MRSA Lurks Among Us

March 23rd, 2015  |  The Blog

Staphylococcus aureus or staph is a common bacteria, which 1 in every 3 people carry on their skin or in their nose. Usually, it does not cause medical issues for those who have staph on their skin surface. But, that said, staph does have the potential to cause serious skin infections, pneumonia or/or a blood infection in some patients.

If a patient develops a staph infection, it is most commonly and effectively treated with antibiotics. Unfortunately, some staph bacteria cannot be eradicated with a typical course of antibiotics. If this is the case, it becomes known as Methicillin-resistant Staphylococcus aureus or MRSA.

Who Gets MRSA?

Patients who are most likely to get a MRSA infection especially include:

  • Those who have been or are hospitalized
  • Those who reside in a nursing home or other skilled care facility
  • Those who have been repeatedly treated for infections in the past with antibiotics
  • Patients who have a variety of medical conditions that lower their resistance to the bacteria

How is MRSA Spread?

There are several ways that a patient can become infected with MRSA, which include:

  • The bacteria can be passed from person-to-person when in contact with an infected patient
  • It can also spread from touching infected surfaces like bed rails, bed linen, bathroom fixtures and other medical equipment
  • It can be spread from the hands of caregivers who carry or have touched something or someone carrying MRSA

Treatment Options

There are less common and stronger than traditional antibiotics that can be used to treat MRSA. Some patients have had active MRSA abscesses surgically drained, followed by a full course of antibiotics.

Once discharged from an acute care setting in which an infection occurred, it is important for a MRSA patient to do the following:

  • Finish entire course of prescribed antibiotics
  • Wash hands before and after dressing changes, if applicable
  • Do not share towels or razors
  • Use hot water for laundry and bed linen washing

Prevention Tips

The greatest prevention, as for all bacteria, is hand washing with soap and water or an alcohol-based hand rub before and after caring for every patient. This is important in a hospital, clinic, office or home setting.

Scrupulous cleaning of all medical equipment, according to the facility policies and procedures, is imperative.

Contact precautions should be initiated for those patients with MRSA. Some of these precautions include:

  • A single/private room or sometimes an isolation room
  • Staff and visitors must wear gown and gloves when caring for or visiting the patient
  • Terminal cleaning of an occupied room and equipment when an infected patient is discharged

Patients should be proactive and feel comfortable asking a healthcare provider, at any level of care-giving, to wash their hands if the patient has not seen them do so upon entry into an examination of hospital room.

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How to Understand Food Labels

March 16th, 2015  |  The Blog

Let’s look at some nutrition information, especially that of healthy foods. So what constitutes a healthy food choice?

It is interesting to note that, according to the US Department of Agriculture (USDA), 43% of all store-bought food items have at least one health claim in print on the packaging.

What Does It All Mean?

Here are a few of the most common health claims on the food packages found in supermarkets in the US:

With Omega-3s

Some products contain a mere 32 milligrams of healthy fat per serving. This is 1/10 the amount found in one ounce of salmon.

The better option, according to the American Heart Association (AHA) is to eat at least two servings, 3.5 ounces, cooked, per week of fatty, omega-3-rich fish like trout or salmon.

Good Source of Antioxidants

What constitutes a “good source?” According to the FDA, if a packaged food contains 10% of the recommended daily intake of vitamins A, C and E, it is a good source of antioxidants.

The better option is to consume antioxidants from natural food sources like fruits and vegetables. One small carrot contains twice as much vitamin A than a full serving of an antioxidant-enriched breakfast cereal.

Eat four servings of fruit and five servings of vegetables per day to meet the suggested requirements. Make note that the more colorful the vegetables, the higher the antioxidant content.

High in Fiber

A high fiber diet, specifically natural fiber, might reduce the risk of heart disease. Some bread, energy bars and other man-made items can deliver up to 35% of the daily fiber requirement.

The better option is to eat natural fiber sources like beans, oats, berries and broccoli.

Made With Whole Grains

What is whole grain? Whole grain denotes foods that are higher in fiber, vitamins and mineral than their refined equivalent. There are many crackers, breads and cereals, which list on the package that they are “made with whole grains.”
There is no minimum content required in order to list “made with whole grains” on the packaging. Some products contain as little as 1/16th of the recommended daily intake.

The better option is to purchase only foods, which list that they are “100% whole grain.” This statement ensures that the product contains no refined flours.

Other Food Package Statements

There are some food items that list “shelf life” and “expiration dates” on the packaging. When should the consumer pay extra heed to these dates?

Eggs

The “sell by” date on an egg carton does not guarantee freshness. Eggs should be kept in refrigerator for 3 to 5 weeks, no longer.

Cereal

The “best by” date on cereals is an estimate of the duration for quality. Cereals will stay fresh and crisp for 3 months after opening, if the inner package is tightly sealed.

Apples

The best way to store red apples is by placing them in a plastic bag with a few holes poked to allow air circulation. The bag should be stored in the refrigerator. The apples should last for up to 3 weeks.

Deli meat

Unopened packages of deli meat will safely last in the refrigerator for 2 weeks, even if the “sell by” date has passed.

Bread

The “best by” date on bread is not significant. Storing a loaf of bread in the refrigerator extends bread freshness by 2 weeks.

So, there you have it, a few tips and tricks about food labeling content. The wording on food packaging is important but leaves room for consumer translation.

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Seizure Wristband Sensor

March 9th, 2015  |  The Blog

Seizures and epilepsy are serious conditions. These medical symptoms and issues are often difficult to track, especially in pediatric patients.

The Concerns About Children and Seizures

Everyone worries about the long-term effects of seizures. These are especially difficult thoughts for many parents:

  • Will the child have a life-threatening seizure during the night while parents are asleep?
  • Will a seizure occur when a child is away from home, either at an overnight event or when they are away at college?
  • How do parents who have a child with a seizure disorder ever soundly sleep?

New Wristband Sensor System

Boston Children?s Hospital (BCH) is on the cutting edge of medical innovations in many specialties. Recently, the Epilepsy Program, in conjunction with a Massachusetts Institute of Technology (MIT), has been conducting trials of a wristband sensor system called Embrace to track seizure activity and provide an alarm for quick medical intervention.

How it Works

The wristband is Bluetooth-enabled and contains two sensors:

  • Motion sensor, which detects repetitive movements as experienced during a seizure
  • Skin conductance measurer, which detects small amounts of sweat on the skin. This activates the patient?s sympathetic nervous system

The combination of the data will sound an alarm when a pre-programmed symptom threshold is reached.

Not only is there an audible alarm worn by the patient, there is also a companion Embrace. This wristband is worn by a parent, caregiver or roommate. It vibrates if there is a patient alert so the patient?s parent, caregiver or roommate can quickly intervene with potentially lifesaving care.

During the research and trial phase, the data collected from the wristband sensor system is cross-referenced with information collected from electroencephalogram (EEG) data. The EEG data is collected and assimilated repeatedly for up to a week of data.

The Data

Thus far, according to the BCH data collected from a base of 80 patients, tracking EEGs documented 16 grand mal seizures in 7 patients during one trial phase. The wristband sensor detected 15 of those 16 documented grand mal seizures.

Over 3,500 monitoring hours, there were 102 false alarms detected, which represented one in about one-third of the trial subjects.

The Benefit

There is a high risk of death for children during a severe epileptic seizure. This innovative sensor will, hopefully, help intercept and treat a seizure disorder and save lives.

The Future of Embrace

The hope is that, eventually, the wristband sensor data can be wirelessly transmitted to the patient?s physician.

A sensor is being developed that can be positioned under the ear and be wirelessly connected to electrodes on the scalp or those implanted in the brain. This form of sensor use is in the development stage.

The device is headed for final product validation tests and then onto the US Food and Drug Administration (FDA) for approval.

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Does the Medication Delivery Form Really Matter?

March 2nd, 2015  |  The Blog

Look around the over-the-counter analgesic and fever aisle. There are so many different forms of medication available. There are tablets, caplets, softgels, gelcaps, liquids, powders, quick-dissolve tablets and chewables. While they are all effective, which one works the fastest?

The Absorption of Medication

After swallowing, traditional tablet forms are broken down into smaller particles, dissolved in the stomach and absorbed by the intestinal tract into the blood. Other forms of medications are absorbed faster because they do not need to be broken down as much as a solid tablet.

Pros and Cons

Here are a few of the pros and cons of the different forms of medications, which are readily available on the market:

Solid tablet or pill form

  • Large pills are hard to swallow, which presents a problem for many people. Tablets do not allow flexibility in dosing like the liquid form provides.

Caplets

  • Caplets are smaller tablets with a smoother coating, which makes swallowing them easier than a traditional pill or tablet.

Capsules

  • Capsules are 2-piece gelatin pills and are easy to swallow.
  • They break down quickly in the stomach because of the gelatin coating.
  • If needed, capsules can be opened. The powdered medication can be mixed into applesauce or another soft food or shake for easy swallowing.
  • Since capsules are not airtight, their shelf life is shorter than tablets.
  • Capsules generally cost more than tablets.

Softgels

  • Softgels are one-piece gelatin capsules that contain liquid medication.
  • They are very easy to swallow but usually larger than other pill forms.
  • Softgels cannot be opened or broken so there is no flexibility in dosing.
  • Gelcaps or softgels are absorbed faster than tablets.

Quick-dissolve tablets

  • Quick-dissolve tablets melt are placed under the tongue and deliver the desired medication via the oral mucous membranes. The medication then enters the bloodstream.
  • Quick-dissolve tablets offer faster relief many other medication forms.

Chewables

  • Chewable medications are expensive on the dollar per milligram price.
  • Chewable medication potency is lower than that of a traditional tablet or capsule.
  • They usually contain sugar and flavoring, which is not appealing to some.

Powders

  • Powdered medications are the most cost-effective form of medication.
  • Powders are the least convenient form of medicine because they need to be mixed with liquid or food before consuming.
  • Powders do offer great dosing flexibility.

Liquids

  • Liquid supplements are absorbed faster than any other form of medication but not enough to be noticeable.
  • Liquids allow for medication dosing flexibility.
  • Liquids are not as portable as pills especially because they often require refrigeration.

The Choice

Patients and their healthcare providers choose different medication delivery forms based upon individual needs and preferences. There are a few factors that influence the decision:

  • Age, specifically a child or adult
  • Ability to swallow pills or not
  • The need to fine-tune medication dose
  • Cost efficiency, in some cases

The delivery choice does not significantly, although it does minimally in some cases, affect the absorption of any medication. The delivery form is a personal choice for personal reasons.

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The Eyes Have It-All About Eyelash Enhancement

February 23rd, 2015  |  The Blog

Long, lush eyelashes are the envy of the runway and the everyday woman. The current beauty trend is for bold eyebrows and stunningly full eyelashes. If you were not born with naturally long and thick eyelashes, you are now in luck. There is a new product available on the market.

SmartLash is a non-prescription, dermatologist recommended, eyelash enhancer. It is an affordable option for many patients.?Many healthcare providers suggest that patients seek the professional opinion of a qualified dermatologist before starting to use this product.

How It Works

Patients who use this product state that 4 weeks of regular use leads to fuller and longer eyelashes. SmartLash can also be used on the eyebrows to make them more shapely.

Most eyelash enhancers are made with prostaglandin, a hormone, which can cause darkened irises (the color around the pupil of the eye) and blurred vision. The darkened irises are an irreversible side effect of some of the more popular prescription enhancers like Latisse. SmartLash does not contain any hormones or parabens.

So what does this product contain??SmartLash contains a blend of polypeptides, amino acids and conditioning agents, which enhance lashes and help to prevent eyelash breakage.

The Mechanics of the Product

SmartLash is easy to use. Here is a simple explanation of how to use it:

  • Apply the eyelash enhancer twice a day for 60 days to achieve the best results
  • Using a convenient applicator, apply the product to the skin at the base of the upper and lower lashes. It should not be applied directly to the lashes
  • It can be applied to the eyebrows, as well, for bold brow enhancement
  • SmartLash immediately absorbs up into the eyelid area and begins to work and transform the eyelashes

Who Can Use SmartLash?

The product is user-friendly. Most people who have used SmartLash have not experienced any eye irritation or eyelid discoloration. Most patients with eye sensitivity can safely use it. It is also safe for most contact lens wearers.

The Effectiveness of the Product

The numbers collected through user studies tell the tale about SmartLash:

  • 100% of participants have seen increased eyelash length, fullness and thickness after 30 days
  • 100% of users needed less mascara to further enhance eyelashes
  • 68% of people using SmartLash had an increase in the length appearance of eyelashes

The Cost of Eyelash Enhancement

The cost is reasonable and the product is dermatologist recommended. SmartLash Eyelash Enhancer costs about $29.95 for a 0.16 ounce container.

The price (literally) of cosmetic enhancements must be weighed against the effectiveness of a product and the potential side effects with regular use.

SmartLash is not FDA approved but neither are many other cosmetic products regularly used in the US.?It is important to note that Latisse, a prescription product, is the only US Food and Drug Administration (FDA) approved eyelash enhancer. Latisse actually stimulates growth of eyelashes but does have some common side effect like darkening of the eyelids.

In The End

There needs to be a frank discussion between the patient and a qualified dermatologist about which eyelash enhancing product is the safest and most effective that individual’s use.

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Hip Replacement Surgery Update

February 20th, 2015  |  The Blog

People are living longer and this very fact impacts the number of joint replacements done in the US every year. This discussion focuses specifically on hip replacements in the US.

Hip Replacement Statistics

According to the US Centers for Disease Control and Prevention (CDC), over 332,000 total hip replacements are performed annually. The need to replace a hip joint can be a direct result of wear-and-tear or the result of a fall and subsequent hip fracture. Certainly, there are many individual reasons why a patient, with the guidance of their physician, chooses to undergo hip replacement surgery.

How Things Have Changed

The traditional or posterior hip replacement is performed by:

  • Muscles on the back or side of the hip are separated so the new joint can be placed.
  • The downsides of this technique include: significant post-operative pain and soreness.

The updated anterior hip replacement:

  • The surgical approach is between the muscles at the front of the hip.
  • The upside of this technique includes: no damage to a muscle and far less post-operative pain.
  • Faster recovery and better overall hip strength are positive benefits of the anterior approach, especially during the first 3 months after surgery.

Ideal Patients for the Surgery

The best candidate for an anterior hip replacement is:

  • Younger
  • Thinner
  • One who will benefit from a faster return to physical activity

It is important to note that patients with a more complex medical history and hip injury are best treated with the more traditional posterior approach to hip replacement.

Anterior Hip Replacement Recovery

The very remarkable and positive post-surgery changes with the anterior hip replacement technique is:

  • Patients are up and walking immediately after surgery
  • Patients usually go home the next day, instead of the traditional 3-day hospital stay
  • Most patients return to work in 2 weeks, instead of the usual 6-week recovery period

What about exercise after an anterior hip replacement? Patients can usually start:

  • Strengthening exercises at the gym after 6 weeks
  • Low impact sports and biking after 3 months
  • High impact sports and tennis after 4 months

Anterior Hip Replacement Popularity

The orthopedic surgeons who are trained in this approach are about 30% of all US orthopedic surgeons. The procedure takes intense training and a great deal of time to perfect. It is a more difficult procedure to perform than the posterior approach.

Of those limited number, who are trained in anterior hip replacement surgery techniques, the orthopedic surgeons report that up to 75% of their hip replacement patient population are undergoing this surgical approach. The percentage of patients with the anterior replacement is rising.

This is truly cutting edge surgery in the field of orthopedics. The bottom line for the patient is less pain after surgery and better mobility.

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Adult Immunization Overview

February 17th, 2015  |  The Blog

With the recent measles outbreak in California, it is appropriate to have a discussion about adult immunizations. This discussion is best done in list form to keep the information concise.

It is important to note that many immunization-preventable diseases are far more serious when contracted by an adult than a child. Adults need updated immunizations for several main reasons, including:

  • General health and prevention
  • Protection for the general population
  • Chronic health Issues
  • Employment
  • Travel

Adult patient need to discuss their individual immunization needs with their primary care physician at their regular visits.

The Vaccines

The following information has been condensed in order to briefly touch upon each important immunization. The US Centers for Disease Control and Prevention (CDC) is an outstanding source for further information.

Tetanus or lockjaw

  • It is a bacterial illness caused by a toxin that enters the body through a cut or scrap
  • One in 3 people who get this disease dies
  • A booster shot is needed every 10 years but can be given sooner if a patient suffers a deep puncture wound
  • This vaccine is given in combination with the diphtheria vaccine every 10 years in a booster called Td
  • It is sometimes administered in adults as a part of the Tdap vaccine, a combination of tetanus, pertussis and diphtheria

Diphtheria

  • This disease is rare in the US
  • Symptoms include fever and swelling or soreness in the throat leading to suffocation
  • This vaccine is given in combination with the tetanus vaccine every 10 years in a booster called Td

Pertussis or whooping cough

  • Childhood protection from this disease can wear off
  • Most adults need to be revaccinated
  • The pertussis vaccine is given in combination with tetanus and diphtheria in a combination called Tdap
    Adults over 65 years, especially those in close contact with a child under 12 months old, should receive one dose of Tdap for protection

Flu or Influenza

  • The flu is a virus with a sudden high fever, muscle aches, sore throat and cough
  • A serious complication is pneumonia, which can be fatal
  • The vaccine is given as a shot or a nasal mist. The shot is inactive virus and the nasal mist is live, weakened virus
  • The mist can only be given to healthy patients between and 49 years of age
  • Those younger than 5 and older than 49 or anyone with a weakened immune system should get the shot, not the nasal mist
  • A new flu shot is needed every year to protect a patient from the illness

Pneumococcal disease or pneumonia

  • One dose for patients 65 and older is necessary to prevent some types of pneumonia
  • A booster is needed for those who received the initial vaccine younger than 65 years old and some of the chronic illness patients
  • Some younger patients need the vaccine earlier, especially those with diabetes, chronic lung disease, chronic liver or kidney disease, sickle cell anemia, transplant patients, post-splenectomy patients and those with a weakened immune system like steroid therapy, chemotherapy, HIV and other cancer patients

Hepatitis B

  • This disease presents with flu-like symptoms, extreme fatigue and jaundice. It causes damage to the liver.
  • It is spread through direct contact with infected blood and body fluids
  • Three doses of vaccine are needed for immunity
  • The populations at the greatest risk include: healthcare workers, people with multiple sexual partners or those with hepatitis B, IV drug users, living with hepatitis B carrier, travel to hepatitis B ridden countries and dialysis patients

Measles

  • The symptoms of measles include rash, fever, sore throat, dry cough and cold symptoms
  • Complications include ear infections, pneumonia, swelling of the brain and potential death
  • Adults born after 1956 might not have had measles nor had the vaccine at the appropriate time of after their 1st birthday. It is imperative that this population is vaccinated
  • Some adults need 1 shot while others need two. The vaccine is usually given in the combination MMR (mumps, measles, rubella) vaccine

Mumps

  • The most common symptom of mumps is swollen salivary glands
  • Adults who contract the illness become seriously ill, in most cases; swelling and damage to the testicles, ovaries, pancreas, thyroid, kidneys, heart, joints and meninges are serious complications
  • One dose of the vaccine, usually given in the combination MMR (mumps, measles, rubella) vaccine, is needed for immunity

Rubella

  • The symptoms of rubella include low-grade fever, joint pain and rash. It is usually mild in nature
  • Serious birth defects or miscarriage can occur if a pregnant woman contracts the disease
  • Only 1 dose of the vaccine is needed; usually given in the combination MMR (mumps, measles, rubella) vaccine
  • A pregnant woman should not be vaccinated nor should a woman get pregnant for 3 months after receiving it

Varicella or chickenpox

  • Chickenpox vaccine should be administered to all adults who have never had the disease or those whose blood test verifies that they do not have immunization to the disease
  • The vaccine is given in 2 shots, 4 to 8 weeks apart
  • Pregnant women should not be vaccinated nor should a woman get pregnant for 1 month after receiving the vaccine

Travel immunizations

  • Travel plans require a variety of immunizations. It is important to plan at least 6 weeks ahead of departure. The best resource is the CDC travel site
  • Generally, travel to Canada, Mexico, the Caribbean, Europe or Australia do not require any special protection. It is always best to double-check with a physician or travel clinic
  • The communicable diseases from which a patient must be protected in some countries include: polio, rubella, measles, tetanus, diphtheria, varicella, hepatitis A and hepatitis B
  • Proof of yellow fever immunization is required in some countries

Protection Personified

Childhood immunizations are important for the health of the greater population as well as the individual child. Adult immunizations are important to maintain the health of the individual and their community.

It is important for every individual to discuss a plan for immunization with a primary care physician.

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What is a Clinical Trial?

February 2nd, 2015  |  The Blog

Clinical trials are important when a rare or life-threatening disease with no known cure rears its head. At this juncture, a clinical trial is sometimes the only treatment choice.

A clinical trial, according to www.clinicaltrials.gov, is a research study in which human volunteers are assigned an intervention (a medical product or procedure) according to a protocol. They are then evaluated for the biomedical effects and health outcomes.

Finding an appropriate clinical trial is not an easy task for the patient or their doctor. How does someone go about finding a clinical trial?

Clinical Trial Websites

The US government has a website called www.clinicaltrials.gov. This site is very technical and can be difficult to navigate. The drugs are listed by their original names, which are usually numbers and random letters.

A newer second clinical trial site is www.myclinicaltriallocator.com, which is far more user-friendly than the aforementioned government site. Dr. Bruce Moskowitz, an internist, designed this site with input from about 43 medical institutions, including Dana-Farber Cancer Institute in Boston and Massachusetts General Hospital.

The websites list where the trials are being conducted, both in the US and outside the country. They also have recruitment information, eligibility and contact information.

Many users state that there is different information about trials on each site and some trials are only listed on one of the sites. Patients are encouraged to search both sites to obtain complete information about a specific clinical trial.

The newer site actually links the user to the government site to make the cross-referencing easier.

Who Participates in Clinical Trials?

Most clinical trials are conducted to treat an existing medical condition. Some of those include:

  • Parkinson’s Disease
  • Cancer

Some trials use healthy participants to evaluate new drugs, devices or interventions. The healthy trials evaluate clinical techniques like blood testing and new imaging.

Looking at the Specifics

The US Food and Drug Administration (FDA) created the www.clinicaltrials.gov site in 1997 with the Modernization Act of 1997 (FDAMA). It became a public site in February 2000.

The National Library of Medicine (NLM) at the National Institutes of Health (NIH) maintains this popular site.? It acts as a registry and database for clinical trials. While all trials are not registered on this site, there are an abundance of choices. The site covers trials in all 50 states and 185 countries.

What information does the site post?

  • Disease or condition
  • Intervention (medical product, behavior, procedure)
  • Title, description and design of the study
  • Requirements for participation or eligibility criteria
  • Locations where study is being conducted
  • Contact information at study locations
  • Links to relevant information on health websites like MedlinePlus and PubMed
  • Study results

A principal investigator (PI), who is most often a physician, leads each clinical trial or clinical research study. Foundations, medical facilities, pharmaceutical companies, doctors and/or various federal agencies like the National Institutes of Health (NIH) and the Department of Veterans Affairs fund the clinical trials.

Participants are required to sign an informed consent to become a part of the study. They have the right to withdraw from all or a portion of the trial at any time. Too much alteration of the trial specifics can make the participant ineligible for the trial.

Trial Phases Explained

Once a clinical trial is submitted for human participation and evaluation, it is “phased” in through four phases.

  • Phase I: The experimental drug or treatment is conducted on a group of 20 to 80 people to evaluate the safety and side effects.
  • Phase II: The study is conducted on a larger group of 100 to 300 people to assess effectiveness and more safety issues.
  • Phase III: A much larger group of 1,000 to 3,000 participants receive the drug or treatment to further assess effectiveness and side effect. It is compared to equivalent treatments.
  • Phase IV: Once the FDA approves the drug or treatment, researchers continue to monitor its safety and effectiveness, including the risks, benefits and best use.

Most trials compare the new drug or treatment against an already approved therapy but some choose to use a placebo comparison. Participants are informed if the PI chooses to use this method.

Bottom Line

Experimental treatments are assessed and evaluated to determine the risks and effectiveness moving forward with the treatment of serious diseases like cancer.

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Measles Outbreak and Anti-Vaxxers

January 29th, 2015  |  The Blog

Measles or rubeola is a communicable viral disease. Before 1980, the year when measles immunization became widely available, there were 2.6 million deaths annually attributed to measles worldwide.

A heightened vaccination program has reduced the number of measles cases and lowered the subsequent deaths by 75% from 2000 to 2013. The number of prevented death is estimated at 15.6 million.

The Vaccine Debate

Measles is a vaccine-preventable childhood disease. The recent measles outbreak at Disneyland in California has brought to light the importance of being vaccinated against this potentially fatal disease.

How is Measles Transmitted?

While the disease is less common than it once was in the US, it is still widespread in less developed countries, especially Africa and Asia. Those people at greatest risk worldwide are the unvaccinated population, especially young children and pregnant women.

Measles is very infectious. A virus causes the illness, which is a member of the paramyxovirus family. It is transmitted by direct contact with an infected person and through the air. Sneezing, coughing and direct contact with infected secretions infects people.

Interestingly, the measles virus stays active and contagious in the air and on infected surfaces for up to 2 hours. The disease can be transmitted to another person for up to 4 days before the rash appears and up to 4 days after the rash erupts.

Classic Symptoms

The first symptoms of measles appear about 10 to 12 days after exposure. The classic symptoms include:

  • Fever, sometimes as high as 104? F, for 4 to 7 days
  • Cough
  • Head cold symptoms, including runny nose and red, watery eyes
  • White spots inside the cheeks, these are often not even seen by the patient because it is before they are very symptomatic
  • Body rash, a generalized, red, maculopapular appearance
  • Conjunctivitis

A measles rash begins two to four days after fever onset and lasts for about 8 days. The rash usually starts on the back of the ears and within a few hours, it spreads to the head and neck and then covers the entire body. It can be itchy.

Treatment Options

There is no anti-viral medication available to treat measles. The main course of treatment is supportive care as different symptoms develop. Depending upon the course of an individual?s illness, these are a few symptom-specific options:

  • Antibiotics for bacterial complications like pneumonia, bronchitis, sinusitis, eye infections and ear infections
  • Bronchodilators for cough
  • Fever reducers like ibuprofen and acetaminophen

Interestingly, vitamin A supplements have been shown a 50% reduction in the number of deaths from the disease. This is especially true in areas where affected children are generally malnourished.

Complications of the Illness

Measles complications range from mild to a very serious. They are more serious when experienced in an adult patient. The potential list includes:

  • Diarrhea
  • Respiratory infections including pneumonia
  • Ear infection
  • Brain inflammation, which causes brain swelling
  • Corneal ulceration, which can lead to blindness

Most measles-related deaths are due to a complication. Complications are most common in children under 5 years old and adults over the age of 20.

Immune deficient and malnourished people, especially vitamin A deficiency, are at a greater risk of developing complications.

Contracting measles while pregnant also increases a woman’s risk of serious complications. It also raises the risk of miscarriage or preterm delivery.

The Prognosis

Most patients survive measles. There are 1 or 2 in 1,000 (0.1%-0.2%) cases that result in death, especially when encephalitis or brain inflammation is experienced.

It is important to note that once a person has measles, they develop a life-long immunity to the disease.

Prevention of the Disease

Increased immunization rates since 1980 has dropped measles deaths by 78%. The measles vaccine is most often given with the rubella and mumps vaccines (MMR) but can be given alone.

One dose of mumps, measles, rubella vaccine (MMR) is given at 12 to 15 months old and a second dose, which ensures immunity to the disease, can be given 4 weeks later but is usually administered at age 4 to 6 years old or just before starting kindergarten, according to the US Centers for Disease Control and Prevention (CDC). With only one dose of the vaccine, there are about 15% of children who do not develop sufficient immunity.

There are several organizations that comprise the Measles Initiative. They include the American Red Cross, The US Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the World Health Organization (WHO). These organizations are working hard to keep the population safe and healthy throughout the world.

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Menopause and Hot Flashes, Ugh!

January 19th, 2015  |  The Blog

Menopause and hot flashes go hand-in-hand. The warm surge of heat over-taking a woman’s body without warning is somewhat overwhelming and uncomfortable.

The treatment choices for hot flashes usually involve some type of hormone therapy, either oral, topical or vaginal. Hormone therapy has its advantages and its disadvantages. The choice to use this treatment option is based on each individual case after consultation with a qualified physician.

There is a new non-hormonal drug treatment choice, which shows great promise in treating hot flashes without the side effects of hormone therapy.

Non-Hormonal Hot Flash Drug

The new drug has been prescribed as the anti-depressant, Paxil, for several years. Renamed and given in a lower dose than used for anti-depressant purposes, Brisdelle is effective in treating systemic hot flashes.

Brisdelle is a generic drug made from paroxetine. While the lowest dose of Paxil is 10 mg, Brisdelle is even lower at 7.5 mg. The hope is that the lower dosing schedule will reduce side effects of the drug for women taking it to reduce hot flashes.

The use of this drug for hot flashes is US Food and Drug Administration (FDA) approved.

How It Works

About 75% of menopausal women, ages 45 to 55, experience hot flashes and night sweats. Hot flashes and night sweats are both considered vasomotor symptoms. These episodes often affect the quality of a woman’s life and can last for five years or longer, in some cases. At best, hot flashes are annoying and bothersome to the individual.

Brisdelle decreases the intensity and severity of hot flashes. Common side effects, present in less than 4% of patients, of the drug include:

  • Headache
  • Dizziness
  • Fatigue
  • Nausea
  • Vomiting

Just like the increased risk of suicide warning on the antidepressant, Paxil, Brisdelle also lists this side effect. Since Brisdelle contains the same active ingredient as Paxil, it still carries an increased risk of suicide.

It is a selective serotonin inhibitor (SSRI), which is taken once a day at bedtime.

Who Really Benefits

Some women cannot use hormone therapy to treat hot flashes. Hormone therapy has its limits when it comes to treating women with a certain and/or significant medical history of any of the following:

Women who must exercise caution when deciding about using traditional hormone therapy include:

  • Those with a significant family history of blood clots
  • Women with a history of breast cancer
  • Those taking Tamoxifen, a selective estrogen receptor modulator used to treat women with breast cancer; Brisdelle will decrease the efficacy of this drug
  • Women with a significant family history of breast cancer

Women who cannot use hormonal therapy for the reasons listed above or do not want to use hormonal therapy for their own personal reasons, now have an alternate treatment option to deal with hot flashes.

The choice about if and how to treat hot flashes, commonly experienced with menopause, is one that should be made by each woman with the guidance of her physician. The risks and benefits of the drug must be evaluated and the decision to take the medication should be made on an individual basis.

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