Pisgah Family Health News

September 2012

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Office Reminders

WE ARE NOW TAKING NEW PATIENTS. If you know someone who needs a physician, please forward this Email, or give them our number.

Now is the time to get your Flu Shot. Click Here for details.

Welcome Janelle Polanco

Janelle (131K)

Pisgah Family Health is proud to welcome Janelle Polanco to our office. Janelle has taken over Tami's job as our full time Medical Assistant.

Janelle has worked for the last 6 years at a large OB/GYN practice in West Islip, N.Y. Janelle moved here with her husband and 2 young daughters and are excited to enjoy the mountains. As a family they enjoy nature walks, trips to the zoo, swimming, and baking.

Eight Years in Practice

Rafting the Nantahala

This August, Pisgah Family Health celebrated eight years of serving our patients. We opened our doors in 2004, and continue to grow every day. We are ever grateful for the trust of our patients that has brought us this far.

To celebrate our anniversary, The staff of Pisgah Family Health took off Friday, August 17th. We enjoyed the beauty of WNC, by rafting the mighty Nantahala River under the guidance of Dr. Curran.

If you have ever wanted to raft a beautiful and chilly river, learn more at http://www.noc.com/

Pisgah Family Health is now on Facebook!

Find us on Facebook Pisgah Family Health is proud to announce it's new page on Facebook. We will keep this site updated with medical news of interest to our patients. This will also allow us to keep our patients up to date with office announcements, such as weather closings.

Free Health Videos on YouTube

Visit us on YouTube Pisgah Family Health is proud to announce the launch of its new YouTube channel. On this channel, we have collected useful videos on a variety of health topics. We hope this will be a way for our patients to learn more about their health conditions in the comfort of their own homes.

Video topics are grouped into playlists, to make it easy to watch the videos that are most relevant to you. The topics currently include diabetes, asthma, cholesterol, smoking, nutrition, mental health, exercise, and many more. As we locate more useful videos, we will post them to the site, and notify our patients by Facebook and our newsletter.

Office Hours

Our office hours are now 8:30-5pm Monday through Friday.   When the office is closed, emergency care is available at the Urgent Care Centers and Mission Hospital ER.  Our answering service can be reached after hours at 251-4873.   Telephone calls are handled by Dr. Curran’s call partners.

  • The office will be closed Monday, September 3rd for Labor Day.
  • The office will be closed November 22-23rd for Thanksgiving.
  • The office will be closed December 24-25th for Christmas.

Medical News

Flu Shots

Get your flu shot here!

The Flu Vaccine is now available at Pisgah Family Health. You can get your shot at any routinely scheduled visit. You can also drop by during our regular office hours just for a flu shot. We are NOT planning a Flu Shot clinic this year, as we have done previously. So please do not wait for the clinic for your shot.

Preventing seasonal flu: Get vaccinated

The single best way to prevent the flu is to get a flu vaccine each season. The seasonal flu vaccine protects against three influenza viruses that research suggests will be most common. About two weeks after vaccination, antibodies develop that protect against influenza virus infection. The Flu Vaccine will not protect against illnesses caused by non-influenza viruses.

This year there are three option for influenza shots:

  • The regular seasonal flu shot is an intramuscular injection. It has been used for decades and is approved for use in people 6 months of age and older, including healthy people, people with chronic medical conditions and pregnant women. Regular flu shots make up the bulk of the vaccine supply produced for the United States.
  • A "hi-dose" vaccine for people 65 and older which also is intramuscular. This shot has a higher concentration of viral particles, which may induce a better immune response. This vaccine was first made available during the 2010-2011 season.
  • An intradermal vaccine is a new option for people 18 to 64 years of age. This shot is injected into the “dermis” or skin, using a smaller needle and a smaller dose. This vaccine is being made available for the first time for the 2011-2012 season.
  • Vaccination with the nasal-spray flu vaccine is an option for healthy people 2 to 49 years of age who are not pregnant. Due to its higher cost, we do not carry the nasal-spray vaccine at Pisgah Family Health.

When to get vaccinated against seasonal flu

Yearly flu vaccination should begin in September, or as soon as vaccine is available, and continue throughout the flu season which can last as late as May. This is because the timing and duration of flu seasons vary. While flu season can begin early as October, most of the time seasonal flu activity peaks in January, February or later.

Who should get vaccinated?

Everyone 6 months and older should get a flu vaccine each year. This recommendation has been in place since February 24, 2010 when CDC’s Advisory Committee on Immunization Practices (ACIP) voted for “universal” flu vaccination in the U.S. to expand protection against the flu to more people.

While everyone should get a flu vaccine each flu season, the vaccine is especially important for those people who are at high risk of having serious flu-related complications or who live with or care for people at high risk for developing flu-related complications.

Who else should get vaccinated?

  • People who live in nursing homes and other long-term care facilities
  • People who live with or care for those at high risk for complications from flu, including health care workers
  • Household contacts of persons at high risk for complications from the flu
  • Household contacts and caregivers of children younger than 5 years of age

Who should not be vaccinated against seasonal flu?

Some people should not be vaccinated without first consulting a physician. They include:

  • People who have a severe allergy to chicken eggs.
  • People who have had a severe reaction to an influenza vaccination in the past.
  • Children younger than 6 months of age (influenza vaccine is not approved for use in this age group).
  • People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.
  • People with a history of Guillain-Barré Syndrome that occurred after receiving influenza vaccine

If you have questions about whether you should get a flu vaccine, consult your health care provider.

Source: http://www.cdc.gov/flu/about/qa/vaccine-selection.htm



What is influenza?

The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. "Flu season" is from October through May, though the winter months seem to be the most common for this illness. The best way to prevent the flu is by getting a flu vaccine each year.

Signs and symptoms of flu

People who have the flu often feel some or all of these signs and symptoms:

  • Fever or feeling feverish/chills
  • Fatigue (very tired)
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches
  • Some people may have vomiting and diarrhea, though this is more common in children than adults.

How flu spreads

Flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.

Period of contagiousness

You may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. Some people, especially young children and people with weakened immune systems, might be able to infect others for an even longer time.

How serious is the flu?

Certain people are at greater risk for serious complications if they get the flu. This includes older people, young children, pregnant women and people with certain health conditions (such as asthma, diabetes, or heart disease), and persons who live in facilities like nursing homes.

Flu is unpredictable. How severe it is can vary widely from one season to the next depending on many things, including:

  • what flu viruses are spreading
  • how much flu vaccine is available
  • when vaccine is available
  • how many people get vaccinated
  • how well the flu vaccine is matched to flu viruses that are causing illness.
  • Flu seasons are unpredictable and can be severe. Over a period of 30 years, between 1976 and 2006, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people.

    Complications of flu

    Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

    Who is at high risk for developing flu-related complications?

    • Children younger than 5, but especially children younger than 2 years old
    • Adults 65 years of age and older
    • Pregnant women
    • American Indians and Alaskan Natives
    • People who are morbidly obese (Body Mass Index [BMI] of 40 or greater)
    • People who have medical conditions including:
      • Asthma (even if it’s controlled or mild)
      • Neurological such as cerebral palsy, epilepsy, stroke, mental retardation, developmental delay, muscular dystrophy, or spinal cord injury
      • Chronic lung disease (COPD, emphysema, and cystic fibrosis)
      • Heart disease
      • (such as congenital heart disease, congestive heart failure and coronary artery disease)
      • Blood disorders (such as sickle cell disease)
      • Endocrine disorders (such as diabetes mellitus)
      • Kidney disorders
      • Liver disorders
      • Metabolic disorders
      • Weakened immune system, such as people with HIV or AIDS, or cancer, or those on chronic steroids)

    Treatment of the flu

    The Centers for Disease Control and Prevention (CDC), recommends that persons suffering from influenza infections:

    • Stay at home until the fever and aches resolve
    • Get plenty of rest
    • Drink a lot of liquids
    • Do not smoke or drink alcohol
    • Consider over-the-counter medications to relieve flu symptoms
    • Consult a physician early on for best possible treatment

    Warning signs are symptoms that indicate that the disease is becoming serious and needs immediate medical attention. These include:

    • Difficulty breathing or shortness of breath
    • Pain or pressure in the chest or abdomen
    • Dizziness
    • Confusion
    • Severe or persistent vomiting

    In children other warning signs include irritability, failing to wake up and interact, rapid breathing, and a blueish skin color. Another warning sign in children is if the flu symptoms appear to resolve, but then reappear with fever and a bad cough

    Over-the-counter medications do not directly cure or shorten the disease, but they do provide relief from influenza symptoms, as illustrated in the table below.

    • Analgesics (Tylenol, Ibuprofen, Naproxen) can treat the fever, aches, pains, sinus pressure, sore throat.
    • Decongestants (guaifenesin) can treat nasal congestion and sinus pressure
    • Antihistamines (Benadryl, Zyrtec, others) can treat sinus pressure, runny nose, watery eyes and cough
    • Cough suppressants (Dextromethorphan and Codeine) can improve a cough.

    Children and teenagers with flu symptoms (particularly fever) should not take aspirin as taking aspirin in the presence of influenza infection (especially Influenzavirus B) can lead to Reye's syndrome, a rare but potentially fatal disease of the brain

    Antiviral medications

    There are several prescription medications which can shorten the duration of influenza illness. These are not cures for the flu, but may make the symptoms last 1-2 days less. These medications are particularly important for people at high risk of complications from the flu. Antiviral medications are only useful if taken in the first 72 hours (3 days) of the illness. These medications include Tamiflu, Amantadine, Rimantadine, and Relenza

    Source: http://www.cdc.gov/flu/about/qa/vaccine-selection.htm

    Diphtheria, Tetanus, and Pertussis Vaccines

    If you have not had a Tetanus/Pertussis vaccination in the last 5 years, YOU ARE DUE FOR YOUR BOOSTER. The USA is experiencing an outbreak of Pertussis, due to poor vaccination rates.

    There are several formulations of vaccines used to prevent diphtheria, tetanus and pertussis. DTaP, Tdap, and Td vaccines are most commonly used. DTaP is given to children younger than 7 years of age, and the other two (Tdap and Td) are given to older children and adults. (Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case "d" and "p" denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The "a" in DTaP and Tdap stands for "acellular," meaning that the pertussis component contains only a part of the pertussis organism.)

    Children should get 5 doses of DTaP, at ages: 2, 4, 6, 18 months, and 5 years. Boosters are given at 12 and 18 years. Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also containing protection against pertussis. Adults 19 through 64 years of age should receive a single dose of Tdap. For adults 65 and older who have close contact with an infant and have not previously received Tdap, one dose should be received. Tdap can be given no matter when Td was last received.

    Q: What is Pertussis?

    Whooping cough (pertussis) is an infection of the respiratory system caused by the bacterium Bordetella pertussis (or B. pertussis). It's characterized by severe coughing spells, which can sometimes end in a "whooping" sound when the person breathes in.

    It is most severe in infants younger than 6 months old before they're adequately protected by immunizations, and kids 11 to 18 years old whose immunity has started to fade. The illness can be spread by older children and adults who have only a mild illness.

    Before a vaccine was available, pertussis killed 5,000 to 10,000 people in the United States each year. Now, the pertussis vaccine has reduced the annual number of deaths to less than 30. But in recent years, the number of cases has started to rise. By 2004, the number of whooping cough cases spiked past 25,000, the highest level it's been since the 1950s.

    Q: How common is Pertussis (whooping cough)?

    A: Even with the success of whooping cough vaccines, the disease is still common in the United States. Many cases are not diagnosed and so are not reported. Yet over the past 5 years, between 10,000 and 27,000 cases have been reported each year. Institutional outbreaks of whooping cough, such as those in a daycare center, school or hospital, are common, taking place each year in many states.

    Q: Why is there more whooping cough in some years than others?

    A: Reported cases of whooping cough vary from year to year and tend to peak every 3-5 years. Our last peak year nationally was in 2010 when more than 27,000 cases were reported. This pattern is not completely understood, but that's why it's important that everyone get vaccinated. If it weren't for vaccines, we'd see many more cases of whooping cough.

    Q: What should I do if I live in an outbreak area?

    A: You can make sure you and your loved ones are up to date with recommended whooping cough vaccines. There are two types of whooping cough vaccines - DTaP for infants and children and Tdap for adolescents and adults. Getting vaccinated with Tdap is especially important for family members with and caregivers of new infants. Also, if caring for an infant, keep him or her away from anyone with cough or cold symptoms.

    Q: Should I delay travel to an area that is having a whooping cough outbreak

    A: No, but those traveling to an area with a whooping cough outbreak should make sure they are up to date on their vaccines. People who are not vaccinated or who are under-vaccinated, including infants too young to be vaccinated, are putting themselves at risk for catching whooping cough.

    Vaccination recommendations:

    • Infants and children should receive 5 doses of the DTaP vaccine at 2, 4, and 6 months, at 15 through 18 months, and at 4 through 6 years. All 5 doses are needed for maximum protection. Children 7-10 years of age who are not fully vaccinated with DTaP should receive a dose of Tdap instead of waiting for the 11-12 year old check up.
    • Adolescents should receive the Tdap vaccine at their regular check-up at age 11 or 12. If teenagers (13 through 18 years) missed getting the Tdap vaccine, parents should ask the doctor about getting it for them now.
    • Adults 19 years and older, who have not previously received a Tdap vaccine, should get a 1-time dose of Tdap in place of the Td booster they're recommended to receive every 10 years. No need to wait until you are due for your Td booster-the dose of Tdap can be given earlier than the 10-year mark since the last Td booster. Receiving Tdap may be especially important during a community outbreak and/or if caring for an infant. It's a good idea for adults to talk to a healthcare provider about what's best for their specific situation.
    • Pregnant women who have not been previously vaccinated with Tdap should get one dose of Tdap during the third trimester or late second trimester - or immediately postpartum, before leaving the hospital or birthing center. By getting Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, likely providing protection against pertussis in early life, before the baby starts getting DTaP vaccines. Tdap will also protect the mother at time of delivery, making her less likely to transmit pertussis to her infant.

    Source: http://www.cdc.gov/vaccines/vpd-vac/pertussis/default.htm#vacc



    What is Shingles?

    Shingles is a rash caused by the Varicella virus, which is also the cause of chicken pox. The rash is often painful and burning (not itchy), and lasts 2-6 weeks. Anyone who has had chicken pox in their life may get shingles. Shingles generally occurs in a dermatome, which is a band of skin served by a single nerve. Shingles can result in Post-Herpetic Neuralgia, which is a long-lasting pain or burning sensation on the skin.

    The vaccine for shingles (Zostavax®) is recommended for use in people 60 years old and older to prevent shingles. The older a person is, the more severe the effects of shingles typically are, so all adults 60 years old or older should get the shingles vaccine. The shingles vaccine is specifically designed to protect people against shingles and will not protect people against other forms of herpes, such as genital herpes.

    In a clinical trial involving thousands of adults 60 years old or older, Zostavax reduced the risk of shingles by about half (51%) and the risk of post-herpetic neuralgia by 67%. While the vaccine was most effective in people 60-69 years old it also provided some protection for older groups. Research suggests that the shingles vaccine is effective for at least six years, but may last much longer.

    Who Should Get the Vaccine

    The CDC recommends Zostavax for use in people 60 years old and older. This is a one-time vaccination. There is no maximum age for getting the shingles vaccine. Anyone over 60 years of age should get the shingles vaccine, regardless of whether they recall having had chickenpox or not. 99% of Americans ages 40 and older have had chickenpox, even if they don't remember getting the disease.

    At this time, CDC does not have a recommendation for routine use of shingles vaccine in persons 50 through 59 years old. However, the vaccine is approved by FDA for people in this age group. Even if you have had shingles, you can still receive the shingles vaccine to help prevent future occurrences of the disease. Generally, a person should make sure that the shingles rash has disappeared before getting vaccinated.

    Who Should NOT Get the Vaccine

    Some people should NOT get shingles vaccine.

    • Women who are or might be pregnant
    • A person who has ever had a severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine.
    • A person who has a weakened immune system because of
      • HIV/AIDS or another disease that affects the immune system,
      • treatment with drugs that affect the immune system, such as steroids,
      • cancer treatment such as radiation or chemotherapy,
      • a history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.

    Possible Reactions to Vaccination

    No serious problems have been identified with shingles vaccine. The vaccine has been tested in about 20,000 people aged 60 years old and older. The most common side effects in people who got the vaccine were redness, soreness, swelling or itching at the shot site, and headache. It is safe to be around infants and young children, pregnant women, or people with weakened immune systems after you get the shingles vaccine. There is no documentation of a person getting chickenpox from someone who has received the shingles vaccine (which contains varicella zoster virus). Some people who get the shingles vaccine will develop a chickenpox-like rash near the place where they were vaccinated. As a precaution, this rash should be covered until it disappears. The shingles vaccine does not contain thimerosal (a preservative containing mercury).

    Reimbursement for Vaccination

    Medicare Part D plans (drug plans) cover the shingles vaccine. The amount of copay (money you have to pay) for vaccination varies. Medicare Part B (medical plans)do not cover the shingles vaccine. If you have private insurance or Medicaid, contact your insurer to determine coverage.

    Source: http://www.cdc.gov/vaccines/vpd-vac/shingles/vacc-need-know.htm

    Health Links

    For local health events, check out these links:

    A few of the most-trusted health information links:

    • WebMD.com A web service with health advice on hundreds of topics.
    • FamilyDoctor.org Patient-oriented information from the American Academy of Family Physicians.
    • CDC.gov The Center for Disease Control features credible information on almost every health topic.

    About our Newsletter

    Dr. Curran and the staff at Pisgah Family Health are proud to publish the Pisgah Family Health News to our patients.  Our goal is to provide regularly updated information about the office and current medical topics.  We plan to publish a new issue each quarter with breaking news.  The newsletters will also be archived on our website, http://www.pisgahfamilyhealth.com/

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