Kudos to Canada

This morning, SRxA’s Word on Health salutes the Canadian city of Hamilton, Ontario, for its pioneering lead in anaphylaxis safety. Hamilton is destined to become the first city in the world to require all food service outlets to have life-saving epinephrine auto-injectors on hand for people with severe food allergies.

The move is being led by Hamilton Councillor  – Lloyd Ferguson, in hopes of avoiding sudden and tragic deaths like one this past spring of a Stoney Creek girl.

Twelve-year-old Maia Santarelli-Gallo had what her doctor said was a mild allergy to eggs and milk that had only ever caused her a runny nose. But last March, while eating an ice cream cone at a Hamilton-area mall with her father and older sister, Maia experienced a sudden, severe allergic reaction.

Her sister found someone with an epinephrine injector, but by the time it was administered, it was too late. Emergency crews took Maia to hospital but she was pronounced dead.

When Councillor Ferguson heard about Maia’s death, he decided to draft a ground-breaking motion to get epinephrine auto-injectors in every restaurant and mall in the city.

He says it’s high time that food providers have access to medicines that could help their customers who develop allergic reactions. He says if automated external defibrillator (AEDs) are now being installed in arenas and other community centers, it makes sense to have epinephrine injectors in areas where food allergy reactions are most likely to occur.

“It took us about 40 years to get defibrillators into public facilities and they have been a great success. This is the next step,” he says.

Allergy specialist Dr. Mark Greenwald, Allergist, and Chief Medical Officer of EpiCenter Medical would like to go further and see public awareness campaigns that would train the public on how to use epinephrine injectors, just as there have been campaigns encouraging people to learn CPR.

Greenwald has developed an online course called EpiPenTraining.com, to offer training on how to recognize allergic reactions, and how to use the injectors. He says such training is vital because during anaphylaxis, seconds count.

And anaphylaxis isn’t rare.  Allergic disease is the 5th most prevalent chronic disease among all ages, and the 3rd most prevalent among children. Every 3 minutes in North America, a food allergic reaction sends someone to the Emergency Room. Every 6 minutes, that Emergency Room visit is for anaphylaxis, that’s 10 patients per hour!

In 25% of people requiring treatment, the reaction is their first episode, and they are completely unprepared.  And for 50% of the people who die from anaphylaxis, the victims had life-saving epinephrine, but it wasn’t used or it wasn’t used in time. The other 50% didn’t carry epinephrine despite their previous allergic episodes.

Participants in the online course become SAVE certified – Save Anaphylaxis Victims in an Emergency.

Debbie Bruce of the Canadian Anaphylaxis Initiative was part of a program this past spring to get epinephrine injectors on all fire trucks in Mississauga. She says that like Maia, up to one-third of people who have allergic reactions outside the home did not realize they had a severe allergy and didn’t carry an epinephrine injector. She is now petitioning politicians  to come up with a national allergy plan.

“I think it is a new reality,” she says. “Reactions happen and we need to be prepared.”

Maia’s mother, Leah Santarelli, backs all efforts to make the public more aware of anaphylaxis and hopes the Hamilton city council passes Ferguson’s motion.

“There’s no guarantee that an EpiPen will save your life 100 per cent of the time, just like a defibrillator won’t save you 100 per cent of the time, but it is there as a safety measure,” she says.

The motion is currently being reviewed by the city’s health team; if approved, it should go before Hamilton city council in October.

We certainly hope that it does and that this trend will rapidly spread across the borders.  As Greenwald says – every second counts!

Adrenaline Junkie

Although we repeatedly hear about the negative health effects of stress, today we’re here to tell you that stress isn’t necessarily all bad. Like food, sex, and shoes, it’s quality, not quantity, that determines whether stress helps or hurts!

Beneficial stress comes in the form of an acute, stimulating surge, like when your raft starts to overturn in some seriously churning rapids. The resulting single adrenaline (epinephrine) burst that comes and goes very quickly is a good thing because it gives you energy and gets you ready to mobilize for immediate action.

Physiologically, the adrenaline created by an abrupt blast of stress sends a flood of oxygen-rich red blood cells through your body, boosts your immune system, and signals your brain to start releasing painkilling endorphins.

Bad stress, on the other hand, is intense and drags on and on. This constant grind causes your adrenal glands to leak a slow, steady stream of another stress hormone: cortisol. And unlike adrenaline, which tends to hit your system in a flash and then dissipate, cortisol often wears out its welcome by hanging around in your bloodstream, driving up blood pressure, suppressing your immune system, and making you more susceptible to a slew of stress-related ailments, including colds, irritable bowel syndrome, migraines, and even heart disease and stroke.

So how do good stressors battle the bad ones? It all comes back to the positive power of adrenaline. In addition to all of its performance-enhancing effects, it triggers the release of dopamine and endorphins, two neurotransmitters that make you feel good – really, really good.

It also makes me feel good – really, really good, given the activities I have planned this weekend. But more of that later…

For now, let’s return to our favorite stress hormone – epinephrine. If you’ve ever tried skydiving, bungee jumping or heli-skiing, you’ll probably remember literally flipping out during your first attempt. But once you landed safely you probably experienced a euphoric, fist-pumping high thanks to dopamine flooding your brain’s pleasure center, giving you. During the next jump, you may still have felt all the same physiological stress responses such as a pounding heart and sweaty palms but instead of being terrifying, it’s exhilarating, because your mind’s already anticipating the thrill of that dopamine reward.

And the more times you do it, the less anxiety you’re likely to feel and the more fun you’ll have. That’s because your brain’s tagging the experience as a positive one.

And the benefits persist.  Before long, your body can start to develop an almost Pavlovian response to stressful situations. If your nerves are tingling, your stomach is clenching, and you can barely breathe, then it’s tricked into thinking something really awesome is about to happen!

That’s what researchers at Texas A&M University found when they put a small sample of men and women through a series of purposely stressful outdoor adventure tasks. Some subjects – the fittest ones who were already comfortable with physical challenges fared better than others. The researchers discovered that those participants had a reduced stress response (including lower blood levels of cortisol) when facing demanding activities like whitewater canoeing or rock climbing. Essentially, they were more confident and less stressed out, even though the tasks were potentially hazardous. This may be because their past experience blazing through strenuous situations made them less likely to perceive new challenges as stressful or difficult. And according to the researchers, it’s possible to transfer that oh-so-cool-and-collected response to life’s other nerve-racking events.

Better still, you don’t have to scuba dive with great whites or BASE jump off the Empire State Building to reap the stress-busting perks of adrenaline. Whether you hit the bunny slope or the double-black-diamond mogul fields, as long as you’re taking a giant step outside your comfort zone, you’ll give your body that adrenaline kick and when you do it regularly and keep testing your edge, you’ll change your relationship with stress for the better.

So next time that little voice inside your head starts clamoring, no freaking way, just go for it and be prepared to reap the rewards.

Which brings me back to my weekend. Keen to test the above theory for myself and readers of SRxA’s Word on Health, I will be spending tomorrow riding some of the longest, highest, fastest most insane rollercoasters in the country…and the following day I will be running with the bulls. If being pursued by twenty-four 1,000-pound bulls doesn’t set my adrenaline firing on all cylinders, then I guess nothing will.

I”ll let you know (hopefully) on Monday!

A Diabetics Best Friend

Guide dogs, watch dogs, hearing dogs, mobility assist dogs,  lap dogs, big dogs, small dogs – SRxA’s Word on Health readily admits to a fondness for them all.

So it’s hardly surprising that we were drawn to a story about Early Alert Canines, a non-profit group in California that is training man’s best friend to detect the subtle scents of low blood sugars and matching them with Type 1 diabetics.

These diabetic alert dogs are trained to recognize the biochemical scent that a diabetic’s body gives off as his or her blood glucose begins to change. The dogs learn that this biochemical scent is a command to the dogs for them to carry out an “alert” action – an early warning that can help their human partners avoid acutely dangerous hypoglycemia, and hyperglycemia.

Because hypoglycemia (low blood sugar) can cause severe problems including coma and death, and because hyperglycemia can contribute to long-term diabetes complications, these early warnings, allow diabetics to check their blood glucose levels and treat themselves appropriately. Thus, these amazing dogs are a not only a diabetic’s best friend, they also become life-changers and life-savers.

Although medical technology makes it possible for diabetics to regularly their own blood sugar levels, there are many times when such checks are problematic or even impossible; during sleep or during intense exercise, school work, or business meetings. Early Alert Canines, on the other hand, are always on alert for their insulin-dependent partners, ready to warn them about critical changes in their blood sugar levels.

“We can’t smell it … It gets down to a molecular level,” says organization executive director Carol Edwards, noting the detection of a “cocktail of chemicals,” such as acetone, adrenaline and endorphins, which are released into the bloodstream as a diabetic’s glucose is dropping.

One person benefitting from the program is Nancy Harrison from California. Over a period of 17 years, paramedics have been dispatched on numerous occasions to revive her during hypoglycemic episodes. Instead of being woken by strangers in blue, wielding an IV and bag of dextrose 50%, when her glucose level starts to plummet.
she now finds an 80-pound yellow Labrador on her chest, alerting her the fact.
“He gets in my face … he’ll plow me down to get me to pay attention to him,” says Harrison, about her dog Kade.

Trained initially by Guide Dogs for the Blind, Kade preferred to eat paper towels, socks and dryer sheets making him unsuitable for the sight-impaired. But when it comes to alerting Harrison, he is all business. When he  commutes with her to work he will put his head on her shoulder and start licking her face if her blood sugar starts to drop.

Early Alert Canines (EAC) trains two main classes of diabetic alert dogs: full-access service dogs and skilled companion dogs.

Full Access Service Dogs are trained and placed with diabetic adults and children age 12 and older. These dogs are fully trained diabetic alert dogs and attend work, school, extracurricular activities, errands, etc., with their diabetic partners. These dogs are accredited service dogs and can legally accompany their diabetic partners anywhere the general public is allowed. Full Access Service Dogs are perfect for people who can commit to having a dog with them all hours of the day.

Skilled Companion Alert Dogs are trained and placed with diabetic children, families with multiple diabetics, and some adults who find a service dog won’t fit into their lifestyle. Skilled Companion Alert Dogs are fully trained in hypoglycemic alerting, and do most of their work in the diabetic’s home, but do not have public access rights.

In order to qualify for the program potential dog owners must be insulin-dependent diabetes who have been using insulin for at least one year and diligently manage their diabetes. EAC is keen to point out that their dogs are not for people who are not attempting to closely control their diabetes. The application process involves an online application, paper applications, a phone interview, a home visit and orientation. There is an application fee of $100.

If approved, the diabetic attends Team Training, during which the diabetic may be matched up with a dog that the staff determines to be a good fit for the individual’s needs. Diabetics seeking placement with a skilled companion attend a one-week course, and diabetics seeking full access service dogs attend a two-week course.

For more information about these very special dogs and the Early Alert Canine program click here.