Coughing/Wheezing After Dinner?

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The After-Dinner Activities You Don’t Want

A quick note first: our usual medical/legal disclaimer applies here, and we are not here to diagnose you or treat you; we are not doctors, let alone your doctors. Do see yours if you have any reason to believe there may be cause for concern.

Coughing and/or wheezing after eating is more common the younger or older someone is. Lest that seem contradictory: it’s a U-shaped bell-curve.

It can happen at any age and for any of a number of reasons, but there are patterns to the distribution:

Mostly affects younger people:

Allergies, asthma

Young people are less likely to have a body that’s fully adapted to all foods yet, and asthma can be triggered by certain foods (for example sulfites, a common preservative additive):

Adverse reactions to the sulphite additives

Foods/drinks that commonly contain sulfites include soft drinks, wines and beers, and dried fruit

As for the allergies side of things, you probably know the usual list of allergens to watch out for, e.g: dairy, fish, crustaceans, eggs, soy, wheat, nuts.

However, that’s far from an exhaustive list, so it’s good to see an allergist if you suspect it may be an allergic reaction.

Affects young and old people equally:

Again, there’s a dip in the middle where this doesn’t tend to affect younger adults so much, but for young and old people:

Dysphagia (difficulty swallowing)

For children, this can be a case of not having fully got used to eating yet if very small, and when growing, can be a case of “this body is constantly changing and that makes things difficult”.

For older people, this can can come from a variety of reasons, but common culprits include neurological disorders (including stroke and/or dementia), or a change in saliva quality and quantity—a side-effect of many medications:

Hyposalivation in Elderly Patients

(particularly useful in the article above is the table of drugs that are associated with this problem, and the various ways they may affect it)

Managing this may be different depending on what is causing your dysphagia (as it could be anything from antidepressants to cancer), so this is definitely one to see your doctor about. For some pointers, though:

NHS Inform | Dysphagia (swallowing problems)

Affects older people more:

Gastroesophagal reflux disease (GERD)

This is a kind of acid reflux, but chronic, and often with a slightly different set of symptoms.

GERD has no known cure once established, but its symptoms can be managed (or avoided in the first place) by:

And of course, don’t smoke, and ideally don’t drink alcohol.

You can read more about this (and the different ways it can go from there), here:

NICE | Gastro-oesophageal reflux disease

Note: this above page refers to it as “GORD”, because of the British English spelling of “oesophagus” rather than “esophagus”. It’s the exact same organ and condition, just a different spelling.

Take care!

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  • When Doctors Make House Calls, Modern-Style!

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    In Tuesday’s newsletter, we asked you foryour opinion of telehealth for primary care consultations*, and got the above-depicted, below-described, set of responses:

    • About 46% said “It is no substitute for an in-person meeting with a doctor; let’s keep the human touch”
    • About 29% said “It means less waiting and more accessibility, while avoiding transmission of diseases”
    • And 25 % said “I find that the pros and cons of telehealth vs in-person balance out, so: no preference”

    *We specified that by “primary care” we mean the initial consultation with a non-specialist doctor, before receiving treatment or being referred to a specialist. By “telehealth” we mean by videocall or phonecall.

    So, what does the science say?

    A quick note first

    Because telehealth was barely a thing (statistically speaking) before the first stages of the COVID pandemic, compared to how it is now, most of the science for this is young, and a lot of the science simply hasn’t been done yet, and/or has not been published yet, because the process can take years.

    Because of this, some studies we do have aren’t specifically about primary care, and are sometimes about specialists. We think this should not affect the results much, but it bears highlighting.

    Nevertheless, we’ll do what we can with the science we have!

    Telehealth is more accessible than in-person consultations: True or False?

    True, for most people. For example…

    ❝Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare.

    Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%.

    Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information.❞

    Dr. Wiam Alashek et al.

    whereas…

    ❝Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people❞

    Ibid.

    Source: Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review

    Now, perception of those things does necessarily equate to an actual increased barrier, but it is reasonable that someone who thinks something is inaccessible will be less inclined to try to access it.

    The quality of care provided via telehealth is as good as in-person: True or False?

    True, ostensibly, with caveats. The caveats are:

    • We’re going offreported patient satisfactionnot objective patient health outcomes (we found little* science as yet for the relative incidence of misdiagnosis, for example—which kind of thing will take time to be revealed).
    • We’re also therefore speaking (as statistics do) for the significant majority of people. However, if we happen to be (statistically speaking) an insignificant minority, well, that just sucks for us personally.

    *we did find some, but it wasn’t very helpful yet. For example:

    An electronic trigger to detect telemedicine-related diagnostic errors

    this one does look at the incidence of diagnostic errors, but provides no control group (i.e. otherwise-comparable in-person consultations) for comparison.

    While most oft-considered demographic groups reported comparable patient satisfaction (per racegender, and socioeconomic status, for example), there was one outlier variable, which was age (as we quoted from that first study above).

    However!

    Looking under the hood of these stats, it seems that age is not the real culprit, so much as technological illiteracy, which is heavily correlated with age:

    ❝Lower eHealth literacy is associated with more negative attitudes towards I/C technology in healthcare. This trend is consistent across diverse demographics and regions. ❞

    Dr. Raghad Elgamal

    Source: Meta-analysis: eHealth literacy and attitudes towards internet/computer technology

    There are things that can be done at an in-person consultation that can’t be done by telehealth: True or False?

    True, of course. It is incredibly rare that we will cite “common sense”, (as sometimes “common sense” is actually “common mistakes” and is simply and verifiably wrong), but in this case, as one 10almonds subscriber put it:

    ❝The doctor uses his five senses to assess. This cannot be attained over the phone❞

    ~ 10almonds subscriber

    A quick note first: if your doctor is using their sense of taste to diagnose you, please get a different doctor, because they should definitely not be doing that!

    Not in this century, anyway… Once upon a time, diabetes was diagnosed by urine-tasting (and yes, that was a fairly reliable method).

    However, nowadays indeed a doctor will use sightsoundtouch, and sometimes even smell.

    In a videocall we’re down to two of those senses (sight and sound), and in a phonecall, down to one (sound) and even that is hampered. Your doctor cannot, for example, use a stethoscope over the phone.

    With this in mind, it really comes down to what you need from your doctor in that consultation.

    • If you’re 99% sure that what you need is to be prescribed an antidepressant, that probably doesn’t need a full physical.
    • If you’re 99% sure that what you need is a referral, chances are that’ll be fine by telehealth too.
    • If your doctor is 99% sure that what you need is a verbal check-up (e.g. “How’s it been going for you, with the medication that I prescribed for you a month ago?”, then again, a call is probably fine.

    If you have a worrying lump, or an unhappy bodily discharge, or an unexplained mysterious pain? These things, more likely an in-person check-up is in order.

    Take care!

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  • I Contain Multitudes – by Ed Yong

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    A little while back we reviewed a book (Planet of Viruses) about the role of viruses in our lives, beyond the obvious. Today’s book gives the same treatment to microbes in general—mostly bacteria.

    We all know about pathogens, and we all know about gut microbiota and that some (hopefully the majority) there are good for our health. This book covers those things too, but also much more.

    Pulitzer Prize-winning science writer Ed Yong takes a big picture view (albeit, of some very small things) and looks at the many ways microbes keep us alive, directly or indirectly. From the microbes that convert certain proteins in breast milk into a form that babies can digest (yes, this means we produce nutrients in breast milk that have been evolved solely to feed that bacterium), to those without which agriculture would simply not work, we’re brought to realize how much our continued existence is contingent on our trillions of tiny friends.

    The style throughout is easy-reading pop-science, very accessible. There’s also plenty in terms of practical take-away value, when it comes to adjusting our modern lives to better optimize the benefits we get from microbes—inside and out.

    Bottom line: if you’d like to learn about the role of microbes in our life beyond “these ones are pathogens” and “these ones help our digestion”, this is the book for you.

    Click here to check out I Contain Multitudes, and learn more about yours and those around you!

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  • Patient Underwent One Surgery but Was Billed for Two. Even After Being Sued, She Refused To Pay.

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    Jamie Holmes says a surgery center tried to make her pay for two operations after she underwent only one. She refused to buckle, even after a collection agency sued her last winter.

    Holmes, who lives in northwestern Washington state, had surgery in 2019 to have her fallopian tubes tied, a permanent birth-control procedure that her insurance company agreed ahead of time to cover.

    During the operation, while Holmes was under anesthesia, the surgeon noticed early signs of endometriosis, a common condition in which fibrous scar tissue grows around the uterus, Holmes said. She said the surgeon later told her he spent about 15 minutes cauterizing the troublesome tissue as a precaution. She recalls him saying he finished the whole operation within the 60 minutes that had been allotted for the tubal ligation procedure alone.

    She said the doctor assured her the extra treatment for endometriosis would cost her little, if anything.

    Then the bill came.

    The Patient: Jamie Holmes, 38, of Lynden, Washington, who was insured by Premera Blue Cross at the time.

    Medical Services: A tubal ligation operation, plus treatment of endometriosis found during the surgery.

    Service Provider: Pacific Rim Outpatient Surgery Center of Bellingham, Washington, which has since been purchased, closed, and reopened under a new name.

    Total Bill: $9,620. Insurance paid $1,262 to the in-network center. After adjusting for prices allowed under the insurer’s contract, the center billed Holmes $2,605. A collection agency later acquired the debt and sued her for $3,792.19, including interest and fees.

    What Gives: The surgery center, which provided the facility and support staff for her operation, sent a bill suggesting that Holmes underwent two separate operations, one to have her tubes tied and one to treat endometriosis. It charged $4,810 for each.

    Holmes said there were no such problems with the separate bills from the surgeon and anesthesiologist, which the insurer paid.

    Holmes figured someone in the center’s billing department mistakenly thought she’d been on the operating table twice. She said she tried to explain it to the staff, to no avail.

    She said it was as if she ordered a meal at a fast-food restaurant, was given extra fries, and then was charged for two whole meals. “I didn’t get the extra burger and drink and a toy,” she joked.

    Her insurer, Premera Blue Cross, declined to pay for two operations, she said. The surgery center billed Holmes for much of the difference. She refused to pay.

    Holmes said she understands the surgery center could have incurred additional costs for the approximately 15 minutes the surgeon spent cauterizing the spots of endometriosis. About $500 would have seemed like a fair charge to her. “I’m not opposed to paying for that,” she said. “I am opposed to paying for a whole bunch of things I didn’t receive.”

    The physician-owned surgery center was later purchased and closed by PeaceHealth, a regional health system. But the debt was turned over to a collection agency, SB&C, which filed suit against Holmes in December 2023, seeking $3,792.19, including interest and fees.

    The collection agency asked a judge to grant summary judgment, which could have allowed the company to garnish wages from Holmes’ job as a graphic artist and marketing specialist for real estate agents.

    Holmes said she filed a written response, then showed up on Zoom and at the courthouse for two hearings, during which she explained her side, without bringing a lawyer. The judge ruled in February that the collection agency was not entitled to summary judgment, because the facts of the case were in dispute.

    More From Bill Of The Month

    Representatives of the collection agency and the defunct surgery center declined to comment for this article.

    Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms, said it was absurd for the surgery center to bill for two operations and then refuse to back down when the situation was explained. “It’s like a Kafka novel,” she said.

    Corlette said surgery center staffers should be accustomed to such scenarios. “It is quite common, I would think, for a surgeon to look inside somebody and say, ‘Oh, there’s this other thing going on. I’m going to deal with it while I’ve got the patient on the operating table.’”

    It wouldn’t have made medical or financial sense for the surgeon to make Holmes undergo a separate operation for the secondary issue, she said.

    Corlette said that if the surgery center was still in business, she would advise the patient to file a complaint with state regulators.

    The Resolution: So far, the collection agency has not pressed ahead with its lawsuit by seeking a trial after the judge’s ruling. Holmes said that if the agency continues to sue her over the debt, she might hire a lawyer and sue them back, seeking damages and attorney fees.

    She could have arranged to pay off the amount in installments. But she’s standing on principle, she said.

    “I just got stonewalled so badly. They treated me like an idiot,” she said. “If they’re going to be petty to me, I’m willing to be petty right back.”

    The Takeaway: Don’t be afraid to fight a bogus medical bill, even if the dispute goes to court.

    Debt collectors often seek summary judgment, which allows them to garnish wages or take other measures to seize money without going to the trouble of proving in a trial that they are entitled to payments. If the consumers being sued don’t show up to tell their side in court hearings, judges often grant summary judgment to the debt collectors.

    However, if the facts of a case are in dispute — for example, because the defendant shows up and argues she owes for just one surgery, not two — the judge may deny summary judgment and send the case to trial. That forces the debt collector to choose: spend more time and money pursuing the debt or drop it.

    “You know what? It pays to be stubborn in situations like this,” said Berneta Haynes, a senior attorney for the National Consumer Law Center who reviewed Holmes’ bill for KFF Health News.

    Many people don’t go to such hearings, sometimes because they didn’t get enough notice, don’t read English, or don’t have time, she said.

    “I think a lot of folks just cave” after they’re sued, Haynes said.

    Emily Siner reported the audio story.

    After six years, we’ll have a final installment with NPR of our Bill of the Month project in the fall. But Bill of the Month will continue at KFF Health News and elsewhere. We still want to hear about your confusing or outrageous medical bills. Visit Bill of the Month to share your story.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • Grain Brain – by Dr. David Perlmutter

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    If you’re a regular 10almonds reader, you probably know that refined flour, and processed food in general, is not great for the health. So, what does this book offer more?

    Dr. Perlmutter sets out the case against (as the subtitle suggests) wheat, carbs, and sugar. Yes, including wholegrain wheat, and including starchy vegetables such as potatoes and parsnips. Fruit does also come under scrutiny, a clear distinction is made between whole fruits and juices. In the latter case, the lack of fiber (along with the more readily absorbable liquid state) allows for those sugars to zip straight into our blood.

    The book includes lots of stats and facts, and many study citations, along with infographics and clear explanations.

    If the book has a weakness, it’s when it forgets to clarify something that was obvious to the author. For example, when he talks about our ancestors’ diets being 75% fat and 5% carbs, he neglects to mention that this is 75% by calorie count, not by mass or volume. This makes a huge difference! It’s the difference between a fat-guzzling engine, and someone who eats mostly fruit and oily nuts but also some very high-fat meat/organs.

    The book’s strengths, on the other hand, are found in its explanation, backed by good science, of what wheat, along with excessive carbohydrates (especially sugar) can do to our body, including (and most focusedly, hence the title) our brain, leading the way to not just obvious metabolic disorders like diabetes, but also inflammatory diseases like Alzheimer’s.

    Bottom line: you don’t have to completely revamp your diet if it’s working for you, but data is data, and this book has lots, making it well-worth a read.

    Click here to check out Grain Brain, and learn about how to avoid inflaming yours!

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  • Willpower: A Muscle To Flex, Or Spoons To Conserve?

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    Willpower: A Muscle To Flex, Or Spoons To Conserve?

    We have previously written about motivation; this one’s not about that.

    Rather, it’s about willpower itself, and especially, the maintenance of such. Which prompts the question…

    Is willpower something that can be built up through practice, or something that is a finite resource that can be expended?

    That depends on you—and your experiences.

    • Some people believe willpower is a metaphorical “muscle” that must be exercised to be built up
    • Some people believe willpower is a matter of metaphorical “spoons” that can be used up

    A quick note on spoon theory: this traces its roots to Christine Miserandino’s 2003 essay about chronic illness and the management of limited energy. She details how she explained this to a friend in a practical fashion, she gave her a bunch of spoons from her kitchen, as an arbitrary unit of energy currency. These spoons would then need to be used to “pay” for tasks done; soon her friend realised that if she wanted to make it through the day, she was going to have to give more forethought to how she would “spend” her spoons, or she’d run out and be helpless (and perhaps hungry and far from home) before the day’s end. So, the kind of forethought and planning that a lot of people with chronic illnesses have to give to every day’s activities.

    You can read it here: But You Don’t Look Sick? The Spoon Theory

    So, why do some people believe one way, and some believe the other? It comes down to our experiences of our own willpower being built or expended. Researchers (Dr. Vanda Siber et al.) studied this, and concluded:

    ❝The studies support the idea that what people believe about willpower depends, at least in part, on recent experiences with tasks as being energizing or draining.❞

    Source: Autonomous Goal Striving Promotes a Nonlimited Theory About Willpower

    In other words, there’s a difference between going out running each morning while healthy, and doing so with (for example) lupus.

    On a practical level, this translates to practicable advice:

    • If something requires willpower but is energizing, this is the muscle kind! Build it.
    • If something requires willpower and is draining, this is the spoons kind! Conserve it.

    Read the above two bullet-points as many times as necessary to cement them into your hippocampus, because they are the most important message of today’s newsletter.

    Do you tend towards the “nonlimited” belief, despite getting tired? If so, here’s why…

    There is something that can continue to empower us even when we get physically fatigued, and that’s the extent to which we truly get a choice about what we’re doing. In other words, that “Autonomous” at the front of the title of the previous study, isn’t just word salad.

    • If we perceive ourselves as choosing to do what we are doing, with free will and autonomy (i.e., no externally created punitive consequences), we will feel much more empowered, and that goes for our willpower too.
    • If we perceive ourselves as doing what we have to (or suffer the consequences), we’ll probably do it, but we’ll find it draining, and that goes for our willpower too.

    Until such a time as age-related physical and mental decline truly take us, we as humans tend to gradually accumulate autonomy in our lives. We start as literal babies, then are children with all important decisions made for us, then adolescents building our own identity and ways of doing things, then young adults launching ourselves into the world of adulthood (with mixed results), to a usually more settled middle-age that still has a lot of external stressors and responsibilities, to old age, where we’ve often most things in order, and just ourselves and perhaps our partner to consider.

    Consequently…

    Age differences in implicit theories about willpower: why older people endorse a nonlimited theory

    …which explains why the 30-year-old middle-manager might break down and burn out and stop going to work, while an octogenarian is busy training for a marathon daily before getting back to their daily book-writing session, without fail.

    One final thing…

    If you need a willpower boost, have a snack*. If you need to willpower boost to avoid snacking, then plan for this in advance by finding a way to keep your blood sugars stable. Because…

    The physiology of willpower: linking blood glucose to self-control

    *Something that will keep your blood sugars stable, not spike them. Nuts are a great example, unless you’re allergic to such, because they have a nice balance of carbohydrates, protein, and healthy fats.

    Want more on that? Read: 10 Ways To Balance Blood Sugars

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    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

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  • Genetic Risk Factors For Long COVID

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Some people, after getting COVID, go on to have Long COVID. There are various contributing factors to this, including:

    • Lifestyle factors that impact general disease-proneness
    • Immune-specific factors such as being immunocompromised already
    • Genetic factors

    We looked at some modifiable factors to improve one’s disease-resistance, yesterday:

    Stop Sabotaging Your Gut

    And we’ve taken a more big-picture look previously:

    Beyond Supplements: The Real Immune-Boosters!

    Along with some more systemic issues:

    Why Some People Get Sick More (And How To Not Be One Of Them)

    But, for when the “don’t get COVID” ship has sailed, one of the big remaining deciding factors with regard to whether one gets Long COVID or not, is genetic

    The Long COVID Genes

    For those with their 23andMe genetic data to hand…

    ❝Study findings revealed that three specific genetic loci, HLA-DQA1–HLA-DQB1, ABO, and BPTF–KPAN2–C17orf58, and three phenotypes were at significantly heightened risk, highlighting high-priority populations for interventions against this poorly understood disease.❞

    ~ Priyanka Nandakumar et al.

    For those who don’t, then first: you might consider getting that! Here’s why:

    Genetic Testing: Health Benefits & Methods

    But also, all is not lost meanwhile:

    The same study also found that individuals with genetic predispositions to chronic fatigue, depression, and fibromyalgia, as well as other phenotypes such as autoimmune conditions and cardiometabolic conditions, are at significantly higher risk of long-COVID than individuals without these conditions.

    Good news, bad news

    Another finding was that women and non-smokers were more likely to get Long COVID, than men and smokers, respectively.

    Does that mean that those things are protective against Long COVID, which would be very counterintuitive in the case of smoking?

    Well, yes and no; it depends on whether you count “less likely to get Long COVID because of being more likely to just die” as protective against Long COVID.

    (Incidentally, estrogen is moderately immune-enhancing, while testosterone is moderately immune-suppressing, so the sex thing was not too surprising. It’s also at least contributory to why women get more autoimmune disorders, while men get more respiratory infections such as colds and the like)

    Want to know more?

    You can read the paper itself, here:

    Multi-ancestry GWAS* of Long COVID identifies immune-related loci and etiological links to chronic fatigue syndrome, fibromyalgia and depression

    *GWAS = Genome-Wide Association Study

    Take care!

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