Flu Shot Campaign Begins

As school bells ring out announcing a new school year and pigskins fly through the air announcing the arrival of a new football season, the Center for Disease Control and Prevention (“CDC”) begins its annual influenza vaccine campaign.  “Flu” or influenza is a viral illness associated with fever, severe muscle aches, general malaise and respiratory symptoms.  Most healthy children and adults can run a fever for 5 – 7 days and fight off the infection over a 10 day to three week period.  There is clearly a long period of malaise and debilitation in many that lasts for weeks after the acute febrile illness resolves.

The illness is especially severe and often lethal in the elderly, in infants, in patients with asthma and chronic lung disease and in those patients who have a weakened immune system due to disease or cancer treatments. Diabetics and heart patients are particularly vulnerable to the lethal effects of unchecked influenza.

The CDC recommends vaccinating all Americans over six years old against influenza.  Adults can receive an injection, or a nasal application.  The 2012 – 2013 vaccine has been updated from the 2011 – 2012 version based on samplings of current influenza viruses spreading around the world.   It takes about two weeks to develop antibodies and immunity to influenza after you receive the vaccination.  If you received the vaccine last season or had the flu last season you are still advised to receive the 2012 – 2013 vaccine this year because immunity fades with time.  Flu vaccine should have arrived in most physician offices and community health centers and pharmacies by mid- August.  The CDC advises taking the shot as soon as it is available.

The vaccines used are not live viruses so one cannot catch the flu from the vaccine. Side effects usually include warmth and tenderness at the injection site and rarely general malaise and low grade fever a day or so later.  The benefits of receiving the vaccine far outweigh these minor and rare ill effects which can be treated with an ice pack to the injection site and some acetaminophen.  Please call your doctor to set up an appointment for a flu vaccine.

For those individuals who catch the flu we still have several antiviral agents available to treat the illness. These agents should decrease the intensity or severity and duration of the flu. We try to use these medicines as infrequently as possible because the flu can develop resistance to them over time.

Prevention of disease is an ever increasing component of our everyday language. Vaccination against an infectious disease such as flu or influenza is clearly one of the more effective preventive strategies physicians have available to offer patients.  While you are making arrangements to receive your flu shot inquire about several other effective adult vaccines including Pneumovax to prevent bacterial pneumonia, Zostavax to prevent shingles and post herpetic neuralgia and Tdap to prevent whooping cough or pertussis and tetanus.

United States Preventive Care Can Be Better, Center for Disease Control Says

Ralph Coates, PhD of the Center for Disease Control (CDC) described in the June 15, 2012 issue of Morbidity and Mortality Weekly Report that by looking back at a U.S. study done between 2007-2010 called “Use of Selected Clinical Preventive Services among Adults,” health providers need to do a more comprehensive job of offering preventive services.

According to the report, only 47% of patients with documented heart and vascular disease were given a recommendation to use aspirin for prevention. They additionally found that only 44% had their blood pressure under control. When looking at cholesterol and lipid control only 33% of the men and 26% of the women were tested with a blood lipid test in the last five years.  Of those patients who did measure their lipid levels, only 32% of the men and women surveyed had their lipids under control. Among diabetics, 13% had poor sugar control with a HgbA1C > 9 (goal is 6-8).

The data indicate that at 37% of the visits, patients weren’t asked about their smoking or tobacco status.  When patients were asked, and answered that they were smoking, only 21% were given smoking cessation counseling and only 7.6 % were prescribed medications or a way to stop smoking.

Screening for cancer needs improvement as well. Twenty percent of women between the ages of 50-74 had not had a mammogram in over two years.  In the same age group, a third of the patients were not current on screening for colon and rectal cancer.

The data was collected prior to the passage of the controversial Affordable Care Act. When the data was analyzed and divided according to socioeconomic status, education level, and health insurance status; it was clear that the poorest and least educated had the fewest screenings. It is hoped that with passage of the new health care law, and new insight by health insurers that it is cheaper to prevent a disease than treat it, these numbers will improve.

There are several other factors that need to be looked at as well. Data is now being collected from electronic medical health records.

I ask my patients about tobacco status on every patient visit.  When I note that the patient is smoking in their electronic health record, there are three or four ways to document counseling has been offered. Only one of them triggers the audit data for the government to review. Our software instructors were unaware of that when they taught us to use the system.  How much of this study is the result of data collection error is unknown.  “Health care providers” – not just physicians, are now delivering health care.

Access to physicians and a shortage of primary care physicians exacerbate the problem. It takes time to extract this information, record it, and counsel the patient. Because PCPs are underpaid, they will continue to see patients in high volumes to cover their expenses, causing the use of comprehensive preventative questioning to remain low.

Sunburn, Sunscreen and How to Avoid Damaging Ultraviolet (UV ) Light

Summer has arrived and individuals are outside trying to obtain the perfect tan.  Exposing yourself to the sun allows your skin to be exposed to ultraviolet light. We are most concerned about ultraviolet light in UV-A spectrum (320-400 nm) and the UV-B spectrum (290-320).  UV-A rays penetrate deeply and cause skin damage including photoaging of the skin, immunosuppression both locally on the skin and systemically and increased risk of cancer and infection. It is the UVB radiation that causes tanning.  The delayed tanning that occurs 3 days after exposure is due primarily to UV-B radiation and is due to a redistribution of melanocytes and new melanin synthesis and formation. This delayed tanning is at best mildly protective against sunburn SPF 2-3 but has no effect on protecting against cancer or photoaging.

Sunscreens can help reduce your risk of developing skin damage and cancer.  Sunscreens are either inorganic containing products that physically shield and block the effects of ultraviolet rays or organic compounds that physically absorb the ultraviolet rays. You should be looking for a sunscreen that is “broad spectrum” protecting against UV-A and UV-B rays.  You want a sunscreen that is substantive.  “Water resistant” products protect up to 40 minutes after water immersion.  “Very water resistant” products protect up to 80 minutes after water immersion.  Data and research shows that a broad spectrum sunscreen with SPF 17 or greater will provide protection against squamous cell carcinomas and photoaging but are less effective in preventing basal cell cancers and melanomas.

It is recommended that we use sunscreen daily on all sun exposed skin. The clouds only scatter UV-B Rays so on cloudy days you are being bombarded with UV-A rays despite it appearing to be overcast.  It will require about a shot glass worth of sunscreen to protect the most sun exposed areas (two tablespoons) which are the face, ears, hands, arms and lips. You should be using an SPF of at least 30 which should be applied 15-30 minutes BEFORE sun exposure.  It should be reapplied every two hours and after swimming or heavy perspiration.

  • Remember that the sun’s rays are strongest between 10 a.m. and 4:00 p.m.
  • Water, sand and, in the winter, even snow reflect UV radiation so be extra careful in those environments.
  • Wear protective clothing such as closely woven, natural fiber, long sleeve shirts and pants, sunglasses and wide brimmed hats.
  • Do not use tanning beds.
  • Do not expect sunscreens to allow you to spend more time in the sun. Long exposure to the sun’s damaging UV rays increases your risk of skin cancer and photoaging.

Summer means longer days and more time spent outside. Be prepared and protect your skin from damage and injury.

Cervical Cancer Screening Guidelines – Role of HPV Testing

The American Cancer Society says women over 30 years old who have had three normal Pap smear test results in a row can get screened every 2-3 years rather than annually. They can be screened with a conventional Pap smear test or a liquid based Pap test or the HPV (Human Papilloma Virus) test.

A recent study at Kaiser Permanente Northern California from 2003 through 2005 suggested that HPV (Human Papilloma Virus) testing may be more accurate than Pap smears. Their analysis showed that:

>  For all women with a normal Pap smear test there were 7.5 cervical cancers detected per 100,000 woman/ years.

>  For all women who were HPV-negative the rate was 3.8 cervical cancers per woman/years.

>  For women who were both HPV-negative with normal Pap smears the rate was 3.2 cervical cancers per 100,000 woman /years.

Hormuzd Katki, PhD, of the National Cancer Institute in Bethesda, Maryland recognized the increased accuracy of HPV testing over Pap testing but encouraged co-testing.

“ Most women still undergo annual screening out of habit” according to Brent DuBeshter, M.D. of the University of Rochester Medical Center in Rochester NY. Even stranger is the case of women post hysterectomy with no cervix continuing to see their gynecologists on an annual basis for pap testing?

The recommendation for annual pap smears had been present for so many years that many doctors and patients aren’t “comfortable with the new guidelines that call for screening every three years in those at low risk for cervical cancer” according to DuBeshter.  “Many providers have a hard time changing habitual practice and adopting new evidence and practice guidelines,” says Ranit Mishori, M.D. of Georgetown University School of Medicine.

What is clear is that screening every three years in low risk patients works. What will need to be determined is the evidence based role of HPV testing in conjunction with, or as a replacement for, Pap smears.