Pisgah Family Health News

October 2014

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

Office News

Flu Shots

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We now have our supply of 2014 quadrivalent and high-dose influenza vaccines! 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 months of October or November 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. Also consider getting these routine vaccinations:

  • Pneumonia vaccine if you are over 65, or have asthma or COPD.
  • Tdap vaccine (tetanus, diptheria, and pertussis) if you have not had it for 6 or more years.
  • Shingles vaccine if you are over 50.

Office Hours

Our office hours are 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.

  • Dr. Curran will be out of the office Monday, October 27.
  • Pisgah Family Health will be closed November 27 and 28 for Thanksgiving holiday.
  • Dr Curran will be on vacation from November 24 through 28. Melissa Martinez will be here for patient care.
  • Pisgah Family Health will be closed December 25 and 26 for Christmas holiday.

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.

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

Please call 24 hours in advance if you are unable to keep your scheduled appointment.

Thank you for referring your family and friends to Pisgah Family Health.

Pink in the Park

Pink-in-the-Park (38K)

October is National Breast Cancer Awareness Month. In Asheville there are several ways you can help to beat breast cancer and support women affected by cancer. Learn more here and here.

On Saturday, October 4th, Dr. Curran and the staff of Pisgah Family Health will run the "Pink in the Park" 5K. This 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.

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 four 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.

When should you get a flu vaccine?

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 over 6 months old 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.

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.

  • Pregnant women, and women planning to be pregnant in the next 6 months.
  • People with Asthma or COPD
  • People who live or work in nursing homes and other long-term care facilities
  • 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

Enterovirus D68

Enterovirus D68 (EV-D68) is one of more than 100 non-polio enteroviruses. This virus was first identified in California in 1962.

EV-D68 infections have recently been documented across the United States, and have been associated with severe respiratory complications in children. From mid-August to September 30, 2014, CDC or state public health laboratories have confirmed a total of 472 people in 41 states and the District of Columbia with respiratory illness caused by EV-D68. North Carolina has confirmed 8 cases of EV-D68 in September.

Enteroviruses commonly circulate in summer and fall. We're currently in middle of the enterovirus season, and EV-D68 infections are likely to decline later in the fall

What are the symptoms of EV-D68 infection?

EV-D68 can cause mild to severe respiratory illness.

  • Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches.
  • Severe symptoms may include wheezing and difficulty breathing. See EV-D68 in the U.S., 2014 for details about infections occurring this year.
  • A very small number of people have had weakness or paralysis of limbs associated with non-polio enterovirus.

How does the virus spread?

Since EV-D68 causes respiratory illness, the virus can be found in an infected person's respiratory secretions, such as saliva, nasal mucus, or sputum. EV-D68 likely spreads from person to person when an infected person coughs, sneezes, or touches contaminated surfaces.

What time of the year are people most likely to get infected?

In the United States, people are more likely to get infected with enteroviruses in the summer and fall. Cases are likely to decline later in the fall.

Who is at risk?

In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become ill. That's because they do not yet have immunity (protection) from previous exposures to these viruses. We believe this is also true for EV-D68.

Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.

How is it diagnosed?

EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person's nose and throat.

Many hospitals and some doctor's offices can test ill patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. Some state health departments and CDC can do this sort of testing.

CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear.

Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

What are the treatments?

There is no specific treatment for people with respiratory illness caused by EV-D68. For mild respiratory illness, you can help relieve symptoms by taking over-the-counter medications for pain and fever. Aspirin should not be given to children. Some people with severe respiratory illness may need to be hospitalized. There are no antiviral medications currently available for people who become infected with EV-D68.

How can I protect myself?

There are no vaccines for preventing EV-D68 infections. You can help protect yourself from respiratory illnesses by following these steps:

  • Wash hands often with soap and water for 20 seconds, especially after changing diapers.
  • Avoid touching eyes, nose and mouth with unwashed hands.
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick.
  • Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

DEA Controlled Substance Changes

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At Pisgah Family Health we strive to minimize our patients' use of dangerous or addictive drugs. Narcotic pain killers are sometimes necessary for short-term pain relief. However, these drugs are seldom useful for long-term pain, and can result in addiction and increased pain perception if used chronically.

This year the DEA issued changes in how it regulates certain narcotic prescriptions. If you use Hydrodcodone (Vicodin, Norco, Tussionex) or Tramadol (Ultram), these changes will affect you.

Effective October 6, 2014, Hydrocodone is classified as a Schedule II controlled substance. This means that prescriptions must be hand signed (not faxed or e-prescribed), and are limited to a 30 day supply, with no refills. These same rules apply to other narcotic pain killers (Oxycodone, Fentanyl, Dilaudid) and stimulant ADD drugs (Adderall, Ritalin, Concerta)

Effective August 18, 2014, Tramadol is classified as a Schedule IV controlled substance. This means that prescriptions must be hand signed (not faxed or e-prescribed), and are limited to 6 months of refills. These same rules apply to sleep aids (Ambien, Lunesta), benzodiazepines (Xanax, Valium, Klonopin, Lorazepam), and muscle relaxers.

DEA Drug Schedules

Drugs and certain chemicals used to make drugs are classified into five distinct categories or schedules depending upon the drug's acceptable medical use and the drug's abuse or dependency potential. The abuse rate is a determinate factor in the scheduling of the drug; for example, Schedule I drugs are considered the most dangerous class of drugs with a high potential for abuse and potentially severe psychological and/or physical dependence. As the drug schedule changes-- Schedule II, Schedule III, etc., so does the abuse potential-- Schedule V drugs represents the least potential for abuse.

A substance need not be listed as a controlled substance to be treated as a Schedule I substance for criminal prosecution. A controlled substance analogue is a substance which is intended for human consumption and is structurally or pharmacologically substantially similar to or is represented as being similar to a Schedule I or Schedule II substance and is not an approved medication in the United States.

Schedule I

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Schedule I drugs are the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence.

Some examples of Schedule I drugs are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote

Schedule II

Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, less abuse potential than Schedule I drugs, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous.

Some examples of Schedule II drugs are: cocaine, methamphetamine, methadone, hydrocodone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin.

Schedule III

Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV.

Some examples of Schedule III drugs are: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone.

Schedule IV

Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence.

Some examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien.

Schedule V

Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes.

Some examples of Schedule V drugs are: cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin.

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, www.PisgahFamilyHealth.com/

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