Your doctor may order a home sleep test for you in order to properly diagnose sleep issues. If you are scheduled to have your home sleep test (HST) completed at MLA, you will meet with a member of the team to learn about how to use the HST device.
This video may also be helpful as a reminder, before you go to sleep:
Thoracentesis (also known as a pleural tap) is a procedure to remove fluid or air from the pleural space. The pleural space is an area between the lung and the chest wall that usually contains just a thin layer of fluid. At times, air or more commonly fluid can collect in this space. If there is enough fluid, a patient can become symptomatic, for example develop shortness of breath. If that occurs, removal can provide relief of these symptoms. Additionally, fluid may need to be removed to help aide in the diagnosis of many conditions. The test is performed as follows: You will sit on the edge of a bed or chair. Your head and arms will rest on a table. The skin around the procedure site is cleaned and the area is draped. A local numbing medicine (anesthetic) is injected into the skin. You will feel a stinging sensation when the local anesthetic is injected. The thoracentesis needle is inserted above the rib into the pleural space and a catheter (small plastic tube) if introduced. You may feel pressure when the needle is inserted into the pleural space. Fluid is collected and will be sent to a laboratory for testing. This procedure has been performed by physicians since 1852!
Cystic fibrosis (CF) is an inherited condition caused by a defective gene (CFTR – Cystic Fibrosis Transmembrane Conductance Regulator) which causes the body to produce abnormally thick and sticky fluid, called mucus. This mucus builds up in the breathing passages of the lungs and in the pancreas, the organ that helps to break down and absorb food. This collection of sticky mucus results in life-threatening lung infections and serious digestion problems. The disease may also affect the sweat glands and a man’s reproductive system. Millions of Americans carry the defective CF gene, but do not have any symptoms. That’s because a person with CF must inherit two defective CF genes – one from each parent. An estimated 1 in 29 Caucasian Americans has the CF gene. The disease is the most common, deadly, inherited disorder affecting Caucasians in the United States. It’s more common among those of Northern or Central European descent. Most children with CF are diagnosed by age 2. A small number, however, are not diagnosed until age 18 or older. Occasionally, relatively mild symptoms may lead to frequent misdiagnosis or no diagnosis at all unless the symptoms become worse. The condition may be misdiagnosed as emphysema, asthma or chronic bronchitis. These patients usually have a milder form of the disease. About 30,000 Americans and 70,000 people worldwide are living with cystic fibrosis. Only a few decades ago, children with CF seldom survived elementary school. Today, thanks to earlier diagnosis and improved treatments, the median survival for those with CF is 47 years of age. With new, novel therapies known as CFTR modifiers this number is likely to climb.
Dr. Schaefer helped to establish the Adult Cystic Fibrosis Program at the UMass-Memorial Medical Center. He sees patients with CF at the CF Center at UMass-Memorial University campus, as well as in MLA’s Worcester office.
UMass-Memorial / UMass Chan Medical School Adult Cystic Fibrosis Program
The UMass-Memorial Adult Cystic Fibrosis Center, accredited by the national Cystic Fibrosis Foundation, specializes in the management of adults with cystic fibrosis. We provide a team approach to care that includes medical, nurse, registered dietician, physical therapy, social worker, and respiratory therapy cystic fibrosis specialists. We collaborate closely with our colleagues in the UMass-Memorial Pediatric Cystic Fibrosis Center to assist adolescents and young adults in the transition from pediatric to adult care.
Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body’s circulation.
Pulmonary function tests are done to:
The most commonly performed test is called “spirometry.” With this test you will breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time. For some of the test measurements, you can breathe normally and quietly. Other tests require forced inhalation or exhalation after a deep breath. You will be asked to wear a nose clip so we can collect all the air that comes out of your mouth. “Lung volume” is measured in other ways. In one way you will be asked to sit in a sealed, clear box that looks like a telephone booth (body plethysmograph) while breathing in and out into a mouthpiece. Changes in pressure inside the box help determine the lung volume.
Lung volume can also be measured when you breathe nitrogen or helium gas through a tube for a certain period of time. For one test known as a “methacholine challenge test” you will have to breathe in medication before the test.
Do not eat a heavy meal before the test. Do not smoke for 4 – 6 hours before the test. You’ll get specific instructions if you need to stop using bronchodilators or inhaler medications prior to the test. The tests are usually very well tolerated. Since the test involves some forced and rapid breathing, you may have some temporary shortness of breath or light-headedness.
Immunotherapy, also known as “allergy shots” is a way of making the body less sensitive to specific substances known as allergens. With reduced sensitivity comes a reduction in your allergy symptoms. Allergic sensitivity is determined by allergy skin tests, or blood tests. This information is used to determine which allergens contribute to your reactions. Mixtures of these allergens are then developed for your therapy. The mixtures are given by injections under the skin.
By starting with extremely tiny doses and gradually increasing, the immune system becomes more tolerant, and thus your allergy symptoms are reduced. There are 2 stages of immunotherapy. Build-Up: This is the 1st stage when the amount of each injection is slowly increased. Most patients receive injections once per week, though if your schedule allows, you can come twice weekly. There are about 25 steps to complete this 1st phase. During this phase some but not all of our patients notice any improvement in their symptoms. Maintenance: The 2nd stage. Once you have reached the highest dose of each mixture, that dose is repeated once a month. Benefits from immunotherapy have been shown when a patient reaches this dose. Because of the potential risk of an allergic reaction, shots are only given by medical professionals trained in the proper administration, and in the recognition and management of complications. For this reason shots are given in the MLA Worcester office only.
There is a 20-30 minute observation period after each shot during which you will wait in the office to be sure that you do not have an allergic reaction. At least 80% of patients who receive immunotherapy have a significant improvement in their allergy symptoms, although many do not feel completely “cured.” Not everyone is able to stop taking all of their allergy medications. Allergy shots do not cure you of your allergies, only make you more tolerant upon allergen exposure or during your season. If therapy is stopped some of the symptoms may return, though most individuals have some long-lasting benefit well beyond the time the shots were discontinued. Because of the need to maintain a regular injection schedule, immunotherapy should not be started unless your schedule allows for fairly regular visits.
If your symptoms are troublesome despite avoidance strategies and medications, allergy immunotherapy may be right for you.
Allergic reactions to flying stinging insects – honeybees, hornets, wasps and yellow jackets – are relatively common. In the southern United States, the red or black imported fire ant now infests more than 260 million acres where it has become a significant health hazard and may be the number one agent of insect stings there. The severity of an insect sting reaction varies from person to person. A normal reaction will result in pain, swelling and redness confined to the sting site. A large local reaction occurs in 10-15% and will result in swelling that extends beyond the sting site. For example, a sting on the forearm could result in the entire arm swelling twice its normal size. Although alarming in appearance, this condition is not dangerous and is often treated the same as a normal reaction. The rarest but most severe sting reaction, called anaphylaxis, occurs in about 0.5% of children and 3% of adults who are stung. At least 90 to 100 deaths per year result from insect sting anaphylaxis.
If you are referred to MLA for evaluation of an insect sting, a careful history will be obtained. Based on this, allergy testing may be performed likely with a skin test, but sometimes through a blood test. As the skin testing for a stinging insect reaction is involved, this will be performed at a separate visit. Based on your history and the results of the testing your physician will be able to recommend the best intervention for you. For those experiencing a severe sting reaction this may include allergy immunotherapy – “desensitization” (see below) as well as self-injectable epinephrine (EpiPen) and MedicAlert® identification.
Knowing how to avoid stings from fire ants, honeybees, wasps, hornets and yellow jackets leads to a more enjoyable summer for everyone. Stinging insects are most active during the late spring, summer, and early fall. Insect repellents do not work against stinging insects. Yellow jackets will nest in the ground and in walls. Hornets and wasps will nest in bushes, trees and on buildings. Use extreme caution when working or playing in these areas. Avoid open garbage cans and exposed food at picnics, which attract yellow jackets. Also, try to reduce the amount of exposed skin when outdoors.
Consider the following additional precautions to avoid insect stings:
The long-term treatment of insect sting allergy is called venom immunotherapy. It is a highly effective program administered by an allergist, which can prevent future allergic reactions to insect stings.
Venom immunotherapy involves administering gradually increasing doses of venom to decrease a patient’s sensitivity to the venom. This can reduce the risk of a future allergic reaction to that of the general population. In a matter of weeks to months, people who previously lived under the constant threat of severe reactions to insect stings can return to leading normal lives.
Cystic fibrosis (CF) is an inherited condition caused by a defective gene (CFTR – Cystic Fibrosis Transmembrane Conductance Regulator) which causes the body to produce abnormally thick and sticky fluid, called mucus. This mucus builds up in the breathing passages of the lungs and in the pancreas, the organ that helps to break down and absorb food. This collection of sticky mucus results in life-threatening lung infections and serious digestion problems. The disease may also affect the sweat glands and a man’s reproductive system. Millions of Americans carry the defective CF gene, but do not have any symptoms. That’s because a person with CF must inherit two defective CF genes – one from each parent. An estimated 1 in 29 Caucasian Americans has the CF gene. The disease is the most common, deadly, inherited disorder affecting Caucasians in the United States. It’s more common among those of Northern or Central European descent. Most children with CF are diagnosed by age 2. A small number, however, are not diagnosed until age 18 or older. Occasionally, relatively mild symptoms may lead to frequent misdiagnosis or no diagnosis at all unless the symptoms become worse. The condition may be misdiagnosed as emphysema, asthma or chronic bronchitis. These patients usually have a milder form of the disease. About 30,000 Americans and 70,000 people worldwide are living with cystic fibrosis. Only a few decades ago, children with CF seldom survived elementary school. Today, thanks to earlier diagnosis and improved treatments, the median survival for those with CF is 47 years of age. With new, novel therapies known as CFTR modifiers this number is likely to climb.
Dr. Schaefer helped to establish the Adult Cystic Fibrosis Program at the UMass-Memorial Medical Center. He sees patients with CF at the CF Center at UMass-Memorial University campus, as well as in MLA’s Worcester office.
UMass-Memorial / UMass Chan Medical School Adult Cystic Fibrosis Program
The UMass-Memorial Adult Cystic Fibrosis Center, accredited by the national Cystic Fibrosis Foundation, specializes in the management of adults with cystic fibrosis. We provide a team approach to care that includes medical, nurse, registered dietician, physical therapy, social worker, and respiratory therapy cystic fibrosis specialists. We collaborate closely with our colleagues in the UMass-Memorial Pediatric Cystic Fibrosis Center to assist adolescents and young adults in the transition from pediatric to adult care.
Mass Lung and Allergy is currently offering Home Sleep Test device pickups from both our Leominster and Worcester offices! Call us at 774-420-2611, option 5 for more information.
Sleep Disorders:
Obstructive sleep apnea (OSA) is a common problem that affects a person’s breathing during sleep. A person with OSA has times during sleep in which air cannot flow normally into the lungs. The block in airflow (obstruction) is usually caused by the collapse of the soft tissues in the back of the throat (upper airway) and tongue during sleep. For more information on OSA click here.
Many people experience difficulty sleeping. Some people have short periods (days to a few weeks) of difficulty falling asleep or staying asleep (called acute insomnia). Others have this difficulty for a month or longer (called chronic insomnia). About 30% of Americans complain of having insomnia. Insomnia can be very disruptive to a person’s life, so understanding insomnia and what can be done to treat it can be helpful to your quality of life. For more information on insomnia click here.
Narcolepsy is a neurologic problem in which your brain is not able to control your sleep-wake cycle. It can cause you to have sudden and overwhelming sleepiness any time of the day. This can cause you to fall asleep at inappropriate times, such as while talking to someone, driving a car, eating, or while at school or work. This can at times put you in danger such as when driving. Narcolepsy is a lifelong condition that never goes away. About 1 in 2,000 people have narcolepsy. It affects men and women equally. Most people with narcolepsy will begin to have symptoms between the ages of 10 and 30 years old. For more information on Narcolepsy click here.
Chronic obstructive pulmonary disease (COPD) refers to chronic bronchitis and emphysema two commonly co-existing diseases of the lungs in which the airways (bronchial tubes) become narrowed. This leads to a reduction of the flow of air to and from the lungs causing shortness of breath. Unlike in asthma, the reduced airflow is poorly reversible and usually worsens over time. COPD is caused by noxious particles or gases, most commonly from cigarette smoking, which leads to inflammation in the lung. Inflammation in the larger airways results in chronic bronchitis (which is characterized by cough and sputum production). Inflammation in the air sacs (alveoli) causes destruction of the tissues of the lung, and this results in emphysema. The natural course of COPD is characterized by occasional sudden worsening of symptoms called acute exacerbations, most of which are caused by infections or air pollution. COPD is the 4th leading cause of death in the U.S., and the economic burden of COPD in the U.S. in 2007 was $42.6 billion in health care costs and lost productivity. The primary risk factor for COPD is chronic tobacco smoking. In the US, 80 to 90% of cases of COPD are due to smoking. Exposure to cigarette smoke is measured in pack-years, the average number of packages of cigarettes smoked daily multiplied by the number of years of smoking. Other factors include exposure to certain workplace dusts and chemicals, air pollution, and genetics. The diagnosis of COPD is considered in anyone who has shortness of breath, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease such as regular tobacco smoking. No single symptom can adequately confirm or exclude the diagnosis of COPD although COPD is uncommon under the age of 40 years. The diagnosis of COPD is confirmed by lung function testing (spirometry). Spirometry can also help to determine the severity of COPD.
Your MLA physician will evaluate COPD by taking a careful history, performing a physical examination as well as reviewing or ordering a chest x-ray, and any other information that you bring to the office visit. If not already done pulmonary function tests will be ordered. COPD management not only consists of appropriate medications but attention to lifestyle change (exercise, smoking cessation), pulmonary rehabilitation, nutrition and if needed, supplemental oxygen therapy.
Allergic rhinitis, commonly known as a runny nose, or when due to pollen exposure, “Hay Fever” is the medical term describing irritation and inflammation of the nose. This results in a variety of symptoms including runny nose, sneezing, stuffy nose, sore throat, itching of the nose, mouth and eyes, as well as tearing of the eyes. An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen or dust, the body releases chemicals, including histamine. This causes allergy symptoms. Hay fever involves an allergic reaction to pollen. A similar reaction occurs with allergy to mold, animal dander, dust, and similar inhaled allergens. The pollens that cause hay fever vary from person to person and from region to region. Large, visible pollens such as those from colorful, showy flowers are seldom responsible for hay fever. Tiny, hard to see pollens more often cause hay fever. Examples of plants commonly responsible for hay fever include trees, grasses, and weeds, in particular, ragweed. Though allergies (and allergic rhinitis) are common, many people who suffer from the symptoms above actually do not have allergy! When consulting your MLA physician it is likely that allergy testing will be performed. This will tell you if in fact your symptoms are due to an environmental allergy and if so, which particular ones. Skin testing (“scratch test”) is the most common method of allergy testing. If your doctor determines you cannot undergo skin testing, special blood tests may help with the diagnosis. These tests can measure the levels of specific allergy-related substances (antibodies), especially one called immunoglobulin E (IgE). Based on the results of the allergy testing, your physician will be better able to recommend various treatments, including avoidance strategies, medications and allergy shots (immunotherapy) to help control your symptoms.
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