Pisgah Family Health

PISGAH FAMILY

HEALTH NEWS

April 2008

OFFICE NEWS

MEDICAL NEWS

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About the Newsletter


OFFICE NEWS

Kit moves on to Nursing School

Kit After five months at Pisgah Family Health, Kit will be moving to Gainesville, Florida with her husband to attend nursing school at The University of Florida. Kit has been helping Julie as a receptionist and working with Tami to assist in her many responsibilities, while taking prerequisite classes for nursing school. Kit really enjoyed being part of the Pisgah Family health community and felt her time in the office was an invaluable experience in the medical profession. Kit was accepted to nursing programs at Duke and Florida and after much deliberation is thrilled to start Florida's program in early May, where she will complete her nursing degree in one year. Her husband will also be attending Law School in Gainesville.
We wish Kit the best of luck with her move and her new career!

Julie's Exciting News!

Julie, our office manager, is expecting her first child this October! In the coming months, you'll notice some fresh faces in our office as we will have new staff helping us during Julie's maternity leave. Please join us in welcoming the new staff while Julie takes on life's greatest challenge.

$100 for 100 Miles in 100 Days

Julie, Tami, and Kit are hitting the pavement at lunch to meet Dr. Curran's challenge of walking 100 miles in 100 days. Dr. Curran is offering $100 bonus to finishers, with the goal of improving our staff's health. Beautiful spring days have made excellent walking conditions, and the 0.3 mile loop around the building has been well-traveled. A chart in the break room is used to document the miles, and the ladies are determined to meet their goal. We encourage all of our patients to get outdoors and enjoy taking care of yourself. Walking is the simplest way to start an exercise routine and is an effective way to burn calories, improve cardiovascular fitness, and strengthen muscle tone.

Ridgefield's Walking Trail

Ridgefield Business Park (our business home) has a 1.4 mile off-road trail for recreational walkers and joggers. The trail passes directly in front of our office, and makes a loop around the entire business park. Most of the trail is wooded and covered in mulch. A small segment passes over sidewalks and roads. The trail includes some hills, and is covered in mulch, so walkers should wear sturdy walking shoes. A detailed map is available at our office.

The trail is available at all hours. We hope this will be a resource for our patients interested in maintaining their fitness.

Ridgefield Walking Trail

Office Hours

Our normal office hours are 9-5 Monday through Thursday, and 9-12 on Friday. Our answering service can be reached after hours at 251-4873. When the office is closed, emergency care is available at the Urgent Care Centers, and at Mission/Saint Joseph hospitals ER.  Telephone calls are handled by Dr. Curran’s call partners.

  • We will be closed Monday, May 26th for Memorial Day holiday.
  • We will be closed Thursday June 26th & Friday 27th for a family reunion.
  • We will be closed July 4th for Independence Day holiday.
  • We will be closed July 7th - 11th, for a medical conference.

Office Reminders

Please turn off your cell phone while in our office. If you must have your phone on, please put it on vibrate and step outside the office to speak.

Please call our office if you are unable to keep any appointment. We will be happy to cancel or reschedule your appointment to a time that is better for you. If you skip an appointment without notification, you are wasting our most valuable resource - our time. Pisgah Family Health has a policy of ending our relationship with patients who skip more than two appoitments.

Now is the time to schedule your annual physical. During the summer months we are less busy, and more able to make time for routine care and physical exams. Please remember to schedule these extensive visits well in advance. You will avoid waiting, and avoid contact with sick patients by having your physical during these months.

Does your child need a physical exam for school, camp or sports? Plan now for these visits. Be sure to have your paperwork completed and vaccination record with you, as these will be necessary for the doctor visit.


Medical News

April is National Child Abuse Prevention Month

April is Child Abuse Prevention Month-an opportunity for you to be a positive force on behalf of the children and families in your community. Preventing child abuse is an action in which each of us can participate. Be aware of the signs of abuse, and know how to report it. No one person can do everything, but everyone can do something.

Signs of Child Abuse

Emotional Abuse

  • A child who is apathetic (just doesn't care).
  • A child who suffers from depression.
  • A child who won't take part in play or school activities.
  • A child who is often hostile or aggressive.
  • A child with a loss of appetite.
  • A child who compulsively overeats

Neglect

  • Any of the signs above.
  • A child who is hungry much of the time.
  • A child wandering outdoors unsupervised.
  • A child unsuitably dressed for the weather.
  • A child who is continually dirty or wearing the same soiled clothes.
  • A child who shows up early or stays late at school.

Physical Abuse

  • Bruises or welts shaped like an object (belt buckle or electric cord).
  • Bruises in unusual places (back, eyes, mouth, buttocks, genital areas, thighs, calves).
  • Layers of different colored bruises in the same general area.
  • "Sock" or "glove" burns on feet or hands or doughnut shaped burns on buttocks (from forcing the child into hot water).
  • Small round burns from cigarettes.
  • Burns in the shape of an object (iron, fireplace tool, or heater).
  • Rope burns on ankles, wrists, or torso.
  • Adult sized bite marks.
  • Suspicious fractures (doctors and nurses are trained to recognize these).

Sexual Abuse

  • Withdrawal or anti-social attitude.
  • Refusal to undress for physical education or sports.
  • Exaggerated interest in sex or "acting out" sex with other children.
  • Unusually seductive behavior.
  • Fear of intimate contact (hugging or sports)
  • Torn, stained, or bloodied clothing.

10 Things To Do Instead of Hurting a Child

  1. Take a deep breath. Take a few more. Remember, you are the adult.
  2. Close your eyes and imagine you are hearing what your child is about to hear, or receiving the same punishment.
  3. Press your lips together and count to 20.
  4. Put the child in a "time-out" chair for a number of minutes. The rule is one minute for each year of age.
  5. Put yourself in a "time-out" chair. Are you really angry at the child or is it something else.
  6. Call a friend to talk about it. If you need to, dial 1-800-4-A-CHILD (National Child Abuse Hotline).
  7. If someone can watch the children, go out for a walk.
  8. Take a hot bath or splash cold water on your face.
  9. Turn on some music. Sing along if you want.
  10. Pick up a pencil and write down a list of helpful words, not words that will hurt. Save the list. Use these words.

If you or someone you know feels overwhelmed by the demands of parenting, call the Parent Helpline at 1-800-342-7472 for information about family support resources in your community.

If you or someone you know is being abused, dial 911 or call the National Child Abuse Hotline at 1-800-422-4453.

If you suspect that a child is being abused or neglected please contact the Department of Social Services.
Buncombe County Department of Social Services
40 Coxe Ave. Asheville, NC 28802
Emergency Phone: (828) 250-5500

kids (16K)



www.preventchildabuse.org

www.buncombecounty.org

www.childhelp.org



FDA Warning about Childrens' Cough and Cold Medicines

(Transcript from the FDA) On January 17, 2008 the Food and Drug Administration issued a public health advisory titled: FDA Recommends that Over-the-Counter Cough and Cold Products not be used for Children under Two-Years-of-Age.

The FDA has completed its review of information about the safety of over-the-counter, also known as OTC, cough and cold medicines in infants and children under two- years-of age. FDA is recommending that these drugs not be used to treat infants and children under two-years-of-age because serious and potentially life-threatening side effects can occur.

FDA's recommendation is based on both the review of the information we received about serious side effects in children and the discussion and recommendations made at the public advisory committee meeting held on October 18th and 19th 2007, at which this issue was discussed. FDA strongly supports the actions taken by many pharmaceutical manufacturers to voluntarily withdraw cough and cold medicines that were being sold for use in this age group.

FDA has not completed its review of information about the safety of OTC cough and cold medicines in children two through eleven-years-of-age. We are aware of reports of serious side effects from cough and cold medicines in children two- years-of age and older. FDA is committed to completing its comprehensive and thorough review of the safety of OTC cough and cold medicines in children two- years-of age and older as quickly as possible and expects to communicate our recommendations to the public in the near future.

Pending completion of FDA's ongoing review, if parents and caregivers use OTC cough and cold medicines in children two- years-of age and older, FDA recommends:

  • Check the "active ingredients" section of the DRUG FACTS label. This will help you understand what "active ingredients" are in the medicine and what symptoms each active ingredient is intended to treat. Cough and cold medicines often have more than one "active ingredient", such as an antihistamine, a decongestant, a cough suppressant, an expectorant, or a combination pain reliever and fever reducer.
  • Be very careful if you are giving more than one OTC cough and cold medicine to a child. Many OTC cough and cold medicines have more than one "active ingredient." If you use two medicines that have the same or similar "active ingredients" a child could get too much of an ingredient which may hurt your child. For example, do not give a child more than one medicine that has an antihistamine.
  • Carefully follow the directions in the DRUG FACTS part of the label. These directions tell you how much medicine to give and how often you can give it.
  • Use only the measuring spoons or cups that come with the medicine or those made specifically for measuring drugs. Do not use common household spoons to measure medicines for children since household spoons come in different sizes and are not meant for measuring medicines.
  • Choose OTC cough and cold medicines with childproof safety caps, when available, and store the medicines out of the reach of children.
  • Understand that using OTC cough and cold medicines are intended only to treat your child's symptoms. OTC cough and cold medicines do not treat the cause of the symptoms or shorten the length of time your child is sick. They only relieve symptoms and make your child feel more comfortable.
  • Do not use these products to sedate your child or to make children sleepy.
  • Call a physician, pharmacist, or other healthcare professional if you have any questions about using cough or cold medicines in children two- years-of-age and older.

We urge parents, caregivers and healthcare providers to report side effects that may be associated with the use of OTC cough and cold medicines in children two-years-of-age and older to us at the FDA's MedWatch adverse event reporting program by phone at 1-800-FDA-1088 or by the Internet at www.FDA.gov/medwatch. Updated information about drugs with emerging safety concerns is available 24 hours a day at our Web site www.FDA.gov/CDER.

Additional information is available at:
http://www.drgreene.com/21_1274.html
http://www.aap.org/sections/socpt/coughandcold.pdf
http://www.fda.gov/CDER/drug/advisory/cough_cold_2008.htm
http://familydoctor.org/PreBuilt/otc_knowingredientschart.pdf

Zetia and Vytorin publicity fallout

This month there has been nonstop publicity surrounding the drugs Zetia (Ezetimibe) and Vytorin (Simvastatin+Ezetimibe). If you are taking either of these drugs for cholesterol, please do not panic. There has been no safety concern about these drugs. Here is Dr. Curran's interpretation of this important news.

In the April 3 issue of the New England Journal of Medicine, the results of the ENHANCE trial were released. This trial followed 720 patients with a genetic disorder predisposing them to high cholesterol and early coronary disease. The study compared cholesterol plaque progression in patients taking Simvastatin (Zocor) vs. those taking Simvastatin (Zocor) plus Ezetimibe (Zetia). The results found no reduction in carotid plaque development with the combination versus Simvastatin alone.

From this trial the media has concluded that Zetia (Ezetimibe) is ineffective at preventing carotid (and perhaps cardiac) disease. There are several important points from this study that have been neglected in the popular media. Here's my analysis:

  1. The study population had a genetic disorder for high cholesterol. The results may not apply to the general population.
  2. The study achieved a reduction in LDL-cholesterol, but only to 141 mg/dl. This is well above the goal of 100 applied to most patients. The failure to adequately lower cholester in these patients may account for the treatment failure.
  3. The measured outcome was carotid (neck) artery disease. Coronary (heart) arteries may not be identically affected.

It is important not to be a victim of publicity for pharmaceuticals, whether it be negative or positive publicity. Here are some simple take-home points about these drugs.

  • It is reasonable to ask for good evidence before buying the latest and most expensive drug. Newer is not necessarily better. More evidence is always better.
  • The statin drugs are the first-line agents for lowering cholesterol. They continue to have the best evidence for preventing coronary artery disease.
  • There is very little evidence that Zetia alone is effective or useful. It is recommended to be used in conjunction with a statin.
  • If Zetia or Vytorin has reduced your cholesterol significantly, you should probably continue the medicine.
  • Before you start or stop any medicine, discuss the choice with your doctor.

For more information, visit these sources:
The ENHANCE trial in NEJM: http://content.nejm.org/cgi/content/full/NEJMoa0800742
critique of the trial: http://www.medpagetoday.com/MeetingCoverage/ACCMeeting/tb/8953
critique of the trial: http://www.pharmalot.com/2008/03/ladies-gentlemen-the-enhance-study-slides/

Health Links

For more health information, check out these links:

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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