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.
The first symptoms of measles appear about 10 to 12 days after exposure. The classic symptoms include:
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.
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:
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:
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.
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.
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:
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:
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.
January 12th, 2015 | The Blog
Ear infections are all too common. Adults can get ear infections but children are the most common patients. When a child gets a cold, 2/3 of the time, they end up with an ear infection.
Why Do Children Get So Many Ear Infections?
Two-thirds of children who get an ear infection end up with an ear infection. Why?
Types of Ear Infections
General ear infection symptoms include:
Babies additionally can get cranky, have trouble sleeping and often refuse to nurse or take a bottle because it hurts their ear(s) to swallow.
This is an infection in the outer ear. Not all swimmer?s ear is the result of swimming. Any defect in the ear, whether from a cotton swab or the ear staying too wet for too long after a shower or bath, can cause it. Wet ears breed bacteria and bacteria breeds infection. It is a plain and simple fact.
If the pressure in the eardrum builds up too much, the eardrum can rupture.
A ruptured eardrum heals itself in a few weeks. This does not affect hearing unless it is a repeated occurrence.
Making the Diagnosis
An otoscope is a tiny flashlight with a magnifying lens attached. This piece of equipment allows a healthcare professional to visualize the inside of the ear.
Treatment Options for Recurrent or Stubborn Ear Infections
Many physicians are reluctant to use antibiotics so as not to create the superbug. Some pediatricians suggest the wait and see philosophy because ear infections sometimes resolve on their own, since some are viral, not bacterial. Antibiotics do not treat viruses.
In some cases, antibiotics are the treatment of choice. This is when the ear infection is bacterial.
Small tubes are inserted through the eardrum(s) to drain fluid out of the middle ear. By relieving the pressure in the ear, pain and hearing issues can often be resolved.
Tubes are deliberately left in place for 8 to 18 months but often fall out of the ear on their own.
Enlarged tonsils apply pressure on the Eustachian tubes, which connect the middle ear to the throat. This pressure can cause recurrent ear infections.
Removing the tonsils can relieve the pressure and reduce the number of ear infections.
Ibuprofen and acetaminophen, both non-prescription pain medications, are usually sufficient to control ear discomfort in both children and adults.
Also, warm, moist compresses to the outside of the ear can offer palliative relief.
Allergy Testing, if indicated
Some middle ear infections can be caused by allergies, which irritate the Eustachian tubes. Allergy testing can lead to determining if allergy medications or allergy shots are indicated. Once the allergies are under control, there can be less ear infections.
Chronic Ear Infections
Repeated and chronic ear infections can cause eardrum scarring. This, in turn, can lead to hearing loss and speech problems. It is important to seek professional healthcare when an ear infection is in question.
Since the common cold virus is the most likely cause of an ear infection, it is important to try and avoid such illnesses. What everyone can do:
Not all ear infections are preventable but the aforementioned precautions can certainly help to reduce the number.
January 9th, 2015 | The Blog
Alzheimer’s disease is a scary diagnosis. It is scary for the patient and for the family and/or caregivers. What does the future hold? How will this disease unfold? What can be done to deal with the symptoms and ramifications, medical, social and financial, moving forward?
There is a 65 years young gentleman trying to find the answers to the many questions and concerns that surround Alzheimer’s disease. This man was diagnosed with early onset Alzheimer’s disease and is out to educate the greater population, while he can still do it.
Here is his story in a snippet:
How will his disease evolve?
The Facts About Alzheimer’s Disease
Alzheimer’s disease is a progressive, terminal brain disease that slowly destroys memory and thinking skills, according to this man’s description. It is caused by an abnormal protein that causes the nerve cells in the brain to shrivel and die.
There is a nonprofit organization, Alzheimer’s Association, which keeps the statistics on the disease. This organization raises funds to conduct research and to provide care to those suffering from the dreaded disease.
This is what their numbers reveal:
These are scary and concerning numbers. Some experts in the filed have coined this disease an epidemic.
The number of case grows because as the general population lives longer, the statistics also grow.
This Man’s Mission
The aforementioned Alzheimer’s patient is on a mission to get people to talk and ask me hard questions. He has traveled through the academic world and into the realm of the disease, through no choice of his own.
As simple signs of the disease overtook this man’s daily life, he decided to seek medical attention. He started to forget if he locked his car, had a couple of minor motor vehicle accidents and missed an airline flight by an hour. What was happening to him?
After a mini stroke or transient ischemic attack was ruled out, the grim diagnosis of Alzheimer’s disease was handed to him.
Treatment for the Disease
There is no cure, yet, for Alzheimer’s disease. There is no magical treatment to prevent the onset of the disease. For now, there are only some drugs, which temporarily slow the symptoms of the disease.
A lesson is there to be had from this brave gentleman who is on a mission to educate the general population, while he can still do it. He states that he is scared and frustrated but wants the world to talk about the disease and try to move forward with research and on the quest to find a cure.
Working diligently, this gentleman is on a mission of awareness and fundraising to stop a disease that has rocked his world and those around him. While trying to keep it positive in a public forum, he still deals with the consequences of the disease everyday of shortened life expectancy.
We all need to take a voice in this disease. If nothing else, act upon any change noted in a friend or loved one. Intercept, don’t look the other way. This gentleman has started the discussion. Now, we all need to continue it.
December 30th, 2014 | The Blog
Eat well, exercise, get plenty of sleep and take your daily multivitamin, right? Isn’t that what we all know to be the formula for staying healthy?
In my day, that was the advice that we all followed. Today, there is a growing case against the need to take a daily multivitamin.
The current thought or trend is that taking vitamin supplements can actually cause dreaded diseases, for which we are taking the multivitamin to avoid, like cancer.
Multivitamins By the Numbers
Interestingly, a vast number of Americans still do believe that taking daily vitamin supplements is crucial to good health. Here are some numeric facts about our vitamin-taking practices:
What a Multivitamin Does NOT Do
According to recently published studies, multivitamins are not a miracle drug and do not:
It is important to note that excess amounts of beta-carotene and vitamin E can actually cause cancer. Too much vitamin A can cause liver damage, which can lead to coma and subsequent death.
Why Do We Take Them?
It is believed that most people feel that more of something is always better and most of our moms always gave us a daily multivitamin. So, if there are sufficient vitamins and minerals in the food that we eat, then taking supplements will be even better, right?
Better general nutrition and vitamin-fortified foods in current day society have helped to prevent many true vitamin deficiencies of the past.
True Vitamin Deficiencies
There are exceptions to these study findings. If someone has a vitamin deficiency, of course, supplements will help. They should only be taken at the advice of a healthcare professional.
One example of a vitamin deficiency is scurvy, a vitamin C deficiency. In years past, citrus juice was used to treat people and then it was discovered that the reason it worked was the vitamin C content. Vitamin C supplements stepped into the treatment plan.
There are other vitamin deficiencies, which include:
These are all potential deficiencies but less common than in years past.
It is important that pregnant women take sufficient folic acid and iodine in order to prevent birth defects. Folic acid is important to prevent neural defects like spina bifida and iodine is important for fetal brain development, according to the Centers for Disease Control and Prevention (CDC).
The Bottom Line
According to the aforementioned studies and an editorial in the Annals of Internal Medicine, people should stop wasting money on vitamin and mineral supplements.
Everything in moderation. Life needs a balance. If a person eats a healthy diet, chances are that they do not need to take vitamin supplements. If they are not needed for a specifically diagnosed deficiency, they should not be taken.
The end decision should be made after a conversation between a patient and their primary care physician.
December 22nd, 2014 | The Blog
Clostridium difficile or C-diff is a serious GI infection, which about 500,000 Americans get every year. Of those half-million people, about 14,000 people die.
C-diff causes nausea, cramping and diarrhea that is debilitating to the patient. The treatment for this condition is usually a potent antibiotic (vancomycin and/or metronidazole) that not only kills the C-diff but also destroys the good gut bacteria. This leaves the patient susceptible to future flare-ups of C-diff infections.
An alternative to the traditional antibiotic treatment is a fecal transfer. By giving an infected person stool from a healthy donor, balance can be restored in the gut.
As vile as it sounds, fecal implants work to treat and cure gut infections. They fecal transplants are delivered through an invasive colonoscopy.
New Treatment Approach
A newer, non-invasive treatment has been devised in which the fecal transplant is delivered through swallowing a poop pill. Healthy people?s poop, stool or solid waste is put into pills to treat others with serious GI issues.
The donor stool is usually from a relative. The stool is cleaned and processed in the lab to remove food particles and bacteria.
The processed stool is packed in triple-coated gel capsules. This prevents them from dissolving until the pills reach the intestines. The pills contain the good stool bugs, not actual poop.
The New Treatment Process
Here is how it works:
The treatment pills are freshly made for each patient because, at this time, the gel capsules can start to dissolve at room temperature. They must be fresh and intact in order to be effective in treating C-diff.
According to infectious disease experts, this treatment is effective for patients who have suffered repeated C-diff infections and relapses. Many did not have a recurrence after undergoing the poop pill fecal transplant.
The potential for the future of fecal transfer is that it be used to treat other conditions like irritable bowel syndrome, inflammatory bowel disease and ulcerative colitis.
This is an innovative and effective treatment for C-diff. It is worthy of discussion with a primary care physician and a qualified gastroenterologist. At that time, the benefits and risks can be discussed and the right decision for each individual will be made.
December 15th, 2014 | The Blog
With there being 62 million women of childbearing age in the U.S., there are a lot of birth control pill prescriptions written each year. More than 27% of all contraceptive users are those who choose the birth control pill. Birth control pills (BCP) are a popular prescription.
Recently, the American Academy of Ophthalmology (AAO) presented research stating that women who took the pill for 3 or more years had double the risk of developing glaucoma, years later.
Glaucoma is an eye disease that can lead to blindness. This research finding set many women who had been taking the BCP into panic mode.
The average woman over 40 years old has a 2% chance of developing glaucoma in her lifetime. The AAO research findings elevate that risk to 4% if someone has been on BCP for 3 years or longer.
Interestingly, women who did not get their first menstrual period until after age 13 have an 11% increased risk of developing glaucoma, whether or not they choose to use the BCP for contraception in later years.
The African American female population has inherent risk factors for glaucoma so should discuss personal contraception choices with their physician. This advice also stands for those women who have a family history of glaucoma.
Other Factors in the Study
There were other factors stated in the study that could potentially increase a woman?s glaucoma risk. They include:
The study did not compare risk factors based upon any specific dose of hormone therapy in the BCP taken by the participants. The information asked in the study was whether the woman took BCP for 3 or more years or not.
It is important to note that women who took BCP many years ago where likely given a higher dose of hormones per pill than is delivered in the newer formulations. Therefore, the risk of glaucoma could be dose induced because estrogen, a hormone in BCPs, is known to affect the eye?s optic nerve.
One More Study
There was another study conducted by the Brigham and Women?s Hospital in Boston, MA, which supports the increased risk for developing glaucoma for woman who take BCP for 5 years or longer. This study states that the risk is a higher 25% but that it decreases the longer a woman is off the BCP.
The researchers in both groups state that there is much more research to be dome on the subject of glaucoma and the birth control pill. Stopping the BCP is not the recommended route for the short term. Unwanted pregnancy can result, which presents another myriad of issues, good and bad. It is important for every woman on taking the BCP to discuss concerns with her physician. It is also important to have regular and comprehensive eye examinations with a qualified ophthalmology specialist.
December 11th, 2014 | The Blog
Prostate cancer is the most common form of cancer in men, other than skin cancer. It is the second leading cause of cancer death in men, other than lung cancer. These are alarming statistics.
According to the American Cancer Society (ACS), there are 233,000 new cases annually in the U.S. That said, close to 30,000 American men will die from the disease in any given year.? These startling statistics translate into the fact that 0ne in seven men will be diagnosed with prostate cancer during their lifetime.
The Good News
Despite the alarming prostate cancer statistics, most cases of prostate cancer are not terminal. There are at least 2.5 million living American men who carry a prostate cancer diagnosis.
Treatment Options, Specifically Surgery vs Watchful Waiting
According to a Swedish study, surgery to remove the prostate definitely saves lives versus watchful waiting. This is especially true in men whose prostate cancer is truly symptomatic.
That said, some physicians warn the public that immediate surgery is not always a necessary treatment option for prostate cancer, especially those diagnosed early with a slow-growing tumor.
What is watchful waiting? This option is when a man diagnosed with prostate cancer is not aggressively treated unless the disease progresses. The benefit of watchful waiting is to avoid the often-debilitating effects of surgery and/or radiation therapy, which include urinary incontinence and erectile dysfunction.
The Current Recommendation
Cancer centers like Boston?s Dana-Faber routinely offer a version of watchful waiting called active surveillance. This involves monitoring the prostate-specific antigen (PSA) levels and a yearly prostate biopsy in men over 65 years old with early, non-aggressive prostate cancer that is not likely to be their cause of death. Some institutions are looking at dropping the active surveillance age to patients younger than 55 years old but the medical community is struggling with where the actual cut-off age should be.
Assessing whether the disease is life-threatening or not in each case is a difficult task. While active surveillance is targeted at the older affected male population, some younger men also wish to delay treatment, rather than undergoing aggressive cancer care. This is an individual and personal plan of care to treat a too common disease in the United States.
The ultimate goal of watchful waiting or active surveillance is to reduce over-treatment in men with low-risk prostate cancer while still working to control and obliterate the disease.
The bottom line recommendation derived by the study is two-fold:
Therefore, patients with a life expectancy of about 20 years should consider more aggressive treatment than those with a shorter life expectancy.
December 3rd, 2014 | The Blog
Belly fat is so annoying. It is not pretty and certainly not healthy. That said, it is also the toughest of fat collections to shed. Sometimes, a little explanation helps to decipher the code on how to get rid of some of the excess belly fat.
It is important to note that there is no single cause of belly fat. A combination of genetics, diet, age and lifestyle all contribute to the potential problem.
Who Has the Most Belly Fat?
Males have more belly fat than women. Women younger than 40 years old carry most of their body fat in the hips, thighs and buttocks. When estrogen levels drop, after 40 years old, most women’s body fat redistributes to the belly area.
Some Important Facts
Here is some important information about belly fat:
Excess belly fat is unhealthier than fat that sits around the hips and thighs. Belly fat is associated with:
Genetics determines some of a person’s body type, as do lifestyle choices, so most people have to work at keeping the belly fat to a minimum.
Food and Drinks
High-fat foods and high-caloric foods expand the waistline and contribute to belly fat.
Alcohol intake specifically targets a growing waistline. When alcohol is consumed, the liver works hard to burn off alcohol and, in turn, does not burn off fat. Alcohol intake also enhances the appetite. Both of these things contribute to a growing waistline.
The best way to eat and drink to reduce belly fat is:
How to Fight Belly Fat
Food and Drink
Spot exercises strengthen the core but are not the solution to reduce belly fat. What works? Aerobic exercise, 30 to 60 minutes most days, is the best choice to reduce belly fat:
The answer sounds simple but takes commitment: Eat healthy and exercise regularly to reduce belly fat.
November 26th, 2014 | The Blog
Broccoli, cauliflower, carrots or green beans…vegetables come in all shapes, colors and textures. They are fresh from the field or flash frozen. They can be consumed cooked or raw. Vegetables are versatile.
Peaches, apples, grapes, bananas or pineapple…fruit also comes in all forms of sweetness or tartness. Fruit is most often consumed raw but is also cooked in many different recipe choices. Fruit can act as a snack, a dessert or an addition to a main course to vary the flavor and texture of the dish.
The Food Groups
There are five food groups to insure a balanced diet, which include:
Together, vegetables and fruit comprise 40% of the food group list. They are important components of a healthy diet.
How Much Produce Should You Consume?
The U.S government recommends that adults consume 5 to 13 servings of fruits and vegetables a day. This recommendation has been challenged by a Harvard School of Public Health study, which finds that there are no additional health benefits if more than five servings are consumed a day.
According to the Harvard study, each daily serving of fruit or vegetables a day lowers a person’s risk of dying from heart disease or cancer by 5% over a 25 year span. Do the math. Eating five servings of produce a day lowers the risk of dying by 25%.
The interesting fact is that eating six, seven, eight or more servings still only reduced the risk of dying by 25%.
The Benefits of Eating Vegetables and Fruit
Besides the wonderful flavors and textures of vegetables and fruit, there are many other benefits to being sure they are a regular part of a healthy diet. Some of the benefits include:
Try This Calculation for Precise and Personalized Intake
The U.S. government has developed a nutrition calculator site where the person’s age, sex and level of activity are entered. The site calculates the daily amount of produce that each person should consume.
An Important Note
There is no downside or harm noted from eating the extra daily servings of produce, that is, more than 5 or 6 servings a day. So, pile on the spinach, tomatoes, blueberries and pineapple.
The overall picture of a healthy diet includes, not only fruit and vegetables, but also other diversified plant-based foods. These include foods like nuts, legumes and whole grains. Each of these choices adds an additional variety of nutrients.