Search for tag: "allergies"

Interviewer: You've tried the sprays and the pills for your seasonal allergies, but they just don't seem to work. So what are the next steps to finding allergy relief?

Dr. Gretchen Mae Oakley is a nose and sinus expert at U of U Health. She's really good with allergies too. So in our previous conversation with Dr. Oakley, we talked about managing those symptoms with prescription and over-the-counter sprays and other medications. If you haven't listened to that podcast, be sure to check that out first. But Dr. Oakley, if those sprays and pills aren't working, what are the next steps that you would take with a patient?

Dr. Oakley: The main next step that we generally talk about with patients is allergy testing, and that is identifying what the patient is specifically allergic to or the things, you know, they're specifically allergic to. And the goal behind doing that allergy testing and the reason we don't necessarily do that upfront is because the main goal is kind of a step towards the immunotherapy option. And this is a treatment for allergies that can be very effective for a lot of patients who, you know, are still struggling after medical therapy. And the idea behind it is basically desensitizing your immune system to the allergies, so it's less reactive to that allergen or those allergens.

Interviewer: And it seems like most people I talked to that have allergies, they'll be like, "Oh, I need to go get my allergies tested." In their mind, it's the first thing that you do. Do you find that to be common?

Dr. Oakley: I do. Yeah. I get that question actually a lot, "Should I be allergy tested?" And it's certainly satisfies our curiosity in many cases of, you know, what we're allergic to, but it doesn't necessarily change the treatment if we haven't done those medical management steps yet, because if, you know, whether you're allergic to this specific pollen or that specific, you know, weed, or this tree, or that grass, you're still going to be using those as, you know, your earlier steps. You're still going to be using, you know, those nasal steroids sprays first or the oral antihistamines first and the antihistamine sprays first, because that has, you know, a broader effect, you know, on all of those.

So that's what we generally don't do that upfront, because it doesn't necessarily change our first couple steps and, you know, the treatment. But it does affect, you know, our later steps. If we're thinking of immunotherapy, we need to know what we're specifically treating for that to work. And so that's kind of where it comes in and the point behind the testing, you know, at that stage generally.

Interviewer: Yeah, so your patients that you take at that point to the testing stage, I'd imagine they're just not finding any sort of relief from the first steps, or their allergies are just so terrible. I mean, what kind of patient then makes it to the testing stage usually? You're able to . . . I would imagine the medical things that you do first, the sprays and the pills take care of a lot of what patients experience.

Dr. Oakley: Yeah. I would say the patients that generally get to that next stage are those that are getting either really severe or really bothersome seasonal allergies that are refractory to the medical therapy. And they just don't want to, you know, suffer every summer, all summer or every spring, all spring. Those are good candidates for immunotherapy. They're getting breakthrough symptoms despite those, you know, medical treatments.

Other patients will have year-long allergies because they may be allergic to, you know, dust mite, and it's all around them. It's in their house. And, you know, there are things they can do, like, you know, try cleaning their house really well. However, we've not seen that those things will fix the problem in a noticeable way. They'll still get their symptoms. And so, you know, those patients are suffering all year, and, you know, there are immunotherapies that can help with those perennial allergies.

An additional option, for example, would be a patient who has a cat that they're allergic to, but they're very, you know, emotionally connected to their cat. It would be distressing for them to get rid of their cat, or it's a partner's cat and, you know, they can't necessarily avoid it. It's not so easy to always get rid of a pet. So that'd be another case where immunotherapy may, you know, play a good role for that patient.

Interviewer: When you get to that point, you do some of the testing, and then after you get the results, how do you proceed to the immunotherapy and how does that work?

Dr. Oakley: So generally, we're identifying the allergies that are causing, you know, the sensitivities that the patients have based on how they respond to, for example, skin prick testing, which would be the most commonly used allergy testing upfront. It can be done, you know, in the office. Patients are tested for multiple allergies at once usually on their arm. You're using a grid system to see what skin responses are the most significant to determine what they're, you know, most allergic to. And those are the allergies that you target, you know, their worst reactions with the immunotherapy. And the idea behind the immunotherapy is giving them very small but ramping up doses of that thing that they're allergic to, to just gradually desensitize the immune system to it.

Interviewer: I remember getting those as a kid. I've had more success with the first line of defense in later life, with some of the new medications that came out, I don't know, probably 20 years ago now, but I say new. So like my experience was the immunotherapy didn't really help me. Do a lot of people experience success with it?

Dr. Oakley: It's generally considered to be 80% to 90% effective. But, you know, it's not 100% effective, as you said. So some people don't get that response. It's generally very effective, but it is a commitment. It's very much a time commitment. You know, it's a three to five-year treatment where patients are coming in anywhere from a weekly to a . . . or I should say anywhere from a twice weekly to a monthly basis for injections, you know, to get that benefit.

Interviewer: Yeah. I remember it was twice a week I'd go in and get those allergy shots. So if immunotherapy doesn't work then, then it sounds like the last option is surgery, and I didn't even know there were surgical methods for allergies. Talk about that.

Dr. Oakley: Well, I should clarify because surgery is more of an assistive option.

Interviewer: Oh, okay.

Dr. Oakley: So not so much a treatment. It doesn't specifically cure or treat allergies. It helps with the symptoms, but in and of itself would not be sufficient. It goes along with these other treatments. So surgery can address some of the more bothersome nasal obstruction symptoms. For example, well, let's just say specifically from anatomical factors, like a deviated septum or enlarged turbinates, which are, you know, shelves of tissue in the nose that warm and humidify the air but can get quite enlarged with allergies. So treating some of those anatomic, you know, factors can improve symptoms of nasal congestion, but you need to treat the trigger as well, the ongoing allergy trigger. So that's that medical management or immunotherapy as well. So the surgery helps, but it's not a treatment in and of itself.

Interviewer: If somebody is listening to this and you just would want them to take away one thing after we're done with our conversation, what would that be?

Dr. Oakley: The main thing I would say is don't suffer in silence. This is a really common problem with many options for treating it. We know from, you know, research study after research study that there is a significant improvement in quality of life when these allergies are managed appropriately in patients rather than just struggling with really bothersome and really distressing, you know, symptoms on a day-to-day or seasonal or yearly basis. You know, try some of these easier steps. Don't hesitate to come in and get some, you know, formal consultation and talk about other options that can really, really benefit you.

Interviewer: There is no cure for allergies. Really the best you can do is manage the symptoms, and the first step to doing that is to avoid the things that give you allergy symptoms, but that can be hard. A lot of times you can't do that. So then the next step are sprays, pills, and eye drops.

Dr. Gretchen Mae Oakley is a nose and sinus expert at U of U Health. She's also an allergy expert, and she's going to take us through the process of trying to figure out how to manage those symptoms and then maybe help us understand when you might need to get professional help. So Dr. Oakley, let's first start with allergy sprays.

Dr. Oakley: There are a couple main nasal sprays that work really well and have great evidence behind them for the treatment of allergies. Our first-line treatment based on the literature and just how well it works in patients is nasal steroid sprays, and fortunately they're all over the counter. Some of those sprays would be, if I were to name some, Fluticasone nasal spray, Mometasone, Budesonide. Those are probably some of the three most common. There're a couple others in that, you know, similar family and those work really well.

You can use them up to twice a day, more than that is not going to help anymore, but once or twice a day use. They're very reliant on regular consistent use, and they have a bit of a slower ramping up effect, so you really want to use them for at least, you know, a few weeks on a daily basis just very regularly to get their full effect rather than, you know, here and there when your symptoms bother you.

Interviewer: If the over-the-counter stuff doesn't work, are their prescription ones that are very different from that, or is most of them over the counter nowadays?

Dr. Oakley: There's an antihistamine spray that is a prescription that can actually work great for a lot of patients too, either as their primary treatment or as a, you know, secondary, an additional treatment if the corticosteroids sprays alone don't work enough for them. That antihistamine spray is called Azelastine, and it works particularly well for those let's call them the wet allergy symptoms, which is, you know, more of those like sneezing, runny nose, itchy, watery eyes, that kind of tickle sensation that we can get with allergies. They work okay for the nasal congestion symptoms, but the steroid sprays work better for that.

Interviewer: What is it that makes it so different from person to person that perhaps maybe a steroidal spray would work for one person but not another, they'd have to use, you know, an antihistamine spray? Is it just the difference in us as humans?

Dr. Oakley: We don't always know exactly why some patients respond better to some sprays, you know, versus others. It may just be a severity of their symptoms. You know, they may get 75% better with the steroid sprays, but it may just not quite be enough. Whereas somebody else where their symptoms are maybe moderate rather than severe, they may do great, and that's all they need.

Some patients may be a little more bothered by like the runny nose and the sneeze, whereas, you know, in those cases antihistamine sprays would work better for them. So sometimes we just get different presentation of our allergies, different symptoms and different severities. But you're right that the other factor is we're all just a little bit different and we respond just a little bit different to certain treatments.

Interviewer: It can be a little frustrating as an allergy sufferer sometimes because I think sometimes as patients we think, "Well, I'm going to go in and the doctor's going to give me the cure," right? But with allergies it sounds like, you know, sometimes you have to do some experimenting on what's going to work best for that individual person.

Dr. Oakley: Exactly. There's definitely some trial and error there to try to get it just right for that patient. The third thing in terms of nasal treatments I didn't mention, that I'd be remiss if I didn't mention, is very straightforward, and it's just some saline in the nose, saline irrigations specifically. Those can work really well as an adjunct treatment. It's not going to in and of itself fix your allergies, but it can help with some of the symptoms along with some of these other treatments by mechanically washing, you know, those allergens, those irritants, those pollens out of the nose so they're not just sitting, you know, on the lining of the nose inflaming it. So it can help, you know, in some of those ways as well.

Interviewer: So do you normally go nasal spray first and then oral medication? Is that how that usually goes?

Dr. Oakley: I would say, in general, yes. I like to give people topical treatments over oral treatments if possible, just because your side effects tend to be lower. The other thought in that however, that I'll talk to patients about, is that certain oral treatments, like oral antihistamines specifically, those tend to work similarly to a nasal steroid spray, have similar effectiveness, but sometimes patients will have symptoms that are not just in the nose. They'll have, you know, maybe some dermatitis that they get with their allergies that bother them or, you know, symptoms like that that are elsewhere, and sometimes the systemic therapy, an oral therapy in that case can be a little bit more helpful than a localized therapy.

Interviewer: So oral medications, let's talk about over the counter first. What are kind of the choices there?

Dr. Oakley: I would say the main one, the front runner are those oral antihistamines. So the newer versions that tend to work better for patients with fewer side effects are those medications like Loratadine and Cetirizine and Fexofenadine. Those are the main kind of newer generation oral antihistamines. The older generation antihistamines would be, you know, what we know as Benadryl, which can work too but has, tends to have higher side effects and be more sedating for patients. So we generally recommend those newer generation, non-sedating medications. And they have great evidence behind them, they work well, and those are over the counter.

Interviewer: And then itchy eyes is another symptom that a lot of people have with allergies. I used to suffer terribly, and then I was prescribed some eye drops, which now I think I can just get over the counter because I've bought them. I think they're the same thing, which makes all the difference in the world. Can you talk about some of the eye drops you might want to look for if itchy eyes are part of your allergy symptoms?

Dr. Oakley: Yeah, eye drops can actually help a lot, and it is generally an antihistamine eye drop. There are a couple different ones. One that's popping into my mind is Olopatadine. That can actually help patients significantly because a constant itchy eye will drive you crazy.

Interviewer: And just like all the other things, the nasal sprays, the oral medications, I had to try a couple of different antihistamine eye drops before I found the one that really kind of worked for me. So you know what, I started out thinking, well, let's see if we can give people, you know, some things they can try on their own, but then you start talking about how, you know, this combination isn't proven to work as well as that combination, and it can get really complicated really fast. So I'm starting to think maybe if like the first nasal spray doesn't work, maybe go see a doctor to try to figure out what combinations of stuff because that does get complicated pretty fast, doesn't it?

Dr. Oakley: It does get complicated pretty fast. It is certainly reasonable to try a couple over-the-counter meds on your own. I personally, you know, if I were in the patient's shoes, I would start a nasal spray and give that a few weeks personally. If that didn't work, you know, I'd maybe try an oral antihistamine for a couple weeks and see how I do. But after that, I don't see a lot of sense in just suffering. I think it's worth going in and talking to your doctor about some alternative options that may help quite a bit rather than just being miserable.

Interviewer: What are the symptoms of food allergies? We'll examine that next on The Scope.

Announcer: This is "From the Frontlines" with emergency room physician Dr. Troy Madsen on The Scope. On The Scope.

Interviewer: If you're listening to this right now, you probably suspect you might have a food allergy and you're curious to know for sure if that could be the case. Probably have a lot of questions and so do I so we're going to talk to Dr. Troy Madsen. He's an emergency room physician at University of Utah Health Care. So symptoms of food allergies, how do I know if I have a food allergy? What are some of the common symptoms? And there's a difference between food allergies and food sensitivities?

Dr. Madsen: Exactly, yeah and that's often a point of confusion, but allergies are like any other kind of allergy. If you have a food allergy, it can range from mild, so maybe some itching, little bit of a rash; to more severe, where you have some throat tightness, some lip tingling, to really severe cases where you just can't breathe. So those are what we think of with allergies.

Interviewer: With food allergies. And is it possible for me to just be minding my business, I'm eating something I've eaten my whole life and now, all of a sudden, my throat's swollen, like I've reacted that quickly and that severely?

Dr. Madsen: It is possible and, surprisingly, it's not uncommon. People I've known who have had eaten shellfish for years and then sometime in adulthood, eat some lobster or some shrimp, and just suddenly develop itching and facial swelling and trouble breathing. So it's entirely possible. You could've eaten this food for years and then, later in life, develop a food allergy.

Interviewer: All right. And if you start having these symptoms, what should you do?

Dr. Madsen: If they're mild symptoms, like a rash, maybe just a little bit of itching, you're probably okay just to take some Benadryl. But if it's more severe, anything that involves the airway, any lip swelling, tongue swelling, throat tightness, trouble breathing, that's where I would even call 911. I mean, you've got to get to the ER because those things can develop really quickly and be life-threatening, just very, very severe reactions.

Interviewer: So those symptoms again, lip swelling, tongue swelling, tingling?

Dr. Madsen: Tingling, I would get to the ER and, again, if you're . . . any concerns about your airway, call 911.

Interviewer: All right. Don't mess around with that.

Dr. Madsen: Exactly.

Interviewer: I feel like we only talked for a few seconds here about this topic. Have we covered it all? Is that pretty much it?

Dr. Madsen: Well, like you mentioned, there's also the issue with food sensitivity versus allergies. So again there, we're talking about very different things, some people may have concerns about gluten or other things in foods. There, they may have some more abdominal cramping, maybe some nausea, diarrhea. That's not a true allergy. Again, the allergies are the things we think of with any sort of allergy: itching, rashes, airway issues, much more concerning in terms of getting to the ER.

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Interviewer: You think you or maybe your kids have pinkeye. How will you know for sure and what should you do about it? We'll talk about that next on The Scope.

Announcer: This is From the Front Lines with emergency room Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. Pinkeye. Let's talk about how you would diagnose a case of pinkeye and then what you would do about it because I hear it could be kind of difficult to diagnose like a school nurse, for example, might not be able to tell the difference from allergies or not. Is that the case?

Dr. Madsen: That is the case. And that's always what I'm thinking in my mind. So the most common thing we have is someone comes in and they say, "My eye hurts" or "My eyes hurt". I look at their eyes, they're red. So a couple of questions I ask and I say, "First of all, did this start in both eyes or did it start in one eye and spread to the other?"

If it starts in one eye, that's more likely what we would call pinkeye. And pinkeye is a bacterial infection often. Sometimes it's a viral infection but it's really tough to tease out which are bacterial and which are viral. Of course the ones we worry more about are the bacterial infections because we're going to treat those with antibiotic drops, but you figure it's not going to necessarily start in both eyes at the same time. It kind of start somewhere. It's going to start in one eye and then maybe you're rubbing that eye and then it spreads over to the other eye. So typically with pinkeye, that's the case.

Interviewer: Okay, so one eye hurts before the other generally.

Dr. Madsen: Exactly.

Interviewer: Red like bloodshot red, what's that red look like?

Dr. Madsen: So the red . . . Yes, that's tough to distinguish from allergies.

Interviewer: There's nothing really unique about it, huh?

Dr. Madsen: Not particularly. It can look a lot like allergies where just if you've ever had like allergies, just seasonal allergies, your eyes are bloodshot, they hurt, they itch, pinkeye looks very similar. With pinkeye though, we often see more discharge or more drainage from the eye. This kind of stuff that's not so much, just your eyes watering, which you have with allergies, but stuff that's kind of a little more whitish in color that looks more like you would imagine an infection looks.

So someone who says they wake up and my eyes are like matted shut. Again, allergies, we can sometimes see that but it's usually more with pinkeye. They have to pry their eye open or their kids' eye or they use like a washcloth and hold it on there to kind of loosen that up and pry it open. That's pretty typically with pinkeye and that helps me out to make that diagnosis.

Interviewer: All right. So then what does treatment look like? You said if it's a bacterial cause, then you would use antibiotic drops. It's hard to tell though, so you just . . .

Dr. Madsen: It is.

Interviewer: You just use antibiotic drops across the board or . . .?

Dr. Madsen: Typically yes, and you don't want to over-treat with antibiotics, but in practical terms, if I were to try and get a culture of the eye, send that to the lab, it takes couple days to get the result. It's not really that useful. So even though it might be viral, it's often bacterial so we treat with antibiotic drops. It means using drops several times a day or often for a week just make sure this clears up. Most people are going to have improvement in their symptoms after two or three days.

Interviewer: What if it's viral though and you're using the drops, they're not doing anything, will it just get better on it's own or . . .?

Dr. Madsen: It will.

Interviewer: Really?

Dr. Madsen: It will. Yes, with the viral it will just get better on its own and the antibiotic drops probably aren't going to do a whole lot for it but, again, it's hard to say because maybe after two or three days, you're feeling better and it could be that the virus got better on its own or maybe the drops treated the bacteria. But it's not the sort of thing, again, where a culture would be that helpful because it's going to take two or three days to get the results back. If it's bacterial, it could get significantly worse and really progressing, cause some issues wherein you can get infections around the eye or extending behind the eye as well.

Interviewer: And untreated, could it cause long term problems if you didn't go into anything about it or would it eventually just clear up regardless?

Dr. Madsen: It could clear up but the concern with the bacterial infections would be something that progresses, again, to where it spreads around the eye.

Interviewer: Infects the rest of, yes, other parts of your eye.

Dr. Madsen: Exactly. And so that's why even though in my mind I say, "Okay, this could be a viral infection," I'm also saying, "I want to treat this as likely a bacterial infection because the possibilities with the bacterial infection could be pretty significant." And I don't necessarily want to tell this person, "Wait two or three days and then come back when you have a significant infection around your eye that might require even something like IV antibiotics or hospital admission," if it got to that point and got that serious.

Interviewer: And don't need to go to an emergency room for this sort of thing. Urgent Care or a primary care provider probably would be able to take care of it.

Dr. Madsen: Absolutely.

Interviewer: And you could . . . even if you have to wait a day?

Dr. Madsen: Yes. Even if you had to wait a day, you're probably okay. I think the challenge for most parents is if their kid gets pinkeye, they're not going to let the kid come to school because it is highly contagious. You've got to make sure you're washing your hands, your kid's washing their hands. Kids get this at school, they pass it to other kids. So a parent's probably not going to want to wait a day to get in to see their primary care doctor. They'll go to an Urgent Care. If you have to come to the ER, you come to the ER. Either way, I'm guessing most parents want to get that treated and get their kid back to school and get them out of the house as soon as they can.

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updated: October 2, 2018
originally published: August 19, 2016

Dr. Gellner: One of the most common reasons a parent brings their children to the pediatrician is because they're concerned their child has an ear infection. I'll talk about the symptoms to watch for and what to do if your child does have one on today's Scope. I'm Doctor Cindy Gellner.

Announcer: Health tips, medical views, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Dr. Gellner: Parents come in all the time saying their child has been pulling on their ear and they know this means they have an ear infection. Well, not so fast. Kids pull on their ears for a lot of reasons, ear infections only being one of them. Other causes are teething, ear pressure from nose congestion or allergies, and because it just plain feels good, especially when kids are tired.

There are a lot of nerve endings in the ear and that's why it's such a popular place for massage therapists and acupuncturists to work on. So other than pulling, your child has no other symptoms. Ear infection? Maybe not. But say your child also has a fever, has had a cold for a while, isn't sleeping like they normally do and are just plain cranky, then it's time to get those ears checked out.

Despite what a lot of people think, going outside in the wind or cold without a hat on won't cause an ear infection. Ear infections happen behind the eardrum, not in front of it where the cold and the wind would hit. An ear infection is caused by bacteria and it's a common complication of a viral cold. Nasal congestion and mucus block off the tube that connects to the middle ear to the back of the throat. That's the Eustachian tube. And then the ears can't drain properly if that's blocked. This makes a pool of fluid, which is a great breeding ground for bacteria and, hence, an infection is born.

Sometimes, kids have what are called serous ear infections. That means there's fluid behind but it's not all gross, and this fluid usually goes away in a few months. This type of infection does not need antibiotics.

Kids between six months and two years are most likely to get ear infections, but they're actually pretty common until age eight when the internal anatomy of the ear starts to change and they aren't as prone to infections. Most kids will have at least one ear infection and over 25% of these children will have repeated ear infections. In a small percentage of children, the pressure in the middle ear fills with puss and that causes the eardrum to rupture and drain. It's usually just a small hole, which heals over the next three months.

Now, you find out your child does indeed have an infection, you need to be sure your child takes the antibiotics prescribed by the pediatrician and finish the entire course to make sure all the bacteria is treated. Tylenol and Motrin can also help with pain.

Some people talk about putting warm oil into the ear, but that's not a good idea. If the eardrum bursts, follow up in three weeks to make sure the infection is gone and the eardrum is healing. Ear infections seem like a rite of passage for some kids. I've had parents try looking in their child's ears with a flashlight to see if they have infections. Trust your child's ear exams to the experts. As pediatricians, we get really good at looking in ears and seeing if there truly is an infection or not.

Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you liked what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Interviewer: You might be having an allergic reaction to your birth control, but maybe you're not. Let's find out next on The Scope.

Announcer: Questions every woman wonders about her health, body and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking to Dr. Kirtly Parker Jones. She's our expert on all things women. So, Dr. Jones, we've been getting a lot of emails about women who are having "allergies" with their birth control, they're just having some sort of reaction to it and they're thinking its allergies. Is it even possible to have allergies with your birth control?

Dr. Jones: Okay, well, let's talk about what an allergy is. An allergy, or an allergic reaction, is where your body recognizes a substance as foreign, makes an antibody to it, and that causes a process, an allergic reaction, that can cause itching, hives, can cause swelling of your throat, difficulty breathing, low blood pressure and passing out. Not necessarily all of those, but it could be. In reality with respect to birth control it is rare for someone to be truly allergic to birth control. The reason is, with respect to birth control hormones, is the hormones are very much like your own hormones and it's unlikely that you're going to be allergic to it.

Now, sometimes birth control pills have dye, have colors in it, so you know when you open your pack there some blue ones or pink ones, so some people are allergic to the dye, probably not so much the hormones. In birth control shots like Depo-Provera, that's a brand, the carrier or the liquid that's in there you may be allergic to that. There are women who actually have allergy to nickel, that's pretty common, but in fact there aren't any birth control methods with nickel and the copper IUD is copper and it is rare to have someone truly allergic to copper because we all need copper in our body, so we're not allergic to it.

There are people who are truly allergic to latex, as in condoms. So yes, that can cause shortness of breath and hives and itching and all those things, so some people are allergic to latex condoms and some people are allergic to that foreign substances, of which there are quite a few, in spermicides. So when you're using a foam or a gel or something which is a spermicide in conjunction with your condom some people are allergic to those. But in terms of birth control pills or birth control shots or birth control implants or IUD's, true allergies are very rare, meaning less than maybe 1 in a 1,000.

Interviewer: So then is it normal?

Dr. Jones: To be allergic? It is not normal. To have side effects? Yes. Let's go back to that normal thing. So something is not normal if it happens to less than 5% of women and side effects happen to more than 5% of women. Now, side effects happen to women because the hormones in either the pill or the hormonal IUD changes some parts of their bodies. So remember estrogens and progestins, the other hormone that is often in birth control methods, they change your body. That happens to you in your natural hormonal cycle and it may change your body when you use them in birth control. So when people say, "I have breast tenderness," or, "I have nausea," or, "I got some acne from that pill."

Interviewer: That's a side effect.

Dr. Jones: That's a side effect, and a side effect isn't an allergy. The other thing is that life happens and some people have things happen concurrently when they're starting a new birth control method. When people say, "Oh, I must be having a side effect from my IUD because I'm crying all the time." "Well, how long have you had that IUD?" "Over four years." Well, in fact, that's not your IUD. What else is happening in your life?

So when you do studies of birth control methods, you often do a placebo-controlled trial. So when you're looking at things like headache and nausea and breast tenderness, you often find that those happen in people who were given a placebo. It's clear that the real attributable number of people who have a side effect would be the number of people who had it with the real drug minus the number of people who had it with the placebo. So headaches, nausea, not feeling well, mood, those can change just because and you just happen to be on birth control at the same time.

So side effects from birth control pills are common and I consider them normal. In fact, some side effects of something like the levonorgestrel IUD, the hormonal IUD of irregular bleeding or very light periods or no periods, that's actually not a side effect. That's a direct cause and some people are annoyed by the irregular bleeding but some people really like the little light periods.

Interviewer: You're still okay.

Dr. Jones: You're still okay. Now if it turns out . . . so when you first start something like birth control pills, headache, nausea, and breast tenderness may be very common side effects, they tend to go away though. So if it's persisted over three cycles, if you can hang out with it, it actually tends to get better.

Interviewer: If you can hang out with it?

Dr. Jones: Yeah, if you can hang out with it. But remember when you say allergy you're really talking about a very specific set of symptoms which are quite rare with birth control methods except latex condoms and some spermicidal gels, but talk to your doctor about it, talk to your doctor. Hopefully they're experienced enough about it or they can call an expert.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: October 4, 2018
originally published: April 22, 2016

Interviewer: A new study is suggesting that watching funny cat videos can help expand your life expectancy. But there are a lot of funny videos, lots of cats, and lots of funny videos of cats. Which ones are the most beneficial to watch if you want to live a long and healthy life? This is coming up next on The Scope.

Announcer: Covering all aspects of women's health. This is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Interviewer: It's been said that laughing has great effects in life. Not only does it reduce blood pressure but it helps with stress and anxiety. Unless you're allergic to happiness, laughing just makes you happier. It's just that simple. But a new study out today is suggesting that laughter from watching a funny cat video not only brightens your day but it can actually help you live a healthier, longer life. Dr. Kirtly Jones is a woman's health expert and she knows all too well that emotional health is a key component of overall good health. But Dr. Jones, the study is telling me that even if I'm not a cat person, watching a funny video of a cat can help with my health. What's going on here? Let's talk about this.

Dr. Jones: Well, actually, there's been a great deal of research about funny cat videos and overall health. And it's important to know that various studies have shown that not only does it help your immune health, and we can talk about that, your cardiovascular health, and most importantly your emotional health. There are some caveats, though, some important things to know.

First of all, some of the early studies had men and women in the same group and those studies weren't as strong. You really have to separate men out because men watching videos, they really only laugh at videos of other men expressing gas or doing something incredibly stupid. So we really need to focus just on women.

Interviewer: Just on us?

Dr. Jones: Just the women. Now, secondly, you have to really identify women who identify with cats because so they did study comparing cat videos with dog videos and lo and behold, there was a subset of people who responded well to dog videos and not cat videos. So they separate them out by a questionnaire. The questionnaire had two questions: one, I think cats are incredibly adorable; and two, I think cats are useless bird killers. And if they separated out the women who responded that they thought that cats were useless bird killers, then the adorable cat lovers were perfect for studying. So indeed, in those women who watched cat videos then there were benefits in a wonderful number of domains. Let's talk about those a little bit.

Interviewer: Okay, yes. Let's break this down to health benefits. So if I want good cardio health but I hate cardio activities like running, cycling, the elliptical stairs, I hate it all, what's my alternative?

Dr. Jones: There's some very good evidence that watching cat videos and laughing is exercise because laughing is exercise. So looking at longer videos, 90-minute videos, you can increase your heart rate and you can increase your respiration and that's really wonderful and you return to baseline very quickly. So 90 minutes might give you an extra 10 calories. Now, a two-minute video doesn't have much cardiovascular benefit, but most people watch their cat video at least 10 times.

So the 10 times , times 2 calories, and then if you get up and have to go pee, which you will, if you keep laughing if you're a woman, so you're going to have to go pee a little bit and come back, you can get to 10 calories by watching it 10 times.

Interviewer: Okay. So now my cardio is good, but if my immune system is kind of just out of whack and I get sick every week, besides drowning my body in orange juice and eating an apple a day, what else can I do to maybe only get sick every other week?

Dr. Jones: There's some very, very good evidence on cat videos and immune function. So they have to laugh and that's important because some cat videos don't make people laugh. If you laugh, then that increases your salivary IgA. Also, laughing makes your killer T-cells, cells that help fight viruses and tumors, be more active. And that's been shown in men who watch videos . . . I can't really discuss about the kind of videos they're watching and laughing at, but for the women and cat videos, their T-cell function worked better. So also, watching cat videos calms people, particularly kitty videos. So if you're watching kiddy, K-I-D-DY and kitty, K-I-T-T-Y, putting them together makes people's cortisols drop and they feel much calmer.

Interviewer: And that in return helps my immune system.

Dr. Jones: Absolutely.

Interviewer: Okay. So because we're talking about women, beauty comes to mind, is there a cat video I can watch to maybe enhance my natural beauty? I mean, if I can deal without my current beauty products, I want to do it without them.

Dr. Jones: Oh great, right. Well, first of all, it's important to understand the smile. Now, you may not have your skin tone be that much more beautiful, but if you have a natural smile and practice your natural smile, you will be much more attractive to others. So practicing that smile, but it has to be a real smile so what they call the Duchenne smile, which involves your facial muscles and your eye muscles, not what they used to call the Pan Am smile or the . . .

Interviewer: Like the Hunger Games smile.

Dr. Jones: The Hunger Games, right. Right. Or the Botox smile. So in fact, it's not so much that your beauty itself and your skin tone, but when you smile, you look more beautiful and practicing your smiles. You practice your smiles in front of the mirror when you're looking at yourself, but the real smile, the Duchenne, named after a very famous neurologist, that reaches your eyes which you only get watching cat videos. So practice those cat videos and your smile will be much more natural.

Interviewer: Remembering all this is going to just stress me out. I'm just going to get stress anxiety because I have to remember every single cat videos that you're telling me about.

Dr. Jones: Think about that "aw". What makes you go "aw"? and there's a cat video for stress relieve as well and this is any video with a cat and a toddler. So if you just Google or go to YouTube and put in "cats and toddlers," you will have definitely an option for stressing out.

Interviewer: It's cuteness overload.

Dr. Jones: Absolutely. Absolutely.

Interviewer: Okay. All right, all right. I don't suppose there's anything that's going to give me abs, is there? Or that just seems way too much now?

Dr. Jones: No, no. Nothing but ab workouts are going to make your abs. But if you want to get rid of that bloating feeling, that unwanted water in your system, you can try watching videso of cat ambushes.

Interviewer: Cat ambushes.

Dr. Jones: Now you may be passing gas when that happens. So if you're startled, but if you have a certain way that you respond to cats ambushing other cats or human beings or birds, anything really of an ambush, you may actually . . . it may help with the bloating.

Interviewer: Earlier, you mentioned that watching kitty videos helps regulate my immune system. What about allergies? Is there anything I can watch to calm them down, keep them at bay?

Dr. Jones: Sometimes, your allergies are an overwork of your immune system. So allergies are complicated and it gets their own category of cat video. I always prescribe the cat cucumber video for people who say that they have allergies, their eyes get red and puffy, they feel kind of puffy in the springtime, that's the perfect video for allergy symptoms.

Interviewer: What if I'm allergic to cats themselves?

Dr. Jones: Well, that's no problem because cat videos had been proven to be hypoallergenic, safe for all ages and persons.

Interviewer: Okay. What about pain? If I'm dying of pain, can a cat video help me?

Dr. Jones: No, Chloe. If you're in pain, you need to see a doctor.

Interviewer: Okay. That's fine. I'm just checking because there seems to be a cat video for everything. Okay, no cat videos for pain relief.

Dr. Jones: Well, that's not exactly true in people with chronic pain. So acute pain, no. So if you ruptured your appendix, I strongly recommend . . .

Interviewer: I got to go see a doctor.

Dr. Jones: That you see the doctor. However, chronic pain, back pain, laughing at videos and the "aw" of cats and babies decreases the sensation of chronic pain, back pain, fibromyalgia, that kind of thing. It just calms . . .

Interviewer: It just calms me down.

Dr. Jones: It calms you down, decreases, and especially as you watch it over and over, you'll feel more calm. As you search the Internet more broadly for even more cat videos, you'll find you won't be thinking about your pain at all.

Interviewer: Okay. Now, this just sounds ridiculous now at this point. Are we . . . Is this study even real or what's going on? Because I feel like you're just playing with me here. Can cat videos actually help me live a longer life?

Dr. Jones: Sorry. Sorry, Chloe.

Interviewer: What's going on? You're laughing? You're laughing and I know why. I know why you're laughing. It's because we just played a prank on everybody. April Fools. Watching cat videos does not help you live a long and healthy life. But, Dr. Jones, tell everybody what does.

Dr. Jones: Laughing is good for you. Those things I said about laughing have been studied in looking at funny videos versus videos, watching, telling you how to repair your vacuum cleaner so people who watch funny videos versus that instructional videos actually do have an improvement in their immune function, a decrease in chronic pain and improvement in their cardiovascular response. And smiling the real smile, not the Botox smile, actually improves not only your sense of wellbeing but those around you. So on this April Fool's Day, I hope everybody gets a smile.

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