“Paging Dr. House!” What Is Sarcoidosis?

by Cecilia M. Smith, DO

Sarcoidosis is an elusive disease. Even the TV series “House,” about the brilliant (but surly) Dr. Greg House and his team of brilliant (but demoralized) subordinates, picked up on that fact. Faced with the weekly challenge of diagnosing a mysterious and deadly disease, at some point during each episode, one of House’s protégés inevitably would suggest, “Maybe it’s sarcoidosis.” And with the disease’s wide variety of symptoms, the many organs it can affect, and the other diseases it can mimic, it was perhaps a diagnosis worth considering.

April is National Sarcoidosis Awareness Month, a good time to learn about this puzzling disease. It is often thought of as a lung disease because the organ most commonly involved is the lungs. But it can affect any organ of the body, such as the lymph glands, eyes, skin, liver, or salivary glands, without causing lung disease. In other cases, only the lungs are affected, a condition called pulmonary sarcoidosis. Pulmonary sarcoidosis can reduce the amount of air the lungs hold and cause breathing problems.

Sarcoidosis is characterized by granulomas—tiny lumps of cells that cluster together in a unique way within the tissue of the organs involved. To help the doctor diagnose the disease, the tissue must be biopsied and examined in a laboratory, and this unique cluster pattern must be present.

To complicate the matter, sarcoidosis is not the only disease associated with the formation of granulomas in tissue. Granulomas can also occur in certain infectious diseases and environmental/occupational exposures. So if granulomas are found, further investigation is needed to determine which disease is causing them.

What causes these clusters of cells to form is not known. Researchers suspect that exposure to certain substances may cause a reaction within a person’s immune system, but they don’t know what those triggers are.

Researchers do know that there is nothing a person “does” to cause sarcoidosis. It is found in every sex, age, race, and country of birth, although it occurs more commonly in Northern Europe and, within the United States, among African Americans. It affects younger adults, between 20 and 40 years of age, more than the very young or the elderly.

Diagnosing sarcoidosis can be tricky. Symptoms can vary widely, depending on the part of the body involved, or there may be no symptoms. When symptoms occur, they may be vague and not specific to sarcoidosis—such as weight loss, fever, depression, night sweats, and sleep problems. If a doctor is not considering it as a possibility, it is likely to be missed or misdiagnosed.

There is not one definitive test to diagnose sarcoidosis. A good history and physical is essential, including family members’ health history. It is important for the patient to mention even vague symptoms, as they could possibly be a clue. Further testing will focus on the organ of the body involved.

Once a diagnosis of sarcoidosis is established, not all individuals require treatment. It depends on which organ of the body is affected. For instance, when the eyes are involved, drug therapy is required. When the lymph nodes are involved, however, no therapy is needed. Treatment is aimed at reducing symptoms and preventing organ damage. Because sarcoidosis can clear in the lungs without therapy, there is some controversy among medical professionals as to when to treat for lung involvement.

Like everything else with this disease, prognosis for people diagnosed with sarcoidosis varies. Many individuals live a long life, while in others the disease progresses and causes organ damage. In rare cases it can be fatal. Comedian Bernie Mac died from complications of sarcoidosis in 2008.

For more on sarcoidosis, including information on living with the disease and chapters on specific organ involvement, see “Sarcoidosis: A Primer,” electronically published by the American College of Chest Physicians. Too bad Dr. House and his team didn’t have access to this great resource!

Photo: Fox TV

Cecilia M. Smith, DO, is a Clinical Professor of Medicine at Jefferson Medical College in Philadelphia and chairs the Department of Medicine at Reading Health System in West Reading, Pennsylvania. She served as co-editor of “Sarcoidosis: A Primer,” published by the Interstitial and Diffuse Lung Disease Network of the American College of Chest Physicians.

 

 

 

 

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How Much Do You Know about Dangerous Blood Clots?

by Barbara Granner

A few years ago, my friend’s boyfriend had something called a pulmonary embolism – a blood clot in his lung. The only thing I knew about it at the time was that it was scary-sounding and life-threatening.

I have since learned that pulmonary embolism – PE – is a serious complication of deep vein thrombosis – DVT. I have also learned that March is DVT Awareness Month.

DVT awareness deserves its own month. According to the results of an informal poll (mine), most people do not know what DVT is or what PE is, other than another name for gym class. Yet someone dies from PE every six minutes. That’s more people than die each year from breast cancer and AIDS combined. Yikes!

So to help combat this lack of awareness, I present to you: A DVT/PE Primer, based on authoritative information from the American College of Chest Physicians, which has compiled the best available evidence-based recommendations on diagnosing and treating DVT and PE in Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: Evidence-Based Clinical Practice Guidelines.

DVT, or deep vein thrombosis, occurs when a blood clot forms in one of the deep veins, most commonly in the lower leg or thigh. The clot can block blood flow and cause leg swelling, pain, tenderness, and skin discoloration. Or it can be symptomless.

The big danger is that part of the clot can break loose and travel to the lungs – a pulmonary embolism. PE is a medical emergency. If the clot blocks a pulmonary artery or one of its branches, it will prevent oxygen from entering the lungs and can cause death.

DVT/PE is not specific to any age, race, or gender. But there are certain risk factors that make you more susceptible. According to the ACCP, major risk factors include: major surgery, major trauma to the legs and/or pelvis, prolonged bed rest and immobility, cancer, advanced age, hereditary predisposition, and previous venous thrombosis. Other risk factors include estrogen use (oral contraceptives or hormone replacement therapy), pregnancy and post-pregnancy, chronic illness, varicose veins or phlebitis, and obesity.

Airplane travel is another risk factor for venous thrombosis, primarily in travelers who have other risk factors or on flights that are 6 hours or longer. Still, it’s always a good idea when traveling, either by train, plane, or automobile, to stop, stretch your legs, and walk around if possible. And the ACCP recommends that high-risk patients wear elastic compression stockings when flying.

The good news is that most patients do not develop long-term complications and recover completely if they receive proper treatment, which usually consists of taking a “blood-thinner” (anticoagulant medication). In extreme circumstances, such as very large venous thrombosis or pulmonary embolism, “clot-busting drugs” may be used.

So know the symptoms of PE: sudden shortness of breath; sharp, stabbing chest pain that may get worse with deep breaths; rapid heart rate; or unexplained cough, sometimes with bloody mucus. CALL 911 IMMEDIATELY if you experience these symptoms. Luckily, my friend’s boyfriend did.

The ACCP has created several patient-education guides about DVT/PE and other blood clots based on the clinical practice guidelines. Access them at The CHEST Foundation’s website, onebreath.org.

 

Barbara Granner is editorial specialist with The CHEST Foundation. She invites readers to share their own DVT/PE stories.

 

 

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World Spirometry Day

World Spirometry Day (WSD) is approaching on June 27, and the COPD Alliance is partnering with OneBreath and several other professional organizations on an outreach event in Chicago that will bring attention to the importance of spirometry as an easy to use tool to help with the evaluation of a person who is suspected to have lung disease, such as COPD or asthma.

The clinicians who are staffing the event in Chicago that will help to determine whether a patient might be at risk for COPD.  They will then use a simple spirometer that will help determine whether COPD might be present. These spirometers are also helpful to determine a person’s “lung age.”  Spirometry is a breathing test that can be administered in your clinician’s office or in the hospital, and the results can be seen and interpreted at the time of the test. Spirometry is the only definitive test to diagnose COPD, and it is a useful tool in evaluating the severity of asthma.

COPD is a chronic lung disease characterized by shortness of breath and a persistent cough and is prevalent in smokers. COPD is estimated to affect 24 million people in the United States and is recognized by the Centers for Disease Control and Prevention as the third leading cause of death, yet it is estimated that as many as 50% of those with COPD remain undiagnosed. Asthma is a chronic inflammatory lung disease that affects another 22 million Americans of all ages and can usually be controlled by working with your clinician by developing an asthma action plan.

Those 35 years of age and older with a smoking history should consider asking their primary care practitioner about whether this simple spirometry test is appropriate for them. If you are interested in attending the event in Chicago or finding an event near you, visit the World Spirometry Day website .

 

Brian Carlin, MD, FCCP is a board certified Pulmonologist who has been active in both academic and private practice for many years in Pennsylvania. Dr. Carlin is a leading proponent of lung health and has held leadership positions in the American College of Chest Physicians, National Lung Health Education Program, and the American Association for Cardiovascular and Pulmonary Rehabilitation.

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Technology Can Help You Meet Your Health Goals in 2012!

OneBreath® focuses on nine prevention areas to improve overall health.  There are countless technology resources available to help you meet your health goals.  Here are a few notable resources:

  • Whole Foods Market Recipes App. This free iPhone® app allows you to specify your dietary needs and search by ingredient. Recipes also list nutritional information and cooking instructions.
  •  Choosemyplate.gov. This site’s SuperTracker gives you personalized nutrition and physical activity plans, tracks your food and physical activities, and provides tips and support to make healthy choices.
  • Digifit App. This free iPhone® app is great for tracking workouts. It maps your route; gives you time, distance, and speed; and also tracks your weight, blood pressure, and sleeping habits. The app provides voice feedback, charts your overall workout stats, and allows you to share your fitness routine with friends via Facebook and e-mail.  Plus, you can integrate your iTunes® music into your workout.
  • LiveStrong’s MyQuit Coach. This free quit smoking app helps with goal setting, gives helpful tips for quitting smoking, lets you track your daily progress and personal motivations for quitting, offers a community of people also working to quit smoking, and provides financial and health data to motivate you to quit. More than 1,000 people have reviewed the app in the app store, and it has received a 4.5 star rating.

 

Which technology tools or Web sites do you use for help in meeting your health goals?  Be sure to share on OneBreath’s Facebook wall at www.facebook.com/onebreathorg.

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Get a Healthy Start to 2012!

OneBreath wants to help you get a healthy start in 2012. Share your own healthy resolutions to be entered into our contest, which runs until January 13, 2012, at 12:01 am ET. You could win a Healthy Resolutions prize package valued at more than $200, including a $100 donation to OneBreath made in honor of the randomly drawn winner of the contest; the cookbook, Comfort Food Fix: Feel-Good Favorites Made Healthy by Ellie Krieger, RD, The New York Times best-selling author and host of Healthy Appetite on the Food Network; Nike+ SportBand; $40 Whole Foods gift card; OneBreath drawstring bag; and a Love Your Lungs® wristband.

There are six ways to enter the contest, and you can enter multiple times.

1.      “Like” OneBreath on Facebook.

2.      Share your healthy resolutions on our Facebook wall. (https://www.facebook.com/#!/pages/OneBreath/163703196974528)

3.     Become a member of OneBreath.org. Register here. https://onebreath.org/sslpage.aspx?pid=290

4.     Follow #onebreathorg on Twitter.

5.     Tweet your healthy resolutions and tag @onebreathorg and #healthyresolutions.

6.     Tweet about your healthy resolutions and encourage your friends to make their resolutions using @onebreathorg and #healthyresolutions.

 

We encourage you to tell your friends and family about this contest via Facebook post, tweet, or e-mail, or send a Healthy Resolutions e-card https://www.onebreath.org/sslpage.aspx?pid=364 to encourage healthy habits in 2012 and support OneBreath’s mission!

 

The winner will be selected randomly and will be announced and notified on OneBreath’s Facebook wall.
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