Pisgah Family Health News

January 2013

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Office News

Welcome Lindsey Bradley

Lindsey

Pisgah Family Health is proud to welcome Lindsey Bradley to our office. Lindsey started in December as our full time Medical Assistant.

Lindsey was born in Asheville and has lived in WNC her entire life. She has worked in the nursing field for 13 years, in both Family Medicine and specialty practices. She enjoys spending time with her two children Dawson and Camdyn. She also enjoys being outdoors, cooking for family and friends, and playing in the park with her daughter.

New Babies!

Our office takes great pleasure in welcoming newborn children to our practice. Dr.Curran sees newborns at Mission hospital for birth, circumcision, and care of serious illnesses. If you know someone who is expecting, be sure to suggest Dr. Curran for their newborn care.

Makaylan Crites

Makaylan Crites was born December 7, 2012, to parents Selena and James Crites.

Gabriel Kai Hyder

Gabriel Kai Hyder was born December 12, 2012, to parents Holly and Stephen Hyder.

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.

Office Reminders

WE ARE NOW TAKING NEW PATIENTS. We provide comprehensive care for infants, children and adults.

If you know someone who needs a physician, please forward this Email or give them our phone number.

Office Hours

Our office hours are now 8:30-5pm Monday through Friday.  If there is low demand, we will close on Friday afternoon. 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 and his call partners.

  • The office will be open 8:30 to 12 on Monday, January 21 for Martin Luther King day.
  • We will have reduced hours March 25-28, for Spring Break.
  • We will be closed March 29 for Good Friday.

Medical News

Statins and Myalgias

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Statins (Crestor, Lipitor, simvastatin, pravastatin, fluvastatin) are widely used to lower cholesterol and reduce cardiac risk. These drugs have proved extremely useful in preventing coronary disease, strokes, and death.

One common side effect of statins is myalgia or muscle pain. This is reported by approximately 10–11% in statin users. A potential explanation for statin myalgia has been the depletion of coenzyme Q10 (CoQ10) within the body. CoQ10 is a fat-soluble antioxidant that is a cofactor for mitochondrial energy production. It is present in almost every single cell in the body and found in dietary fat. The reduction in CoQ10 may decrease mitochondrial energy production and result myalgias while an individual is on a statin.

Clinical trials have shown that CoQ10 supplements may decrease the incidence and severity of statin myalgia. CoQ10 is thought to work by replenishing the depleted CoQ10 levels in muscle mitochondria and/or through an antioxidant mechanism. Supplementing with CoQ10 may help treat statin myalgia and perhaps decrease the risk of cardiovascular disease.

It has been shown that muscle pains associated with statins are directly correlated with the dose. If the statin concentrations are increased, there is a greater chance that a patient will experience muscle pain.

Statin-induced myalgias may be increased by medications and foods that inhibit the liver metabolism of the statin. Grapefruit juice and Pomegranite juice both are significant inhibitors of the cytochrome system of liver metabolism. These juices should be avoided by statin users.

Many patients on statins also take the cardiac meds verapamil, diltiazem, or amlodipine. These medications also may increase the concentration of statins, and therefore increase myalgias. Patients using verapamil or diltiazem should consider taking a non-CYP3a4-metabolized statin such as pravastatin, rosuvastatin or fluvastatin or change verapamil/diltiazem to amlodipine if appropriate. Amlodipine and Simvastatin should be used concommitantly only in low doses, and with awareness of possible myalgias.

In summary, there is moderate evidence that CoQ10 can help treat statin myalgia. There is no established ideal dose of CoQ10. Studies have used doses of CoQ10 ranging from 50 milligrams to 1,200 milligrams in adults. Follow the instructions on the bottle or get advice from your doctor or a dietitian. Keep in mind that different supplement brands might have different ingredients and strengths.

Source: James J DiNicolantonio, Expert Reviews in Cardiovascular Therapeutics. 2012;10(10):1329-1333.

Influenza

influenza

The Asheville area is now experiencing a serious outbreak of influenza and parainfluenza. If you have a fever or other flu symptoms, STAY HOME to avoid spreading the illness. See your doctor if you have flu symptoms and any of the risks listed below. If you have not had your flu shot, get one now from your local pharmacy.

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.

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
  • 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)

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

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

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

Antiviral medications

There are several prescription medications which can shorten the duration of influenza illness. These may reduce the symptoms of the flu, and 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

Shingles

Shingles

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

Fun Health Facts about Pets

Fact: Dog Kisses Can Make You Sick

Think dogs' mouths are cleaner than humans? Think again. Dogs' chops are teeming with bacteria, and may harbor germs like salmonella and campylobacter. These organisms get into a dog's mouth from eating spoiled food or when he uses his tongue as toilet paper. Then a kiss moves these germs from pooch to person, potentially along with a nasty case of diarrhea.

Fact: Humans Can Make Pets Sick

It's not common, but it happens. H1N1 "swine" flu has hit cats, dogs, and ferrets -- contracted from their sick owners. Most often it's mild, but a few pets have died, so vets advise frequent hand washing and separate beds when the owner is sick. Dogs and people can also share the same strains of E. coli bacteria. And MRSA, the "superbug", can move between humans and dogs.

Myth: Cats Steal a Baby's Breath

This superstition goes back to the 1700s. When babies died of sudden infant death syndrome (SIDS), people were quick to blame a cat seen lying in the crib. Today, soft toys, illnesses, a stomach-lying position have all been linked to SIDS - but not cats. Cats are drawn to cribs because they're warm, cozy, elevated places - perfect for a catnap.

Fact: Dogs Can Smell Diabetes

It sounds like a Lassie TV episode, but it's truth, not fiction. Dogs can sniff out a dangerous drop in blood sugar in a diabetic owner and alert the person to take action by pawing, licking, whining, or barking. A few dogs have even been trained and placed as diabetic service dogs. Their nose for hypoglycemia (low blood sugar) is correct 90% of the time, according to their trainers.

Fact: Smoking Kills Cats and Dogs

Secondhand smoke increases the risk of at least two fatal cancers in cats: lymphoma and oral carcinoma. Housecats get a double dose of toxins by breathing cigarette smoke in the air and by licking the residue off their fur when grooming. Dogs with long noses may develop cancerous nasal tumors from living with a smoker -- and short-nosed breeds are more prone to lung cancer.

Source: http://www.medicinenet.com

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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