Pisgah Family Health News

October 2013

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October is Breast Cancer Awareness month - have you had your mammogram?


Office News

Flu Shots

FluDot (8K)

We now have our supply of 2013 influenza vaccine! Pisgah Family Health will NOT hold a flu shot clinic this year. Instead, we will give flu shots to our patients on a walk-in basis, during our regular business hours. Please visit any time during the month of October to get your shot. Vaccinations can also be given at your regularly scheduled visit, but not when you have a fever.

The flu vaccine is recommended for everyone over 6 months of age. Infants and the elderly are at highest risk of influenza complications. Also at high risk are adults with asthma, COPD, heart conditions, or pregnancy.

Flu shots are most useful when given in October or November, to prevent the seasonal flu which occurs each winter. This year's flu shot is similar to last year's, containing both H1N1 and seasonal influenza vaccinations.

Office Reminders

Call our office to schedule your flu shot during October!

Are you overdue for your annual physical? If it has been more than 2 years since your last exam, call now to schedule your physical.

Does your child need a physical to start school or to play sports? Please call our office to schedule!

Bring your medication bottles to each visit. This helps us keep your medications up to date.

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.

  • Pisgah Family Health will be closed November 28 and 29 for Thanksgiving holiday.
  • Dr Curran will be on vacation from November 25 through 29. Melissa Martinez will be here for patient care.
  • Pisgah Family Health will be closed December 24 and 25 for Christmas holiday.

Pink in the Park

On Saturday, October 5th, the staff of Pisgah Family Health will run the "Pink in the Park" race. This 5K run in Biltmore Park raises money to support breast cancer research.


Medical News

Flu Shots

What is seasonal influenza? influenza kid

Influenza, commonly called "The Flu," is caused by influenza viruses which infect the respiratory tract (i.e., the nose, throat, lungs). Unlike many other viral respiratory infections, such as the common cold, influenza can cause severe illness or life-threatening complications in many people. The best way to prevent seasonal flu is by getting a flu vaccination each year.

In the United States, on average 5% to 20% of the population gets the flu each year. More than 200,000 people are hospitalized annually from seasonal flu-related complications, and about 36,000 people die from seasonal flu-related causes.

What are the symptoms of the flu?

Influenza is a respiratory illness. People who have the flu often feel these symptoms:

  • Fever and chills
  • Muscle or body aches
  • Headaches
  • Fatigue
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Some people may have vomiting and diarrhea. This is more common in children.

Flu Bug

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

Shingles Vaccine

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

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. North Carolina 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.

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.

How common is Pertussis (whooping cough)?

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.

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

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.

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

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.

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

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

Pneumonia Vaccine

Pneumococcal disease is caused by Streptococcus pneumoniae bacteria. It is a leading cause of vaccine preventable illness and death in the United States. Anyone can get pneumococcal disease, but some people are at greater risk than others:

  • People 65 years and older
  • The very young
  • People with certain health problems
  • People with a weakened immune system
  • Smokers

Pneumococcal disease can lead to serious infections of the:

  • Lungs (Pneumococcal pneumonia kills about 1 out of 20 people who get it.),
  • Blood (Bacteremia kills about 1 out of 5 people who get it),
  • Covering of the brain (meningitis kills about 3 of 10 people who get it).

Pneumococcal polysaccharide vaccine (PPSV)

Pneumococcal polysaccharide vaccine (PPSV) protects against 23 types of pneumococcal bacteria, including those most likely to cause serious disease.

Most healthy adults who get the vaccine develop protection to most or all of these types within 2 to 3 weeks of getting the shot. Very old people, children under 2 years of age, and people with some long-term illnesses might not respond as well, or at all.

Another type of pneumococcal vaccine (pneumococcal conjugate vaccine, or PCV) is routinely recommended for children. Four doses are given before the age of 2 to achieve immunity.

Who should get PPSV?

  • All adults 65 years of age and older.
  • Anyone 2 through 64 years of age who has a long-term health problem such as:
    • heart disease
    • lung disease
    • sickle cell disease
    • diabetes
    • alcoholism
    • cirrhosis
    • leaks of cerebrospinal fluid or cochlear implant
  • Anyone 2 through 64 years of age who has a disease or condition that lowers the body's resistance to infection, such as:
    • Hodgkin's disease
    • lymphoma or leukemia
    • kidney failure
    • multiple myeloma
    • nephrotic syndrome
    • HIV infection or AIDS
    • damaged spleen, or no spleen
    • organ transplant
  • Anyone 2 through 64 years of age who is taking a drug or treatment that lowers the body's resistance to infection, such as:
    • long-term steroids
    • certain cancer drugs
    • radiation therapy
  • Any adult 19 through 64 years of age who:
    • is a smoker
    • has asthma

How many doses of PPSV are needed, and when?

Usually only one dose of PPSV is needed, but under some circumstances a second dose may be given. A second dose should be given 5 years after the first dose.

  • A second dose is recommended for people 65 years and older who got their first dose when they were younger than 65 and it has been 5 or more years since the first dose.
  • A second dose is recommended for people 2 through 64 years of age who:
    • have a damaged spleen or no spleen
    • have sickle-cell disease
    • have HIV infection or AIDS
    • have cancer, leukemia, lymphoma, multiple myeloma
    • have nephrotic syndrome
    • have had an organ or bone marrow transplant
    • are taking medication that lowers immunity (such as chemotherapy or long-term steroids)

Some people should not get PPSV or should wait

  • Anyone who has had a life-threatening allergic reaction to PPSV should not get another dose.
  • Anyone who has a severe allergy to any component of a vaccine should not get that vaccine.
  • Anyone who is moderately or severely ill when the shot is scheduled may be asked to wait until they recover before getting the vaccine. Someone with a mild illness can usually be vaccinated.
  • While there is no evidence that PPSV is harmful to either a pregnant woman or to her fetus, as a precaution, women with conditions that put them at risk for pneumococcal disease should be vaccinated before becoming pregnant, if possible.

What are the risks from PPSV?

About half of people who get PPSV have mild side effects, such as redness or pain where the shot is given. Less than 1% develop a fever, muscle aches, or more severe local reactions. A vaccine, like any medicine, could cause a serious reaction. But the risk of a vaccine causing serious harm, or death, is extremely small.

Source: http://www.cdc.gov/vaccines/hcp/vis/vis-statements/ppv.html

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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, www.PisgahFamilyHealth.com/

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