In-Flu-End-za?

We're seeing a lot of flu "A" in my emergency department. The local university, my grad-school alma mater notes that despite the having the greatest number of students vaccinated this flu season, they also have the greatest number of students on campus who have been diagnosed with flu. So what happened? Vaccine mismatch - that's what.

Each year in February experts meet under the authority of the Food and Drug Administration to decide what flu strains will be included in the vaccine for the following flu season. They try to predict which virus strains will be the most likely to spread in the following year.

Flu season begins in the Far East and this data is used to help predict what will strike the US, but like all medicine, this prediction is partly scince and partly art (a guess based on knowledge). Most years the prediction is fairly accurate, but this year the experts and the manufacturers didn't so so well. Last winter they recommended a certain strain of flu "A" be included in this year's vaccine, but the manufacturers weren't able to find samples that would grow properly in the production process.

Unfortunately for those of us out here on the front lines, this missing strain of flu "A" is the most prevalent one we're seeng this year, accounting for about 60% of all the cases of flu, and next year's production may not be any better. For the first time ever the expert panel has recommended a complete change of next year's vaccine. Each year the vaccine is "travalent," meaning that it is made up of the three currently most common strains of flu; manufacturers have been asked to completely overhaul next year's vaccine, which may make production difficult. It may help that two of the three newly recommended strains were included in the 2007 vaccine for the Southern hemisphere, making it possible that manufacturers will have a bit of a "jump start" on the new production plans.

Let's hope they're right! This year's vaccine is about 85% effective at preventing illness in young, healthly individuals, despite my alma mater's experience. Unfortunately college students aren't really my biggest concern; it's the elderly, the very young, and the chronically compromised that I have to worry about, and this year the vaccine has let them down. Let's hope we get it right in 2008-09.

Wash your hands and stay well! Laurie

Related Topics:

• WebMD Video: Fighting the Flu
• The Flu and You - Urgent Response Guide

Technorati Tags: flu, vaccine, influenza A

How's Your Blood Pressure?

How's your blood pressure? Are you at "goal?" Controlling blood pressure is critical to one's cardiovascular health. It is a well-established fact that when a person has uncontrolled hypertension (blood pressure or B/P) there is a significant increase in the risk of heart attack and stroke. Yet despite this well-known fact, the rate of good B/P control has reached a plateau in men in the US, and rates of uncontrolled hypertension in women are actually rising!

In Washington, DC and many southern states one in four women has high blood pressure that isn't well controlled, a deplorable fact given how much we know about blood pressure management, how many inexpensive medications we have available to us, and how many options there are to health care providers to refer their patients to dietitians and exercise programs such as cardiac rehabilitation to learn the lifestyle changes that will lower blood pressure!

In the study that documented these trends, which appears in the February 11th edition of Circulation, study author Dr Majid Ezzati (Harvard University, Boston, MA) notes that while some states are doing better than others with blood pressure control, the trend is consistent: Men are not gaining any better control and women's blood pressures are actually worsening overall.

Dr. Ezzati speculated that some of the contributing factors may be the obesity epidemic, which is hitting women harder than men, and the fact that women are less likely to have access to good health care. Dr. Ezzati also suggests that health care providers may have become complacent about measuring B/P at office visits and addressing numbers that are out of range.

He notes that providers can be reluctant to add medications to the patient's regimens and that they often don't address lifestyle changes. I know that I often hear from my colleagues that they don't have time to address lifestyle changes in a short office visit or that they don't bother, because they don't believe that patients are likely to make behavioral changes. I don't buy that though, as there is evidence that that when a health care provider takes the time to address a needed behavioral change and links that need to the patient's current health status, the patient is more likely to make that change. As an example, I am more likely to get someone to consider stopping smoking if I say to them, "Your chest x-ray shows evidence of damage to your lungs from your years of smoking. You should talk to your health care provider about how s/he can help you to quit smoking." I do this all the time in the ED, and I said something similar to people when they were under my care as a primary care provider.

One of Dr. Ezzati's theories may have been upheld in another recent study, which suggests that both gaining a patient's agreement to follow a medication plan and increased medication prescriptions are needed in order to control B/P. In a study designed to examine barriers to blood pressure control over time, lead investigator Dr Michael Ho (Denver Veterans Affairs Medical Center, CO) reported that although it is important to increase therapy by adding medications, it also matters whether or not a person is actually taking their medications as they are prescribed.

The study looked at 10,000 individuals with hypertension and cardiovascular disease in a managed care setting. The results indicated that approximately 1/3 of patients in the group with consistently elevated B/P did not have either an increase in the dose of their current medication or additional medications added. Another third of the patients had medication changes made by their health care provider, but did not take them as prescribed. Dr. Ho emphasizes that communication between the prescriber and patients is critical to improving outcomes. He notes, "Doctors all want to bring blood-pressure levels under control, but sometimes intensifying therapy might not be the right approach. The correct response might be to simply get the patient to take the medication."

I could not agree more and I have to point out that the best health care providers are those who encourage communication between themselves and their patients, by knowing what questions to ask and how to ask them in order to find out if the medications are being taken correctly. These include, but may not be limited to:

1. "How often do you forget to take your medications?"


2. "Are you able to afford the medications that have been prescribed for you?"


3. "Do you have any trouble taking your medications the way they are supposed to be taken?"

These questions assume that sometimes we forget to take our medications and that it's ok, and gives one an opportunity to strategize with the person to find memory aides that will help them remember to take their medications. It also gets to the root of potential financial problems with obtaining meds and allows the provider to seek out less expensive alternatives to current prescriptions.

Finally, these questions allow for any other concerns the patient has to be brought to light, for example how to schedule medications safely. I once had a patient reveal to me that she'd been getting up in the middle of the night to maintain the medication schedule given to her in the hospital, when she could have easily adjusted her medications schedule to her usual daily home routine. She would not have done that for long, I can assure you! She would also have stopped taking the medication before she would have admitted to me that she wasn't willing to get up in the night, assuming that I'd think less of her because she didn't make her medication-taking a priority. So it pays to ask, and in an inviting manner if you want to hear the truth.

Take care, Laurie


Related Topics:

• Your Healthy Heart: Women's Guide


• 10 Ways to Control Your Blood Pressure

Technorati Tags: hypertension, heart disease, heart health, blood pressure, obesity

Romance is Good for Your Heart

My plans for bi-weekly posts went out the window this past week due to a family member's surgery. It was elective, but things never go quite as planned, do they? As the token member of the health care community in my family I spent some time at the hospital, and gladly, but that meant I didn't post as planned. Things are going great there now, and I hope to return to my posting plan. I am even going to try to get ahead, so that there will be posts to go up while I'm away on vacation in a few weeks. We'll see how that goes; sometimes I'm a crazy person thinking that I can accomplish all the things on my list!

Thursday is Valentine's Day of course. Here are a couple of interesting valentine facts: the US Greeting Card Association reports that nearly 1 billion greeting cards are sent in the world for Valentine's Day; this makes the holiday second only to Christmas in terms of cards sent. They also estimate that 85% if these cards are sent by women; no surprise there I think!

Although Valentine's Day was originally acknowledged as a celebratory holiday for various early Christian martyrs named Valentine, the first written association with romance appears to be a poem written in 1382 by Chaucer (The Canterbury Tales), called the Parlement of Foules. It was written to honor the first anniversary of the engagement of King Richard II to Anne of Bohemia ,who were married at age 14.

Here at Web MD there is a great article about the benefits of chocolate for your health that will make it that much easier to indulge your sweet tooth this week. I didn't know that it's botanical name, Theobroma cacao, translates to "food of the Gods." For those of you thinking about a little romantic interlude with your Valentine it might be a good idea to eat a little dark chocolate together. It contains the chemicals phenylethylamine and serotonin, which are thought to be mood boosters and mild sexual stimulants.

Planning a Valentine's Day meal for your loved one? Think about your menu carefully and you could make it romantic and heart-healthy! How about starting with a glass of red wine (130 calories, 5 grams of carbs)? It's flavonoids have an antioxidant effect in the body, may raise HDL ("good") cholesterol levels and may help prevent blood clotting in vessels.

For appetizers, try a seafood item, such as shrimp cocktail: three ounces have only 130 calories, 1 gram of fat, and 12 grams of carbohydrate. But here's the good part, it's a low-fat, high-protein treat that contains lots of zinc and mood-brightening, heart-healthy omega-3 fatty acids. Avoid frying your seafood appetizer, which really increases the calories and heart-unhealthy fat. For your main course, try broiled salmon with steamed vegetables (about 590 kcal, 40 g fat, 5 g carbs). Choose colorful vegetables that are high in flavenoids, which boost immunity and heart health. The protein in this meal choice can also increase the production of dopamine, a mood enhancer that will make you feel good.

For desert try chocolate-dipped strawberries: 6 berries contain 180 kcal (that's only 90 for each of you), 9 g fat, and 24 g carbs. Strawberries contain anthocyanins, which are chemicals that improve blood flow to the body, so of course that's good for your heart!

While planning that romantic dinner for two, keep in mind that just being in love can improve your health. Various investigations have shown that loving relationships can help prevent plaque build-up in the arteries and protect against cardiovascular disease, boost the body's disease-fighting antibody levels, reduce levels of stress hormones, and lengthen our lives. All good reasons to treat that special loved one to a special Valentine's Day treat!

Happy, Heart-healthy Valentine's Day to all! Laurie

Related Topics:

• Modern Life Takes a Toll On Our Hearts
• WebMD Videos: Modern Love

Technorati Tags: Valentines, heart health, diet, nutrition, love, chocolate

A Vote for Health

Among the current headlines at WebMD is space dedicated to the US Presidential candidates and their positions on health care. Please read this and anything else that you can find about this topic. Then please, vote - vote with you mind, heart, and information! Health care is a critical issue to this election and although I won't try to unduly influence you, here a few thoughts from someone who lives in the system every day, trying to do my absolute best to take care of you and your loved ones.

The US health care system is a bit broken, but it's not a total disaster. There are lots of really great health care providers - docs, NP's (nurse practitioners) and PA's (physician's assistants) - out there working really hard, but there aren't enough of us. Putting restrictions on the reimbursement and ability to practice of advanced practitioners such as NP's and PA's just further handicaps the system, especially in rural areas.

There are great, good, not-so-good, and really bad health care providers in all walks, be it MD, NP, or PA. People should be scrutinized on an individual basis for poor outcomes, not on the basis of their degrees and initials. There is enough work for all of us, and given the declining enrollment in schools for all primary care professions (but especially medical doctors) and the increasing numbers of "boomers" in the system, the country is going to need all of us that it can get!

An emphasis on prevention and wellness promotion is a very good thing. Many candidates SAY they endorse this. My apologies in advance to all of you who are struggling with your weight, or smoking cessation, or addiction, but the system has to stop coddling these behaviors. We need an insurance system that provides people with the support, tools, educational resources, and incentives to improve their health.

We need a system that helps people to find someone to take care of them as a primary care provider and discourages use of the ER for every little sniffle and sprain. By discourage I really mean penalize for misuse and abuse. But first we need to make options for them to do otherwise readily available. In my opinion we have to stop paying for visits to the ER like I see every day, in which an individual says to me, "I have an appointment with my doctor later today/tomorrow/2 days from now, but I just couldn't wait any longer for this stubbed toe/sore neck/ankle sprain/cough I've already had for 2 weeks" (or insert your favorite simple problem here).

We need to give incentives to companies to pay for employee wellness programs and to include adequate breaks in their day for exercise. There are any number of research studies that demonstrate increased worker productivity on the job and improved overall health when they are given the opportunity for a 20-30 minute exercise break or organized stretching session during the work day. So what if companies lose an additional 1/2 hour of work time if the time that is actually spent working is more effective?

Insurers need to provide adequate incomes through reimbursement to health care providers for both sick care and "well" visits in which people are taught to control their diabetes, cholesterol, or diet, or make a quit smoking plan. Health care providers who make the effort to become certified as specialty educators, (certified diabetes educators are one example) and maintain that certification through continuing education, should not have to fight to be reimbursed for providing diabetes education to patients. When a person with diabetes learns enough strategies and effectively applies them to reduce their overall blood sugar readings to a certain degree they decrease their risk of developing heart disease by 25-35% Tell me that doesn't save money!

Finally, we need to find a way to control malpractice claims. There is a role for personal responsibility in health care, and I shouldn't have to look over my shoulder every minute worrying about whether or not an individual is going to follow my instructions and return to see me in the office or the ER if something in their condition changes.

Your vote is an opportunity to influence the country's progress for the next four years. The ability of our country's health care system to improve health outcomes and controlling costs is critical to the health of hundreds of thousands of baby boomers who are coming of age. Please consider your vote thoughtfully.

Take care,

Laurie

Related Topics:

• Health Care Reform
• Universal Health Care Coverage

Technorati Tags: vote, health care, election, candidates, health and wellness, health insurance