Each month,
Goodall Hospital provides information on a timely health
topic in its Healthbeat column that appears in local
newspapers. This page will be updated each month to
provide you with an archive of these articles.
This
information is not intended to be a substitute for
professional medical advice and we recommend that you
consult your healthcare provider with any questions or
concerns you may have regarding information in these
articles or your current medical condition.
Articles by
Topic:
Bell's Palsy -
Usually Short-Lived
Most
patients feel extreme distress when they experience the
symptoms of Bell's palsy. Over a couple of hours or a
couple of days, the facial muscles on one side become
progressively weaker and that side of the face begins to
droop. The initial sign may be an ache behind the ear on
the affected side and an exaggerated sensitivity to sound.
By the time Bell's palsy has taken its course, the person
may be unable to perform simple functions such as smiling,
frowning or blinking an eye. Craig thought he was having a
stroke and went to the emergency room-a wise move because
a stroke often presents with similar symptoms. Actually, a
doctor diagnoses Bell's palsy by ruling out other causes
of partial facial paralysis, such as a stroke, multiple
sclerosis, a tumor of the inner or middle ear, a skull
fracture, an ear infection or shingles. Most of these
illnesses have additional symptoms and more severe
consequences, so prompt medical attention is crucial.
Bell's palsy affects only one side of the face and, unlike
stroke, does not include central nervous system symptoms
such as weakness or lack of coordination in other parts of
the body. Even though a stroke is far more threatening,
Bell's palsy usually has a more exaggerated paralysis on
the affected side of the face. A diagnosis of Bell's palsy
may actually be greeted with relief because in most cases
the partial facial paralysis will resolve itself in a few
weeks. Bell's palsy affects roughly 50,000 Americans each
year, with the greatest prevalence among persons 15 to 44
years of age.
Pregnant Women at Risk
Sir
Charles Bell, the Scottish surgeon who identified the
disorder in 1830, observed that it was more prevalent
among pregnant women. Subsequent studies have confirmed
that pregnant women are three times more likely than
non-pregnant women to get Bell's palsy, and the risk is
greatest during the third trimester or immediately
following childbirth. Persons with diabetes, hypertension,
the flu or a cold also seem to have a higher than average
vulnerability. Overall, however, prevalence is about the
same among men and women, and the paralysis occurs equally
often on both sides of the face. Loss of control over
facial muscles occurs when the facial nerve becomes
swollen and then compressed by the bony canal through
which it passes so that it can no longer transmit impulses
from the brain to the facial muscles. The reason for the
sudden swelling is unknown. At one time, doctors believed
it was associated with fluid retention or hypertension.
Other theories link the swelling to a viral infection or
inflammation. Recent evidence suggests it may be
associated with the herpes simplex virus (HSV), which also
causes cold sores and fever blisters. Although not
life-threatening, Bell's palsy can create substantial
suffering. When the eye on the affected side does not
close, it must be protected against dust, debris and
excessive dryness. Eye lubricants, ointments and
artificial tears are sometimes recommended along with an
eye patch or protective tape at night. Among persons
suffering only partial paralysis, 90 percent recover full
function of facial muscles within three to six weeks, and
most of the rest recover by the end of six months. In the
meantime, most patients are unable to talk, eat or smile
normally and may lose taste sensations on one side Persons
who suffer full paralysis don't fare as well. A little
over half recover full function of their facial muscles
and another 20 to 30 percent get partial recovery, often
with some involuntary facial movements persisting
indefinitely. About 10 to 20 percent never get better. For
them, the only options involve plastic surgery, although
physical therapy may be helpful in retraining facial
muscles and providing social support.
What Can Be Done?
At
this time, there is nothing that can be done to prevent
Bell's palsy, and there is no treatment that has been
proven effective. Most doctors prescribe a steroid such as
prednisone and sometimes an antiviral medication such as
acyclovir in an effort to quickly reduce the swelling of
the facial nerve. A recent review of randomized controlled
trials found no strong evidence that steroids provided any
long-term benefit, although one study indicated some
effectiveness from the combination of acyclovir and
prednisone. These medications are generally safe although
pregnant women are advised to avoid steroids. Surgery has
been used in the past in an effort to relieve compression
of the facial nerve. It's rarely performed today except
for severe cases since the procedure carries a risk of
damaging other nerves while offering no guarantee of
recovery. In most cases, treatment consists of watchful
waiting, with frequent examinations to track recovery.
Generally, the sooner recovery begins, the less risk there
is of residual after effects. And usually, improvement
begins within two to three weeks.
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New Options for Back Surgery
As
most of us who have suffered lower back pain know, it only
hurts when you stand, or sit, or breathe. The back is an
intricate array of stacked bones encasing the delicate
spinal cord, all supported by muscles and ligaments.
Misalignment, a tear, sprain or other damage to any part
of this complex architecture can result in severe pain and
mobility problems. Wired for signal transmission, the back
is extraordinarily good at delivering any message
involving the word pain. Back pain strikes 80 percent of
all adults at some time in life. The causes are many, from
a muscle strain to a herniated disc or nerve entrapment.
Some back pain will resolve within a few days with a
little care; in other cases, pain can persist for months
and years. Unresolved pain prompts half a million
Americans to undergo back surgery every year. This number
continues to rise, despite the fact that outcomes for back
procedures are often less certain than for many other
types of surgery. Options are improving, thanks to new
surgical techniques such as thermal catheter therapy for
discs and spinal endoscopy. New technology, including
spine cages, are also cause for hope. Some new methods
offer less invasive surgery with shorter recovery times.
Time Is on Your Side
In
almost all cases, the early treatment of low back pain
should be conservative. Nonspecific strains and sprains
account for 70 percent of patients who see their doctor
with lower back pain. Ninety percent of them will recover
within two weeks by simply following their doctor's
instructions. A smaller percentage of lower back problems
involve herniated discs, a very painful condition. Even
here, patients tend to improve with time. Only about 10
percent of those with herniated discs are still in so much
pain after six weeks that surgery is considered. Early
conservative treatment includes determining the source and
cause of the pain. An obvious first step is to avoid
re-injuring the back. Ice packs applied for 15 to 20
minutes five or six times per day for the first 24 hours
usually help relieve inflammation. After that, heat can be
alternated with ice. Although it hurts to move, back
experts recommend staying mobile if possible. Prolonged
inactivity creates muscle weakness. Talk to your doctor
about what works best for your specific diagnosis. Pain
medication and muscle relaxants are usually the focus of
treatment in the early stages. Acetaminophen or
nonsteroidal antiinflammatory drugs (NSAIDs) are usually
prescribed first to treat pain. If these aren't adequate,
your physician may prescribe a stronger drug such as
codeine. When conservative treatment has been followed for
six weeks with little improvement, a patient may be
considered for surgery. More than 650,000 back surgeries
are now performed annually; at least one third involve
disc surgery. Back surgery continues to evolve but, as
with any innovation, it often takes years before studies
can give clear comparisons of new procedures with
traditional techniques and overall success rates. IDET (Intradiscal
Electrothermal Therapy). This is a relatively new therapy
to treat back pain caused by tears or small herniations in
a lumbar disc. IDET is scalpel-free surgery performed
under local anesthetia and may be used as an alternative
to more traditional surgery involving fusion of the spine.
It involves puncturing the skin with a needle and
threading a thermal catheter into the disc, then heating
the tissue inside the disc. The heat is believed to work
by causing the collagen fibers that make up the disc wall
to contract and thicken, closing tears and cracks. Tiny
nerve endings may also be desensitized by the heat. When
pain is strictly limited to a disc problem, IDET appears
to help about 70 percent of patients, decreasing their
pain by about half. It brings complete pain relief to
about 20 percent of patients. Endoscopic Spinal Surgery
offers another minimally invasive alternative to
traditional surgery. Arthroscopic joint surgery has become
standard for many knee and shoulder procedures in recent
decades. Proponents hope that endoscopic spinal surgery
will become more common in the future as more surgeons are
trained in the technique. The surgeon passes instruments
and a scope through small incisions, allowing access to
difficult to reach areas in the spine with a minimum of
damage to surrounding tissues. Endoscopy may also make it
possible to pinpoint and treat back problems more
precisely. Spinal cages were approved by the Food and Drug
Administration in 1997 as alternative equipment for use in
surgical spine fixation. Traditional spine fixation
surgery uses bone screws, plates and rods to support the
spine after the cartilage discs between vertebrae have
degenerated seriously enough that the spine has become
unstable. Spine cages are alternative hardware. They are
actually hollow titanium screws packed with bone, usually
taken from the patient's own femur. Pairs of cages are
inserted between the patient's vertebrae, stabilizing the
spine and relieving pressure on nerves. The cage is
designed to promote fusion of the spine and ultimately
provide relief of pain. One study evaluating spine cages
found good or excellent outcomes for more than two thirds
of subjects-both spine cage patients and patients
receiving the traditional rods and screws. New therapies
and technologies continue to emerge to help those with
long-term pain. The rest of us can take comfort in the
knowledge that when back pain strikes, it will probably
resolve with your doctor's care and a little patience.
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Cataracts - Removing the
Haze
The
first signs may be a fogging of vision, changes in color
perception, or a sensitivity to glare which makes night
driving difficult. A cataract may develop gradually over a
number of years - barely noticeable at first but
eventually leading to a substantial impairment of vision.
Cataracts are the leading cause of blindness worldwide,
but those who detect symptoms early have little to fear.
Cataracts are easily diagnosed by eye specialists, and
surgical treatment is nearly always effective. A cataract
is a cloudy or opaque formation in the normally
transparent lens of the eye. The lens, which helps focus
light on the retina at the back of the eye, is made up of
approximately 35 percent protein and 65 percent water. As
people age, changes in the lens proteins occur. A cataract
is formed when these proteins condense, scattering light
and producing an opacity that can impair vision. Cataracts
can occur on any part of the lens. How much vision is
impaired depends largely on the location and density of
the cataract. The greatest vision impairment is caused by
cataracts formed on the nucleus, the area directly behind
the pupil. Cataracts become increasingly more common with
age. Between the ages of 52 and 64, the likelihood of
developing a cataract is 50 percent, while an estimated 70
percent of people over 70 are affected. Age-related
cataracts usually occur in both eyes. Cataracts can also
occur following trauma to the eye, or as a result of other
health problems such as diabetes. Congenital cataracts
occur very rarely in newborns, often the result of a
disease or infection in the mother during pregnancy. In
addition to blurry, filmy or fuzzy vision and changes in
color and night vision, cataracts are characterized by a
decreased ability to distinguish between light and dark.
Studies have shown drivers with cataracts to be at much
higher risk for car crashes. Other symptoms include poor
central vision, a frequent need for changed eyeglass
prescriptions, poor vision in sunlight and improvement in
near vision coupled with a decrease in distance vision.
Surgery Is Major Option
Cataracts that cause only minor or no visual changes may
require no treatment but should be monitored regularly at
scheduled visits to an ophthalmologist or optometrist. For
those whose quality of day-to-day life is compromised by
cataracts, however, surgery is the only option. Cataract
surgery is the most frequently performed surgical
procedure in the United States. It is also one of the
world's oldest procedures, introduced to Europe from India
by Alexander the Great. Over 85 percent of all cataract
surgeries performed in the United States and the United
Kingdom today are done by phacoemulsification, or
ultrasonic cataract removal. Ultrasound vibration is used
to fragment the nucleus, which is then aspirated through a
very small incision. This procedure takes only 15 minutes;
visual rehabilitation takes one to three weeks.
Sight-threatening complications are rare. At the time of
cataract surgery, an artificial replacement lens is
usually inserted. These plastic lenses, called intraocular
lenses, are now available in folding designs to
accommodate the small incision made in phacoemulsification.
When intraocular lenses are not inserted, contact lenses
and cataract glasses are typically prescribed. After
cataract surgery, cloudiness can develop on the back part
of the lens capsule, causing the blurry vision to return.
This is known medically as posterior capsule opacification,
or an after-cataract. This can be treated by a quick, safe
and painless outpatient procedure called YAG capsulotomy.
Using a YAG laser, a small hole is created in the back
wall of the capsule.
Can
Cataracts Be Prevented?
Many
factors contribute to cataract development. Recent studies
have suggested that genetic makeup puts some people at a
higher risk. While there is very little one can do to
change her genes or reverse the effects of time, there are
several ways to reduce the risk of cataract development.
Recent studies show that the relative risk of cataracts
for smokers is more than one and one-half times that of
never-smokers. And, if you needed another reason to quit,
the same study showed that smoking cessation considerably
reduces the risk. For former smokers, the relative risk of
cataract decreases with time. Exposure to ultraviolet B
rays (also linked to sunburn and skin cancer) increases
the risk of cataracts. When out in the sun, it is
important to protect your eyes with a wide-brimmed hat and
sunglasses. Sunglasses approved by the American National
Standard Institute block 95 percent of UVB rays.
Uncontrolled diabetes can lead to cataracts as well as
other eye problems. Diabetics can reduce the risk of
cataracts by keeping their blood sugar under control.
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Staying Cool About Burn Injuries
A
grease fire starts in your oven, and before you can get it
under control, you have singed eyebrows and burned your
hands and arms. Or perhaps your toddler pulls on the
tablecloth and brings a pot of hot coffee down on his face
and body. A burn injury nearly always conjures up images
of catastrophe. Burns are the third leading cause of
accidental death in the United States, in addition to
causing substantial disfigurement and disability. Of the
more than two million burns requiring medical care each
year, however, more than 95 percent can be successfully
managed through outpatient treatment. Minor burns are
common- touching a hot object on the stove or falling
asleep in the sun. While they're painful, they can nearly
always be managed with a few days of self care. Burn
emergencies, like the two described above, require a
level-headed response and prompt medical attention.
Whether it's you or someone else suffering the burn, the
important thing is to stay cool. The first task is to get
the person free of the source of injury, taking care of
course to keep yourself out of danger. When a person's
clothes are flaming, the instinct usually is to run. The
real way to extinguish the flame is to throw a blanket
over the person or to practice the 'stop, drop and roll'
technique. Once the fire is out, clothing that is
smoldering or still wet from boiling water should be
removed, along with jewelry such as watches or rings,
since they could impede circulation when the injured
tissue begins to swell. Any clothing that sticks to the
skin should be left for medical personnel to remove. The
next step is to cool the burned area, in most cases with
cool water or cool compresses. Avoid ice, however, since
it can cause additional damage to tissue. And if burns are
extensive or severe, you have to be careful not to induce
hypothermia. Burns involving chemicals or electricity
require special care. If the person is still touching an
electrical source, the current can pass through his body
to electrocute you, so make sure the power is shut off
before you act. Chemicals should be washed or gently
brushed away before you do anything else. Then the skin
exposed to chemicals should be irrigated with large
amounts of water for at least 20 minutes. If burns require
emergency medical attention, there may be other possible
problems such as shock, inhalation injuries, carbon
monoxide poisoning or broken bones. Don't move the person
if there is any chance of a neck or spine injury.
Classification of Burns
The
classification of burns using first, second and third
degree is being replaced by four categories:
1. A
superficial burn, including most sunburns or brief contact
with a hot object such as an oven rack, involves damage to
only the outer layer of skin, known as the epidermis.
Although these burns can be swollen, red and painful, they
normally heal without scarring in about a week, requiring
only moisturizing agents and painkillers.
2. A
superficial partial thickness burn involves both the
epidermis and the layer of skin underneath, the dermis.
Like a superficial burn, the wound will blanch briefly
when pressure is applied, but this kind of injury usually
leads to painful blistering and weeping. Typically caused
by scalds or by brief contact with hot objects, these
burns usually heal without scarring within two to three
weeks.
3. A
deep partial thickness burn extends to the deeper layers
of the dermis and may appear dry, pale or whitish yellow
rather than blistered. Depending on their location, these
burns often require skin grafting.
4. A
full-thickness burn, formerly known as third degree,
involves damage to the entire upper and lower layers of
skin plus the underlying tissues. These are usually
painless at first because nerve endings have been
destroyed, and they appear dry, leathery and pearly white,
yellow or charred. These wounds will not heal and
generally require surgical intervention with skin grafts.
The
vast majority of burn injuries are superficial and respond
to self treatment-soaking in cool water plus application
of an antibiotic ointment or a skin care product such as
aloe vera if the burn is weeping. If necessary, a dry
gauze bandage can be used to protect the burned area.
Within a few days, the skin over the burn will peel off,
and healing will take care of itself. Any deep partial
thickness or full-thickness burn probably requires a
doctor's attention, if for no other reason than to monitor
against infection or other complications. Severe and
extensive burns affect every organ system in the body and
require specialized care at a burn center.
Advances in Treatment
Persons
suffering severe burns benefit from dramatic advances in
treatment over recent years. As recently as 10 years ago,
doctors usually scrubbed and cleaned the wound and waited
for spontaneous healing. This led to many deaths from
infection. Today, dead tissue is removed surgically or
with lasers right away, creating a clean, open wound for
skin grafting. The best results come from grafts taken
from the patient's own body, but when large areas of the
body are burned, the availability of donor sites becomes a
problem. Doctors have begun to successfully use cadaver
grafts from skin banks as well as a number of skin
replacement products, each of which has its unique
properties and advantages. Using a team approach, a burn
center offers a comprehensive program of physical therapy
and rehabilitation, focusing on physical, emotional and
psychological effects of the burn trauma. Three decades
ago, a person suffering burns over 40 percent of his or
her body surface was almost certain to die. Today, half of
individuals survive, even after suffering an 80 percent
burn.
HEALTHWIRE - JANUARY, 2002
"BURNS-WHEN TO SEEK TREATMENT"
CONTACT: FRED MCTAGGART, Ph.D.
(616)
344-1946
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New Therapies Target Brain Tumors
Brain
tumors are among the most difficult of cancers to treat.
Hidden within the skull and protected by the brain barrier
that prevents toxins, including chemotherapy, from
reaching delicate brain tissues, the brain is less
accessible and less amenable to treatment than other
organs. Improvements in imaging techniques that allow us
literally to look inside the brain are leading to earlier
detection and diagnosis of tumors. Radical new approaches
to treatment, as well as refinements in more traditional
therapies, are lengthening survival time for some brain
tumor patients and offer hope for more effective treatment
options in the future. Not all brain tumors are alike.
Some are essentially benign and if removed may never
return. Others are aggressive and highly malignant and
usually return in the months following surgery. Tumors are
normally classified according to cell type. Physicians
generally prefer to talk about them as secondary tumors,
which often have a very good prognosis, and malignant
primary tumors that tend to have a poor outcome. Tumors of
the brain and spinal cord can occur at any age, and no
specific cause has been identified. They are most common
in adults over age 50 and in children. Brain and spinal
cord tumors are the second most common form of cancer in
children, accounting for about one fifth of all childhood
cancers. Generally, children with brain tumors fare better
than adults. According to the American Brain Tumor
Association, 180,000 people were diagnosed with brain
tumors in 2001. Of that number, more than 16,000 were
diagnosed with a malignant primary brain tumor, the most
serious kind. The most common malignant brain tumors,
glioblastoma multiforme and anaplastic astrocytoma have a
poor prognosis because they tend to recur despite
treatment. A great deal of research is focused on these
types in an effort to improve outcomes.
High-Tech Helpers
Sophisticated noninvasive imaging techniques that allow
doctors to look inside the brain include PET scans and
magnetic resonance imaging (MRI). An MRI can detect and
pinpoint the position of a tumor, providing a three
dimensional image of the mass. An accurate picture of the
tumor makes it possible to target surgery and follow-up
radiation to highly specific areas. Surgery to remove a
brain tumor is the initial standard treatment.
Unfortunately it's never possible to remove the entire
tumor. Surgery to remove a breast lump takes out the lump
plus a margin of healthy tissue surrounding the lump to
ensure that all the cancerous cells are removed. Taking a
margin of healthy brain tissue would destroy healthy brain
cells with unacceptable results for the patient. Surgery
is then followed by radiation or sometimes chemotherapy to
try to eradicate the remaining tumor cells. A new form of
radiation delivery has shown promise in extending the life
of some brain tumor patients. The new technique, called
GliaSite, is currently being tested in clinical trials at
Stanford University Medical Center. Rather than delivering
radiation through the scalp and healthy brain tissue, this
technique uses a balloon attached to a catheter that is
threaded to the site to deliver radiation. It allows more
controlled delivery of higher doses of radiation directly
to the area from which the tumor was removed. Traditional
surgery and radiation therapy extends the life of patients
with invasive tumors by about a year. GliaSite has
extended survival to about 80 weeks. A number of other
targeted approaches to radiation delivery are being
investigated at other medical centers. Photodynamic
Therapy (PDT) offers a different approach to targeting
cancerous cells left behind after surgery. Currently in
Phase III clinical trials at multiple sites, PDT uses red
light at a specific wavelength to destroy tumor cells that
have been treated with a photosensitizing agent. The
advantage of PDT is that it is relatively selective,
killing tumor cells but sparing healthy tissue, and it
works regardless of tumor cell type. There is no
cumulative tissue damage and the procedure can be repeated
if necessary. Disadvantages of this approach include
swelling in the brain that accompanies the death of tumor
cells. The therapy is usually done after surgery, using
the cavity left by the tumor removal to allow space for
some of the swelling. Another complication is the light
sensitivity patients suffer after receiving the
photosensitizing drug. Eyes and skin must be vigilantly
protected from natural light for about 30 days. Patients
need to wear protective clothing and glasses and stay out
of sunlight for that period. A different solution in being
pursued by researchers at Duke University using genetic
engineering to modify a poliovirus. The virus has shown
early success in treating brain tumors in mice.
Researchers chose the poliovirus because it selectively
targets brain cells, making it an excellent delivery
system for a virus aimed at brain tumor cells. To avoid
the risk of causing polio, the poliovirus has been
combined with the rhinovirus, the virus responsible for
the common cold. The engineered virus was tested in mice
with experimental brain tumors. The tumors were destroyed
within days after a single dose of the virus replicated in
the cancerous cells. Researchers now need to test both the
safety and effectiveness of this approach in humans,
usually a lengthy process. Research into better ways to
treat brain tumors continues on multiple fronts. Better
delivery systems for chemotherapy, more targeted
approaches to radiation therapy and recent breakthroughs
in genetics raise hope for better survival rates and
cures.
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Lyme Disease - Keep the Ticks Off
A
spring or early summer walk in the woods is an excellent
way to say goodbye to the winter blahs. But no matter how
warm the temperature, make sure you leave the shorts and
sandals at home.One of the most dangerous creatures you'll
encounter in the woods at this time of year is the deer
tick, about the size of a poppy seed but able to bring
about rather severe symptoms now known as Lyme disease.
Lyme disease is an infection with Borrelia burgdorferi,
passed on to humans by a tick, usually a deer tick. The
disease includes not only a characteristic rash but fever,
headache, stiff neck, body aches and fatigue. If left
untreated, the disease can progress to persistent,
sometimes chronic, symptoms such as fatigue, arthritis,
heart or nerve problems (sometimes including partial
facial paralysis) and even disturbances of memory and
attention. First identified among children living near
Lyme, Connecticut in 1975, Lyme disease is believed to
have existed in Europe many years earlier and became more
prevalent in the United States with the increase in the
deer population and the influx of suburbia into rural,
wooded areas. Incidence of the disease is increasing
rapidly, with the number of cases nearly doubling from
1991 to 2000. It has been identified in virtually every
state, although 95 percent of cases still occur in 12
where deer ticks are most prevalent-Connecticut, Rhode
Island, New Jersey, New York, Delaware, Pennsylvania,
Massachusetts, Maryland, Wisconsin, Minnesota, New
Hampshire and Vermont. Ticks pick up the bacteria from the
blood of mice, other mammals or birds, then spend much of
their adult life on deer, before dropping off in late
winter to lurk on grass blades or fallen leaves. Mid-May
to mid-June is peak season for ticks, that are most likely
to be found in woods or nearby shady grasslands. Ticks are
particularly fond of places where the woods and grasslands
merge, and those, of course, are good areas for spring
outings. There's no need to worry about deer ticks jumping
or flying at you; humans usually pick them up at the level
of the knee or below. Once on the human body, the tick
then crawls to a more secure location, often on the back
of the neck or the hairline. Children and older adults are
most at risk of Lyme disease, but anyone spending time in
wooded habitats of states with high populations of deer
ticks can be infected. That includes not just hikers and
campers. but those who walk or run on wooded trails and
even golfers who send an occasional shot into the rough.
When detected early, Lyme disease is readily treated with
antibiotics, but an even better approach is to keep the
ticks off from the beginning.
Tips
for Prevention
If you
can't avoid the places where deer ticks might be lurking,
you should be sure to keep your skin covered, particularly
your legs and feet. Wear closed shoes, long sleeved shirts
and pants that fit snugly at the ankles. Some hikers even
tape their pant legs closed or clamp pet tick collars
around their ankles. Ticks show up better on light-colored
clothing. Before venturing out, spray insect repellant
containing DEET on exposed skin except for the face,
following the instructions, of course, for safety.
Clothing can be sprayed with the insecticide permethrin.
After your walk, shower as soon as possible and wash your
clothing. Although water will not necessarily kill ticks,
it may wash them away, and spin drying at high
temperatures will kill them. Even if a tick attaches
itself to you, your risk of infection is estimated at less
than two percent. Nevertheless, check your skin carefully
several times a day and before going to bed. Areas
preferred by ticks include the belt line, just under the
breasts, around the arm pits and groin and above the hair
line. Because they are so small, ticks are hard to spot
and easily mistaken for a freckle or a speck of dirt.
Remove any ticks you find with fine-tipped tweezers,
grasping the tick firmly as close to the skin as possible
and pulling gently without squeezing the tick's body.
Mouth parts of the tick left in the skin should not
transmit disease, and you may cause more damage to the
skin trying to get every piece out. Be sure to wash the
area thoroughly and then apply antiseptic. A vaccine,
Lymerix, was approved by the Food and Drug Administration
in 1998, but pulled from the market by the manufacturer on
February 26, 2002. The vaccine was effective for only
about 75 percent of cases, and there were claims of
arthritis and other side effects, none of which were
confirmed in a placebo-controlled re-evaluation conducted
by the Centers for Disease Control.
Early Treatment Is Key
Because
the risk of getting an infection from a tick bite is low,
most doctors don't prescribe antibiotics unless there are
other signs of Lyme disease. A new rapid blood test can be
performed in the doctor's office, but it's useful
primarily as a first step and does not establish a
diagnosis.The characteristic skin rash of Lyme disease,
known as erythema migrans, starts as a small red spot at
the site of the bite, expanding over a period of days or
weeks to form a circular or oval shape resembling a bull's
eye. It can range in size from a dime to the entire width
of a person's back. Only about 80 percent of Lyme disease
patients, however, have a rash.The flu-like symptoms of
early Lyme disease are more likely to be persistent or to
recur intermittently compared to those of a viral
infection. If necessary and administered early enough,
antibiotic treatment is usually sufficient to head off
long-term complications. While long-term complications can
be severe and disabling, they are not as common as many
Americans fear, and they can nearly always be prevented by
early detection and treatment. On a beautiful spring day,
it's a shame to have your outdoor pleasures spoiled by
fear of tiny creatures lurking in the undergrowth. But if
you live in an area that could be inhabited by deer or
deer ticks, it's better to be safe than sorry.
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The ABC's About RSV
We've
all had it, whether we know it or not. Often mistaken for
the flu or the common cold, respiratory syncytial virus
(RSV) emerges in the winter months, beginning with a fever
and a runny nose, then developing into a cough. At its
worst, it can bring on lower-respiratory complications
such as bronchitis or pneumonia.
Like the flu, RSV deserves attention due to the sheer
numbers of hospitalizations it generates. In the United
States, more than 100,000 children are hospitalized yearly
with the virus, and rates have been climbing since the
1980s. Five to ten percent of elderly adults contract RSV
in any given year. About 90 percent of children develop
RSV during the first two years of life and, because the
virus constantly undergoes slight mutations, one-time
infection does not prevent recurrence.
Some of us battle RSV on an almost yearly basis, and while
the virus is often little more than a nuisance among
healthy adults, its possible complications warrant
attention.
During the fall and winter months, when RSV hits its peak,
this highly contagious virus runs rampant in day care
centers and schools. Adults living with children or in
communal living facilities also face a substantial risk of
infection.
RSV circulates through direct physical contact as well as
through airborne droplets released during coughing or
sneezing. It also survives for several hours on household
objects.
Because it occurs at the same time of year and has similar
symptoms, RSV is frequently mistaken for flu. RSV is
characterized by nasal congestion and, in later stages of
the illness, wheezing. While a fever may accompany either
illness, the flu generates a more acute fever.
Protecting Infants, Elderly
Healthy adults should have no trouble fending off either
ailment in about a week without treatment, but proper
diagnosis may be important among infants and the elderly.
In these cases, a doctor can identify RSV with a simple
nasal swab.
RSV targets the cells lining the respiratory tract. As
these cells die, they conglomerate into mucus, leaving the
patient with nasal congestion. Meanwhile, the body
responds to dying cells with inflammation and fluid
production, causing swelling in the airways.
In most adults, the virus remains in the upper respiratory
tract, causing coughing and general cold symptoms. When
RSV becomes more severe, however, such as in those with
pre-existing lung conditions, it descends into the lower
respiratory tract. Here, the small airways known as
bronchioles constrict, causing wheezing and difficulty
breathing.
There is currently no vaccine for RSV, and treatments
generally focus on supporting the patient while RSV runs
its course. Although it is virtually impossible to prevent
your child from acquiring RSV during some stage of
development, you can exercise preventive measures during
your baby's periods of highest susceptibility.
Among healthy full-term babies, delaying RSV infection
beyond the first six months of life may significantly
reduce the risk of complications such as bronchiolitis. In
order to prevent early infection, practice vigilant
hand-washing and keep infants away from large groups of
people and individuals with cold symptoms. Limit your
child's exposure to smoking, especially within the home.
Breast feeding may also provide modest protection against
RSV infection. Premature babies and those with lung or
heart conditions account for the highest rates of
RSV-related hospitalizations. Fortunately, more direct
preventive measures are available for these children.
When dealing with an infected child, administer
non-aspirin fever reducers and clean the child's nasal
passages frequently.
If an infected child is younger than six weeks or
experiences dehydration, difficulty breathing or a
respiratory rate greater than 50 breaths a minute, contact
a doctor immediately.
Like the flu, RSV deserves attention due to the sheer
numbers of hospitalizations it generates. In the United
States, more than 100,000 children are hospitalized yearly
with the virus, and rates have been climbing since the
1980s. Five to ten percent of elderly adults contract RSV
in any given year.
Despite the current lack of effective RSV treatment and
prevention, hygiene, proper diagnosis and supportive care
remain crucial among these high-risk populations.
HEALTHWIRE
SEPTEMBER, 2003
RESPIRATORY SYNCYTIAL VIRUS
PAGE
CONTACT: URSULA MCTAGGART
(269) 344-1946
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Living as a Cancer
Survivor
About
one million Americans are diagnosed with cancer each year,
according to the American Cancer Society. About half that
number will be cancer-free after five years. They are
cancer survivors - and their numbers continue to swell
each year. It is estimated that there are now 10 million
cancer survivors in the United States, who have lived
through the shock and turmoil of a cancer diagnosis, the
pain and trauma of treatment and the relief that their
cancer has either been eradicated or is in remission.
Being a survivor means they can have hope and make plans
for the future. They have their lives back. But for most
it's a life that has changed dramatically. A diagnosis of
cancer forces most people to confront their mortality, to
reconsider basic questions about family, work and health.
For some, the disease makes it possible to focus on the
essentials in life and lose much of the clutter that had
seemed important before. Cancer may express itself as a
physical disease, but its aftermath can be far-reaching,
affecting an individual's psychological and emotional
being, work environment, social roles, intimate
relationships and insurance status. Patrick, a
middle-aged, divorced man treated six years ago for colon
cancer is physically well but has to deal with the
inconvenience of a colostomy and the altered self-image
that goes with it. A salesman who worked mainly on
commission, Patrick was unable to work for an extended
period after his diagnosis and initial treatment that
required two surgeries and chemotherapy. He now works for
his brother who owns a mid-sized company and wanted to
ensure that Patrick had good health insurance and a
flexible schedule that would allow him to recover fully.
The bond between the brothers has strengthened; they now
go fishing together regularly and Patrick, always an
attentive father, has made it a priority to spend even
more time with his young daughter. "I feel like I have my
life back," Patrick said, "even though the colostomy is a
hassle. At first I was afraid of dying and I felt bitter,
but mostly I worried about not being there for my
daughter, Annie. She's a big priority for me now."
Facing the Fear
Cancer
survivors have faced the fear of death and most experience
an ongoing fear of recurrence of the disease. With some
types of cancers, survivors are given a clean bill of
health after three to five years. Others, like breast
cancer, can recur many years later. And treatment with
radiation and chemotherapy create some risk of secondary
cancers in future years. Advances in treating childhood
cancers mean that 70 percent of children with cancer will
survive into adulthood. The pediatric cancer centers that
follow these children in the years after treatment are not
geared to treat them as they reach adulthood. These young
adults need to establish a relationship with a primary
care physician in their area and ensure that the doctor is
aware of their cancer and treatment history. Many issues
follow adult survivors of childhood cancers including
fertility problems, damage to organs, the risk of a
secondary cancer and problems with insurance and
employment. The aches and pains that most of us accept as
part of daily life can have frightening implications for a
cancer survivor who worries that any new pain may signal a
return of cancer. A positive way to channel anxiety about
health is to make healthy lifestyle changes -getting
regular exercise (check with your doctor to find out what
is right for you) and eating a healthy diet.
Regaining Control
Loss of
control can be one of the most devastating aspects of a
cancer diagnosis. Mentally drained and often physically
ill, most patients expend their energy on just getting
through treatment in the early months. But after treatment
ends, survivors have a chance to regain control in their
lives. This might be expressed as cooking meals again,
planting a garden, returning to work, taking up new
interests or making major changes in lifestyle, personal
relations or philosophy. Some cancers-breast cancer, for
example-have a public mechanism for recognizing and
bringing survivors together, but most cancers don't have
that level of organized support. There are, however, a
number of organizations devoted to cancer
survivorship. The National Cancer Institute established
the Office of Cancer Survivorship website in 1996. The
website provides lists of resources for cancer survivors
and links to articles on pediatric and adult cancer
incidence and survival (). Click on "Survivorship
Research." Being a cancer survivor is a lifelong mission.
There is no right or wrong way to go about it. Some walk
away from treatment and don't look back; others experience
a profound change in the way they see the world and their
place in it. While a certain amount of fear and anxiety is
probably normal and can be channeled into vigilance
concerning health issues, counseling or joining a survivor
support group can help with anxiety that interferes with
life and its fulfillment.
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Some Simple Steps May Minimize Holiday Stress
The
holidays are supposed to be a joyous time spent with
friends and family. But how often do you hear a friend,
family member or colleague say "I’m sure things will be
much better when the holidays are over." That phrase is a
certain sign that holiday stress is hard at work, but
according to Connie Roux, an educator at Goodall Hospital
who teaches Stress Management, there are several steps
that can be taken to minimize the anxiety.
"I
think the most important thing to do during this time is
to take the time to relax," Roux said. "This might include
taking a nap, a long bath or practicing deep breathing and
relaxation techniques. It might be as simple as listening
to soothing music for 15 or 20 minutes. With all the
running around during the holidays, it’s important to take
some time and re-charge."
In
addition to relaxing, Roux offered several other tips to
ensure that holiday stress does not crash the party.
Set your priorities - The things that matter most to
you during the year, like family, friends, colleagues,
should continue to be your focus. Get the most important
things done first. It’s OK to let ‘some things slide’
during this time.
Keep eating habits as normal as possible - It’s
important not to skip a meal. Do not choose this time of
year to go on a diet, since the temptations at holiday
gatherings will surely add to your stress. Remember to
balance the holiday fare with healthy foods like fresh
vegetables, whole grains and salads.
If you drink alcohol, do so in moderation – There are
many stresses that can come from overindulgence, including
dehydration, hangovers and offending someone who is
important to you. Be sure to remain hydrated by drinking
plenty of water.
Get extra rest – Most people get run down during the
holidays by their social calendar. Try to stagger your
holiday events and get plenty or rest. If you know you’re
going to be out late twice during the week, for example,
go to bed earlier on the other nights.
Exercise - It’s proven that exercise is a super stress
reducer. A vigorous walk can make you more efficient
during the day and may help you sleep better at night.
Be realistic - Make sure you take into account the
demands of your daily life and don’t be afraid to ask
family members for help. Remember, saying ‘no’ to someone
will only reduce stress if you choose not to feel guilty
about it. It may be a good idea to overestimate the time
it may take to complete certain tasks. That way, you may
not get frustrated and stressed when waiting in line at a
store or scrambling for a parking spot.
If
these steps are followed, it’s a good bet that holiday
stress will be minimized and that the time spent with
friends and family will be far more enjoyable for all
concerned.
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Eye Care Crucial for Diabetics
If you have diabetes,
you're used to monitoring your body-checking your diet,
blood sugar, blood pressure and cholesterol. And you know
the importance of regular meetings with your doctor, nurse
educator, dietitian and other members of your health care
team.
But how long has it been since you saw your eye
doctor?
Eye problems are among the
common complications of diabetes and often lead to severe
disability, even blindness. Yet preventive eye care
generally does not get the attention it deserves. While
diabetes treatment guidelines recommend dilated eye
examinations once a year by an ophthalmologist, studies
indicate that only about half of diabetics have their eyes
examined that frequently.
In most cases, patients are unaware of changes taking
place in their eyes until disease has progressed to a
dangerous point. These changes are also likely to go
undetected during a routine eye check by a family doctor.
That's why it's crucial to have comprehensive dilated eye
examinations conducted by an ophthalmologist with
specialized equipment and training.
Types of Eye Problems
Cataracts and glaucoma are
both 1 1/2 to 2 times more prevalent among diabetics than
other persons. The most common diabetes-related problem,
however, is retinopathy, abnormalities in the
light-sensitive nerve tissue that lines the back of the
eye and transmits visual images to the brain.
At least in part because of higher than normal blood sugar
levels over a number of years, small blood vessels in the
eye weaken and begin to leak fluid, which can cause
swelling and eventually blurring of vision. Diabetic
retinopathy, the leading cause of blindness, cannot be
cured, but if detected early enough it can be managed.
There are three basic
types of eye problems that afflict diabetics:
- Nonproliferative
retinopathy usually starts with tiny aneurysms, blood
vessels that bulge and then may leak into the retina. As
the disease gets worse, some areas of the retina do not
get an adequate supply of oxygen-rich blood, damaging
retinal tissue but rarely affecting vision.
- Proliferative
retinopathy, occurs after nonproliferative retinothapy.
New blood vessels begin to form in an effort to maintain
normal blood flow. These new blood vessels are fragile,
however, and susceptible to rupture. When they bleed
into the jelly-like vitreous that fills the eye, the
result is blurred vision or even temporary loss of
sight. If scar tissue develops, it can pull the retina
away from the back of the eye, creating a risk of
permanent blindness.
- Macular edema can occur
at any stage of retinopathy. It involves accumulation of
fluid around the macula, the most sensitive part of the
retina that is crucial for seeing fine detail. The
result can be blurring or distorting of vision, with
straight lines appearing warped, or even changes in
perception of colors.
Without regular eye
examinations, early retinopathy may go undetected, but
once it progresses to the proliferative stage, untreated
disease leads to blindness in about half of cases.
If detected early enough,
on the other hand, retinopathy can be effectively treated
or slowed through the use of laser therapy. Performed by
an eye specialist, usually in the doctor's office, these
procedures use brief bursts of light targeted at specific
areas inside the eye.
When there's macular edema,
the laser is focused directly on leaking blood vessels in
a procedure known as focal macular coagulation. To head
off the development of new blood vessels, scatter laser
coagulation delivers 1500 to 2000. The best preventive
plan is to get regular exams while keeping blood sugar,
hypertension and cholesterol under tight control. Laser
therapy is not a cure for retinopathy, and it has some
side effects, including loss of peripheral vision. But if
performed early enough, it reduces the risk of visual loss
by 50 to 60 percent.
If blood vessels continue
to leak or bleed, an ophthalmologist can perform a
vitrectomy, drawing out the jelly-like vitreous that fills
the eye and replacing it with a salt solution. This
procedure must be performed in an operating room under
local anesthesia, sometimes in combination with laser
treatment to further reduce bleeding.
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Don't Stand of Unsightly Toes
Julie had always loved
summer, but this year, she had mixed feelings. With
thickened, dark-colored nails that had appeared on her big
toe and second toe, she was self-conscious about going
barefoot on the beach or wearing sandals or open-toed
shoes.
A visit to her doctor
confirmed a fungal nail infection. And Julie learned that
she is not alone in her reluctance to bare her feet in
public. An estimated 11 million Americans suffer from
fungal nail infections. Her doctor had both good and bad
news about her condition. The good news was that effective
treatments are now available The bad news? Treatment takes
time and patience. It may be next summer before Julie can
feel good about wearing sandals again.
Fungal nail infections (a condition known as
onychomychosis) are caused by dermatophytes, fungi that
can invade skin, nails or hair. They thrive in damp, dark,
moist conditions. Sweaty feet trapped in shoes, the floors
of bathrooms and locker rooms or any place where people go
barefoot are potential breeding grounds. Tinea pedis
(Athlete's Foot) is a fungal infection of the foot caused
by the same type of fungus. Left untreated, Athlete's Foot
can invade the nails, where it is far more difficult to
treat.
A fungal nail infection usually begins with a white or
yellow spot on the nail. As it progresses, it spreads over
the entire nail, which often becomes thick, may turn
brown, yellow or black and becomes cracked and ragged at
the edges. The nail may lift up from the nail bed and the
skin around the nail can become swollen and inflamed. When
the nail separates from the bed, it sets up a breeding
ground for a secondary infection.
Effective Treatment Available
Until recently, doctors didn't have very effective
treatments for fungal nail infections. In the mid-90s,
however, the Food and Drug Administration approved the use
of two new oral drugs, itraconazole (Sporanox) and
terbinafine (Lamisil). The drugs are effective because
they are absorbed into the blood at high enough levels
that penetrate the nail root and the nail where they
remain for a number of months. They kill the infection and
stay around long enough to prevent it recurring.
Although most patients tolerate these drugs well, liver
damage is a potential side effect, and they should be
taken under the close supervision of a physician. Pregnant
or nursing women should avoid the drugs. Itraconazole can
be taken daily for three months. Sometimes it's prescribed
at a higher dose to be used in cycles of one week on,
three weeks off for several months. Studies show that the
continuous dosing gives better results, however.
There are a number of drug interactions that can occur
with itraconazole, some potentially serious. It can cause
serious reactions for people using the antihistamine
terfenadine (Seldane). It also should not be used by those
taking cyclosporine, digoxin, astemizole (Hismanal) and
triazolam (Halcion).
Treatment with terbinafine uses daily oral medication for
three months. Terbinafine can be used safely by patients
taking Seldane.
These drugs are sometimes used in combination with a cream
that is applied to the nail. The cream helps control the
infection and speeds the healing process.
The newest prescription drug for treating fungal nail
infection is a paint-on lacquer. Penlac Nail Lacquer (cicloporix)
is a clear polish that inhibits the growth of the nail
fungus. The lacquer has to be applied to nails and skin
daily for up to 12 months and frequent removal of debris
and careful trimming of nails is important. Penlac is less
expensive than the oral antifungals. It has fewer side
effects than the oral drugs, but is also less effective.
Studies show that Penlac worked for about one third of
patients. Success rates with the oral drugs are between 54
and 70 percent.
When the toenail has a very severe infection or is causing
a lot of pain, the nail may be removed. A new nail
normally grows back with time.
Removing the nail is not as frightening a task as it
sounds. An ointment is rubbed on the surface of the nail
for a number of days to loosen it. Then it can be easily
lifted from the nail bed. Regular use of an antifungal
cream until the new nail grows in helps ensure the nail
will be healthy.
Don't Let Fungus Get a Toehold
The difficulty of treating a nail infection is reason
enough to take steps to protect feet from fungal problems.
Some risk factors such as advancing age, diabetes or a
compromised immune system can't be avoided, but they can
increase your level of vigilance. There are a number of
basic guidelines everyone can follow to minimize the
chance of fungal foot infections:
• Avoid walking barefoot in locker rooms, bathrooms and
other common areas.
use protective footwear such as flip flops.
• Keep bathroom surfaces at home clean and avoid sharing
towels.
• Dry feet and between toes thoroughly after showering.
• Keep feet clean and dry. If your feet get sweaty
running, walking or playing sports, change into clean
shoes and socks after activities.
• Avoid nylon socks and hose. They don't breathe and
encourage fungal growth.
• Wear shoes made of materials that breathe, such as
leather.
• If you have athlete's foot, treat it promptly so the
fungus doesn't have a chance
to spread to nails.
• Foot powders can help lower the risk of developing an
infection. They contain
antifungal agents and help reduce friction and moisture.
• When you cut your nails, cut them straight across. Don't
pick at the nails or '
surrounding skin.
• Nail polish and artificial nails trap moisture under the
nail and set up an
environment for fungal growth.
Good foot hygiene can help you prevent fungal infections.
If you think you have athlete's foot, you can try an
over-the-counter cream, powder or spray. If it doesn't
take care of the problem in a reasonable time, see your
doctor for a prescription-strength cure.
If you have what appears to be a fungal nail infection,
you'll need to see your doctor for a definite diagnosis
and for a prescription to take care of the problem. The
right treatment, along with time and patience should
result in toenails you won't be hiding in the sand.
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Flu Breeds 'Winter of Discontent'
Perhaps it was a bout of flu that King Richard III
remembered when he spoke of "the winter of our
discontent." Flu tends to be a memorable event with a
cluster of symptoms that includes fever, headache, cough,
upper respiratory distress, exhaustion and all over aches
and pain.
Last winter was a relatively mild flu season. A less
severe outbreak one season can lead to complacency the
next year with fewer people lining up for shots. But our
heightened awareness of SARS should give us pause to
reflect on the dangers of flu. SARS killed several hundred
people worldwide. Complications of the flu kill between
30,000 and 40,000 Americans each year and hundreds of
thousands worldwide.
Unlike the SARS virus, we have an effective weapon against
influenza. Unfortunately, many even in high-risk
categories fail to take advantage of a simple shot than
can help avoid a week of misery and, in some cases, save
lives.
Influenza is a viral illness with a number of active
strains circling the world at any given time. The flu
vaccine is composed of the two or three strains health
experts predict will be dominant in North America in the
coming winter. The strains selected for the 2003-2004
vaccine are A New Caledonia virus, A Moscow virus and B
Hong Kong virus.
There are a number of false assumptions about the flu
vaccine. Because it's made with inactivated virus, it
can't give you the flu. It does, however, take a couple of
weeks before your body builds up enough antibodies to be
protective. So it's possible to get the flu in the period
shortly after having the shot before you are protected.
It's also possible that the strains selected in the annual
vaccine may not adequately reflect the most common strain
in your area. And because the dominant strains vary from
year to year you have to have the flu vaccine every year
to maintain protection.
Seniors Are at Greatest Risk
Seniors are the highest risk group during flu season and
health experts recommend flu vaccines for all adults over
age 50, and especially those over age 65. Because the
immune system weakens with aging, the body is less able to
mount an effective immune response to the vaccine, making
the vaccine less likely to fully protect older adults.
Despite this fact, seniors reap enormous benefit from the
flu vaccine. During the 2000 flu season, those over age 65
who were vaccinated for flu were 52 percent less likely to
become infected with the flu and 50 percent less likely to
die from any cause. Yet many seniors are missing out on
this simple preventive measure. According to the U.S.
Centers for Disease Control and Prevention in 2001 only 63
percent of adults over age 65 received the flu vaccine.
It's not just seniors who benefit from flu shots. Although
officially recommended for those over age 50, flu shots
can be a boon for people of any age who want to avoid the
downtime and illness associated with flu.
For those who would rather endure a week of the flu than a
shot, there's a new, painless option. FluMist is an
influenza vaccine delivered as a nasal mist. The Food and
