Pisgah Family Health



November 2006






About the Newsletter


Flu Shots

Now is the time to get your flu shot!

This appears to be an early flu season in North Carolina. Yancey and Mitchell counties have already had a significant outbreak of Influenza type B which forced closure of their schools. As of this date, DNA typing has not been performed on the strain in Yancey county, but Type B influenza is usually covered by the vaccine.

There has been no shortage of Flu Vaccine in 2006, but some distribution has been delayed. We have about 80 shots left, and they are available to the first patients who request them. You do not need an appointment for a flu shot - just come in anytime during our regular business hours.

This year the flu vaccine is recommended for all people over 6 months of age. Children under two will require two half-doses given 30 days apart.

If you have symptoms of the flu (fever, muscle aches, fatigue) it is too late for the flu vaccine.  Make an appointment to be evaluated.  Antibiotics do not cure the flu, but an antiviral such as Tamiflu® can shorten the course of illness.

The Pneumonia vaccine is often given at this time as well. This vaccine prevents infection with strep pneumoniae, which is a common cause of pneumonia. This is recommended for people with chronic lung or heart disease, and all people over age 65. The pneumonia vaccine should be repeated every 5-10 years.

Welcome Danielle Deines

Danielle (32K)

As you may know, our nurse Tami Nicholson will begin her maternity leave ANY DAY NOW. Danielle Deines, our nurse intern, has been working with Tami for the past two months, and is proficient in all aspects of patient care. Danielle will be working with us until at least January.

Shut-In Runners

On November 4th, Dr. Curran and Danielle competed with 200 other runners in the annual Shut-In run. This greuling trail race follows the Shut-In trail from the North Carolina Arboretum to the foot of Mount Pisgah, climbing 3000 feet in elevation over almost 18 miles. On this day the weather was cool and crisp, and the trail was covered with fresh dry leaves, making the race even more treacherous.

Dr. Curran ran aggressively, holding eighth place until to the halfway mark. However several twisted ankles and falls eventually took their toll, and he finished in 14th place. Danielle ran smart and consistent through her first Shut-In, to take 4th among the women.

The top man (Shiloh Milke) and woman (Meadow Tarves) are siblings, proving that youth and good genetics will beat age and poor training every time.

Shut In Finishers

Dr. Curran and friends at the finish line of the Shut-In run.

Office Hours

  • Our normal office hours are 9-5 Monday through Thursday, and 9-12 on Friday.
  • We will be closed for Thanksgiving from Wednesday, November 22nd through Friday, November 24th.
  • We will be closed for a medical converence on Friday, December 1st.
  • We will be closed for Christmas on December 25th and 26th.
  • We will be closed for New Year's on January 1, 2007.
  • 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. Dr. Curran shares call with seven local physicians who are all board certified in Family Medicine, and can admit patients to Mission hospitals.
  • Our answering service can be reached after hours at 251-4873.

Office Reminders

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

Remember to bring your insurance card to each visit and present it to the receptionist when you check in. This ensures we have the most current insurance information for you.

Please notify our office if you have a new mailing address or phone number.

Medical news

Great American Smokeout

If you smoke, the American Cancer Society can help you kick the habit. And there are many ways for you to double your odds of succeeding. It starts with planning your quit attempt. Why not give up cigarettes for the day? Maybe forever? Why not start on Thursday, November 16, 2006 during the 30th annual Great American Smokeout?

Why Is It So Hard to Quit Smoking?

Mark Twain said, "Quitting smoking is easy. I've done it a thousand times." Maybe you've tried to quit too. Why is quitting and staying quit hard for so many people? The answer is nicotine.


Nicotine is a drug found naturally in tobacco. It is highly addictive - as addictive as heroin or cocaine. Over time, the body becomes both physically and psychologically dependent on nicotine. Studies have shown that smokers must overcome both of these addictions to be successful at quitting and staying quit. When smoke is inhaled, nicotine is carried deep into the lungs, where it is absorbed quickly into the bloodstream and carried throughout the body. Nicotine affects many parts of the body, including your heart and blood vessels, your hormonal system, your metabolism, and your brain. Nicotine can be found in breast milk and even in cervix mucous secretions of smokers. During pregnancy, nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants. Several different factors can affect the rate of metabolism (the work of the living cell in the body) and excretion (or getting rid of the waste) related to nicotine. In general, a regular smoker will have nicotine or its by-products present in the body for about 3 to 4 days after stopping. Nicotine produces pleasant feelings that make the smoker want to smoke more. It also acts as a kind of depressant by interfering with the flow of information between nerve cells. As the nervous system adapts to nicotine, smokers tend to increase the number of cigarettes they smoke, and therefore the amount of nicotine in their blood. After a while, the smoker develops a tolerance to the drug, which leads to an increase in smoking over time. Over time, the smoker reaches a certain nicotine level and then smokes to maintain this level of nicotine. In fact, nicotine, when inhaled in cigarette smoke, reaches the brain faster than drugs that enter the body intravenously.

Nicotine Withdrawal

When smokers try to cut back or quit, the absence of nicotine leads to withdrawal symptoms. Withdrawal is both physical and mental. Physically, the body reacts to the absence of nicotine. Psychologically, the smoker is faced with giving up a habit, which requires a major change in behavior. Both must be addressed in order for the quitting process to work. Withdrawal symptoms can include any of the following:

  • feelings of frustration and anger
  • irritability
  • sleep disturbances, including having trouble falling asleep, staying asleep and having bad dreams or even nightmares
  • dizziness (which may only last 1-2 days in the beginning)
  • depression
  • trouble concentrating
  • headache
  • tiredness
  • increased appetite

These symptoms can lead the smoker to again start smoking cigarettes again to boost blood levels of nicotine back to a level where there are no symptoms. If a person has smoked regularly for a few weeks or longer and abruptly stops using tobacco or greatly reduces the amount smoked, withdrawal symptoms will occur. Symptoms usually start within a few hours of the last cigarette and peak about 2 to 3 days later. Withdrawal symptoms can last for a few days to several weeks.

Why Quit?

Your Health

Health concerns usually top the list of reasons people give for quitting smoking. About half of all smokers who continue to smoke will end up dying from a smoking-related illness. Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also a risk factor for many other kinds of cancer as well, including cancer of the mouth, voice box (larynx), throat (pharynx), esophagus, bladder, kidney, pancreas, cervix, stomach, and some leukemias. For the first time, the Surgeon General includes pneumonia in the list of diseases caused by smoking.

Smoking increases the risk of lung diseases such as emphysema and chronic bronchitis. These progressive lung diseases - grouped under the term COPD (chronic obstructive pulmonary disease) - are usually diagnosed in current or former smokers in their 60s and 70s. COPD causes chronic illness and disability and is eventually fatal.

Smokers are twice as likely to die from heart attacks as are nonsmokers. And smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles, as well as cerebrovascular disease that can cause strokes.

Smoking also causes premature wrinkling of the skin, bad breath, bad smelling clothes and hair, and yellow fingernails and hair, yellow fingernails and an increased risk of macular degeneration, one of the most common causes of blindness in the elderly.

For women, there are unique risks. Women over 35 who smoke and use birth control pills are in a high-risk group for heart attack, stroke, and blood clots of the legs. Women who smoke are more likely to have a miscarriage or a lower birth-weight baby. Low birth-weight babies are more likely to die or to be impaired.

Based on data collected in the late 1990s, the US Centers for Disease Control (CDC) estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.

No matter what your age or how long you've smoked, quitting will help you live longer. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who continue to smoke. Ex-smokers also enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health, and reduced rates of bronchitis and pneumonia.

Ex-smokers also enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health status, and reduced rates of bronchitis and pneumonia.

For decades the Surgeon General has reported the health risks associated with smoking. Regardless of your age or smoking history, there are advantages to quitting smoking. Benefits apply whether you are healthy or you already have smoking-related diseases. In 1990, the Surgeon General concluded:

  • Quitting smoking has major and immediate health benefits for men and women of all ages. Benefits apply to people with and without smoking-related disease.
  • Former smokers live longer than continuing smokers.
  • Quitting smoking decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease.
  • Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birth weight baby to that of women who never smoked.
  • The health benefits of quitting smoking far exceed any risks from the less than 10 pound weight gain or any adverse psychological effects that may follow quitting.

When Smokers Quit - What Are the Benefits Over Time?

  • 20 minutes after quitting: Your heart rate and blood pressure drops.
  • 12 hours after quitting: The carbon monoxide level in your blood drops to normal.
  • 2 weeks to 3 months after quitting: Your circulation improves and your lung function increases.
  • 1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
  • 1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's.
  • 5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.
  • 10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease.
  • 15 years after quitting: The risk of coronary heart disease is that of a nonsmoker's.

Visible and Immediate Rewards of Quitting

Quitting helps stop the damaging effects of tobacco on your appearance including:

  • Premature wrinkling of the skin
  • Bad breath
  • Stained teeth
  • Gum disease
  • Bad smelling clothes and hair
  • Yellow fingernails

Kicking the tobacco habit offers benefits that you'll notice immediately and some that will develop gradually over time. These rewards can improve your day-to-day life immensely.

  • Food tastes better.
  • Your sense of smell returns to normal
  • Ordinary activities no longer leave you out of breath (for example, climbing stairs or light housework)
The prospect of better health is a major reason for quitting, but there are others as well.


Smoking is expensive. It isn't hard to figure out how much you spend on smoking: multiply how much money you spend on tobacco every day by 365 (days per year). The amount may surprise you. Now multiply that by the number of years you have been using tobacco and that amount will probably astound you. Multiply the cost per year by 10 (for the upcoming 10 years) and ask yourself what you would rather do with that much money. And this doesn't include other possible expenses, such as higher costs for health and life insurance, as well as the health care costs due to tobacco-related conditions.

Social Acceptance

Smoking is less socially acceptable now than it was in the past. Most workplaces have some type of smoking restrictions. Some employers even prefer to hire nonsmokers. Studies show smoking employees cost businesses more to employ because they are out sick more frequently. Employees who are ill more often than others can raise an employer's need for expensive temporary replacement workers. They can increase insurance costs both for other employees and for the employer, who typically pays part of the workers' insurance premiums. Smokers in a building also typically increase the maintenance costs of keeping odors at an acceptable level, since residue from cigarette smoke clings to carpets, drapes, and other fabrics. Landlords may choose not to rent to smokers since maintenance costs and insurance rates may rise when smokers occupy buildings. Friends may ask you not to smoke in their houses or cars. Public buildings, concerts, and even sporting events are largely smoke-free. And more and more communities are restricting smoking in all public places, including restaurants and bars. Like it or not, finding a place to smoke can be a hassle. Smokers may find their opportunities for dating or romantic involvement, including marriage, are largely limited to other smokers, who make up only about 1/4th of the population.

Health of Others

Smoking not only harms your health but the health of those around you. Exposure to secondhand smoke (also called environmental tobacco smoke or passive smoking) includes exhaled smoke as well as smoke from burning cigarettes. Studies have shown that secondhand smoke causes thousands of deaths each year from lung cancer and heart disease in healthy nonsmokers. Smoking by mothers is linked to a higher risk of their babies developing asthma in childhood, especially if the mother smokes while pregnant. It is also associated with sudden infant death syndrome (SIDS) and low-birth weight infants. Babies and children raised in a household where there is smoking have more ear infections, colds, bronchitis, and other respiratory problems than children from nonsmoking families. Secondhand smoke can also cause eye irritation, headaches, nausea, and dizziness.

Setting an Example

If you have children, you probably want to set a good example for them. When asked, nearly all smokers say they don't want their children to smoke, but children whose parents smoke are more likely to start smoking themselves. You can become a good role model for them by quitting now.

Treating the Commmon Cold

Flu and Cold season is now upon us. The most common illness at this time of year is an Upper Respiratory Illness. An Upper Respiratory Illness (URI) can include sinusitis, rhinitis, bronchitis, or pharyngitis. Most URIs are caused by viruses such as the common cold. These viruses do not improve with antibiotics. We cannot shorten the duration of the illness. However, your body's own defenses will eventually clear the illness. The only treatment for a viral URI is to treat the symptoms, so you feel less sick.

Rarely, URIs are caused by bacteria. An antibiotic is required to kill a bacteria. If you are taking an antibiotic, you should still treat your symptoms as necessary.

Most cough and cold remedies contain several different medications. Only by reading the list of active ingredients can you identify which medicine is right for you. Listed below are some of the most common and most useful ingredients in cold remedies.

Guaifenesin is a mucolytic. It makes mucus more watery, so you can clear out congestion or sinus pressure. Guaifenesin is safe in pregnancy, hypertension, diabetes, and for children. The adult dose is 600-1200mg every 8-12 hours. You will find guaifenesin in Mucinex and most Robitussin products.

Pseudoephedrine is a decongestant. It dries out your nose and throat, reducing mucus secretion. It is a stimulant, so side effects include elevated blood pressure and heart rate, feeling jittery and wakeful. Pseudoephedrine should not be used by people with hypertension or heart conditions or strokes. The adult dose is 30-60mg every 6 hours.

Dextromethorphan is a cough suppressant. It may make some people drowsy or dizzy. It is safe to use in pregnancy, hypertension, diabetes, and for children. The adult dose is 10-30mg every 6 hours. Products with dextromethorphan often have DM in their name.

Antihistamines are also decongestants. They dry out your mucus membranes and suppress an allergic response. Antihistamines are very useful for treating allergies, rashes and hives. Antihistamines should not be used by people with glaucoma or urinary retention, and should be used carefully by people with hypertension. The newest antihistamine, Claritin/loratadine 10mg does not cause drowsiness, and can be taken once per day. Most antihistamines cause drowsiness, and last 6-8 hours. These include Benadryl/diphenhydramine (25-50mg), chlorpheniramine (2-4mg), Brompheniramine (2-4mg), phenylpropanolamine (12-25mg), and Clemastine (1mg).

Anti-inflammatories are used for relief of pain and fever. They can irritate the stomach, elevate blood pressure, and cause swelling. They should be avoided by people with ulcers, CHF or renal disease. These include Aspirin (200-650mg every 4 hours), Motrin/Advil/ibuprofen (200-600mg every 8 hours), and Aleve/naproxen (200-400mg every 12 hours.) Aspirin should not be used by children.

Tylenol/acetaminophen is used for relief of pain and fever. It is safe to use in pregnancy, hypertension, diabetes, and for children. It should not be used by people with liver failure. The adult dose of acetaminophen is 325-650mg every 4-6 hours. Never exceed 4000mg per day. A child's dose is 5-7mg per pound, every 4-6 hours.

Nasal Saline is simply salt water. It is safe for all children and adults. You can make it at home or buy it in a squirt bottle. Saline is useful to clear nasal congestion and reduce nasal dryness. This is particularly useful for recurrent nosebleeds. Nasal saline should be used every hour as needed.

Afrin Nasal Spray is a very powerful nasal vasoconstrictor. It reduces runny nose and congestion. Unfortunately, Afrin is rapidly addictive to the nasal membranes. It is safe to use Afrin every 4-6 hours for 2-3 days. If you use it longer, you are likely to develop rebound rhinitis.

Eccanacia and Vitamin C are thought to boost the immune system. Some people use them to prevent or treat colds or URIs, however, there is no evidence that they actually work. Both are safe for children and adults.

Alcohol/ethanol is an ingredient in many over-the-counter cold remedies and home remedies. Alcohol increases cellular permeability, allowing viruses to spread easier. Alcohol causes dehydration and drowsiness. Alcohol should be avoided while you are sick.

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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