March 10th, 2014 | The Blog
Lice. The word scares every parent, teacher and school nurse. In the big picture, what does it really mean?
Parents feel a true sense of embarrassment when they get that call or note from the school nurse stating that their child or some other child in the class has lice.
The tiny glossy lice eggs embed in the hair along the scalp surface. Most schools have a no-nit policy. Let the lice removal or picking begin.
One-third of cases with nits, when left untreated, continue on to have an issue with lice.
The Current Treatment
Most lice-treating products involve an initial shampoo treatment followed by a second medicated shampoo one week later.
The New Recommendations
Head lice pose no health threat to the individual, according to public health experts. The new thought is that a no-nit policy is unnecessary.
The American Association of Pediatrics (AAP) has voiced concern about young students unnecessarily missing a week or more of school under the current no-nit policies. The AAP has worked at getting schools to adopt the new, more liberal policy for over ten years.
The AAP makes their point about getting rid of the current school lice policies by stating that checking for lice on every child is futile. Schools do not routinely check for strep throat or chicken pox, both of which are more dangerous than lice.
Some school systems have taken the new recommendation and discontinued the no-nit policies. How are lice findings handled?
Recent statistics show that about 60% of childhood head lice are resistant to over-the-counter chemical treatments, according to the New England Journal of Medicine.
Lice do respond to the newer treatments available, many of which are prescription strength. Malathion or Ovide is one such lice treatment. Unfortunately, many health insurance companies do not cover these treatments and they are costly, about $100 for a usual course of treatment.
Some health insurance companies require a child to undergo the readily available over-the-counter treatment before they will cover a prescription strength treatment. If lice survive the OTC treatment, some insurance companies will then pay for the prescription.
The Bottom Line
The earlier the treatment for lice begins, the more effective and the easier the situation is to control. Vigilance is a key factor. Parents should screen their children regularly, about weekly, for lice. Young children can be readily checked during bath time or when their hair is being combed or braided for school.
March 3rd, 2014 | The Blog
Anything but a stroke! That is the plea or prayer of the average member of today’s population. Having a stroke is usually life altering, not in a positive way.
Stroke affects 795,000 Americans every year. Of that number, 3% have survived the stroke with some residual health problems.
A stroke happens when blood suddenly stops flowing to the brain. A blood clot or an arterial rupture in the brain causes a stroke. About 20% of strokes are the result of an artery rupturing and subsequent bleeding in the brain.
Blood carries oxygen and nutrients to the brain. Without the blood, brain cells die.
The results of having a stroke can be devastating. The residual symptoms can include:
Men Versus Women
According to recent research studies, women suffer 53.5% of new strokes in America.
Stroke is the 3rd leading cause of death for women and the 5th leading cause of death for men. It is the 4th leading cause of death overall. There are over 77,000 deaths for women and over 52,000 for men each year. This statistic sets the sexes apart.
Women usually have more debilitating effects than men after suffering a stroke.
Women Are Unique
There are some life and health risks that put women in a unique situation and at a greater risk for stroke than men.
Unique risks for women:
Common risks for women:
It is important to note that women who develop preeclampsia, a condition of dangerously high blood pressure or hypertension, during pregnancy have double the chance of having a stroke as they age than women who had a completely healthy pregnancy. Preeclampsia is most common during the third trimester of pregnancy.
Taking birth control pills can elevate blood pressure, especially in women 45 to 49 years old. High blood pressure increases the risk of stroke. A red flag marker for stroke is a woman who takes birth control pills and smokes.
Atrial fibrillation is a cardiac arrhythmia that increases the risk of stroke four-fold, especially in women 75 years or older. This irregular heart rhythm causes blood to pool and potentially clot within the heart.
Hispanic women have a history of having a stroke at a younger age than other populations. Obesity and high cholesterol play into this statistic. Black women also have a higher risk of stroke than Caucasian women.
The American Heart Association (AHA) and the American Stroke Association (ASA) have recently released stroke prevention guidelines, specifically for women. These two groups report that the proper stroke prevention can prevent 80% of strokes in women.
The AHA and ASA stroke prevention guidelines include:
Physicians need to focus on stroke prevention for women. Other recommendations include:
Population projections indicate that the female population will increasingly overtake the male population as time moves forward. Women also live longer than men. These facts increase a woman’s chance of suffering a stroke at some time during her life.
February 24th, 2014 | The Blog
Smoking stinks. Smoking is harmful to a person’s health. With those thoughts in mind, CVS has issued a ban on selling cigarettes and other tobacco products by October 2014. Tobacco products, in this case, include cigarettes, cigars and chewing tobacco.
CVS’s decision has been commended by President Obama as a powerful example, by the American Public Health Association as a historic decision and by the American Association of Cancer Research as a visionary move. Kudos to CVS!
The Marketing Strategy
Tobacco product displays in pharmacies and convenience stores are designed to maximize the visual presence and encourage impulse purchases, especially in those people who are trying to kick the habit, in whatever form their tobacco comes.
The Journal of Public Health recently published a study stating that children as young as middle school age are 50% more likely to start smoking if they see one of these visually tempting wall displays at least once a week, compared to those children who do not see such a display. The power of a visual cue is astounding.
CVS’s decision to stop the sale of tobacco products is predicated on the argument that, anyone in the healthcare business should not be in the business of selling tobacco products.
Think about it…it is an oxymoron, of sorts.
CVS will surrender $4 billion annually in tobacco sales. This is an astounding sales revenue to forfeit.
It remains to be determined if this decision will result in fewer people smoking overall. It will, at least, make tobacco products a little more difficult to find. Although, keep in mind that gas stations and convenience stores will continue to sell the tobacco products.
Interestingly, 5 years ago, the City of Boston banned tobacco sales in all pharmacies. This impacted 85 retailers leaving 10% fewer retailers selling tobacco products throughout the city.
There are the doubters and the believers that CVS’s ban on tobacco products will impact the overall number of smokers in the U.S. The end result remains to be seen.
Hopefully, other big chain pharmacies, like Walgreen, Rite Aid and more, will follow suit. If they choose to follow CVS’s lead, a greater impact will be realized.
Perhaps, corporate peer pressure will help. After the City of Boston imposed the tobacco ban 5 years ago, 79 other cities and towns across Massachusetts did the same thing. This demonstrated peer pressure at its best.
The general consensus of healthcare professionals and organizations that strive to reduce general tobacco use is this: the voluntary reversal of tobacco sale by CVS will impact other pharmacies to ban cigarette sales. Voluntarily deciding to stop selling tobacco products makes a bigger social statement than a mandate.
February 18th, 2014 | The Blog
Acetaminophen is a common drug used to treat minor pain and reduce fever. It is found as acetaminophen alone and as an added ingredient in other combination medications like Percocet and acetaminophen with codeine.
A health concern for patients taking acetaminophen has become a concern because, in some cases, it can cause serious skin reactions.
Over the course of 40 years, there have been almost 100 cases of a serious skin reaction to acetaminophen. There have been 67 resulting hospitalizations and 12 deaths. This is a potentially serious, albeit rare, reaction.
The U.S. Food and Drug Administration (FDA) has stepped in and made new safety and label warning recommendations.
U.S. Food and Drug Administration requires that a warning about this potentially serious adverse reaction be listed on the labels of all prescription drugs containing acetaminophen.
The FDA ruling takes into account both prescription drugs containing acetaminophen and plain OTC acetaminophen. The manufacturers of the common over-the-counter (OTC) drug will be requested to add a warning to their labels, as well.
Ibuprofen and naproxen are often used to treat pain and fever, as an alternative to acetaminophen. Interestingly, these common drugs already include the same skin reaction warning on their labels.
The potential skin reaction is called Stevens-Johnson Syndrome (SJS). It is a rare condition but it can be lethal. The symptoms of SJS include:
This serious adverse reaction can happen even after just one dose of acetaminophen.
Treatment of SJS
Patients who develop any rash or other skin condition while taking acetaminophen should stop taking the drug immediately and seek medical attention with their physician or in an emergency room. Even an occasional minor skin reaction warrants medical attention, according to the FDA ruling.
The treatment, in an intensive care unit, is supportive care. It includes:
The medical team includes burn, ophthalmology, infectious disease and dermatology specialists.
According to the SJS, there are 150,000 deaths in the U.S. every year due to adverse drug reactions. This statistic makes adverse drug reactions the 4th leading cause of death in the U.S. The reaction to acetaminophen plays a role in this statistic and must be taken seriously.
Acetaminophen is a common ingredient alone and in many other drugs. Many patients have used it over many years. This makes it difficult to get the attention of most people and have them take this potential threat seriously. It is important to note that this skin reaction to acetaminophen is rare.
February 10th, 2014 | The Blog
Menstrual cramps are a fact of life for many women. It is no fun to have these mild to sometimes debilitating lower abdominal cramps every month from puberty through menopause.
Dysmenorrhea or painful menstrual cramps account for 600 million lost work hours every year in the U.S.
There is a potential new treatment for menstrual cramps on the horizon. Everyone has heard of the little blue pill, right? Well, Viagra started out as an anti-hypertensive or high blood pressure medication. Then, it became a popular treatment for erectile dysfunction (ED). And now, it is a potential treatment for primary dysmenorrhea (PD) or moderate to severe menstrual cramps.
Standard Treatments for Primary Dysmenorrhea
There are current and standard treatments suggested for the usual monthly menstrual pain that some women experience. The most common treatments include:
Ibuprofen, an over-the-counter non-steroidal anti-inflammatory drug, is the first-line pain medication for menstrual cramps. With frequent and prolonged use, ibuprofen does have potential side effects including gastric ulcers and kidney damage. A hormone called prostaglandin affects menstrual cramps; ibuprofen has anti-prostaglandin properties so helps alleviate cramps.
Oral contraception or the birth control pill, which is a prescription drug regulated by a primary care physician or OB/GYN specialist, is a common and effective treatment choice. By regulating the menstrual cycle, associated cramps are often improved.
Promising New Treatment
Viagra or sildenafil citrate is most commonly prescribed for erectile dysfunction. Sildenafil is actually the active ingredient in the brand name Viagra medication. This drug is the promising hope to treat primary dysmenorrhea.
Interestingly, there was an earlier study in which oral Viagra was used. The oral administration of the drug was found to increase pelvic pain, in some cases, and also cause a common side effect, headaches. Given these results, the new study uses vaginal suppositories to deliver the Viagra not pills.
The vaginal delivery is effective because the drug is intended to deliver local relief to the uterus. It also carries very few, if any, side effects.
The U.S. National Institutes of Health (NIH) conducted the new study. Women, 18 to 35 years old, with moderate to severe menstrual cramps or primary dysmenorrhea (PD) were involved in the study. The results showed that a 100 mg vaginal suppository of sildenafil citrate was nearly twice more effective in relieving pain than a placebo over a 4-hour period.
How it Works
Viagra causes the blood vessels in the pelvis to dilate, which increases the blood flow to the uterus. This, in turn, increases the oxygen to the pelvic tissue and relieves menstrual cramp pain.
There were no complaints about side effects with the vaginal suppository delivery of the drug.
Availability of the Drug
There is still work to be done and more comprehensive studies to be completed before Viagra is approved by the U.S. Food and Drug Administration (FDA) to treat primary dysmenorrhea. There is a promising outcome on the horizon. Stay tuned.
February 3rd, 2014 | The Blog
This is winter. Winter is cold. Excessive exposure to cold can lead to frostbite. Frostbite is serious and needs immediate medial attention to the potential long-term consequences and effects.
Unprotected body parts and those areas with less circulation are the most at risk. The most likely affected areas are:
The Mechanics of Frostbite
The human body works hard to preserve heat when a person is outside in frigid cold temperatures. The circulatory system forces heat to the body’s core in an effort to keep the heart and lungs warm. This protective mechanism reduces blood flow to the fingers and toes, which makes them more susceptible to frostbite.
Here are some important facts and explanations about frostbite:
Toes are the most common body part to get frostbite.
This protective mechanism of frostbite reduces blood flow to the fingers and toes, which makes them more susceptible to freezing damage.
Frostbite happens quickly.
While most cases of frostbite happen with extended exposure, it can happen quickly. Bare skin can freeze in five minutes, if exposed to below zero degrees Fahrenheit temperatures.
Warm water helps to rewarm frostbitten areas. But, do these things first:
Soaking the affected body part in warm water, not hot water, will make the tissue warm and flexible. The rewarming process can be painful. Over-the-counter analgesics can help to ease the pain. Frostbitten areas should not be rewarmed if there is a chance of refreezing.
Exercise helps prevent frostbite.
Exercise keeps blood flowing to the affected area. Caution must be taken to avoid exhaustion by over exerting.
Loose-fitting layers of wool help prevent frostbite.
Layers of loose-fitting clothes allow ventilation and insulation. Wool is a better choice than cotton because it still provides insulation, even when it gets wet.
A mix of different fabrics for different layers is ultimately the best choice for the best protection. The Centers for Disease Control and Prevention (CDC) recommend an inner layer of wool, silk or polypropylene. A wind-resistant outer layer will offer further protection. A water-repellent fabric is the ultimate outside layer.
Frostbite causes actual ice crystals inside the body.
The fluid within frostbitten tissue actually freezes and forms ice crystals. Blisters can develop as the skin thaws. There is a potential for infection where blisters burst.
Healing takes a long time. Once blisters form, then they scab and permanent scarring is possible.
All frostbitten fingers DO NOT have to be amputated.
Frostbite can be superficial or deep. Superficial wounds lead to blisters and usually a full recovery Deep frostbite affects muscles, tendons and bones, which can end with amputation.
Smoking, alcohol and heart disease increase the risk of developing frostbite.
Any action that constricts blood flow to high-risk body parts ads to the chance of developing frostbite.
Earrings and other metal jewelry can increase the risk of frostbite.
These items speed up the cooling of the skin and add to the frostbite risk.
Children are more likely to get frostbite than adults.
Children lose heat faster from their skin than adults and they are more likely to stay outside longer. Both of these facts make them more likely to develop frostbite.
Cats and dogs can get frostbite.
Fur does not make dogs and cats immune to frostbite. They are still at risk, especially their toes, ears, tail, stomach and face. Affected areas turn white, gray or blue.
The Best Advice
Knowing the facts is the first step to understanding this potentially dangerous medical condition. Frostbite must be taken seriously to avoid long-term complications. Seek medical attention immediately at the first sign of frostbite.
January 27th, 2014 | The Blog
What is a superfood? A superfood is a fruit or vegetable that is loaded with antioxidants, vitamins and other plant nutrients. According to nutritionists at the Cleveland Clinic, superfoods are those foods that contain high quality nutrition.
Here are 10 of the most readily available winter superfoods. Yes, there are seasonal superfoods as they become plentiful to the consumer. The first two on the list carry over from the abundant fall superfood crops.
In an effort to convey all of the important points about each superfood, they are presented as bullet point lists:
A balanced diet, rich in winter super foods will provide a strong base to stay healthy during the cold and flu season. Sprinkle in the key winter superfoods throughout the day, starting at breakfast and continuing through the remaining snacks and meals.
January 20th, 2014 | The Blog
Peanut allergies are serious, very serious. The best way for someone with a peanut allergy to avoid a problem is not to ingest any peanuts or peanut-containing products. The Journal of Allergy and Clinical Immunology has recently published a new report about easing severe peanut allergies.
When trace amounts of peanuts hide in baked goods or other foods or the product package states the standard, manufactured in a facility that process peanuts, it is beneficial if a patient can tolerate even a tiny amount of peanut exposure to avoid a potentially life-threatening allergic reaction.
It must be understood that the new protocol is not a cure. It allows patients with severe peanut allergies to tolerate trace amounts of peanuts, which might, otherwise, be fatal.
Who is Allergic to Peanuts?
The numbers of peanut allergies have tripled over the past ten years. Millions of children have an allergy to peanuts. Millions of children carry an Epi-Pen to school every day.
It is important to note that 80% to 95% of all general food allergies are peanut or tree nut related. Tree nuts include almonds, walnuts, pecans, pistachios, cashews, chestnuts, hazelnuts, macadamia nuts and Brazil nuts.
This is a method of exposing a patient to tiny amounts of their allergen, in this case, peanuts, in a controlled medical environment. Patients are not given enough of the allergen to cause a reaction but given enough to help them begin to tolerate it. Over time, the dosage of the allergen is slowly increased.
Up to 30% of patients do suffer a severe reaction to even the smallest dose of their allergy trigger. In this situation, the desensitization process is stopped.
The Treatment Protocol
The patients involved with the study were pretreated with the anti-allergy medication, first with either monthly or bi-monthly injection for 12 weeks. Then, they began the desensitization process.
Powerful Anti-Allergy Medication
Omalizumab or Xolair, a U.S. Food and Drug Administration (FDA) approved drug used to treat allergic asthma, has been shown to enhance the desensitization process. It works by attaching to the body’s IgE antibodies. The IgE antibodies are produced by the immune system when a trigger food is introduced into the system. Xolair helps to prevent allergic reactions.
Methodical Desensitization Process
To start, one-tenth of a milligram of ground-up peanut is ingested by the patient. This is a miniscule piece of one single peanut. The dosage is increased by tiny amounts every 30 minutes. The process is so slow and gradual that at the end of six hours, a patient has ingested about 2 1/2 peanuts, in total.
The desensitization process, including the Xolair pre-medication, continues for eight weeks, during which the patients are given larger numbers of peanuts. The goal is for the patient to consume 10 peanuts everyday with no reaction or a very mild reaction, at worst.
The next step in the process is to stop the Xolair pre-medication and continue ingesting the daily peanuts for the balance of one year.
Downside of the Treatment
Xolair is an expensive drug. It is not FDA-approved for treatment of food allergies. For this reason, health insurance companies do not cover the cost. The hope is that, once the study and results are confirmed, the payment process will change.
Patients with a life-threatening peanut allergy trigger can suffer the consequences by ingesting as little as one-quarter of one peanut.
Being desensitized to tolerate two peanuts is certainly enough to protect a patient from the aforementioned trace exposure.
At the end of the desensitization process, patients need to continue eating peanuts, daily peanut M & Ms or Reese’s so their body continues to tolerate them. This will keep the IgE antibodies against peanuts on the downslide. Interestingly, some patients with a severe peanut allergy do not like the taste of peanuts so the daily intake becomes drudgery.
Researchers at Boston Children’s Hospital are trying to find different ways to provide daily peanut intake for those who do not like the taste of peanuts. A couple of the options include peanut flour, which can be substituted in cookies or other baking recipes or a capsule or pill, which can be swallowed whole.
What is Next?
The researchers who worked on the peanut allergy desensitization hope to begin working with other food allergies and, perhaps, multiple food allergies at one time.
January 13th, 2014 | The Blog
It is time, one last time, to revisit the subject of the flu 2013-2014. As the flu begins to hit some areas of the country quite aggressively, it is important to encourage those who have not received the flu shot to do so, as soon as possible. It is not too late.
How Well It Works
The flu vaccine prevented 6.6 million cases of the flu last year, according to the Centers for Disease Control and Prevention (CDC). That number translates into 80,000 fewer hospitalizations for this potentially serious illness.
The CDC feels strongly that the general population can improve those numbers because, as of November 2013, only 40% of all eligible Americans had been vaccinated. That number is up from 37% at the same time last year, November 2012.
Who Are the Holdouts?
Only 40% of pregnant women have been vaccinated, despite their higher risk of complications.
The other group of concern is healthcare workers. Nationwide, only 63% of them have had a flu shot. This is a serious deficit because healthcare workers can easily spread the flu to their patients.
In simple terms, almost everyone over 6 months old should get the flu shot, with the exception of the patients delineated below. The very limited groups who should not get the flu shot include, but are not limited to:
Flu Shot Availability
There is still plenty of flu vaccine available throughout the country. There is a simple-to-use app available to find flu vaccine availability near where a patient lives. Check out this site:?http://vaccine.healthmap.org. There are at least 50 pharmacies listed, as well as the type of flu vaccine that is available at each location.
There are several types of flu vaccine including:
Flu Symptoms Nobody Wants
The flu comes with concerning and miserable symptoms, which include:
Complications of the flu include:
More than half of hospitalizations for the flu are patients over 65 years old.
The Bonuses of Getting a Flu Shot
According to the Journal of the American Medical Association (JAMA), the flu shot can reduce a patient’s risk of having a heart attack, stroke or heart failure, especially if they already have established heart disease. The risk is 36% lower than someone who did not have the flu shot.
Why? The theory is that flu viruses cause inflammation, which can cause cardiac arrhythmias, fluid around the heart or the release of plaque in an artery resulting in blocked circulation to the heart muscle or and subsequent heart attack.
Getting the flu shot protects a person from this miserable and potentially dangerous illness. Very importantly, getting the flu shot also protects not only the patient but everyone else around the patient.
Do yourself and everyone around you a favor. Just get a flu shot, if you have not already done so.
January 6th, 2014 | The Blog
Germaphobes beware! There is a new concern by the U.S. Food and Drug Administration (FDA) about the safety and effectiveness of antibacterial soaps. Make note: this does not include alcohol-based hand sanitizers; it is about antibacterial soaps only.
An interesting fact in the big picture of the soap industry: Antibacterial soaps comprise almost half of the current $900 million liquid soap industry in the U.S.
The Ingredients of Concern
There are two basic antibacterial soap ingredients causing concern in the health profession. They are:
This chemical was originally, the 1970s, used by surgeons as an antimicrobial. It was not intended for consumer use but has become a popular component in bar soaps.
Originally intended for use in bar soaps and has become a popular and standard ingredient in current day antibacterial soaps.
Technically, they are both pesticides, of sorts, so the Environmental Protection Agency (EPA) mandates that triclosan and triclocarban be safe for the overall environment. They wash down household drains into water supply and soil so the recent discussions have become paramount concerns for the EPA.
In March 2013, the EPA opened a safety review of triclosan, five years ahead of plan, due to environmental concerns. Interestingly, Canada has declared the chemical to be toxic and is in the process of banning products containing triclosan from being sold in the country.
There is a proposed regulation to ban triclosan and triclocarban from popular soap products. The active ingredients include triclosan are found in liquid soaps and triclocarban is found in bar soaps. Household cleaning products can also contain these active ingredients.
Manufacturers must prove that using these chemicals in their products is safe and more effective than plain soap and water for preventing the spread of infection
Long-term exposure to the active ingredients in these soaps, according to the FDA:
Alcohol-Based Hand Sanitizers
These products, like Purell and anti-bacterial wipes, do not contain the triclosan or triclocarban. They are alcohol-based leave on products. Alcohol-based hand sanitizers are not affected by the new FDA concerns.
There is some toothpaste that contains triclosan. One such brand is Colgate Total. These toothpastes will not be formally affected by the FDA regulations because previous clinical trials of the toothpastes have already shown that the benefits of the products outweigh the risks.
What Will Need to be Done
Manufacturers must prove that their product works better than plain soap and water and that they pose fewer health risks. The fewer health risk portion of this scenario is a difficult one to prove. At that point in the process, the manufacturers will need to:
There is a six-month window for the manufacturers of the affected products to respond to the regulation. The six months allows for public comment.
Then, there is a 60-day rebuttal period following the six-month comment period.
Depending upon the data and outcome of the comments, the proposed FDA rule can be finalized.? If the new FDA recommended standards are accepted, they would take effect one year later. The full regulation changes will not be started until 2016.
The FDA recommends the following for hand-washing, until such time that the anti-bacterial component is clarified:
In 2012, Johnson & Johnson voluntarily removed triclosan and triclocarban from all baby products. The company plans to remove triclosan from adult products by 2015.
The manufacturer of Lysol brand products, Reckitt Benckiser Group, has started to phase triclosan out of their products.
A group called Beyond Pesticides works diligently in Protecting Health and Environment with Science, Policy and Action. They provide a comprehensive list of products containing triclosan, which should be avoided. The link to their website and list is:
Until the facts and regulations are sorted out and approved by the FDA, the best advice is to avoid products that claim to be antibacterial or antimicrobial. Check labels before purchasing any of the potentially affected products.