Weekly View » Ask Dr. Fleming

Winterize!

Weekly View — Thu, 29 Oct 2015 05:09:10 +0000

When you think about winterizing your vehicle this winter, consider protecting yourself as well. Being cooped up inside more during the winter months puts us at risk for many respiratory illnesses, and disease caused by the bacteria Streptococcus pneumoniae (or pneumococcus) is a specific threat. This bacteria causes thousands of deaths each year in the U.S., with about 18,000 over age 65. In addition, many more end up in the hospital with serious illnesses including pneumonia (lung infection) and meningitis (infection of the covering of the brain and spinal cord).
Pneumonia severity can range from a fairly mild viral form (hence the layman’s term “walking pneumonia”) to a life-threatening version caused by multiple bacteria. Pneumococcus can cause sinusitis or ear infections, but once in the body, the bacteria can spread and cause pneumonia or even meningitis. Like other infectious diseases, those with compromised immune systems are at increased risks, and these include the young and the elderly.
What’s new? Have you heard there’s a vaccine for pneumonia? It turns out that there are now two different vaccines that help protect against pneumococcal disease, and these have different recommendations. As usual, here are some more acronyms — PPSV23 (also called Pneumovax23) is Pneumococcal Polysaccharide Vaccine (directed against 23 strains of the bacteria) and PCV13 is Pneumococcal Conjugate Vaccine (directed against 13 strains). These vaccines are made differently, and although there is some overlap, each is effective against some strains that are not covered by the other vaccine. Thus to be maximally protected, one needs to get both vaccines.
Both vaccines are recommended for adults age 65 and older, both are recommended for 19 and over with certain health conditions or who are smokers (PPSV23 specifically for smokers), and both are recommended for age 19 and older who have weak immune systems due to disease or medications. If you’re over age 65, both vaccines are recommended, but you cannot get both vaccines at the same time. PCV13 is recommended first, followed by PPSV23 12 months later. However, you can get either of the pneumonia shots and a flu shot at the same time. The good news is that booster shots are not needed — once is enough!
Children should also be protected against pneumococcal disease. In children, pneumococcal bacteria cause ear infections in addition to pneumonia and meningitis, and studies have shown that pneumococcal vaccination helps protect against ear infections and reduces the need for tubes in the ears. PCV13 is now part of the recommended routine immunization schedule for those 2, 4, 6, and 12-15 months of age. Children 2–5 years should get a dose of PCV13 if they were never vaccinated or didn’t complete the series during their first 2 years of age or have one of several chronic conditions. Older children age 6-18 should also get a dose of PCV13 if they have certain health conditions or didn’t finish a PCV13 series when younger.
Pneumococcus is serious business, folks. You can read one family’s story of almost losing their twin boys to pneumonia at www.cdc.gov/vaccines/vpd-vac/pneumo/downloads/dis-pneumo-color.pdf. Please visit your primary care provider and discuss how you can winterize your family this winter — and longer!

Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (www.JanePauleyCHC.com), a Federally Qualified Health Center (FQHC) with offices in Indianapolis, Anderson, Greenfield, and Shelbyville. Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Or you can write your medical questions to Dr. Fleming at AskDrFleming, 5317 E. 16th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).

It’s Flu Season – Don’t let it be Open Season on YOU!

Weekly View — Thu, 24 Sep 2015 05:09:01 +0000

How bad will this year’s flu season be? It’s impossible to predict, and thus the only safe thing to do is get protected now. Which camp are you in? It seems there are two groups of people on opposite sides of the fence regarding flu shots. There are those that adamantly state something like, “No way! The last time I got one of those, I got the flu!” These people ignore the strong science that is responsible for the manufacturing of the flu shots from dead parts of the season’s expected flu viruses. Dead parts of viruses can’t give you influenza. The other camp is anxious to get their flu shot each year because they understand the very real danger of not getting it.
People sometimes choose to ignore science, but real-life stories are powerful. One of the most telling and emotional videos favoring getting annual flu shots was on the CDC Web site a few years ago. It depicted a woman walking down the sidewalk of a residential neighborhood holding hands with her young child. With a lump in my throat, I read about how she used to have two children, but one had died of influenza. The living one had been vaccinated.
The sobering fact is that an average of about 23,000 (4,000-49,000) people dies of influenza complications each year in the United States. We often don’t hear much about it unless there is a new twist like the 2009 H1N1 Flu or concerns about Bird Flu. We just cannot take thousands of deaths for granted each year.
Influenza symptoms are nonspecific and can include high fever, headache, cough, sore throat, fatigue, runny nose, body aches, diarrhea, and vomiting. Some people might only have a low grade fever and runny nose, while others might develop complications like pneumonia that lead to hospitalization and sometimes even to death. People who are very young, elderly, or who are immuno-compromised are at higher risk.
Timing can explain many people’s confusion. Let’s say you get exposed to the flu virus at work by a coughing coworker but don’t realize it. You feel fine and a couple of days later your primary care physician (PCP) convinces you to have a flu shot. A few days after the shot you develop flu-like symptoms and complain vehemently that the flu shot gave you the flu! However, the virus from your coworker actually gave you the flu, not the shot. If you had received the flu vaccine a couple of weeks or more before being exposed to your sick coworker, you probably wouldn’t have contracted the illness.
Others say they got a shot one time and they still got the flu. No vaccine is perfect, and it is possible (but much less likely) to get the flu after vaccination. Much more likely, however, is that the vaccinated person got a “flu-like” illness with some of the same symptoms as influenza A or B, the serious bad guys.
“I’m pregnant. Can I still get a flu shot?” Yes! It’s especially important for you to get vaccinated because you are at higher risk when pregnant. (You should get the shot, not the nasal vaccine.) There’s no recommendation for pregnant women or those with chronic medical conditions that put them at higher risk to get special permission from their doctor to get a flu shot at a work site clinic or pharmacy.
If you think you have flu symptoms this winter, please see your PCP right away. There are medications to treat flu victims, but they only help if started very early in the course of the disease. Four thousand to forty-nine thousand people will die of the flu in the United States this year. Don’t be one of them! Which camp are you in? Can we make a deal? Even if you think maybe you don’t want a flu vaccine, would you please at least talk to your PCP about it? Let’s fight this thing! Visit www.cdc.gov/flu for more information about the 2015-2016 flu season.

Swat!

Weekly View — Thu, 27 Aug 2015 05:09:05 +0000

The first human cases of West Nile virus were reported last week in Indiana’s Madison and Huntington counties. This isn’t unexpected at this time of year, and Indiana joins 44 other states reporting West Nile virus (WNV) in mosquitoes, birds, or humans.
WNV was first isolated in 1937 from a feverish patient in the West Nile District of northern Uganda. The first epidemic level of human infection was in Israel in 1951. WNV hit New York City in 1999, and within three years the virus had spread to the West Coast. Over the years the symptoms of WNV infection have become progressively more serious.
Humans contract WNV through the bite of a mosquito which has previously bitten an infected bird. There are two main groups of mosquitoes, Nuisance and the Culex. Nuisance mosquitoes prefer flooded and swampy areas, recreational areas and parks/homes, and the bite is noticeable (painful), thus alerting the victim of possible infection risk. The Culex mosquito is the one that can carry WNV, and it prefers standing water like what’s found in old tires and children’s swimming pools after a summer rain. Unlike the Nuisance mosquito, the bite of the Culex is barely noticeable, thus increasing the chances that you could be at risk without evening knowing you had been bitten.
People may start to show symptoms of WNV infection within 3-15 days of a mosquito bite. The disease can be anywhere on a wide spectrum of severity. Mild symptoms can include low grade fever, headache and muscle aches, or eye irritation, not unlike many other viral infections including mild cases of influenza. However, WNV can cause serious infections with high fever, aches, disorientation, convulsions, coma, paralysis, and even death.
WNV has been found in most all age groups from the youngest to the oldest, but is more common over 50 and in those with weakened immune systems. What about other animals? Other animals can get WNV and the spectrum of disease is similar to humans. Even though no cases have occurred by transmission from animals to humans, the CDC recommends avoiding bare hand contact with sick or dead animals.
What can we do to minimize the risk of WNV this summer and fall? Here are a few recommendations:
• Do not allow standing water on your property and keep brush trimmed. Properly dispose of old tires, swimming pools, or other containers that can hold water. Keep swimming pools and wheelbarrows turned over when not in use.
• Clean clogged roof gutters.
• Keep larger swimming pools well chlorinated, and don’t let water stand on pool covers.
• Use an insect repellent containing DEET. Swatting the little pests is effective if done before the bite.
• Wear proper clothing to cover the skin and keep mosquitos out.
Pregnant women are not at higher risk, but there is a real but very low risk of transmission to the fetus. Pregnant women can and should use mosquito repellent to help reduce risk. WNV may be transmitted via breast milk.
Although WNV antibody and virus tests are available, these are not usually used in the setting of mild symptoms, and a negative test does not insure absence of the virus. There are no vaccines or specific treatment for WNV infections. The most serious infections involve infection in the brain (encephalitis), and hospitalization for supportive care is necessary. Patients who recover can have lingering headaches and fatigue, but many recover completely. If you think you have symptoms of a viral infection, always see your primary care provider for further evaluation of your risks.

Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Or you can write your medical questions to Dr, Fleming at AskDrFleming, 8931 E. 30th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).

He said, NSAID

Weekly View — Thu, 30 Jul 2015 05:09:01 +0000

You might have heard about some new warnings about NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). These are a popular group of medications that many of us use to combat fever, headache, and various muscle and joint aches and pains. Included are the common over-the-counter (OTC) medications ibuprofen (Advil and Motrin) and naproxen (Aleve), as well as multiple prescription NSAIDs. Aspirin is also an NSAID, but aspirin is in a special category and excluded from the newest specific warnings. Acetaminophen (e.g. Tylenol) is also very useful for fever and aches and pains, but it is not an NSAID and is also excluded from the new warnings. The NSAIDs fight fever and pain whenever such are caused by inflammation, the process commonly involved when your body is fighting off an insult.
In 2005 the Federal Drug Administration (FDA) issued warnings that NSAIDs carry increased risks of heart attack and stroke, in addition to the known risks of severe stomach or other gastrointestinal bleeding. Now 10 years later, the FDA has strengthened the original warnings after studying additional data. A boxed warning (also called “black box warning”) is a special notice enclosed in a box on the medication label, on the package insert, and on advertisements. It’s the highest level warning that a medication can carry and remain on the market in the United States. One component of the boxed warnings is that the increased risk of heart attack and stroke exists even after only a short time of use (e.g. a few weeks), so there is significant risk even for the occasional user of these medications. People with known cardiovascular disease are at highest risk, but even those without known disease are also at risk. The risks are higher with higher doses and for longer treatment times. These medications should be completely avoided in the weeks following a heart attack.
NSAIDs and aspirin both affect the blood cells called platelets and affect their ability to form clots. (A clot in an artery feeding the heart or brain means a heart attack or stroke.) Although aspirin is an NSAID, the mechanism of action is different overall than that of the NSAIDs, and aspirin is actually protective against heart attack and certain kinds of strokes.
If this seems confusing or contradictory, it’s because it is a little complicated. Aspirin, NSAIDS, and acetaminophen are all common OTC medications used for fever and pain from a variety of causes. They each have several primary benefits and risks. A very limited summary is:
• “Non-Aspirin” NSAIDs (e.g. Aleve, Motrin, naproxen). Benefits – Fever and pain relief. Risks – Increased risk of peptic ulcer disease and bleeding, increased risks of heart attack and stroke, even during relatively short treatment periods.
• Aspirin (NSAID, e.g. Bayer Aspirin). Benefits – Fever and pain relief, protection against heart attacks and certain strokes. Risks – Increased risk of peptic ulcer disease, increased bleeding tendency.
• Acetaminophen (not an NSAID, not anti-inflammatory). Benefits – Fever and pain relief. Risks – Primarily liver damage, especially at doses exceeding the recommended daily maximum of 4,000 mg (8 maximum strength 500 mg tablets per day).
So what to do the next time you have a headache, muscle ache, or fever associated with a mild viral illness? As you can see from the above discussion, it depends on your particular medical history, and is best discussed with your primary care provider (PCP). For a couple of days, it might not matter which of the three groups you choose from, but if I had had a recent heart attack or a family history of heart attack or stroke, or I needed to take an NSAID for an extended period or often, I would pass on the NSAIDs and discuss it with my PCP.
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Or you can write your medical questions to Dr, Fleming at AskDrFleming, 8931 E. 30th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).

“Baby” Aspirin – Not for Babies!

Weekly View — Thu, 25 Jun 2015 05:09:00 +0000

Aspirin is an effective headache and fever reducer in adults, and aspirin can help alleviate the pain from arthritis and other musculoskeletal problems. Aspirin can also help prevent certain types of clots that can form in arteries of the heart and brain. You may have heard that, unless otherwise contraindicated, taking a daily low dose aspirin is part of a good preventive strategy for avoiding heart attack and stroke. Low dose aspirin, or “baby” aspirin, refers to the 81 mg tablet of the common fever- and pain-reducer also called acetylsalicylic acid, ASA, or salicylate. Not only is the 81 mg tablet often labeled “baby” aspirin, these are available in orange, cherry, and other flavors appealing to children. “Baby” aspirin is also comes in chewable tablets, again appealing to mothers of young children who cannot swallow tablets.
However, despite juvenile names used in the past (Baby Aspirin, Children’s Aspirin), aspirin is not usually recommended for children. Current preparations are often labeled “Baby” (note quotations), Low Dose, and/or have other disclaimers such as “Not recommended for households with young children.” Reye’s Syndrome is a serious condition that can affect children recovering from viral conditions such as influenza (flu) or chickenpox (varicella). Since these diseases are often associated with headaches, fever, and/or muscle aches, parents might be tempted to give their child aspirin to relieve these symptoms. However, studies have shown that up to 95 percent of children with Reye’s Syndrome were given aspirin while treating symptoms of a viral infection. Thus there is an association between Reye’s Syndrome and children who have taken aspirin while recovering from viral illnesses. Reye’s Syndrome can result in lethargy, vomiting, and coma. Early treatment is the key to survival, but survivors can have permanent brain damage. As many as 30 percent die of the disease. Fortunately, Reye’s Syndrome has been relatively rare since aspirin has been linked to its cause. However, 600-1200 cases still occur each year in the U.S.
The American Academy of Pediatrics, CDC, FDA, U.S. Surgeon General, National Reye’s Syndrome Foundation, and the World Health Organization all advise NOT to give aspirin to children under age 19 when treating fevers or apparent viral infection. Teens in particular may self-treat viral symptoms and not be aware of the risk of Reye’s Syndrome or that their chosen cold remedy contains aspirin. Parents should teach teens about Reye’s Syndrome and the risks of aspirin.
Most of the time an alternative to aspirin should be considered when treating childhood symptoms such as fever and headache, especially when recovering from a viral illness like influenza or chickenpox. The most common alternatives to aspirin for headache and fever include acetaminophen (e.g. Tylenol) or an NSAID (nonsteroidal anti-inflammatory drug). Aspirin is an NSAID, and others include ibuprofen (e.g. Advil, Motrin) and naproxen (e.g. Aleve). Since only aspirin has been linked to Reye’s Syndrome, any of these alternatives are much safer than aspirin in these situations.
There are some rare exceptions in which a physician might prescribe aspirin to a child. These include the rare Kawasaki Disease that involves inflammation of blood vessels or certain cases of inflammatory juvenile arthritis.
So despite the name “baby aspirin,” certainly do not give aspirin to a baby, or even to an older child or teen unless specifically under the care of a physician. Always read medication labels carefully and look out for aspirin. Anytime your child or teen is sick, please discuss specific treatments with your primary care provider. You do have one, right?

The Scan’s The Plan!

Weekly View — Thu, 21 May 2015 05:09:55 +0000

Think the risks of cigarette smoking are exaggerated? Lung cancer tops the list of deaths from cancer in the United States. Smoking causes 85 percent of all lung cancers, and about one-third of all adults in the U.S. smoke. That’s a lot of people at risk, and lung cancer is deadly — about 90 percent of patients die of the disease.
The most common type is non-small cell lung cancer, or NSCLC. As with other cancers, the earlier it is found, the higher chance for a cure. Make no mistake though, lung cancer is very deadly. If it has already spread to distant parts of the body when discovered, the 5-year survival rate is only about 4 percent. Bleak. If the spread is more limited to only the area’s lymph nodes, the 5-year survival rate is still only 25 percent. If localized only to the lung and no spread to the lymph nodes, survival is 52 percent, still not very encouraging. However, if detected at the earliest stage, the 5-yr survival for NSCLC is 77 percent — way more encouraging than the 4 percent of late-detected cancer.
Unfortunately, only a small percentage of lung cancers are discovered at the earliest stages. Screening has been studied using regular chest x-rays; cell studies of sputum from the lungs; and computed tomography (CT or “CAT”) scans that give very detailed images. Of these, the low dose CT (LDCT) is the most sensitive for catching early lung cancers. Despite some excitement in this area, in 2004 the United States Preventive Services Task Force (USPSTF) determined that there was not enough evidence to recommend screening for lung cancer in people without symptoms. However, further studies led to a new recommendation last year that those at high risk of lung cancer be screened with LDCT annually, symptoms or not.
What’s high risk? You are at high risk for lung cancer if you are age 55-80, and have a history of heavy smoking, and currently smoke or have quit within the past 15 years. Smoking is measured by how many “pack years” a person has smoked. To figure your pack years, multiply the number of packs you smoke per day times the number of years you have smoked. Some examples: If you’ve smoked 1 pack per day (PPD) x 30 years = 30 pack years. If you’ve smoked 2 PPD x 15 years = 30 pack years. Or 3 PPD for only 10 years = 30 pack years. In all of these examples, you would be considered a heavy smoker and at high risk of lung cancer.
Are there any exceptions? Yes, but only a few. You can stop annual screening when you have stopped smoking for 15 years. The only other exception would be if you develop a condition that severely limits your life expectancy (you’re going to die of something else before the lung cancer) or your ability to undergo lung surgery if cancer is found in the screening.
Are there any risks? Of course there are a few to be considered with your primary care provider (PCP), but these are small. The main risk is that of a false-positive. This is when lung cancer is detected on the LDCT screening scan, but in fact, there is no cancer present. This could lead to unnecessary biopsies, surgeries, and anxiety, each with some associated morbidity and even mortality.
Even the LDCT involves a small amount of radiation. But one scan is less than the normal amount of background radiation we all receive during the year, a little more than a mammogram, and a little less than a head CT. Since the risk of radiation is cumulative, the larger number of years that you receive the annual screenings, the more increase in the small chance of a radiation-induced lung cancer.
The USPSTF has studied the risks and benefits of LDCT and concluded that the benefits significantly outweigh the risks of LDCT screening for lung cancer in those at high risk. Using evidence-based techniques, the USPSTF has assigned a high Level B grade to its recommendation for LDCT lung cancer screening. It can be a real life saver — please discuss your risks with your PCP soon and stay healthy.

Don’t be Tricked by Ticks!

Weekly View — Thu, 23 Apr 2015 05:09:58 +0000

Last month we talked about some illnesses prevalent in the warmer months, including the childhood illnesses Fifth Disease and Hand-Foot-Mouth Disease. As we get outside more, folks will be camping, picnicking, and otherwise enjoying the outdoors with sporting events and other activities. Sooner or later, someone is going to find a tick on themselves or their pet and wonder about danger of illness and how to remove the tick.
Ticks are of the class of animals called arachnids, which includes spiders and mites. Ticks live by hematophagy (eating blood!), and they attach and feed on humans, other animals and even reptiles. Ticks comprise diverse families of hard- and soft-shelled species. We are most familiar with the hard-shelled variety that we find on ourselves or our animals (usually dogs).
Ticks are called vectors because they bring or “vector/aim” disease-causing bacteria to us. There are scores of mild and serious illnesses brought to us by ticks. A few diseases that you might have heard about include Lyme Disease, Rocky Mountain Spotted Fever, and maybe Q Fever, but included are other nasty diseases with scary names like Crimean Congo Hemorrhagic (bleeding) fever, tularemia, and tick-borne meningoencephalitis (brain infection). Discussion of all diseases transmitted by ticks is beyond the scope and space of this discussion, but we’ll discuss two here.
Lyme Disease – Bacteria called Borellia burgdorferi from the blacklegged tick cause Lyme Disease. The tick bites and attaches to human skin, and while the tick is filling up on our blood, the bacteria are being transmitted to our bloodstream. In essence, we feed them and in turn, they infect us with bacteria that cause headache, fever, and a classic rash called erythema migrans. Some redness may develop at the site of the tick bite, and this could be any exposed part of the body. The site redness may disappear over a couple of days, and this is reassuring. But sometimes the rash starts expanding in a generally circular fashion, with some internal areas clearing as the borders expand. This can leave a typical “bulls-eye” appearance. During the first 1-4 weeks, as the rash is appearing and expanding, other symptoms begin and include fever, tiredness, joint aches, and swollen lymph nodes. Of course, the best prevention is avoiding tick bites in the first place by wearing appropriate skin-covering clothing and using repellants, along with avoiding likely habitats. Once a tick has bitten, disease can often be prevented by early removal. Antibiotics used to treat early stages of Lyme Disease include doxycycline and amoxicillin. Most people treated in the early stages of the disease recover completely, but a few do not. Some unfortunate people are plagued for months with joint and muscle aches, even after treatment. The good news is that most people eventually recover.
Rocky Mountain Spotted Fever (RMSF) – Despite the name, RMSF occurs at a medium incidence in Indiana. It is caused by the bacterium Rickettsia rickettsii, and this bacterium is also brought to us by tick bites. The most common ticks are the American dog tick and the Rocky Mountain wood tick. Symptoms are similar to those of Lyme disease in that there can be fever, headache and muscle pain, but there can also be abdominal pain and vomiting with RMSF. There is also usually a rash, but this is different than the bulls-eye rash of Lyme disease. The rash of RMSF is complicated, but more diffuse than the target rash of Lyme disease. The rash usually appears within the first few days after a tick bite, but a few people never develop the rash at all. The rash starts out as flat, pink, non-itching spots on the wrist or ankles, but then spreads to the extremities and trunk. While the disease can be fatal, early treatment with doxycycline can be curative.
Besides preventing tick bites in the first place, early removal of an attached tick is highly advisable. You’ve probably already heard of several methods by family members and friends which are not likely professionally recommended. Don’t try to apply heat (e.g. matches) or covering with nail polish. The best advice is to remove the tick as soon as possible by grabbing it close to the skin with clean tweezers and pulling straight up with gentle pressure until it detaches. Don’t twist or jerk or the mouth parts may be left behind. If this happens, try to remove as best you can with the tweezers, and then clean the area and your hands thoroughly with soap and water or iodine.
Of course, if you feel badly and think you might have a tick-borne illness, consult your primary care provider as soon as possible. You do have one, right? Be safe, and enjoy summer!

Spring Has Sprung

Weekly View — Thu, 26 Mar 2015 05:09:59 +0000

I know Daylight Savings Time (DST) has its fans and foes, but life has been so much different since the time change and the advent of Spring! 9-5’ers now have a life after work, and hopefully the bitter sting of winter has passed. Winter wheat is out and grass is greening. However, with the good comes some health concerns, so this month let’s discuss a potpourri of childhood illnesses and other health and safety concerns
Childhood illnesses — Erythema Infectiosum (a.k.a. Fifth Disease or “Slapped Cheek” Syndrome) is a usually mild viral illness in children caused by Parvovirus B19, common in the spring. It begins with mild nonspecific symptoms like fever and runny nose. A few days later a characteristic redness of the cheeks (as if the child’s cheeks had been slapped) appears. An itchy, lacy rash follows on the trunk and extremities, and even on the bottoms of the feet. Although symptoms usually resolve in about a week, the illness can last several weeks. Although Fifth Disease is more common in children, adults can get it and are more likely to complain of painful joints for several weeks. The disease is caught by exposure to respiratory secretions from an infected person in the first stages of the illness. It can also be transmitted by blood, and pregnant women can pass the virus to their unborn child. Once you’ve had Fifth Disease, you usually are protected and do not get it again. Treatment is symptomatic, and the disease eventually goes away spontaneously in healthy people. Immuno-compromised people (e.g. cancer, leukemia, HIV) are at greater risk of severe complications. Prevention involves the usual — frequent hand washing, avoiding persons who are ill, and staying home from work or school when ill.
Hand, foot, and mouth disease (HFMD) is also common in the warmer months, extending into the fall. This is another usually mild viral disease, this one being caused by one of the family of picornaviuses, the most common being Coxsackievirus A16 and Enterovirus 71. The illness is most common in children, starts with fever, fatigue, and sore throat, and usually involves a rash on the hands and feet, with painful sores in the mouth. Transmission is by way of nose and throat fluids, and even via ingested fluid containing feces in recreational water (e.g. insufficiently chlorinated swimming pools). Like Fifth Disease, treatment of HFMD is symptomatic, and prevention is general good health and hygiene. HFMD should not be confused with Hoof and Mouth Disease, a disease of livestock.
As the weather tempts us to get outside more, next month we will discuss tick-borne infectious diseases. These are also common in the warmer months when ticks and people are outside and active. Besides infectious diseases, warmer weather should alert us to other dangers to our health. It’s not too early to use sunscreen with a high SPF. Each year people get taken by surprise by the just-beginning-to-warm temperatures and end up with a serious sunburn from being outside too long with insufficient skin protection.
Of course, camping is a favorite activity in the warmer months, and we all see raccoons in campgrounds and other wooded areas. Did you know that those cute raccoons can carry the roundworm Baylisascaris? Ingestion of soil (children seem to like eating dirt!) in areas frequented by raccoons can lead to a rare but serious roundworm infection. Keep garbage contained tightly closed, and avoid specific areas where raccoons are frequent, especially when children are present.
So to get the most enjoyment from the warming days ahead, take some common sense precautions and avoid annoying to life-threatening conditions putting a damper on your fun. Stay safe and enjoy the warmer weather!
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Or you can write your medical questions to Dr, Fleming at AskDrFleming, 8931 E. 30th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).

Measles — No Mickey Mouse!

Weekly View — Thu, 26 Feb 2015 06:09:51 +0000

If you’ve seen the news lately, you know that Measles (also called rubeola) is trying to make a comeback! The latest outbreak began in Disneyland in California, among unimmunized people. Measles is a highly contagious respiratory illness caused by a virus. Prior to the development of an effective vaccine in 1963, 500,000 cases of Measles were recorded in the U.S. annually, with many hospitalizations and about 500 deaths. Measles is contracted from infected persons via droplet transmission, i.e. from the person’s nose, mouth, or throat via direct contact, cough, or sneeze. Measles can be “caught” up to 2 hours after an infected person leaves a room. Measles begins like many similar respiratory illnesses with a fever — but eventually includes the “3 Cs” — Cough, Coryza (runny nose), and Conjunctivitis (red eyes). Finally a rash develops about the 4th day. The rash starts as flat red spots on the face and spreads downward to the neck, trunk, legs, and feet. The fever usually spike to about 104 degrees F about the time the rash first appears. A person is infectious and can spread the disease between 4 days before the rash until 4 days after the rash.
The first measles vaccine was developed in 1963. This was a “killed vaccine” made from dead virus. However, it was determined that this initial vaccine was ineffective in preventing the spread of measles. In 1967 the first effective vaccine was developed, and this was an “attenuated vaccine” meaning it contains a small amount of live virus; enough to stimulate an immune response, but not enough to cause the disease. The most common way to receive a measles vaccine today is via the measles-mumps-rubella (MMR) vaccine.
Are you in danger of getting Measles? Although Measles was declared eradicated in the U.S. in 2000, it continues to arrive from other countries to infect those who are not immune. Since 2000, case numbers have ranged from 37 in 2004 to 644 in 2014. So far this year through February 6th, there have been 121 cases in 17 states and the District of Columbia, but none yet in Indiana. The recommended childhood immunization schedule calls for a Measles vaccine at age 12-15 months and a second dose at age 4-6 years. Adults who didn’t receive 2 doses as a child should have at least 1 dose or prove immunity via a lab test. College students and adults working in high risk areas like heath care should have 2 doses separated by at least 28 days. Measles vaccine is extremely effective — 93 percent from one dose and 97 percent from 2 doses. You are considered safe from Measles if you were born before 1957 (assumes you had and survived the disease).
There are concerns about a growing number of people who are not immunizing their children, leaving them vulnerable to Measles and other morbid or deadly childhood diseases. These pockets of unimmunized people (mostly children) are not only at risk themselves, but increase the risk of measles making a comeback and reestablishing itself in our country. If you have questions about immunizations, please discuss with your primary care physician (PCP). You can just say “No” to Measles and help keep it out of Indiana — and America.

New Year’s Resolutions

Weekly View — Thu, 22 Jan 2015 06:09:08 +0000

Did you make New Year’s resolutions? Diet? Stop smoking? Good for you, but as we begin 2015, please consider adding a few more items to your “To Do” list for this year. We will mention recommendations first for all people in general, then those specifically for men, and finally recommendations for women. All:
1. Update your immunizations. For most adults, these would likely include immunizations for influenza, pneumonia (1 or 2 shots), tetanus and pertussis (whooping cough), and shingles.
2. Check and know your numbers. Know your blood pressure and know what’s normal (18-59, less than 140/90, age 60+, <150/90). These are the latest general recommendations, but there are many considerations depending on age, race, and specific conditions. Know your total cholesterol, as well as the breakdown of the good and bad cholesterol. If you have diabetes, know your sugar before breakfast (fasting) and supper, and know your A1C. A1C is the number that indicates diabetic control over a period of a month or so and doesn’t depend on the hour by hour fluctuations in sugar with meals and exercise.
3. Get a screen for colon cancer, which is largely preventable with meticulous adherence to screening recommendations. Get a check for hidden blood in the stool annually, and a colonoscopy every ten years if previous is normal.
4. If you’re a baby boomer, ask your provider for a blood test for hepatitis C, a liver virus common in this age group.
5. If you use tobacco in any form, make this the year to stop. Your primary care provider (PCP) can help. Limit alcohol intake, if at all. Men should drink no more than 2 drinks per day, and women should limit to one. Of course, if you are pregnant or think you might be, don’t drink alcohol at all. Do not use drugs — oral, inhaled, or intravenous. Seek help if you think you might have a problem with addictions.
6. Get a screen for depression and partner violence.
7. Consider a screening ultrasound for peripheral vascular disease and aneurysm. This will include checking the carotid arteries in the neck that could lead to stroke, the abdominal aorta for an aneurysm (dangerous bulge), and the arteries in the legs for blockages that could lead to non-healing ulcers and even the loss of a limb.
8. Get a screen for diabetes, especially if you have high blood pressure.
9. Practice safe sex and avoid serious to life-threatening sexually transmitted infections. Limit sexual partners.
10. Consider taking a daily 81 mg coated aspirin (“baby aspirin”) to help prevent stroke and heart attack.
Men:
1. Get an annual prostate check at your PCP office that includes a blood test for PSA (prostate specific antigen).
2. Erectile dysfunction is common after age 50, and it can be treated. But not if you don’t ask, so don’t be shy.
Women:
1. Get an annual mammogram and clinical breast exam at your PCP office.
2. Make sure your Pap test is current. Testing now begins at age 21, and should be done every 3 years through age 29. At ages 30-65, the testing interval can be extended to 5 years if “co-testing” is done and negative. Co-testing refers to doing both the Pap test and a test for HPV (human papilloma virus).
3. At age 65 and over, get a DEXA screen for osteoporosis (thinning bones that increase risk for fracture).
These are the latest general guidelines and recommendations. These should only be pursued in a team effort with your PCP. If these seem complicated or overwhelming, remember that you only need to remember to have at least an annual checkup with your PCP. You do have one, right? Wishing you all a happy and healthy 2015!

Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Or you can write your medical questions to Dr, Fleming at Ask Dr. Fleming, 8931 E. 30th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).