PISGAH FAMILY

HEALTH NEWS

October 2006

OFFICE NEWS

MEDICAL NEWS

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www.PisgahFamilyHealth.com/

OFFICE NEWS

Office Hours

  • Our normal office hours are 9-5 Monday through Thursday, and 9-12 on Friday.
  • We will be closed Friday, October 13th through Monday, October 16th.
  • We will be closed for Thanksgiving from Wednesday, November 22nd through Friday, November 24th.
  • We will be closed on Friday, December 1st.
  • 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.

Flu Shots

Pisgah Family Health will be offering a Flu Shot Clinic on Friday, October 20th. We will try to vaccinate as many of our patients as possible on that day. If you would like to get a Flu Shot this year, please call to schedule an appointment.

Unlike previous years, there does not appear to be a shortage of Flu Vaccine in 2006. We have received our full supply, and do not expect any rationing of the shots. The flu vaccine is most effective if administered between mid-October and mid-December. Patients with the following risk factors should be sure to get the flu vaccine every year.

AT RISK FOR COMPLICATIONS OF THE FLU

·  children ages 6-23 months

·  people over 65

·  people ages 2-64 years with chronic medical conditions

·  all women who will be pregnant during flu season

·  residents of nursing homes and long-term care facilities

·  health-care workers involved in patient care.

·  caregivers of children younger than six months.

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.

Welcome Danielle Deines

Danielle (32K)

As you may know, our nurse Tami Nicholson is expecting her second child in December. To prepare for her maternity leave, we are training a nurse intern to cover her absence. Danielle Deines is now working with Tami, and will take over Tami's duties until she returns. Danielle has already proven herself quite capable at phlebotomy, vaccinations, vitals, and most aspects of patient care.

Office Reminders

Fasting Labs: If you are having fasting labs drawn, you should not eat anything for eight hours before the test. You may drink plenty of water or black coffee, but no cream or sugar or solid food. Usually, fasting labs are drawn in the morning, from 8:30 to 9am. An appointment is not necessary, but you should call ahead to make sure our nurse will be here for the blood draw.

HIPAA: Federal Law states that we can not release any of your information without your written consent. Please let us know if you would like to authorize us to release information to your spouse or a family member.


Medical news

Head Lice

What are head lice?

Also called Pediculus humanus capitis (peh-DICK-you-lus HUE-man-us CAP-ih-TUS), head lice are parasitic insects found on the heads of people. Having head lice is very common. However, there are no reliable data on how many people get head lice in the United States each year.

Who is at risk for getting head lice?

Anyone who comes in close contact (especially head-to-head contact) with someone who already has head lice is at greatest risk. Occasionally, head lice may be acquired from contact with clothing (such as hats, scarves, coats) or other personal items (such as brushes or towels) that belong to an infested person. Preschool and elementary-age children, 3-11, and their families are infested most often. Girls get head lice more often than boys, women more than men. In the United States, African-Americans rarely get head lice. Personal hygiene or cleanliness in the home or school has nothing to do with getting head lice.

What do head lice look like?

There are three forms of lice: the egg (also called a nit), the nymph, and the adult.
Here are the three lice forms compared to a penny.
Photo credit: CDC

Egg/Nit: Nits are head lice eggs. They are very small, about the size of a knot in thread, hard to see, and are often confused for dandruff or hair spray droplets. Nits are laid by the adult female at the base of the hair shaft nearest the scalp. They are firmly attached to the hair shaft. They are oval and usually yellow to white. Nits take about 1 week to hatch. Eggs that are likely to hatch are usually located within 1/4 inch of the scalp.
Image credit: CDC Illustration of egg on a hair shaft.

Nymph: The nit hatches into a baby louse called a nymph. It looks like an adult head louse, but is smaller. Nymphs mature into adults about 7 days after hatching. To live, the nymph must feed on blood.
Photo credit: CDC Nymph louse.

Adult: The adult louse is about the size of a sesame seed, has six legs, and is tan to greyish-white. In persons with dark hair, the adult louse will look darker. Females, which are usually larger than the males, lay eggs. Adult lice can live up to 30 days on a person's head. To live, adult lice need to feed on blood. If the louse falls off a person, it dies within 2 days.
Image credit: CDC Adult louse

Where are head lice most commonly found?

They are most commonly found on the scalp, behind the ears and near the neckline at the back of the neck. Head lice hold on to hair with hook-like claws found at the end of each of their six legs. Head lice are rarely found on the body, eyelashes, or eyebrows.

What are the signs and symptoms of head lice infestation?

Tickling or feeling of something moving in the hair. Itching, caused by an allergic reaction to the bites. Skin irritation. Sores on the head caused by scratching. These sores can sometimes become infected.

How did my child get head lice?

Contact with an already infested person is the most common way to get head lice. Head-to-head contact is common during play at school and at home (sports activities, on a playground, slumber parties, at camp). Less commonly: Wearing clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons, recently worn by an infested person. Using infested combs, brushes, or towels. Lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infested person.

How is head lice infestation diagnosed?

An infestation is diagnosed by looking closely through the hair and scalp for nits, nymphs, or adults. Finding a nymph or adult may be difficult; there are usually few of them and they can move quickly from searching fingers. If crawling lice are not seen, finding nits within a 1/4 inch of the scalp confirms that a person is infested and should be treated. If you only find nits more than 1/4 inch from the scalp (and don't see a nymph or adult louse), the infestation is probably an old one and does not need to be treated. If you are not sure if a person has head lice, the diagnosis should be made by your health care provider, school nurse, or a professional from the local health department or agricultural extension service.

Source: www.cdc.gov

Treating the Commmon Cold

Now that school is back in session, we are seeing an increase in cases of Upper Respiratory Illnesses. 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.

HPV Vaccine is now available

Overview

HPV infection is the most common sexually transmitted infection (STI) in the United States (U.S.), with approximately 20 million Americans currently infected. Each year, an additional 6.2 million people become newly infected.1 As many as half of those infected with HPV are adolescents and young adults, ages 15-24 years. 2

While most HPV infections are asymptomatic and transient, HPV is of clinical and public health importance because persistent infection with certain oncogenic types can lead to cervical cancer. Cervical cancer is one of the most common cancers in women worldwide. Certain oncogenic types also have been associated with other, less common anogenital cancers. Moreover, non-oncogenic HPV types can cause genital warts and, rarely, respiratory tract warts in children.

On June 8, 2006, an HPV vaccine was licensed by the Food and Drug Administration (FDA) for use in females, ages 9-26 years. Another HPV vaccine is in the final stages of clinical testing, but not yet licensed. These vaccines offer a promising new approach to the prevention of HPV and associated conditions.

Genital HPV Infection

Over 30 types of HPV infect mucosal surfaces, including the anogenital epithelium (i.e., cervix, vagina, vulva, rectum, urethra, penis, and anus).

Genital HPV can be divided into “high-risk” (i.e., oncogenic or cancer-associated) types, and “low-risk” (i.e., non-oncogenic) types. HPV 16 and 18 are the most common high-risk types found in cervical cancer. HPV 6 and 11 are the most common low-risk types found in genital and respiratory tract warts.

Natural history of HPV

Over half of sexually active women and men are infected with HPV at some point in their lives.3 Approximately 90% of women with HPV infection become HPV-negative within two years.4 The gradual development of an effective immune response is thought to be the likely mechanism for HPV DNA clearance. However, it is also possible that the virus remains in a non-detectable dormant state and then reactivates many years later.

Many women with transient HPV infections may develop mild cytologic (Pap test) abnormalities that spontaneously regress.

About 10% of women infected with HPV develop persistent HPV infection. Women with persistent high-risk HPV infection are at greatest risk for developing high-grade cervical cancer precursor lesions (cervical intra-epithelial neoplasia or CIN 2,3) and cancer.

HPV-Associated Disease

Persistent infection with high-risk types of HPV is associated with almost all cervical cancers. The age-adjusted incidence rate for invasive cervical cancer in the U.S. was 8.7 per 100,000 women in 2002 (most recent year for which data are available).5 In that same year, 3,952 women died from this disease in the U.S.

Persistent infection with high-risk types of HPV is also associated with cancers of the vulva, vagina, penis and anus. However, these cancers are considerably less common than cervical cancer.

Genital HPV infection with low-risk types of HPV is associated with genital warts in men and women. About 1% of sexually active adults in the U.S. have visible genital warts at any point in time.2

Very rarely, perinatal transmission of low-risk HPV infections can result in respiratory tract warts in infants and children, a condition known as recurrent respiratory papillomatosis (RRP).

Prevention of Cervical Cancer

Cervical cancer once claimed the lives of more American women than any other type of cancer. But over the last 40 years, widespread cervical cancer screening using the Pap test and treatment of pre-cancerous cervical abnormalities have resulted in a marked reduction in cervical cancer incidence and mortality in the U.S. HPV DNA testing is now widely used with Pap smears for cervical cancer screening and management.

Today, as many as 82% of women in the U.S. have been screened with a Pap test in the past three years. Despite this, screening programs are not reaching all women in the U.S. It is estimated that half of the women diagnosed with cervical cancer have never been screened for cervical cancer, and an additional 10% have not been screened in the previous five years.

HPV Vaccine

A quadrivalent HPV vaccine (manufactured by Merck) has recently been licensed by the FDA for females ages 9-26 years. The vaccine protects against four types of HPV (6,11,16,18), including two that cause 70% of cervical cancers and two that cause 90% of genital warts. The vaccine has been tested in over 11,000 females (ages 9-26 years).

This vaccine is made from non-infectious HPV-like particles (VLP), composed of the major capsid protein. There is no thimerosal or mercury contained in the vaccine.

The vaccine should be delivered through a series of three intra-muscular injections over a six-month period (at 0, 2, and 6 months).

Clinical trials in females (ages 16-26 years) have demonstrated 100% efficacy in preventing cervical precancers caused by the targeted HPV types. The vaccine has also been found to be almost 100% effective in preventing vulvar and vaginal precancers and genital warts caused by the targeted HPV types. The vaccine has no therapeutic effect on HPV-related disease; it does not protect from disease due to HPV types already acquired.

Efficacy studies for the vaccine in males are ongoing. Data will be available in the next few years.

The vaccine appears to be safe and there are no serious side effects. Adverse reactions are mainly injection site pain. This reaction is common but mild.

The duration of protection is unclear. Current studies indicate the vaccine is effective for five years. There is no evidence of waning immunity during that time period. This information will be updated as additional data regarding immunity become available.

The CDC Advisory Committee on Immunization Practices (ACIP) has recommended routine vaccination for 11-12 year-old girls and catch-up vaccination for 13-26 year-old females.

Ideally, the vaccine would be administered before onset of sexual activity. However, females who are sexually active may also benefit from vaccination. Those who have not been infected with any vaccine HPV type would receive the full benefit of vaccination. Those who have already been infected with one or more HPV type would still get protection from the vaccine types they have not yet acquired. Few young women are infected with all four vaccine HPV types (6,11,16,18).

While it is possible that vaccination of males with the quadrivalent vaccine may offer direct health benefits to males and indirect health benefits to females (through herd immunity), there are not yet data to confirm this. No efficacy data are available for use in males. This information will be available in the future.

The retail price of the vaccine is $120 per dose ($360 for full series).

If the ACIP recommends the vaccine for routine use, federal health programs such as Vaccines for Children (VFC) will cover the HPV vaccine for persons less than 19 years of age who are VFC eligible.

Although an effective HPV vaccine is a major advance in approaches to the prevention of genital HPV and associated diseases, it will not replace other prevention strategies since vaccines will not work for all genital HPV types. Vaccinated women will still need regular cervical cancer screening since the vaccine will NOT provide protection against all types of HPV that cause cervical cancer, and since some women may not receive the full vaccine series (or they may not receive them at appropriate intervals). Vaccinated women should still practice protective sexual behaviors (e.g., abstinence, monogamy, limiting the number of sex partners, and/or using condoms, which is associated with lower rates of genital warts and cervical cancer10 ), since the vaccine will not prevent all HPV types—nor will it prevent other STIs.

A bivalent HPV vaccine (being developed by GlaxoSmithKline) is in the final stages of testing in females and may be available soon. This vaccine would protect against the two types of HPV (16,18) that cause 70% of cervical cancers.

Additional Sources of Information

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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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