Avoiding Holiday Heartburn

Prone to heartburn? You'll want to pace yourself during the holiday feasts.

Prone to heartburn? You’ll want to pace yourself during the holiday feasts.

The holiday season is in full swing and undoubtedly, you’re already salivating at the thought of enjoying Thanksgiving, Hanukkah, Christmas and New Year’s feasts. Unfortunately, many a holiday spread goes awry for those who suffer from acid reflux and resulting heartburn. Acid reflux occurs when stomach acids are regurgitated back up through the upper body, courtesy of an esophageal sphincter failing to close at the right time. The resulting burning sensation in your chest is known as heartburn. For some people, the symptoms may present differently resulting in hoarseness, a sensation of something being stuck in the throat or difficulty swallowing. These are the symptoms of laryngopharyngeal reflux, when acid from the stomach is regurgitated farther than the esophagus up to the larynx.

Even if you’re prone to acid reflux symptoms, you can enjoy Grandma’s holiday turkey and fixings without dread by eating smart.

  • Don’t overdo it: Piling up and chowing down on a heaping plate of food is temping, but overeating or eating too quickly can push acid into the heartburn-generating danger zone. Choose small portions of a few of your favorite items on the table and take your time.
  • Make smart choices: Dark meat has a higher fat content, and fat is a top acid reflux trigger. Choose light meat cuts instead. Avoid creamy or dairy-based foods and sauces and choose multigrain rolls. Know that some otherwise healthy options also can trigger symptoms, too, including citrus fruits, tomatoes, raw onion and garlic.
  • Flavor with ginger: Small amounts of ginger can actually help ease heartburn, and it’s a great way to flavor veggie side dishes including carrots, cabbage, peas, broccoli and green beans.
  • End your meal on a healthy note: Even if you make all the best choices at dinnertime, know that popular after-dinner items can wreck your efforts. Alcoholic or caffeinated beverages and rich, high-fat desserts like chocolate pie are common culprits. In any case, a post-meal walk or a short nap with your head elevated six to eight inches can help to ward off a bout of acid reflux.

The good news is that acid reflux is highly manageable and symptoms can be alleviated with over-the-counter medications. However, if you’re hit with a case that seems more severe than usual, symptoms may be accompanied by a persistent cough, difficulty swallowing or a sensation of something in your throat (globus sensation) that lasts more than two weeks. Then, it may be time to see a doctor.

Five Possible Reasons for Your Nosebleeds

Repetitive nosebleeds may signal an underlying medical condition.

Repetitive nosebleeds may signal an underlying medical condition.

Upward of 60 million Americans experience a nosebleed each year, and not because of clumsiness or someone’s mean right hook. Rather, many of these seemingly instantaneous nosebleeds have no immediately discernable cause. Here are five possibilities:

  1. Dry air: Winter is soon upon us, and with it many hours cozied upon the couch enjoying the warmth of your indoor heater. Trouble is, artificial heat can sap the moisture out of the air in an enclosed space and that can cause your nasal lining to dry out, leaving it highly susceptible to cracking and bleeding. Using a high quality humidifier inside can help keep this type of nosebleed at a minimum.
  2. Use of certain medications: Blood clotting is a necessary step in stopping or preventing a nose bleed. So use of any anticoagulant (blood-thinning) or anti-inflammatory medication can contribute to a nosebleed or hinder its being stopped. Common culprits are prescription medications like warfarin or clopidogrel, as well as over-the-counter drugs like aspirin, and nonsteroidal anti-inflammatory drug (NSAIDS) and any medication prescribed to treat irregular heartbeats or the effects of stroke or heart attack.
  3. Underlying health conditions: While they may seem harmless, some nosebleeds can be an indication of potentially serious underlying health conditions. These may include liver disease, kidney disease or heart conditions like hypertension (high blood pressure) and congestive heart failure.
  4. Drug and alcohol use: Chronic consumption of alcohol or certain illicit drugs such as cocaine can lower the blood’s ability to clot and cause frequent nosebleeds.
  5. Deviated septum: The nasal septum is the wall that separates your right and left nasal cavities. Normally, it’s perfectly straight. But when it’s deviated (leans to one side) air that enters the nose hits the septum where it curves. This causes the lining of the septum to dry, crack and bleed frequently.

An occasional nosebleed typically is nothing to worry about. However, if you or your child experience multiple nosebleeds in a week, or a nosebleed that lasts more than a few minutes or won’t stop with direct pressure, it’s highly recommended that you seek medical treatment. Call 904-461-6060 to schedule a consultation at St. Augustine Ear, Nose and Throat’s St. Augustine or Ponte Vedra locations.

How to Know if you Need a Tonsillectomy

Is it a simple sore throat or tonsillitis?

Is it a simple sore throat or tonsillitis?

Sore throats are a dime a dozen, especially as the temperatures drop and we head into the cold and flu season that begins in September and runs through February. But sometimes, what you’re experiencing is far more serious than a run-of-the-mill throat infection. It just may be tonsillitis.

Because they produce certain types of disease-fighting white blood cells, your tonsils are considered your immune system’s first line of defense against bacteria and viruses that enter your mouth. Unfortunately, this means that your tonsils themselves are particularly vulnerable to inflammation or infection. What you think is a garden variety sore throat may actually be tonsillitis if it’s accompanied by:

  • Pain on one side of the throat
  • Painful or difficult swallowing
  • Hoarseness in your voice
  • High fever
  • Enlarged or swollen lymph nodes or glands in your neck
  • A white or yellow coating on your tonsils
  • Severe or recurring sore throat

Another clue is in the frequency of symptoms. A single case of tonsillitis likely will pass in about 10 days in children, slightly longer in adults. However, if you experience multiple episodes of tonsillitis in year, a tonsillectomy may be in order.

But a sore throat isn’t the only reason to consider a tonsillectomy. Obstructive sleep apnea, a potentially serious disorder in which the throat muscles intermittently relax, blocking your airway and causing your breathing to repeatedly stop and start during sleep, also can be effectively addressed with a tonsillectomy.

If you have children, be aware that tonsillitis is more common in pre-pubescent youth because that’s the period during which the tonsil’s immune system function is most active. However, the condition can hit at any age.

If you believe you or your children are suffering a bout of tonsillitis or may be in need of a tonsillectomy, St. Augustine Ear, Nose & Throat can help. Call 904-461-6060 to schedule a consultation at our St. Augustine or Ponte Vedra locations.

Swimmer’s Ear – Do You Know the Symptoms?

If you and your family will spend time in the swimming pool this summer, make sure you know the symptoms and risks of swimmer's ear.

If you and your family will spend time in the swimming pool this summer, make sure you know the symptoms and risks of swimmer’s ear.

Summertime here in sunny Florida inevitably means lots of time spent in the pool, the river or the ocean. Swimming is a favorite pastime, offering a cool respite from the sweltering sun. But that relief may be short-lived if you catch a case of swimmer’s ear, say specialist at St. Augustine Ear, Nose and Throat.

Swimmer’s ear is an infection in the outer ear canal, which runs from your eardrum to the outside of your head. The most common cause is water that remains in your ear after a swim, creating a moist environment that’s prime real estate for bacterial growth. However, it also can be caused by damage to the thin layer of skin lining your ear canal, often caused by placing objects like cotton swabs, hairpins or finger tips in your ear; and by sensitivity or allergic reactions to hair product or jewelry.

Swimmer’s ear infections can range from mild cases that can be treated with drops to severe cases that can have long-term effects. Symptoms include:


  • Itching in the ear canal
  • Slight redness inside the ear
  • Mild discomfort that’s intensified by pulling on your outer ear or pushing on the tragus (that small, pointed prominence situated in front of the ear)
  • Some drainage of clear, odorless fluid


  • More intense itching
  • Increasing pain
  • More extensive redness in the ear
  • Excessive fluid drainage
  • Pus discharge
  • A sensation of fullness inside your ear and partial blockage of the ear canal by swelling, fluid and debris
  • Decreased or muffled hearing


  • Intense pain that radiates to the face, neck or side of the head
  • Complete blockage of the ear canal
  • Redness or swelling of the outer ear
  • Swelling in the lymph nodes in the neck
  • Fever

If gone untreated, swimmer’s ear can lead to complications including temporary hearing loss, bone and cartilage damage, and long-term or deep tissue infection, and potentially fatal infections that can spread to other parts of the body including the brain or nervous system. Prevent swimmer’s ear by keeping your ears dry; draining them by tipping your head to the side after swimming; swimming in well-maintained swimming pools rather than ponds, lakes or ocean spots that may have high bacterial counts; avoiding putting fingers or foreign objects in your ear; and protecting your ears from irritants like hairsprays and hair dyes.

If you or your children experience symptoms of swimmer’s ear, call 904-461-6060 to schedule a consultation at St. Augustine Ear, Nose & Throat’s St. Augustine or Ponte Vedra locations.

Dr. Kalpana DePasquale to Host Outreach Program on Sinus Conditions, Treatments

Flu allergy. Sick girl sneezing in tissue. Health

In support of National Sinus Pain Awareness Month, St. Augustine Ear, Nose & Throat and Avanti Medical Spa founder Dr. Kalpana DePasquale will host an outreach program designed to educate patients about treatment options in otolaryngology, ear, nose, and throat care. Slated for March 31, 6pm in Flagler Hospital’s Osceola Conference Room, this interactive program details all the latest innovations in treating chronic sinusitis for those with sinus disease, allergies, and related illnesses.

Research by the National Institutes of Health shows that sinus problems are are among the leading causes for children and adults to stay home from school or work. Consider these statistics:

  • Upward of 28.5 million adults in the United States are diagnosed with sinusitis each year – a figure that represents nearly 13 percent of the nation’s adult population.
  • Some 11.7 million visits to physician’s offices result in a primary diagnosis of chronic sinusitis each year.
    In 2012, 17.6 million US adults (7.5 percent) and 6.6 million children (9 percent) were diagnosed with hay fever.
  • That same year 7.8 million children (10.6 percent) suffered respiratory allergies.
  • Worldwide, sensitization rates to one or more common allergens among school children are currently approaching 50 percent.

Dr. DePasquale specializes in technologically-advanced procedures for treating sinusitis and related conditions, including Balloon Sinuplasty™, a minimally-invasive endoscopic procedure that accomplishes the same results as traditional surgery without requiring an incision; and PROPEL®, a dissolvable, spring-like steroid-releasing implant designed to prop open the sinuses after surgery. She is a sought-after speaker on a myriad of ear, nose and throat issues, plus skin care topics. She speaks on behalf of multiple medical device manufacturers, is an expert for the American Osteopathic Association and serves as a faculty member at The Sinus Forum, a series of conference-style events featuring otolaryngologists from across the nation.

This free-of-charge event is open to the public and includes light refreshments. Flagler Hospital is located at 400 Health Park Blvd.in St. Augustine. Find out more at www.saent.net or by calling 904-461-6060.

When a Cold isn’t Just a Cold – Sinusitis Symptoms & Risks

If the sinus congestion just won't go away or is accompanied by pain or pressure in the face, you may have sinusitis.

If the sinus congestion just won’t go away or is accompanied by pain or pressure in the face, you may have sinusitis.

The 2014-2015 cold and flu season is well underway. So, no one’s surprised to experience watery eyes, a stuffy nose and sneezing. Chalk it up the common cold, manage your symptoms and let the virus run its course. But if you’re still waiting for relief after about 10 days, that’s a sign that your common cold has led to something more serious – sinusitis.

Sinuses essentially are air spaces in your head that are connected to your nose and lined with mucous membranes and tiny hair-like structures called cilia, which help to move mucus across the sinus membranes and toward the nearest exit. Most people have four sets of nasal sinuses located in the forehead above the eyes; inside the cheekbones; behind the bridge of the nose; and behind the nose, just beneath the brain. But everyone’s sinuses are as different as a set of fingerprints.

In any case, sinusitis happens when an infection or allergy makes the tissues inside your sinuses inflamed, red and swollen. Symptoms include stuffy nose; nasal discharge; cough; sore throat; fever; headache and pain or pressure in the face or teeth, especially when bending forward; and a decreased sense of smell or taste. Like colds, sinusitis cases typically resolve themselves within a few weeks. But there are signs that should prompt a visit to the doctor’s office.

  • Nasal discharge that’s green or yellow in color: This can be a sign of a bacterial infection.
  • Sinusitis symptoms that last more than a few months: When symptoms persist past the three-month mark, you have chronic sinusitis. This may indicate more serious underlying causes including allergies, polyps, immune deficiencies or dental diseases.
  • Nasal polyps: When sinuses remain inflamed for extended periods of time, the membranes may thicken and swell, creating grape-like masses called polyps. These polyps can swell large enough to block the nasal airway, making it difficult or even impossible to breathe through your nose. While many can be treated with medication, some nasal polyps will require surgery.

If you have persistent symptoms of sinusitis, it’s critical that you get medical treatment. That’s because your sinuses and your brain are separated by only a thin layer of bone. If a sinus infection makes its way through the bone, it can infect the lining of your brain, causing meningitis, or even infect the brain itself – two potentially life-threatening issues. Infections also can make their way into your eye sockets threatening permanent blindness. Call 904-461-6060 to schedule an appointment with a specialist at St. Augustine Ear, Nose & Throat.

Symptoms of Hyperthyroidism & Hypothyroidism

If you've experienced unexplained weight gain, your thyroid could be to blame.

If you’ve experienced unexplained weight gain, your thyroid could be to blame.

Known as the “great regulator of mind and body,” the thyroid is a butterfly-shaped gland that produces hormones credited with controlling metabolism, the system that helps the body use energy. But when your thyroid goes into overdrive, producing too little or too much hormone, it can wreak havoc on your body and health.

When your thyroid gland produces too much hormone, it’s called hyperthyroidism, while a low level of the same hormone is referred to as hypothyroidism. Symptoms of each include…


  • Unexplained weight loss
  • Swelling in the neck
  • Sped-up heart rate
  • Feelings of anxiety, irritability, restlessness or trouble sleeping
  • Excessive sweating or an aversion to heat
  • Muscle weakness or trembling hands
  • Vision problems
  • Diarrhea
  • Irregular menstrual periods


  • Unexplained weight gain
  • Fatigue or feelings of depression
  • Feeling cold
  • Dry skin and brittle nails
  • Numbness or tingling in the hands
  • Constipation
  • Abnormal menstrual periods

Additionally, hair loss or swelling in the neck can be caused by either hyperthyroidism or hypothyroidism. Both issues tend to affect women more than men, and hypothyroidism is particularly common among women over 60. Other risk factors include a family history or personal history of either issue, or any autoimmune disease.

If you’re experiencing symptoms of either hyperthyroidism or hypothyroidism, treatment is critical. Contact St. Augustine Ear, Nose and Throat at 904-461-6060 to schedule an appointment with our Thyroid Specialist, Dr. Zeeshan Aziz.

Driving While Allergic – It’s Almost as Bad as Drunk Driving, Study Shows

A new study shows that driving while suffering allergies is akin to driving while drinking.

A new study shows that driving while suffering allergies is akin to driving while drinking.

As any longtime allergy sufferer knows, it’s no joke when allergies hit. The sniffling, the sneezing, the itchy, watery eyes – These and other symptoms can significantly affect not only the way you feel, but your ability to work productively throughout the day. But that’s not all. According to a new study, allergies also can affect your ability to safely operate a vehicle.

In fact, researchers say that driving while suffering a seasonal allergy (also called allergic rhinitis or hay fever) episode can be much like driving while drinking alcohol. Conducted in the Netherlands during the off-season, the study analyzed the driving abilities of 19 patients, all of whom were in their 30s and had grass or tree pollen allergies, after being exposed to pollen. Each participant then was administered either a nasal spray medication, an antihistamine or a placebo and let loose on a 60-minute driving course. Driving tests were conducted four times over a period of several days. In the last 15 minutes of each session, participants were given verbal memory tests to see how many words presented via the car’s audio system they could recall.

The results are unnerving. Patients treated with steroid-based nasal sprays fared well on the test, followed by those treated with antihistamine medications. But for patients who took placebos, driving performance and memory took a serious hit. Results showed that while driving with watery eyes, runny nose and fatigue, these participants’ driving skills were comparable to that of someone operating a vehicle with a blood alcohol content of 0.03 percent. That’s just below the legal limit of 0.05-percent BAC in most countries.

Though the legal limit here in the United States is 0.08-percent BAC, it’s important to note that judgment and coordination can be affected with a BAC as low as 0.02 percent. That’s of significant concern considering that a full 30 percent of American adults suffer allergies. What’s more, study participants were tested in easy driving conditions in clear weather without distractions of cell phones, radios and the like. Add inclement weather, cell phone calls or texts and just one chatty passenger and you can imagine how much worse results may have been for the placebo-administered patients. While seasonal allergies have been anecdotally linked to automobile accidents, the actual related effects on a driver’s performance were unknown prior to this study.

If you suffer seasonal or other allergies and are a licensed driver, don’t take chances on the road. Call 904-461-6060 today to schedule a consultation with an allergy specialist at St. Augustine Ear, Nose & Throat.

Are you Ready for an Allergic Asthma Attack?

Do you know exactly how to use you inhaler? Practicing its use can help keep you calm in the event of an unexpected allergy or asthma attack.

Do you know exactly how to use you inhaler? Practicing its use can help keep you calm in the event of an unexpected allergy or asthma attack.

The best course of action for an allergy sufferer is to know and avoid allergy triggers. But that’s not always possible. One can easily avoid cats, but knowing when a pet left a hair on the sweater your coworker wears to work is impossible, for instance. And for those whose allergies are triggered by pollen, dodging a sudden summer storm takes all but moving to the desert.

Luckily, there are ways to prepare for the inevitable and respond quickly when an allergic reaction or asthma attack hits unexpectedly:

  • Always have your medications close at hand and make sure you know exactly how to use them. This is particularly important if you use an inhaler or an epinephrine injector, as your stress level may be high during an allergy or asthma attack. You also may need to take a higher dosage of a medication depending upon the severity of your attack.
  • Get protected early on. Many allergy and asthma specialists will recommend you get a flu shot each fall. That’s because respiratory infections like the flu can significantly effect your lung function, making you more susceptible to an attack.
  • Rise, shine and check the forecast. Weather and air quality reports for your geographical area are easily found online and typically are broadcast on morning radio and TV news shows. Also, check your local office of the American Lung Association to sign up for local air quality text alerts. If possible, plan to stay inside on days whe air quality is poor and prone to triggering an allergic or non-allergic asthma spell.
  • Stay calm and breathe. Anxiety can make your allergic reactions worse. According to the Agency for Healthcare Research and Quality, rapid and shallow breathing techniques aimed at stopping hyperventilation can help you quickly reduce or even avoid certain symptoms of an asthma attack. Many patients say yoga breathing techniques help them thwart asthma attacks as well.
  • Be wary of changes. If you notice an increase in the rate at which you need to use your quick-relief medications, it may be time to boost your dosage or change your medications altogether. Talk with your doctor as soon as possible.
  • Know when to seek medical help. Most asthma attacks can be quickly and effectively manged with prescribed medications and techniques. But a severe attack may require more intense and immediate medical treatment. Store phone numbers for your doctor’s office and other emergency contacts in your cell phone or keep them in a pocket, wallet or purse and make sure anyone you’re traveling with knows how to find them.

If you suffer from allergies or asthma, medical treatment by an experienced specialist is a must. Call 904-461-6060 to schedule a consultation today.

Another Great Reason to Kick the Smoking Habit: Protecting your Hearing

A new report suggests a strong link between smoking and hearing loss - Another great reason to add smoking cessation to your New Year's resolutions.

A new report suggests a strong link between smoking and hearing loss – Another great reason to add smoking cessation to your New Year’s resolutions.

Kicking the cigarette habit tops New Year resolutions lists for millions of Americans, and for multiple reasons. Stopping smoking improves your circulation; lowers you risk of a multitude of health ailments including lung disease or cancer, heart attack or stroke, coronary disease, throat cancer, emphysema and allergies; boosts lung function, allowing you to breathe easier; and improves the look of your skin, hair and fingernails.

But there’s another great reason to nix the habit, says Dr. Kalpana DePasqaule of St. Augustine Ear, Nose & Throat. Though it hasn’t been studied as deeply as links with other complications, smoking has been known by scientists and doctors for decades to have a link with hearing loss. And a recently published report AudiologyOnline from Western Michigan University backs that claim.

The hearing process and mechanisms are extremely complex. When a sound is produced, it activates a disturbance in the air in the form of sound waves. These sound waves travel into the outer ear and down the ear canal, where they vibrate the tympanic membrane, more commonly known as the ear drum. The vibrations then pass through three small bones to the fluid- and blood-filled cochlea and are picked up by tiny, hair-like cells, which transmit sound to the brain via electrical impulses along the auditory nerve.

WMU’s report suggests that the myriad of toxic chemicals drawn into the body with each inhalation of cigarette smoke can significantly affect the middle ear vibrations and the inner ear hair cells. It’s no surprise when you consider that those toxins include formaldehyde, benzene, arsenic, vinyl chloride, ammonia, hydrogen cyanide and upward of 1,000 other substances. It’s believed that these adverse effects happen in three ways:

  1. Nicotine and carbon monoxide may deplete oxygen levels in the cochlea, which can cause tissue damage;
  2. Nicotine also is thought to damage neurotransmitters in the auditory nerve. These neurotransmitters essentially function as chemical messengers to the brain. If they’re damaged, they’re unable to deliver those messages;
  3. Environmental toxins introduced into the body during adolescence, when mechanisms within the hearing nerve are not yet fully developed, can cause significant damage and impair further development.

If you’re a smoker determined to kick the habit, there no doubt are services in your area to help. Did you start smoking as an adolescent, or have you smoked for a long period of time? If so, call 904-461-6060 and schedule a hearing screening today. We’ll help you determine whether you’ve suffered hearing loss and discuss ways to help improve your hearing.