Asokan Chithra

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Categories: Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Physicians & Surgeons, Allergy & Immunology, Physicians & Surgeons, Dermatology, Physicians & Surgeons, Emergency Medicine, Physicians & Surgeons, Endocrinology, Diabetes & Metabolism, Physicians & Surgeons, Gynecology, Physicians & Surgeons, Internal Medicine, Physicians & Surgeons, Neurology, Physicians & Surgeons, Obstetrics And Gynecology, Physicians & Surgeons, Ophthalmology, Physicians & Surgeons, Otorhinolaryngology (Ear, Nose & Throat), Physicians & Surgeons, Pediatrics, Physicians & Surgeons, Psychiatry

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Phone: (928) 758-6200

Address: 1971 Highway 95 # A, Bullhead City, AZ 86442

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Asokan Chithra

General Practitioners

Arthritis
Sinusitis
Sinusitis is an inflammation of the skin that lines paranasal sinuses. The paranasal sinuses are pairs of hollow cavities in the skull that are of varying shapes and sizes. They are located around the nose and communicate with the nose through tiny openings. There are four pairs of sinuses: Maxillary, ethmoid, frontal and sphenoid. They are lined by cells that bear fine, hairlike cilia and by mucus-secreting goblet cells. The cilia by beating in a wave-like motion propel the mucus towards the openings of sinuses and into the nasal cavity. Any interference with the beating of cilia will result in accumulation of mucus in the sinuses. The accumulated mucus gets secondarily infected with bacteria, and this leads to a sinus infection. When the process is less than three weeks in duration, it is known as acute sinusitis. Chronic sinusitis is more than six weeks in duration, and subacute sinusitis is between 3-6 weeks in length.
Pediatric Care
Increased exposure to allergens also predisposes to the development of allergies. Living mostly indoors, having inadequate ventilation and having exposure to dust mites, animal dander, and cigarette smoke during early life stimulates the TH2 arm of the immune system resulting in allergies. Breastfeeding for at least one year, delaying introduction of solid foods in the infant’s diet until the infant is 6 months old and avoiding introduction of regular cow’s milk and meat before one year, eggs before 18 months and fish, seafood, peanuts and tree nuts before three years of age are some of the commonly advised strategies to prevent or postpone the development of allergies in children born in families with high incidence of allergies. The American Academy of Pediatrics recommends that pregnant and breastfeeding women avoid peanut-containing foods from their diet.
Snoring
Allergic rhinitis can be complicated by the development of sinusitis, asthma, ear infections and even by snoring and sleep apnea. Optimal management of allergic rhinitis often results in their improvement. In one study, regular treatment with prescription nasal sprays reduced the incidence of ER attendance due to acute asthma exacerbation by 50% in adult patients with asthma and allergic rhinitis.
Ear Infections
Allergen immunotherapy is suggested for treating allergic rhinitis and asthma. Many studies over the years, here and abroad have decided it helps 70-90% of allergy sufferers. Studies have shown it helps prevent the development of new allergies in children, makes the existing allergies better and improves the quality of life, sleep and work for patients. A study involving over two hundred children with allergic rhinitis over ten years decided that allergy injections might have even prevented asthma in these children. It is a common knowledge that allergy sufferers on allergen immunotherapy suffer less from complications such as sinus and ear infections. Doctors and patients agree the allergy injections reduce the cost of treatment for allergic rhinitis and asthma overall.
Sleep Disorders
Sleep disorders are common. It is estimated that 20 million Americans (1 in 15) are affected by sleep apnea. Good sleep is essential for our physical and emotional well-being. Lack of satisfactory and enough quality sleep could lead to fatigue, headaches, poor concentration and daytime sleepiness. This could also result in impairment of work and learning. Sleep-disordered breathing is associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, diabetes, and sleep deprived driving accidents. This also translates into 23 billion in health care costs a year. Sleep apnea is more prevalent in men who are also obese.
Family Practice
Saline nasal irrigation with an NETI pot is an age-old and time-tested technique used by millions of practitioners of Yoga over thousands of years in India. Its popularity is increasing all over the world in recent years. Many published articles in the recent medical literature confirm its many benefits. A recent survey among doctors in family practice in Wisconsin stated that 87% of the survey participants approved the use of saline nasal irrigation as an ancillary treatment for various upper respiratory diseases. Treatment guidelines in both Canada and the United States now favor the use of nasal irrigation for all causes of rhinosinusitis and postoperative cleaning of the nasal cavity. In children with nasal allergy symptoms studies have shown that use of saline nasal irrigation is safe, effective, improves their quality of life and reduces the need for topical prescription nasal sprays. Pregnant women (in whom the unnecessary use of medications could harm the baby) who used saline nasal irrigation regularly reported significant improvement in nasal congestion and stuffiness in another study.
Emergency Care
Particles less than 5 microns do not reach our lungs because of efficient filtration by our nostrils. The pollens are bigger than this. Researchers have found that pollens primarily affect nostrils in allergy sufferers and cause allergic inflammation (swelling) of the nostrils and sinuses. Eventually, this inflammation spills over and spreads to affect the lungs also. This explains why at the height of pollen season, some allergy sufferers complain of the tightness of chest and difficulty breathing. It is known that following thunderstorms, the pollens get fragmented into smaller particles (less than 5 microns), and this facilitates their entry into lungs to worsen asthma symptoms! It is also known that following Santa Ana winds in California, emergency room visits for asthma exacerbations go up.
Constipation
Bronchitis
Diarrhea
Pneumonia
Immunizations
Those individuals afraid of needles should not worry, as the injections are much less painful than the deep intramuscular shots received with routine immunizations. The shots are given with a very fine tipped needle subcutaneously in the arms just below the surface of the skin to minimize discomfort. Children often have an initial fear of the shot, but after experiencing the first shot deal well with the follow up injections. Often after discovering, the injections are helping, children do not mind and it becomes routine.

Ophthalmologists

Glaucoma
All Antihistamine Allergy Relief Eye Drops (Patanol, Pataday, Optivar, Azelastine, Zaditor, etc. Call us if you are not sure). DO NOT STOP GLAUCOMA DROPS.
Cataracts
(INCS) Intranasal corticosteroid sprays (fluticasone, Flonase, Nasacort AQ, Rhinocort Aqua, Nasonex, and Omnaris) are available by prescription only. They are safe. They do not cause addiction (in fact they have to be used daily to exert any benefit and allowances may not be noticeable for up to 7 days after beginning treatment!). Some are approved for use even in young children because of their excellent safety profile! A study in England showed that nasal corticosteroids do not cause cataracts. If used correctly (pointing to ears with your head looking down), their tendency to cause nosebleeds can be reduced. Occasionally they can cause headaches. Consult with your eye doctor if you have glaucoma before using them. The INCS are effective if you have nasal congestion and stuffiness as chief complaints. Their regular use with Sinus Rinse may help with your snoring and sleep apnea.
Eye Exam
Some people are put off by the word ‘steroids’ and they do not want to use them due to fear of side effects or due to confusion with ‘anabolic steroids’ used illegally by athletes. Inhaled steroids used in the treatment of asthma are quite different from anabolic steroids and are safe in mild to moderate doses especially when regularly monitored by your physician. Periodic eye examination to detect early glaucoma and cataracts, regular monitoring of height and bone density and proper use of calcium and vitamin D supplements will prevent or minimize the ocular and bone complications of inhaled or oral steroids.

Pregnancy
Labor and Delivery
Cigarette smoke predisposes to the development of allergic sensitization. A prospective study from Germany suggests there is an increased risk of allergen sensitization in children whose mothers smoked up to the end of their pregnancies and continued to smoke after childbirth especially in families with strong history of allergy. If you are using tobacco and become pregnant or planning to become pregnant, this may be a perfect opportunity to quit smoking to help your baby grow normally and have fewer allergies. Avoiding exposure to dust mites and animal dander has shown variable results in preventing allergies. Some studies show benefit and others do not. It might be possible that exposure to cats, dogs and dust mites early in life has a harmful effect only on children who are genetically predisposed to developing an allergy to these allergens and not in others. Since the current technology does not help us to recognize such children at risk early, it is safer to avoid exposure to cats, dogs, other animals and dust mites if your family has strong history of allergy and asthma.

Internal Medicine
An allergist and immunologist is a physician specially trained to manage and treat allergies and asthma. Becoming an allergist/immunologist requires completion of at least nine years of training. After completing medical school and graduating with a medical degree, a physician will then undergo three years of training in internal medicine (to become an internist) or pediatrics (to become a pediatrician). Once physicians have finished training in one of these specialties, they must pass the exam of either the American Board of Pediatrics (ABP) or the American Board of Internal Medicine (ABIM).

Multiple Sclerosis
Any interference with this could cause anosmia or hyposmia. Both conditions can be temporary or permanent. Head cold, sinus infection, allergic rhinitis (hay fever), vasomotor rhinitis, nasal polyps, significant deviation of nasal septum, exposure to toxic fumes, heavy smoking, head trauma and tumors involving nose are some of the common causes of hyposmia or anosmia. Infections involving the brain, nerve damage from lack of oxygen or following viral infections, degenerative brain diseases such as Parkinson's and multiple sclerosis and brain tumor and hydrocephalus are uncommon causes. Systemic disorders such as diabetes, hypothyroidism, cystic fibrosis and certain diseases involving kidneys and liver could be occasional culprits. Infrequently lack of smell could be genetically arbitrated and run in families.

Depression
Insomnia
Anxiety

Endocrinologist

Diabetes Care
Hypothyroidism
Besides cold and allergies, there are other causes for rhinitis. Irritants such as smoke, pollution, newsprint, new paint and strongly scented skin and body care products can cause rhinitis symptoms in many patients. Similarly, changes in temperature, humidity and atmospheric pressure and ingestion of alcohol and spicy food could also result in similar symptoms. Occasionally rhinitis can be caused by medications such as aspirin, NSAIDs, birth control pills, hormones, certain blood pressure medications and others, poorly controlled hypothyroidism, abuse of certain over-the-counter nasal sprays such as Afrin, sniffing cocaine, and pregnancy (due to the effect of hormones the baby makes). In dry climates, nasal stuffiness could be the predominant symptom resulting from dryness of the nasal mucosa.

MRI
Copies of medical records that are relevant to your visit from your family physician or other specialists - Include hospital records, Office visit notes, lab test results, previous allergy evaluation reports, biopsy reports, x-ray, CT or MRI reports or any other pertinent information
X-Rays
Computed Tomography
The tests that you undergo to diagnose mold related illness depends on the type of sickness you have. Allergy skin tests, blood tests to measure eosinophils and serum IgE level, Chest x-ray, Pulmonary Function Test and CT scans or MRIs of sinus cavities and chest are some of the commonly offered diagnostic procedures. More specialized tests to diagnose specific conditions are also available. Air-samples, when collected from different parts of the suspected building by professionally competent people, may give valuable information as to the likelihood of having mold growth in the building.
Chemotherapy
During the entire time for 96 hours it is very important that you stay in cool environments and avoid vigorous work or activities to minimize sweating. In addition, you should not take shower to avoid wetting the back. However you can take sponge baths. Medications such as steroids (prednisone, prednisolone, Medrol Dosepak and steroid injections), topical steroid creams and chemotherapy for cancer can interfere with the patch test results and can cause false negative results. Please inform your physician if you have taken any of these medications in the preceding 4 weeks. Antihistamines such as Benadryl, Claritin, Zyrtec or Allegra do not interfere with patch testing and therefore can be continued.

Eczema
Some children (but not all) who are thus sensitized go on to develop allergic diseases. Atopic dermatitis (a.k.a eczema) is often the first expression of allergic disease in children. Eighty percent of children who develop atopic dermatitis do so during the first year of life. Forty percent outgrow eczema by 3 or 4 years old. Another 40% will have the intermittent disease, and only 20% will develop the persistent disease into adulthood. It is important to realize that 75% of children who have eczema as toddlers will develop allergic rhinitis (hay fever) and 50% will develop asthma during school-going years.
Fungus
Allergic rhinitis, commonly known as hay fever can develop or get exacerbated following exposure to molds. It causes significant sneezing, sniffles, nasal stuffiness and congestion, postnasal drainage, and even sinus pressure headaches. Mold allergy is often perennial. It can get worse following summer rains and during dry and windy weather. Inflammation of sinus linings causes sinusitis. Mold spores can develop into fungal balls inside sinus cavities and can cause bleeding. However, most often they are asymptomatic and discovered on routine x-ray studies. In patients who are immunocompromised (having low white blood cell counts, HIV or Primary Immunodeficiency Diseases, Cancer, Leukemia or Lymphoma), inhaled spores can start growing inside the sinus cavities, start eroding the bony walls of sinuses and cause tissue destruction (Invasive Fungal Sinusitis). The fungus could also spread to other organs through the bloodstream and could cause life-threatening illnesses.
Rashes
Skin Care
Hydration of the skin is paramount in keeping the integrity of the skin. A dry skin results in itching and scratching leading to the formation of rash and secondary skin infection which in turn can aggravate the skin symptoms. Therefore, the following measures are recommended Short, tepid showers for 10 minutes once or twice daily are recommended. Prolonged baths, especially bubble baths are discouraged as they may cause irritation and further drying of the skin. After the shower, the skin should be pat-dried gently using a soft towel and not rubbed vigorously.

Allergies
Dr. Asokan writes allergy and immunology articles in Kingman Daily Miner Newspaper at biweekly intervals. They are published under Health & Fitness section. Please read them.

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