The Dangers of Sleep Apnea

September 15th, 2014  |  The Blog

Sleep apnea affects all facets of life, by day and by night. It is important to diagnose and treat sleep apnea. Management of the condition improves the quality of life and general wellness.

Sleep apnea studies are traditionally done in a hospital setting. There are sensors, electrodes, microphones and infrared cameras involved in the process. Sleep technicians monitor the patient throughout the process, which can be uncomfortable because someone watches them sleep.

The Statistics

Some interesting statistics about sleep apnea include:

  • 18 million Americans have moderate to severe apnea
  • 75% of patients with sleep apnea are unaware that they have the condition

The warning signs of sleep apnea include:

  • Waking up tired
  • Dozing off during the day, even in bright daylight

The biggest concern:

Sleep apnea can be fatal. When sleep apnea occurs, the brain does not get sufficient oxygen. When this happens throughout the night, the risk of having a stroke is four times greater than someone without sleep apnea.

An Updated Process

There is a new home sleep test, manufactured by NovaSom, which eliminates hospitalization. Instead of someone watching the patient sleep, the test is done in the privacy of the patient’s home.

How it Works:

  • The home test is done over three nights
  • The equipment is mailed to the patient’s home and also returned by mail. It includes: a belt clipped around the waist, a blood oxygen sensor worn on the finger, a breath sensor hooked over the ear and right under the patient’s nose and a computer modem sized box, which is worn on the arm (all the devices plug into this box)
  • The patient wires on the device, about a 15 minute process
  • While the equipment recharges each morning, it sends the previous night’s collected data to NovaSom for analysis

The Benefits of the Home Test

The cost of a home test is dramatically less than the traditional hospital-based test. The home sleep test cost averages $300 versus the hospital cost of about $3000.

The testing device is more portable so allows the patient to turn onto either side to sleep. In the hospital, patients are restricted to sleeping only on their back because of the equipment configuration.

If a piece of equipment comes loose, there is an audible reminder to check it for proper placement.

What the Home Test Does Not Do

The NovaSom home test does not record brain waves or activity. The hospital-based test does record these. What is the concern?

A home sleep apnea test can be inaccurate if the patient lies awake all night staring into the darkness because the brain waves are an indication of whether they are actually asleep or not. While lying awake, sleep apnea is not a problem so this could give an inaccurate assessment of the patient.

Who Should Not Use the Home Test?

Those with some medical conditions are not candidates for the home test. They include:

  • Heart failure
  • Emphysema
  • Seizures

The Results

Sleep apnea is measured by the number of times a person stops or almost stops breathing for at least 10 seconds per hour. The data collected represents the following results:

  • Less than 5 times is minimal
  • 5 to 15 times is mild
  • 15 to 30 times is moderate
  • Over 30 times is severe

When apnea occurs, the oxygen level in the body drops significantly. The normal oxygen level is at least 90%. With sleep apnea, it can drop into the 70% range.

The equipment also monitors snoring. In this case, snoring is qualified as any loud breathing, not just the traditional snoring sound. The NovaSom monitor has a very sound sensitive microphone.

Some sleep specialists project that hospital-based sleep apnea tests derive higher rates of the condition because the patient has to sleep on their back to accommodate the equipment. This back-lying position further closes an already narrow upper airway.

Treatment Options After Diagnosis

The treatment options for sleep apnea include:

  • Using a continuous positive airway pressure (CPAP) machine at night that forces air into the lungs while the patient sleeps
  • Losing weight
  • Drink less alcohol
  • Go to bed earlier

The treatment downsides include:

Patients dislike wearing the CPAP; it is cumbersome and restrictive

So what really works? Lifestyle changes that include weight management and less alcohol intake are key factors in reducing sleep apnea.

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Food Labels Explained

September 9th, 2014  |  The Blog

Who reads food labels anyway? Actually, according to a recent survey, less than 50% of Americans actually regularly read food labels.

Nutrition (food) labels tell the story. They are an important source of information that every consumer should read. It is essential to know how to read, but more importantly, how to understand the information on a food label.

The FDA

The U.S. Food and Drug Administration (FDA) controls and updates any and all changes made to food labels. They have recently made some changes in an effort to simplify the standard food labels.

The Changes

The upcoming FDA-approved changes to food labels will include:

  • A larger, bolder print for easy reading
  • Larger, more realistic serving sizes rather than the standard ? cup serving size that no one follows
  • Added sugar amounts, which delineates natural sugar (as in fruit) from processed or added sugars like honey, brown sugar, molasses and agave. Each teaspoon of processed sugar contains additional 15 calories
  • Potassium content
  • Vitamin D content

Now, What Will be Removed From the Label?

Calories from fat will be removed because the type of fat is more important than the amount of fat.

What They Say

In addition to the aforementioned changes, the other information listed on food labels includes:

  • Total fat per serving
  • Saturated and trans-fat amounts, which should be a low as possible to prevent clogging arteries
  • Fiber
  • Sodium
  • Calcium
  • Protein is listed as grams per serving. Interestingly, to find the recommended daily intake of protein, the average person should divide their body weight (pounds) in half to reach the number of grams they need

The percentage of each content item (such as protein, fiber or potassium), which an individual needs on a daily basis, and the amount that each serving of the food contains is listed beside the item on the label.

It is important to disregard the information on the front of the package labeling as being a factual guide for the nutrition content. The front of most packaging is designed to catch the consumer?s attention, not give solid nutrition facts about the food item. Examples of the misleading labeling include descriptions like light, healthy, low-fat, all natural and 100% natural.

Important Quirky Facts to Remember

Some food items (like cereal) list the serving size by weight. Given that, the serving size for healthy cereals such as Cheerios looks much larger than that of a crunchy, sweeter, albeit healthy, granola. It is important to watch the serving size in items such as this.

Individual serving-size containers definitely help the consumer with portion control and their quest to limit overeating.

Some products, like a 20-ounce soda and a bag of crunchy, salty snacks, will show calories per bottle or bag. Many consumers currently think that one serving is the entire package, especially when the item is snack-sized. This is a misleading notion because even a snack-sized bag can contain 2 or 3 servings. Be sure to read the label.

Food labels contain a lot of information that goes unread. Watching the daily intake of each component listed on a food label will lead to healthier eating and, ultimately, help with overall wellness in most consumers.

Bon appetit!

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The Benefits of Eating Nuts During Pregnancy

September 3rd, 2014  |  The Blog

There has been a significant rise in childhood food allergies, especially nuts, over the past generation. This has prompted many studies about whether or not a pregnant woman should include nuts in her diet or not. The question remains unanswered, despite the research findings.

Earlier Philosophy

In years past, physicians used to believe that the best way to reverse the up-ticking trend in food allergies was to have babies avoid exposure to the popular allergens like nuts while in utero and during the first few years of life. Women were encouraged to avoid eating peanuts and tree nuts, even if they have no personal allergy.

The Updated Nut Allergy Theory

The previous practice and benefits of avoiding nuts during pregnancy has been somewhat disproved.

Current research, done by Boston Children’s Hospital, finds that babies born to women who consumed peanuts, almonds or other nuts on a daily basis during pregnancy are 30% less likely to develop peanut or tree nut allergies than those whose mother rarely ate nuts during pregnancy.

While the study shows strong support for pregnant women eating nuts, the study leaders have not made a firm declaration to change the universal practice of nut avoidance.

The Research

Women with and without nut allergies themselves were studied in the research.

Babies born to women with nut allergies who ate safe nuts during pregnancy?or those they were not allergic to nuts have a slight increase in nut allergies. It proved to be a non-significant increase. The data was compared to the statistics found in women with nut allergies who ate no nuts at all during their pregnancy.

The research is inconclusive with regard to a firm recommendation as to whether or not women should eat nuts during their pregnancy to protect their babies. The one conclusion the study derived is that women should not be afraid to eat nuts during their pregnancy, if they wish to do so.

It is important to note that peanuts are a good source of protein and also provides folic acid in the woman’s diet. Folic acid is important to prevent neural tube defects in the unborn. There are clear and present benefits to eating nuts, including peanuts, while pregnant.

The decision to be a nut eater or a nut avoider is left up to each woman during her pregnancy. Medical input from the attending obstetrician and involved pediatrician will help make the decision about whether to imbibe or not.

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Identifying Early Symptoms of Parkinson’s Disease

August 25th, 2014  |  The Blog

Parkinson’s disease (PD) is a progressive nervous system disorder. It slowly and adversely affects a person’s movement. PD also:

  • Causes resting tremors
  • Creates muscle rigidity
  • Affects speech, sometimes making it inaudible and slurred
  • Causes a blank facial expression

Medications, which have many potential and potent side effects, are currently used to control the symptoms of PD. There is no cure for Parkinson’s disease.

Hyposmia is a Clue

Interestingly, almost all patients with PD have a decreased sense of smell or hyposmia. This is one of the first clinical symptoms of the disease, although not fully recognized or fully evaluated by the medical community as a whole.

It is important to note that not everyone with a decreased sense of smell has or develops Parkinson’s disease. There are many other causes that can make a patient lose their sense of smell.

New Diagnostic Tools for Parkinson’s Disease

Once hyposmia is established in the clinical setting, further testing is available to determine if the patient is on the path to developing PD. These studies will help to identify patients who will likely develop clinical symptoms of PD. The tests include:

  • Olfactory or smell testing
  • Dopamine transporter (DaT) imaging

The single photon emission computed tomography (DAT-SPECT) is done after DaTscan or I-ioflupane in injected into the patient’s vein to enhance imaging. The DaTscan is visualized and recorded by a special gamma camera.

The U.S. Food and Drug Administration (FDA) have approved DaTscan, a radiopharmaceutical agent. The side effects of this agent include:

  • Headache
  • Dizziness
  • Increased appetite
  • Uneasy or crawling feeling under the skin

Those with a DATdeficiency went on to develop PD in 61% of those tested. Their clinical symptoms developed within four years of testing.

The Benefits of Knowing

The clinical application of the new diagnostic tools remains limited to research-only casess at this time. It remains to be determined if the general population who appears to be at risk of developing PD, according to testing outcomes, would benefit from medication treatment trials. The medications would provide neuro-preventive potential to those at risk.

The International Parkinson’s and Movement Disorder Society (MDS) speculates that treating patients in neuro-protective medication trials will have greater success in treating PD than waiting to treat those who present for treatment with clinical features (tremors, gait issues, inability to swing arms when walking, blank facial expression) of Parkinson’s disease.

One Caveat to the Story

There is also research afoot regarding whether there is a link between hyposmia and Alzheimer’s disease. Currently, the loss of smell in patients suspected of developing Alzheimer’s disease leads to further cognitive testing to solidify a positive diagnosis.

Loss of smell is associated with the first cranial nerve, which is one of the first points impacted by cognitive decline.

Again, early diagnosis of the disease would support earlier treatment intervention to slow the process. Medications are especially helpful in treating early symptoms of Alzheimer’s disease.

More research on the subjects, both Parkinson’s disease and Alzheimer’s disease, is pending.

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A Concern for Hysterectomy Patients

August 11th, 2014  |  The Blog

A hysterectomy is done for a variety of medical reasons. Sometimes it is done to remove fibroids, endometriosis or for other reasons. There might be a cancer diagnosis or not.

It is important to note that this blog discussion focuses on laproscopic hysterectomies, not the traditional open abdominal surgery.

Laproscopic vs. Traditional Open Surgery

Open abdominal surgery requires a 3 to 7-inch incision. There is a longer recovery than laproscopic surgery but it allows the uterus to be removed intact.

Laproscopic surgery is done through several tiny incisions on the abdomen. It allows faster recovery than traditional open surgery. The uterus or fibroids must be cut into small pieces, which are then removed through the tiny incisions on the abdomen.

The Equipment

Recent research shows that a surgical device used during a laparoscopic hysterectomy might spread cancer in the patient’s body. The American Medical Association (AMA) has published a report about the device and called it?risky. The U.S. Food and Drug Administration (FDA) advised physicians to stop using it.

The device, which is causing all of the concern, is a laparoscopic power morcellator. A morcellator utilizes spinning blades to slice uterine fibroids or the entire uterus into fragments that can be removed through the small laproscopic incisions.

The morcellator has been in use in the U.S.for about 20 years but there is very little data about it available prior to the current cancer concerns.

The Problem

A recent study found that 1 in 368 women who have a hysterectomy actually have hidden or undiagnosed uterine cancer. The most common cancers of concern are uterine sarcoma and endometrial cancer.

The morcellator can spread previously undetected cancerous tissue inside the body. When the uterus or other tissue is morcellated, pieces of the tissue can errantly remain in the body. If they are cancerous, this can spread the disease.

A Suggested Solution

If the uterus is placed inside a protective bag before morcellating, stray tissue pieces remain contained and cannot escape to other areas of the body. There are some U.S. hospitals that have recently started this extra precautionary measure.

The Decision

Supporters of the morcellator argue that banning it is the wrong decision. They say that more women will have unnecessary traditional abdominal hysterectomies, which result in more significant scars, longer recovery time and the risk of more surgical complications.

Opponents of the device argue that the risk of using the morcellator is too high for an elective procedure. They say that there are alternatives to using the device, which should be considered.

Interestingly, in a recent study of 230,000 laparoscopic or minimally invasive hysterectomies, only 16% of them were performed with the morcellator after the safety of the device came into question.

The largest manufacturer of the device is Johnson & Johnson. The company recently suspended sales of the morcellator based on the FDA recommendation.

The FDA is considering whether to restrict or possibly ban the use of morcellators. A decision will be announced within this year.

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Ebola Explained

August 6th, 2014  |  The Blog

Ebola is a deadly virus. It is named for the Ebola River that runs close to where the first cases of the illness were identified in 1976.

Where is the Outbreak?

The virus originally presented in Sudan and the Democratic Republic of the Congo.

Currently, there is an Ebola outbreak in West Africa including the countries of Guinea, Liberia, Nigeria and Sierra Leone.

According to healthcare authorities, the virus is highly unlikely to be a credible threat on U.S. soil.

How Deadly is the Virus?

According to the World Health Organization (WHO), there are over 1,600 cases of the illness in West Africa. Of those cases, nearly 900 have died.

There are five known strains of the virus. The current culprit is Ebola Zaire.

About 90% of people, depending upon the reporting agency, who contract the illness die in underdeveloped countries. The U.S. Centers for Disease Control (CDC) states that the variation in the mortality rate reflects the benefits of early medical intervention. It is still unknown if modern medical care in a U.S. intensive care unit would make a positive difference in the mortality rate.

Patients typically die in 7 to 14 days after the symptoms first occur.

Spreading the Virus

The Ebola virus is not airborne. It takes vey close contact with an infected person in advanced stages to contract the illness. It can spread from infected animals (fruit bats, chimpanzees, gorillas, forest antelope and monkeys) or humans.

The virus spreads by close contact with skin and bodily fluids. Almost all bodily fluid can transmit the virus. They include:

  • Blood
  • Vomitus
  • Feces
  • Urine
  • Sweat
  • Saliva
  • Breast milk
  • Tears

Kissing and sex can transmit Ebola. Patients with the illness are not typically well enough to engage in such activities, according to authorities.

The incubation time for Ebola, when symptoms occur after being exposed to the virus, is 14 to 21 days.

Symptoms of the Illness

Initially, Ebola presents with symptoms of a bad case of the flu. These include:

  • High fever
  • Muscle pain
  • Headache
  • Sore throat
  • Intense weakness

More serious symptoms quickly develop, which include:

  • Vomiting
  • Diarrhea
  • Internal bleeding/hemorrhaging
  • External bleeding/hemorrhaging
  • Kidney failure
  • Liver failure

The virus can be in a person?s system for three weeks before they have any outward symptoms. If they survive the illness, the virus can stay in the body for several weeks after they recover.

Vaccine or Cure Availability

Neither option, a vaccine nor a cure, is currently available.

Treatment options for Ebola are supportive in nature. Support measures include the following: IV fluids including electrolyte replacement, medications to control blood pressure, mechanical ventilation and transfusions.

Until the current outbreak, drug companies did not prioritize an Ebola vaccine or cure. The recent crisis has brought the need to the forefront in the medical field and has accelerated the much-needed process.

Preventing the Spread

Contact precautions are necessary, including gowns, gloves and eye protection. Universal precautions, which covers treating all bodily fluids and blood as if they are infected, are very important. Hand washing is always an important precautionary measure.

Educating the public, in the highly affected areas, to avoid close contact with sick people and dead bodies is critical to preventing the spread of the disease.

The risk of the disease spreading to the U.S. is highly unlikely. The mere distance from West Africa to the U.S. is significant enough that a sick person would have trouble making the trip.

Declaring the Outbreak Over

Public health officials will declare the Ebola outbreak in West Africa to be over in 6 weeks after the last case is diagnosed. This can take 3 to 6 months, according to the CDC.

The Future

The National Institutes of Health (NIH) have been developing an Ebola vaccine for several years. They plan to begin an early stage vaccine trial in September 2014.

Depending upon the vaccine study results, which are expected by January 2015, it could be available to health workers in affected African countries sometime in 2015.

 

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Afrezza: Inhaled Insulin for Treating Diabetes

July 30th, 2014  |  The Blog

Treatment options for diabetes are ever evolving. Those with type 1 or type 2 diabetes have a new U.S. Food and Drug Administration (FDA) approved treatment option, inhaled insulin. The FDA approval is for safety and effectiveness of the drug.

The new drug, Afrezza, is a fast-acting insulin, which requires no needles. The inhaled drug is taken before each meal. Afrezza does not replace injected long-acting insulin for those patients who need that form of treatment.

It is important to note that there was an inhaled insulin called Exubera, which was FDA approved in 2006. The manufacturer withdrew it from the market in 2007 due to poor sales numbers and an overly complicated administration process for the patient.

Afrezza is the new and improved inhaled insulin.

How It Works

Afrezza is inhaled and absorbed through the cells in the lungs and into the blood stream.

The drug peaks in the blood about 15 to 20 minutes after it is inhaled. This is a difference compared to injected insulin, which peaks about an hour after it is taken.

Afrezza also clears faster from the body than injected insulin. After it quickly peaks, the drug is gone from the body in 2 to 3 hours. This is a difference from injected insulin, which remains in the body for about 4 hours after it is taken. Manufacturers of Afrezza tout this as a major benefit citing that Afrezza?s rapid response and rapid exit from the body mimic a normally functioning pancreas.

How it is Administered

A powdered dose, in an individual cartridge, of Afrezza is administered in a small, whistle-sized inhaler. Each cartridge contains one single dose of the drug.

It is easy to teach a patient how to use the inhaler to administer the drug.

Benefits of Afrezza

There are a few main benefits to this inhaled insulin product, which include:

  • No needles involved; 10% to 15% of insulin dependent patients are adverse to needles
  • Controls blood sugar equally as well as injected insulin, according to research studies
  • Less likely to cause a very low blood sugar, which is a common complication of insulin
  • Less weight gain, probably due to the short length of time the medication is in the body
  • Patients who do not have good blood sugar control using oral medications have better regulation using inhaled insulin
  • Patients might need less insulin than the traditional injected insulin

The Cost

The manufacturer compares the cost of inhaled insulin to the cost of the fast-acting and common pen form insulin. The cost of a fast-acting pen insulin costs $270 a month for those who need an average of 30 units of insulin a day, before health insurance coverage.

Side Effects of the Drug

The most commonly reported side effects of Afrezza are:

  • Low blood sugar
  • Cough
  • Throat pain
  • Throat irritation

The drug warnings also include the possibility of sudden chest tightening or acute bronchospasm. This potential side effect makes Afrezza be contraindicated for patients with asthma, COPD or those who smoke.

Some physicians are concerned about the effect of Afrezza on lung tissue, the mouth and esophagus.?The FDA is investigating whether Afrezza creates any potential risk of lung cancer. This is an important factor in the success of the drug.

Afrezza is not recommended to treat diabetic ketoacidosis, which is a serious complication of diabetes. Diabetic ketoacidosis is a condition in which the body makes high levels of ketones or blood acids.

In Closing

Afrezza is not yet available to the general patient population. With the FDA approval, it will be available in the not-to-distant future, according to the manufacturer MannKind, who is seeking a pharmaceutical partner in the marketing effort.

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A Guide to Childhood Vaccines-Part 2

July 21st, 2014  |  The Blog

Continuing on with the Guide to Childhood Vaccines. Part 2 includes a look at the following important vaccines:

Hepatitis B

Hepatitis B is a virus that attacks the liver. It is contracted by exposure to blood or body fluids of an infected person. The illness is serious and can lead to a higher risk of cancers. There is not treatment.

Dose 1 of the vaccine is given to any age followed by dose 2 at least one month later and dose 3 at six months after the first dose. A 3-shot series protects the patient for a lifetime.

Hepatitis A

This virus affects the liver. People with the disease who do not wash their hands after using the bathroom can spread Hepatitis A.

Hepatitis A causes nausea, vomiting, jaundice and stomach pain. The illness is usually worse in adults than children. Symptoms usually abate after a few months. There is no treatment, except palliative measures.

The vaccine is administered at 12 to 15 months old and followed by a booster 6 to 18 months after the first dose.

Hemophilus influenza type B (HIB)

Hemophilus influenza type B is a bacterium. It causes meningitis, pneumonia and/or other serious infections which can be fatal. Coughing and sneezing spread the illnesses. Treatment for these illnesses is antibiotics.

The HIB vaccine is administered at 2, 4 and 6 months old followed by a booster at 12 to 15 months. There is an individual vaccine and HIB is also in a combination vaccine called Pentacel.

Poliomyelitis (Polio)

Polio is a virus spread by contact with body fluids like saliva. Most people who contract polio are symptom-free. One percent of cases lead to paralysis or death. The U.S. has been polio-free since 1979 but the disease is still active in other parts of the world.

There is not treatment for the disease.

The polio vaccine is sometimes given as an injection or as a drink, but the U.S. gives it as a shot. It is administered at 2, 4 and 6 months and again at 4 to 6 years old.

Meningococcus

This bacterial illness causes serious and sometimes fatal blood infections and meningitis. Coughing, sneezing and exposure to saliva of an infected person spread it. Meningococcal illnesses can be treated with antibiotics if they are started quickly, otherwise the disease can be fatal.

The vaccine is given at 11 to 12 years old and a booster is administered at 16 years old. In special cases, the vaccine can be given earlier.

Human papilloma virus (HPV)

There are at least 40 types of HPV, all of which are not covered by the vaccine. HPV causes cervical cancer and other cancers in both men and women. It also causes genital warts and can infect oral and throat mucosa. The virus spreads through contact with an infected person’s body fluids. It is the most commonly transmitted sexually transmitted infection. There is no treatment for HPV but the virus resolves in some people after a few years.

The HPV vaccine is a 3-dose series given over a 6-month period. The series is usually started at age 11 or 12, but can be given as early as 9 years old.

Influenza

Influenza is a viral illness, which can lead to pneumonia. People can die from the flu, especially the elderly, the very young and people with pre-existing health issues like asthma.

This illness is spread via coughing, sneezing and contact with saliva. There are medications that can shorten the duration of the illness and make the symptoms milder.

People with a severe egg allergy should not get the regular vaccine; a new egg-free vaccine has been FDA approved. Anyone 6 months and older should get the vaccine every year. For those under age 9 receiving the vaccine for the first time, two doses, at least one month apart, are required for the first season.

Varicella

Varicella or chicken pox is a viral illness. Coughing, sneezing and/or contact with skin lesions spreads it. The illness is very contagious. In extreme cases, varicella can cause brain infections or pneumonia. Infected skin lesions can cause serious bacterial skin infections.

Treatment of varicella includes medication that can lessen the symptoms and shorten the duration for the illness.

The first dose of the vaccine is given at 15 months old. A booster is needed at 3 to 4 years old but can be administered as early as 3 months after the first dose.

The Round Up

As detail-oriented as the typical vaccine schedule seems, pediatricians are adept at following the requirements to keep the pediatric population in the U. S. safe and protected.

 

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A Guide to Childhood Vaccines-Part 1

July 14th, 2014  |  The Blog

Childhood vaccines protect the child receiving them as well as the public at-large. It is important to keep the prescribed vaccine schedule up-to-date.

There is a lot to understand about vaccines schedules. Parents rely heavily on their child’s pediatrician to keep the schedule rolling.

With the onslaught of new and improved vaccines, there are different names and combination vaccines available. It is the individual pediatrician’s choice, with input from the parent/guardian, to determine the best choice for each child.

Diphtheria

Diphtheria is a bacterial infection, which is spread by coughing and sneezing, has been obliterated in the U.S. since 2003. It is treated with an anti-toxin.

This vaccine is part of the DTaP and Tdap series and is also found in the new combination vaccines Pediarix and Pentacel. It is administered in the DTap at 2, 4 and 6 months old with boosters at 12 to 18 months and 4 to 6 years old.

Pertussis

Pertussis, a bacterial infection, is commonly called whooping cough. It causes a serious respiratory illness that is highly contagious.

Pertussis is treated with antibiotics, which are more effective before the whooping sound cough begins. This is difficult to treat in early stages because most people are unaware that they have the illness until the distinct cough starts.

This vaccine is a part of the DTap series.

There have been many recent cases of pertussis in the U.S. prompting a concerted effort to get more adolescents and adults immunized. It is important that every pregnant woman be immunized with each pregnancy.

Tetanus

Tetanus or lockjaw is a bacterial infection, which usually enters the body through a skin wound. It presents as a nervous system disorder and can cause death. Immunization has made the disease rare in the U.S. It is treated with Tetanus immunoglobulin.

The vaccine is a part of the DTap vaccine. TdaP is administered at 11 years old. Adults should get the TdaP once and then get the Td every 10 years. Pregnant women should get the TdaP with every pregnancy.

Pneumococcus

Pneumococcus causes a bacterial infection, which is spread by saliva and sneezing. It is especially dangerous to patients with a compromised immune system.

The vaccine is administered at 2, 4 and 6 months old with a booster at 12 to 15 months.

Mumps

Mumps is a viral illness that spreads through close contact with an infected person.

The disease can affect the brain and cause testicular inflammation with subsequent infertility. This is no treatment for mumps.

Mumps vaccine is part of the MMR (measles, mumps, rubella) series. It is given at 12 to 15 months. In unusual cases, it can be given before 12 months of age. In this situation, a second dose is needed at 12 to 15 months. All children receive a booster dose at 3 to 4 years of age. The booster can be given as early as one month after the first dose.

Measles

Measles is easily spread via coughing and sneezing. The illness causes a rash and fever but can evolve into a brain infection or pneumonia leading to death. There is no treatment for measles, except palliative measures.

There are still reported cases in the U.S. for people who are under-immunized with only one dose or have received no measles immunizations.

Measles is part of the MMR vaccine, which is administered at 12 to 15 months. It can be given earlier if a child has been exposed to the disease or is traveling to a country with potential exposure. In this case, a second dose is needed at 12 to 15 months. All children receive a booster dose at 3 to 4 years of age. The booster can be given as early as one month after the first dose.

Rubella

Rubella or German measles is part of the MMR vaccine. It is another virus, which is spread by sneezing and coughing. This is a serious disease for pregnant women because it can cause birth defects to a fetus. There is no treatment.

The MMR vaccine is administered at 12 to 15 months but is given earlier if a child has been exposed to the disease or is traveling to a country with possible exposure. If MMR is given before 12 months old, a second dose is needed at 12 to 15 months. All children receive a booster dose at 3 to 4 years of age. The booster can be given as early as one month after the initial dose.

Follow along next week for the wrap-up with A Guide to Childhood Vaccines-Part 2.

 

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Colorectal Cancer Screening Update

July 7th, 2014  |  The Blog

Colorectal cancer is the 2nd largest cause of death from cancer in the U.S. It takes the lives of 268,783 Americans each year. Lung cancer strongly precedes colorectal cancer as the biggest killer in the U.S. by taking 792,495 lives annually. A close 3rd in the rankings for cancer death is breast cancer, which steals 206,983 lives every year.

The good news, according to the American Cancer Society (ACS), is that the death rate from colorectal cancer has dropped 3% annually from 2001 through 2010. Why is the number dropping? Here are a few ideas from the authorities:

  • Better compliance with colorectal screening for those over 50 years old
  • Improved treatment options
  • Fewer actual colorectal cancer cases because many precancerous polyps are snipped out during screening colonoscopies

The Recommended Plan

The National Cancer Institute (NCI) and the Mayo Clinic, as well as other high profile healthcare groups, agree with the plan of care to prevent and assess colon health. Colorectal screening is recommended for all 50 to 75 year olds.

The screening and testing options include:

  • Annual stool test, which detects early cancers, not polyps
  • Sigmoidoscopy every 5 years OR colonoscopy every 10 years

Annual stool test

  • A sample of stool taken by the patient after a bowel movement and placed on a specimen card to which a drop of a guaiac developer is applied or a stool sample is taken by a physician during a rectal exam
  • While this test gives very preliminary information, it is better than no test at all

Sigmoidoscopy

  • Requires a gentler prep, which is an enema, not the strong laxative used for a colonoscopy
  • Visualizes only the lower one-third of the colon
  • Misses polyps that are higher up in colon
  • Cannot excise polyps using this study so, if any seen, colonoscopy must still be done

Standard colonoscopy

  • Requires a stringent and thorough bowel prep
  • IV sedation is administered for the procedure
  • Allows direct visualization of the colon through an endoscope
  • Polyps can be removed through the endoscope

It is important to note that the new health law provides full coverage for colorectal screening without any co-payment. Since the health law only mandates full coverage of the actual screening, there are exceptions to the no co-payment such as the charge for polyp removal or when a colonoscopy is done after a positive fecal screening.

Downsides of a Colonoscopy

The vast reluctance to undergo a standard colonoscopy is rooted with some of the following points:

  • An intense bowel prep is needed to clean out the colon
  • The risks of anesthesia, which is actually sedation, not general anesthesia
  • The chance of colon perforation during the procedure, which is less than 1%

More Improvement Needed

Currently, one in three adults, 50 to 75 years old, do not get screened as recommended.

A major healthcare goal is to increase the number of American screened for colorectal cancer. The U.S Department of Health and Human Services wants to drop the compliance rate to one in five by 2018.

New Options

According to the New England Journal of Medicine, there is a new and improved stool test, which detects DNA found in cancer cells. It is 93% accurate in detecting colorectal cancer.

There are a few new screening options on the horizon, which include:

Virtual colonoscopy

  • This is a low-dose CT scan that takes images of the colon
  • Currently, it requires the same prep as a standard colonoscopy
  • Software is being developed to remove fecal matter from the images and allow visualization of the colon, tumors or polyps

PillCam Colon

  • An image capsule called a the PillCam Colon, which is swallowed, takes pictures in the large intestine as it travels through the system. The image capsule requires the same vigorous prep as a colonoscopy
  • It can detect but not remove any polyps that it identifies. If a polyp is photographed, a colonoscopy must still be done to remove it

In the End

As more and more screening options become available, the hope and goal is to have better overall colorectal cancer screening compliance in the U.S. Colorectal cancer takes too many lives, which can be saved with a little preventive healthcare.

 

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