they were younger, so they tend to hold the drugs in their system longer,” Dr. Fricchione says, meaning that older adults are more sensitive both to the intended effects of a medication as well as any possible side effects. For that reason, many older adults are prescribed dosages at half the recommended amount—the “start low, go slow” approach.

It’s also important that you and your doctor have a conversation about potential side effects. You need to know what to be on the lookout for and how to respond. You should also know that stopping a medication or changing your medication regimen without first consulting with your doctor can sometimes be dangerous.

Equally important is that you give medications a chance to work and not give up too soon. Some side effects are short-lived as your body gets used to the drug. In some cases, changing the dosage or the time of day you take the medication can be helpful. And there are times when a second medication is needed to manage the side effects. While this may not seem like an ideal arrangement, taking an additional pill may be a small price to pay for the benefits derived from that initial treatment.

If you have any questions about side effects, talk with your doctor. Your pharmacist may also be a good resource. And when you have those conversations, be as forthcoming as possible about the details of your symptoms, including when they started, what (if anything) eases them, and how they make you feel. Sometimes mood-related side effects can be difficult to describe by the individual, so having a partner, family member, or friend at the appointment may be useful in describing any changes that have occurred since starting the medication.

The post When Your Meds Change Your Mood appeared first on University Health News.

How Accurate Is a Pulse Oximeter?

A pulse oximeter uses a light source that shines through your fingertip. By measuring the amount of light that passes through your fingertip, the device can estimate how much oxygen is being carried by your red blood cells. This procedure has become such a common part of physical exams that it has been called a fifth vital sign, along with temperature, pulse, respiratory rate, and blood pressure.

Pulse oximeters that are used in a doctor’s office or health care facility are regulated and tested by the FDA. This type of pulse oximeter can also be prescribed by a doctor for home use. An example would be a patient who has lung disease and needs to check oxygen levels frequently. To be approved by the FDA, these devices are checked against oxygen saturation measured by an ABG.  They must be accurate to within two to three percent of an ABG.

Pulse oximeters are also available for home use without a prescription, but these are not regulated by the FDA. Smart phone apps for pulse oximetry are a recent addition. These devices are not intended for medical evaluation. They are intended for general wellness or as a way for athletes or pilots to check their oxygen level.

During the recent COVID-19 epidemic, many people purchased over-the-counter pulse oximeters to check their oxygen saturation because it became commonly known that a low oxygen saturation could be a sign of a COVID infection. The FDA became alarmed about the use of OTC devices and issued a safety communication to doctors and consumers. The FDA warned that OTC pulse oximeters might not be accurate, especially in certain people. These devices might not be accurate in people with dark skin, cold skin, thick skin, or poor circulation. They might also be affected by nail polish, dirty nails, or artificial fingernails.

Do You Need a Pulse Oximeter Reading Chart?

Pulse oximeters are easy to read, so no additional chart is needed. If your oxygen saturation is below 92%, you should contact your doctor. ©Marvin Samuel Tolentino Pineda | Getty Images

Although you will find pulse oximeter charts on the internet, you really don’t need a chart. Pulse oximeters are easy to read. They give you your pulse and oxygen saturation right on the device. You just have to remember a few numbers. A normal oxygen saturation is 95 to 100 percent. If your oxygen saturation drops below 92 percent, you should contact your health care provider. If it falls below 88, you should get immediate medical attention.

Remember that pulse oximetry is only an estimate of oxygen saturation. A health care provider will look for other signs and symptoms of low oxygen saturation based on pulse oximetry and may do an ABG. Low oxygen saturation may occur in these conditions:

• COVID or other infections of the lungs, like pneumonia
• A blood clot that travels to the lung
• After surgical anesthesia
• With some medications that suppress breathing (like opioid drugs)
• Long term lung conditions like COPD, asthma, or lung cancer
• Heart disease
• Sleep apnea

How to Use a Pulse Oximeter at Home

Unless you have a condition that requires you to keep track of your oxygen saturation, you don’t need a home pulse oximeter. If you want to try one of these devices, keep in mind that OTC devices are not always reliable. When using an OTC device, it is also important to know the signs and symptoms of low oxygen saturation, which may include:

• A blue tint to the lips, face, or fingernails, called cyanosis
• Difficulty breathing or shortness of breath on exertion
• An unexplained and persistent cough
• Cheat pain or tightness
• A racing pulse

If you use one of these devices, follow the directions that come with the device. Before you put it on your finger and remove any nail polish or artificial nails. Make sure your hand is warm, relaxed, and positioned below the level of your heart. Be still until the reading shows up on the device. If you are in good health, it is unlikely that you will have any drop on oxygen saturation without other signs or symptoms. Pay more attention to trends over time than a single reading. If in doubt, contact your health care provider.

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NCCIH says that about 9 to 10 percent of Americans use chiropractic care every year for relief of back or neck pain, headache, general wellness, disease prevention, energy, strengthening the immune system, and improving memory and concentration. Spinal manipulation of the neck or back is used mainly to treat low back pain, neck pain, and headache.

It is normal to have some increase in pain after spinal manipulation. According to the Mayo Clinic, side effects of spinal manipulation can include increased pain, fatigue, and headache. These side effects should not be severe or long-lasting. Although the risks from spinal manipulation by a trained and licensed chiropractor are low, complications can include damage to the disc between spine joints (herniated disc) or damage to nerves leaving the spinal column. These complications may cause longer-lasting pain, numbness, tingling, or weakness.

A very rare but very serious cause of pain and weakness after neck manipulation is a tear in one of the arteries that pass through the spine of the neck to supply the brain. A tear in one or more of these arteries can cause a stroke. This injury is called a cervical artery dissection. It may also be caused by a sports or whiplash injury that suddenly and forcefully moves the neck. The symptoms are sudden pain and loss of movement.

Should You Get Spinal Manipulation?

According to NCCIH, there is moderate evidence in studies to support spinal manipulation for low back pain and weak evidence for headache or neck pain. A review of 15 studies on spinal manipulation for low back pain, involving about 1,700 patients, found that spinal manipulation can give moderate relief to people with low back pain.

A review of 51 trials on spinal manipulation for neck pain, involving over 2,900 patients found that evidence for relief for neck pain was weak. A review of studies on spinal manipulation for headache rated the evidence of improvement to be low.

According to a 2020 review of alternative therapies for pain, published in the journal Advances in Therapy, there is a lack of evidence to support the use of spinal manipulation for migraine headaches, although over 50 percent of chiropractors use this treatment for migraines. This review also found that evidence for relief of neck pain was weak and that spinal manipulation was a poor choice compared to other therapies.

NCCIH says spinal manipulation has been studied for many other conditions including fibromyalgia, pediatric ear infections, COPD, bedwetting, menstrual pain, asthma, and high blood pressure without evidence of relief or improvement in these conditions.

Recommendation for Spinal Manipulation

The best evidence for the use of spinal manipulation is for low back pain. Clinical practice guidelines from the American College of Physicians recommend spinal manipulation as one of the options for treating low back pain.

NCCIH says this treatment is relatively safe when performed by a trained chiropractor, physical therapist, or osteopathic physician. The most common side effect is temporary pain and stiffness. If you see a chiropractor for back pain, you should tell your chiropractor about any medical conditions you have and any dietary supplements you take. Mayo Clinic advises against spinal manipulation if you have

• Severe osteoporosis
• Back or neck pain that includes tingling, numbness, or weakness
• Cancer in your spine
• A diagnoses of any type of spinal abnormality
• An increased risk of stroke

According to the CDC, common stroke risks include a previous stroke or transient ischemic attack, high blood pressure, high cholesterol, heart disease, diabetes, and obesity. Mayo Clin notes that spinal manipulation does not work for everyone, so if you do not see any improvement after several weeks, it might not be the best option for you.

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What Does Air Quality Mean and What Is Unhealthy Air Quality?

Every day, the EPA issues AQI numbers for areas all around the country. This number tells you if your air quality is good, moderate, unhealthy, or bad. AQI numbers start at 0 and can go up to 500. The higher the number, the worse the air pollution. AQI numbers rarely go above 200 in the United States. These are the numbers and what they mean:

• AQI of 0 to 50 is good air quality, and safe for everyone. The color code on an AQI chart is green.
• AQI of 51 to 100 is moderate air quality. AQI of 100 is the limit of air quality considered to be satisfactory for most people. People who are very sensitive to air pollution may have symptoms from this level of pollution. The color code is yellow.
• AQI of 101 to 150 is unhealthy air quality for sensitive groups, such as people with asthma or other lung conditions. People without these conditions usually do not have symptoms. The color code is orange.
• AQI of 151 to 200 is very unhealthy for sensitive people. They may experience severe respiratory symptoms. People without lung problems may also experience symptoms. The color code is red.
• AQI of 201 to 300 is very unhealthy for everyone and a health alert is issued. The color code is purple.
• AQI over 301 is hazardous for everyone and a health warning emergency is issued. The color code is maroon.

Respiratory Symptoms From Unhealthy Air Quality

These symptoms can include cough, throat irritation, shortness of breath, chest tightness, wheezing, or chest pain or burning. It may be painful to take deep breaths. Lung conditions like COPD or asthma may suddenly get worse. Hospital admission for respiratory disease typically goes up during a time of poor air quality. People who are at risk of respiratory issues during a period of poor air quality include children and adults with asthma, people over age 65, and people with long-term health conditions like diabetes and heart disease.

What to Do When Air Quality Is Unsafe for You

If you or someone in your family is at risk from air pollution, you should check the daily AQI numbers in your area. You can find your AQI numbers in your local newspaper or on your local news station. National media companies like CNN, The Weather Channel, and USA Today publish AQI numbers and warnings for all areas of the country. You can also find your AQI at the EIP website airnow.gov.

If your state or local environmental protection department participates in a program called EnviroFlash, you can receive air pollution alerts or warnings. These warnings are especially important for unexpected air pollution from fires.

If the air quality is unsafe for you:

• Limit outdoor air exposure.
• If you need to be outside, avoid times of higher high air pollution, late afternoon and evening.
• Stay away from highway traffic areas.
• Avoid moderate exertion outdoors, which includes activities like brisk walking, light jogging, physical work, and or running sports.

Indoor air pollution could come from the poor quality air outside, so make sure to stay on top of replacing air filters around the home.

Do Air Purifiers Work for Air Pollution?

AQI only measures outdoor air pollution. If you are at risk from poor air quality, the EPA recommends an indoor air purifier. Indoor air pollution may come from outdoor air it may come from indoor air pollution sources like cooking, cleaning, or secondhand smoke. The EPA says that using a portable air purifier or upgrading the air filter in your furnace, central heating, or air-conditioning system can help to improve indoor air quality.

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