SALT LAKE CITY — Cedar, oak, birch, cottonwood.

They’re a big part of the local landscape, but they’re also causing Utahns a lot of trouble lately.

“We had a relatively warm winter and what might be perceived as an early or mild spring and this has promoted very high pollen counts,” said Dr. Charles Rogers, a board-certified allergist with Allergy Associates of Utah and Intermountain Medical Center. Rogers works out of two offices and definitely keeps busy this time of year.

Pollen counts for a variety of trees are already way above average, “extra high,” according to Intermountain Allergy and Asthma, which produces daily measures of what’s in the air in the Salt Lake Valley.

“This year is the same or worse than other years,” Rogers said. “But it has come on somewhat earlier.”

Tree pollens are typically bad from March through June, grass pollens pick up in late April and are prevalent through July, and weed season is worst from July to October. this year, many trees have been pollinating since February.

“These things have a tremendous negative impact on quality of life,” said Dr. Craig Moffat, a board-certifed allergist at Alta View Hospital and the Intermountain Sandy Clinic. He said allergies have a tendency to interfere with school, work and daily life, often leading to decreased productivity and absenteeism.

“The best treatment is to change your parents or change your genes,” Moffat joked. “But since we can’t do that, there’s actually really good therapy available.”

Allergies, he said, are inherited from a person’s parents. if one parent has allergies, children have a 33 percent chance of also having allergies. The percentage increases to 66 percent when both parents suffer from allergies. Moffat’s family history (he has one parent with allergies) actually helped him determine his own career path, as he wanted to help others find relief.

Children aren’t typically affected by seasonal allergies until age 5, and Moffat said symptoms continue to get worse through a person’s 20s and 30s, when they peak and eventually fade away at age 70 or 80.

Both doctors said initial appointments with an allergist or a primary care physician involve recording a patients’ history and examining symptoms.

Typical symptoms for seasonal allergies, Moffat said, include red, itchy, watery eyes and runny nose, sneezing and itchiness.

HONOLULU — the media frenzy surrounding reports of bedbug infestations in new York may increase acute anxiety and mood disorders. Although the numbers of cases are few — just 10 in the study reported here — Evan Rieder, MD, of Langone Medical Center, and colleagues are urging colleagues to be aware of the risk associated with the current bedbug outbreak. “They’ve occurred in patients with a history of psychiatric illness and without,” Rieder told MedPage Today during an interview at his poster at the American Psychiatric Association meeting here. among the 10 patients diagnoses included anxiety, depression, and relapse of controlled bipolar disorder. Others were diagnosed with monosymptomatic delusional disorder — imagining that one is crawling with pests, even though no infestation exists. Action Points  

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Explain that the media frenzy surrounding reports of bedbug infestations in new York may increase acute anxiety and mood disorders.

“If you’re always struggling with seeing the world as an unsafe place, its easy [for something like this] to bolster your delusions,” said Kenneth Silk, MD, of the University of Michigan, chair of APA’s scientific program committee, who was not involved with the study.

Silk relayed the example of working in an emergency department in Michigan the morning after September 11 and seeing a series of bipolar disorder patients — a greater number than usual, he said — with exacerbations of mania: “We felt the event definitely had something to do with the exacerbations of illness.”

As the prevalence of bedbug infestation has risen considerably in new York City and globally in recent years, so has worry about the insects, Rieder said.

Some savvy pest control companies have coined the term “bedbug psychosis” to describe the paranoid feelings that often accompanying a confirmed infestation.

Rieder and colleagues presented detailed review of six of the 10 cases, who ranged in age from 21 to 75. Two of the patients — 21- and 23-year-old women — who relapsed after their bedbug ordeal had controlled bipolar disorder, while a 75-year-old woman had a schizophrenia.

“Any doctor seeing patients [with bedbug infestation and preexisting psychoses] should be on alert,” Rieder told MedPage Today. “These people can decompensate even if they’ve been medically stable for a significant period of time.”

Two others who developed some form of psychiatric illness only had a history of depression or anxiety — including a 39-year-old male patient who developed delusional disorder — and one, a 22-year-old woman, had no prior medical or psychiatric history.

Most of the conditions resulted from increasing anxiety and depression, tied to various factors including greater social isolation and financial distress due to the expense of fumigation, the researchers said.

Rieder and colleagues also conducted a review of the literature and found that bedbug-related psychiatric issues have not been addressed. Thus, more research is needed into the mechanisms underpinning the association, they said.

Rieder speculated that bedbugs create a unique problem compared with other pests such as cockroaches and mice because their effects are felt a bit more personally, as the latter don’t have such a close, physical effect on humans.

Bedbugs are also much harder to detect and exterminate, which could reduce a patient’s ability to feel confident about being secure in their space, Rieder said.

Similarly, he said, the bed is associated with comfort and protection, and not knowing whether the pests are there can undermine that.

“There’s something about the sanctity of the bedroom and the fact that bedbugs are attracted to warmth and blood that violates something that’s really personal,” Rieder said. “Mice and rats aren’t taking a blood meal from human beings.”

Silk agreed, noting that does seem to be a personal intrusion compared with other pests — “especially if it involves a place that you retreat to for comfort.”

It’s also unclear why certain patients develop psychotic symptoms in response to real or threatened infestations, while others do not — an area that also needs further review, the researchers said.

They concluded that physicians who diagnose bedbug infestation or those who treat patients already dealing with an infestation should screen those patients for new psychiatric symptoms.

The researchers reported no conflicts of interest.

Incontinence can happen to anyone, although it’s more common in women than in men. STORY HIGHLIGHTS

• There are treatments and lifestyle changes that can help with incontinence
• Recommended: about two liters of fluid a day (eight 8-ounce glasses) for balance
• Avoid caffeine, sugar and certain medications

(Health.com) — Incontinence can happen to anyone, although it’s more common in women than in men.

"Mild urinary leakage affects most women at some time in our lives," says Mary Rosser, M.D., Ph.D., an assistant professor in obstetrics and gynecology at Montefiore Medical Center, in New York City. "although it is more common in older women, younger women may experience leakage as well."

You may have stress incontinence, urge incontinence, or some other type. The good news is that there are treatments — and lifestyle changes — that can help.

Health.com: What type of incontinence do you have?

Fluid intake

It’s no surprise that too many drinks — whether water, milk, or other beverages — can be a problem for people with incontinence.

However, you can’t solve incontinence by severely cutting back on fluids. this can lead to dehydration, constipation, and kidney stones, which can actually irritate your bladder and make symptoms worse.

It’s important to get the right balance, says Rosser, who recommends about two liters of fluid a day, which is eight 8-ounce glasses. (The right amount depends on your lean body mass.)

If you’re prone to nighttime incontinence, cut back your fluid intake in the evening.

InHealth: Simple solutions for an overactive bladder

Alcohol

If you have incontinence, happy hour can be anything but happy. Alcohol is a diuretic. It causes you to produce more urine, which can contribute to urge incontinence. and it can irritate the bladder, which is a problem for those with overactive bladder.

"Limiting the amount of alcohol you consume to one drink a day can help," says John L. Phillips, M.D., program director of urology at New York Medical College, in Valhalla, New York.

Health.com: 3 ways to manage overactive bladder

Coffee and tea

Coffee and tea, once your best friends, may now be your worst enemies.

They contain caffeine, which like alcohol, is both a diuretic and a bladder irritant.

"Caffeine is implicated in directly causing irritation of the bladder lining. People who do have bladder problems, on average, do better if they reduce their caffeine consumption, so it’s the first thing we look at," says Phillips.

Decaf coffee and tea, which contain small amounts of caffeine, may be no better. if you love your caffeine, cut back slowly to avoid headaches and other withdrawal symptoms.

Chocolate

Sorry chocolate lovers, but thanks in part to the caffeine content, this sugary treat may spell trouble for an overactive bladder.

It doesn’t matter if it’s dark or milk chocolate, hot chocolate, or chocolate milk (which contains about the same amount of caffeine as decaf coffee).

When it comes to incontinence, all might pose a problem.

Sugar

Before you replace your chocolate fix with Twizzlers, consider this: Controlling your sweet tooth may also help you control your bladder.

Although not as well-studied as caffeine and alcohol, sugary foods, including those that contain honey, corn syrup, and fructose, can also aggravate your bladder, some evidence suggests.

Artificial sweeteners may be no better; some research indicates they contribute to urge incontinence.

But that doesn’t mean you have to cut out sweets completely. "Sugar is enjoyable — just make it part of a balanced diet," says Phillips.

Health.com: 12 natural remedies for incontinence

Fizzy drinks

A can of Coke may be a double whammy for your bladder thanks to the caffeine and carbonation.

Carbonated drinks have been shown to worsen some incontinence symptoms.

"when someone is suffering from incontinence, we suggest cutting artificial foods and colorings, chemicals, and caffeine, and trying to stick to a more natural diet, filled with natural antioxidants and vitamins, including fruits and vegetables, and water," says Phillips.

Try eliminating bubbly beverages — even those without caffeine — to see if it helps.

Spicy foods

If it’s hot, you may have to go.

Studies suggest that people who avoid spicy foods, like curry, chili pepper, and cayenne pepper, may reduce their urinary incontinence symptoms.

"There are certain foods that are triggers for people with incontinence or overactive bladders, including spicy foods, which doctors have identified as common irritants for women," says Kristen Burns, an adult urology nurse practitioner at Johns Hopkins Hospital, in Baltimore.

"The best thing is to avoid foods and drinks if you notice they are a problem for you."

Citrus fruits

They may provide vitamin C, but citrus fruits and drinks can be a problem for people with urge incontinence.

Acidic foods and beverages, such as grapefruits, oranges, limes, lemons, and even tomatoes, can irritate your bladder, and may worsen incontinence symptoms.

"The bladder muscle has all kinds of nerves that can be affected by irritants, like acidic foods, which can exacerbate urgency symptoms," says Burns.

Health.com: Gotta go? 13 reasons for urine trouble

Cranberry juice

Because it’s often used to help control urinary tract infections (UTIs) and bladder infections, many people wrongly assume that cranberry juice can also help with an overactive bladder.

Unfortunately, when it comes to certain types of urinary problems, like incontinence, cranberry juice can actually make symptoms worse, due to its acidic pH.

"Cranberry juice (unless you have frequent UTIs and want to prevent infections) is not a good choice for someone who already has an irritable bladder, because of its acidic content," says Burns.

Medication

Certain heart medications, blood pressure-lowering drugs, muscle relaxants, sedatives, and other drugs can make incontinence worse.

"Diuretics remove excess fluid from the body so the heart and other organs can function more efficiently," says Rosser. "this leads to an increased fluid load to the bladder."

Talk to your doctor about whether your prescription medications might be contributing to incontinence — don’t cut back or stop taking them on your own.

Also try to avoid caffeine-containing medication in general, such as Excedrin.

Copyright Health Magazine 2010

More than 25,000 veterans from Iraq and Afghanistan are enrolled at the VA Medical Center in San Diego. An estimated 20 percent of those vet have some level of Traumatic Brain Injury (TBI).

Credit: Courtesy of Julian Cook

Above: Julian Cook before he left the military in Feb 2010

You would never guess, looking at 25 year old Julian Cook, that he has been through two major roadside bomb blasts while serving Army deployments in Iraq. he doesn’t show any visible wounds. Cook didn’t admit to himself that anything was wrong when he got home in 2009.

“I just thought that it would go away,” he said. he told himself he just had a headache. “But sometimes,” he said, “it just gets way too painful to ignore.”

There were other symptoms that really bothered Cook, like when he was sitting talk with someone and all of a sudden he just stropped talking.

“And don’t know where I was going with it, don’t remember what I was talking about. and you know, it can happen at the most random moments.”

Cook finally sought help. He’s been working for several months in a program called CogSMART, the brain child of UCSD psychiatrist Elizabeth Twamley.

“People with mild to moderate TBI look just like everybody else,” Twamley said. “So it’s really an invisible disability.”

Twamley said she’s proved that CogSMART helps her mentally ill clients. now she’s working with the VA to see if it’s an effective treatment for the new vets like Julian Cook who are trying to get a job.

Cook’s partner in the treatment program is employment specialist Laurie Arnold. She’s been working with him on basic things like how to deal with his chronic sleep problems.

When they started the program Cook said he was sleeping maybe three hours a night. now he says he sleeps between five and six hours. “So I did gain a couple of hours,” he said.

Cook learned how to consciously observe his own body to relax. he also learned tricks to help him control the bouts of anger that sometimes gripped him unexpectedly. he would focus on his heart rate and try consciously to slow it down.

He and Arnold also worked on practical skills to help him focus because he seemed unable to make headway on anything he set his mind on. He’s taking a master’s degree in business studies, and found it almost impossible to concentrate on long lectures, or take effective notes. Arnold gave him a smart pen — a little tape recorder to record lectures, and he’s learning how to identify the important points to take notes on.

But remembering things continues to be a challenge. Cook described a technique he calls “overlearning” that he uses if he gets a call from a doctor’s office. he repeats information back to the person on the other end of the phone, writes it down and then reads it to himself after the call is ended.

“So I just said it, read it, and wrote it,” he explained,” so I’m three more times likely to remember it.”

As with any program, it’s not just the skills, it’s the people that make the difference. Laurie Arnold is constantly encouraging Cook. She’s his number one advocate and reminds him of everything he accomplished when he was in the military.

“I’ve seen other resumes and they’re not as diversified,” Arnold told Cook “.so I think you’re not giving your self credit in realizing you were a project manager, and you had this medical background and you were a team leader. so they were giving you these responsibilities because they felt that you were capable.”

“Yes, yes,” Cook agreed, soaking up the support.

Cook already has a degree in business that he earned while he was in the military. he said he studied nights and in between shifts while he was deployed. But though he’s been back in the civilian world for well over a year now, he’s had no luck landing a job that would use that qualification. Instead he was spotted by a talent scout and offered a job modeling. his good looks make up for his memory problems.

But Cook isn’t ready to settle for this. he said his main goal is to land a more legitimate job. he remembers only too well the responsibility he had in the military, before the bomb blasts and the headaches. he said the modeling job is a “just until” job.

“Just until I finish school, just until I find a more reputable job,” he said. “Until then, I’ll just be modeling.”

Elizabeth Twamley, who developed CogSMART, said there are thousands of vets in Cook’s position, who suffer from TBI symptoms that noone can guarantee will go away.

“It’s a population for which we formerly didn’t have any interventions,” she said, “and yet there are a lot of people seeking help for their cognitive problems. so VA clinicians and researchers are trying to respond to that need. the jury is still out. we are still collecting data on what treatments work.”

Ironically, Twamley said the new GI bill has made it more difficult to recruit vets for her study. That’s because so many returning vets have chosen to go back to school and take the generous living allowance that goes with it. at $2,200 a month on top of tuition, they don’t need to find a job to survive.

But Twamley said many of these vets are struggling to learn effectively with lingering TBI symptoms. and if the economy doesn’t improve by the time they graduate, they may find it difficult to find a job in a competitive marketplace, she explained.

In the mean time, Twamley said the rate of employment for veterans with TBI in her supportive study group is lower than for her mental health patients — only about 30 percent of them have found jobs so far. she said this is a population that faces numerous barriers — from cognitive to emotional. she said many have family crises that are difficult to resolve after years in the military, and cognitive training alone won’t necessarily open the door to a new future.

NEW YORK (Reuters Health) – Excessive crying in infants, otherwise known as colic, has been linked to symptoms of depression in the mother. Now a study conducted in the Netherlands links infant colic to depression in the father as well.

The finding that continuous paternal depression appears associated with increased risk for colic among infants, "might inspire future fathers with depressive symptoms to seek treatment," Dr. Mijke P. van den Berg told Reuters Health.

Van den Berg, of Erasmus Medical Center in Rotterdam, and colleagues assessed symptoms of depression in several thousand sets of parents when the mothers were 20 weeks pregnant. they found that about 12 percent of the fathers and 11 percent of the mothers showed signs of depression.

For example, they answered positively to questions about feeling lonely, blue, hopeless, or worthless; having "no interest in things," or having "thoughts of ending life," the researchers report in the journal Pediatrics.

Later, when the infants of these parents had reached 2 months of age, the researchers assessed parental reports of excessive crying.

Overall, 4.1 percent of depressed fathers, compared with 2.2 percent of non-depressed fathers, had infants who cried for at least 3 hours daily on 3 or more days in the previous week. Corresponding figures among depressed and non-depressed mothers were 4.8 and 2.2 percent, respectively.

Excessive infant crying remained more prevalent among depressed fathers and mothers even after allowing for parental age, education level, and ethnicity; gender and number of children; and paternal smoking.

Moreover, adjustments for depressive symptoms among the other parent did not alter these findings.

Traditionally, research and clinical practice focused on the influence of maternal depression during and after pregnancy, whereas "this study shows paternal mental well-being should also be taken into account," van den Berg told Reuters Health.

Additional research is needed to attempt to "disentangle the possible mechanisms" associated with paternal depression and infant colic, noted van den Berg.

SOURCE: Pediatrics, July 2009.

© Copyright (c) Reuters

One child in Craven County was confirmed to have the highly contagious respiratory disease known as whooping cough, and there are several other children in the county who are also likely to have the disease.

The confirmed case of whooping cough, or pertussis, was seen in a child not old enough to attend school who had not been vaccinated for the disease because of religious reasons, said Summerly Cotton, adult health clinical coordinator for the Craven County Health Department. The child was treated and released from CarolinaEast Medical Center, and is now recovering.

The child was the sibling of two children at Creekside Elementary School who have probable cases of pertussis, Cotton said. Those students also were not vaccinated.

Cotton said parents can receive exemptions for their children from the state’s immunization requirements for religious reasons.

“(That) generally doesn’t put the public at risk, it puts the child at risk,” she said. “The child is at risk for getting the illness, but the other children have been vaccinated against it.”

There are also six other children who are suspected to have pertussis. Those children are students at H.J. MacDonald Middle School, James W. Smith Elementary, Arthur W. Edwards, and three children attend Creekside.

All of those children were vaccinated for the disease, except one child was not up to date on his or her vaccinations. The children had not been in contact with the child with the confirmed case.

“It might just be that they haven’t had the vaccination long enough,” Cotton said, of the children who were vaccinated. “It just may take some time for your body to build up some antibodies to it.”

Cotton said the health department has asked people who have spent 15 minutes or more or who have come within 3 feet or less of any person with symptoms of the disease to be treated.

“We’re asking their physicians to go ahead and treat that person with an antibiotic, just so they don’t get sick,” she said.

She said letters were sent out initially to H.J. MacDonald Middle School stating that all children needed to be treated, but she said that is not the case. she said that unless a child’s parents were contacted by the health department directly, the child does not need to be treated. she also said parents should not be concerned about sending their children to school.

“we had sent out letters notifying the parents to monitor their children for symptoms,” she said. “we sent out a letter to the physicians in the local area just to monitor for the symptoms as well.”

Cotton said initial symptoms of pertussis are similar to those associated with the common cold. The infection later causes coughing characterized by a “whoop” sound as a person breathes in, and can also result in vomiting. The disease can be treated with antibiotics.

“Older children tend to do relatively fine with it and with treatment, get over it very easily,” she said. “Oftentimes, the younger infants have to be hospitalized a little bit more often to receive supportive therapy.”

Jill best, the health department’s immunization nurse, said the DTaP vaccine protects against pertussis as well as against diphtheria and tetanus.

The vaccine is given at the department when a child reaches 2 months of age, 4 months, 6 months, and 12 months, best said. there is also a booster shot given to 4-or-5-year-old children that is required for children entering kindergarten.

Best also said there is another vaccine, Tdap, that protects against pertussis. A single dose is recommended for children 11 to 12 years old before a child enters the sixth grade.

Amy Caruso, public information officer for the N.C. Immunization Branch of the N.C. Department of Health and Human Services, said vaccines are not 100 percent effective in all people. she said that across North Carolina in July through November, there was an unofficial count of 135 confirmed pertussis cases, she said.

Laura Oleniacz can be reached at 252-635-5675 or at .