Health Care and Allergies

Allergy season. Everyone knows about it, and everyone hates it. And, at least one out of every 5 Americans suffers from allergies as reported by WebMD. Common causes of allergy symptoms include food allergies such as peanut allergy or milk allergy, and seasonal allergies resulting from grass, weed, tree pollen, or various molds. Cat allergies and dog allergies can also cause miserable symptoms such as itchy eyes, sneezing, nasal congestion, and wheezing. Allergic skin conditions can cause a rash and itchy skin.

WebMD reports that allergies are an abnormal response of the immune system. People who have allergies have an immune system that reacts to a usually harmless substance in the environment. This substance (pollen, mold, animal dander, etc.) is called an allergen. Allergies are a very common problem, affecting at least 2 out of every 10 Americans. When a person is exposed to an allergen, a series of events takes place:
--The body starts to produce a specific type of antibody, called IgE, to bind the allergen.
--The antibodies attach to a form of blood cell called a mast cell. Mast cells can be found in the airways, in the GI tract, and elsewhere. The presence of mast cells in the airways and GI tract makes these areas more susceptible to allergen exposure.
--The allergens bind to the IgE, which is attached to the mast cell. This triggers a reaction that allows the mast cells to release a variety of chemicals including histamine, which causes most of the symptoms of an allergy, including itchiness or runny nose.

If the allergen is in the air, the allergic reaction will likely occur in the eyes, nose and lungs as reported by WebMD. If the allergen is ingested, the allergic reaction often occurs in the mouth, stomach, and intestines. And, sometimes enough chemicals are released from the mast cells to cause a reaction throughout the body, such as hives, decreased blood pressure, shock, or loss of consciousness. Allergy symptoms can be categorized as mild, moderate, or severe (anaphylactic). Mild reactions include those symptoms that affect a specific area of the body such as a rash, itchy, watery eyes, and some congestion. Mild reactions do not spread to other parts of the body. Moderate reactions include symptoms that spread to other parts of the body. These may include itchiness or difficulty breathing. A severe reaction, called anaphylaxis, is a rare, life-threatening emergency in which the response to the allergen is intense and affects the whole body. It may begin with the sudden onset of itching of the eyes or face and progress within minutes to more serious symptoms, including abdominal pain, cramps, vomiting, and diarrhea, as well as varying degrees of swellings that can make breathing and swallowing difficult. Mental confusion or dizziness may also be symptoms, since anaphylaxis causes a quick drop in blood pressure. Most allergies are inherited, which means they are passed on to children by their parents. People inherit a tendency to be allergic, although not to any specific allergen. When one parent is allergic, their child has a 50% chance of having allergies. That risk jumps to 75% if both parents have allergies.

According to the National Institutes of Health (NIH), an allergy is a reaction of your immune system to something that does not bother most other people. Scientists think both genes and the environment have something to do with it. Normally, your immune system fights germs. It is your body's defense system. In most allergic reactions, however, it is responding to a false alarm. Although allergies can make you feel bad, they usually won't kill you. However, anaphylaxis is life-threatening. People who have allergies often are sensitive to more than one thing. The substances that often cause reactions are:
--Pollen
--Dust mites
--Mold spores
--Pet dander
--Food
--Insect stings
--Medicines

Approximately 50 million Americans suffer from some form of allergic disease, and the incidence is increasing as indicated by the NIH. In many cases, the allergic reaction typically continues: these newly released mediators recruit other inflammatory cells to that site, resulting in additional inflammation. Many symptoms of chronic allergic disease—such as swelling, excessive mucus and hyperresponsiveness to irritating stimuli—are the result of tissue inflammation due to ongoing exposure to allergens. Major allergic diseases include:
--Allergic rhinitis, or “hay fever”
--Allergic conjunctivitis (an eye reaction)
--Asthma
--Atopic dermatitis, or allergic skin reactions
--Urticaria, also known as hives
--Severe allergic reactions to substances such as food, latex, medications, and insect stings
--Problems commonly resulting from allergic rhinitis—sinusitis and otitis media (ear infections)

Antibodies circulate in the bloodstream and are present in almost all bodily fluids according to the NIH. They help to capture unwanted invaders. People who have allergies have an antibody called Immunoglobulin E, or IgE. When allergens first enter the body of a person predisposed to allergies, a series of reactions occurs and allergen-specific IgE antibodies are produced. Following IgE production, these antibodies travel to cells called mast cells, which are particularly plentiful in the nose, eyes, lungs and gastrointestinal tract. The IgE antibodies attach themselves to the surface of the mast cells and wait for their particular allergen. Each type of IgE has specific “radar” for one type of allergen only. That's why some people are only allergic to cat dander (they only have the IgE antibodies specific to cat dander) and others seem to be allergic to everything (they have many more types of IgE antibodies.)

The next time an allergic individual comes into contact with the allergens to which he or she is sensitive, the allergens will be captured by the IgE. This initiates the release of chemical “mediators” such as histamine and other chemicals from the mast cells. These mediators produce the symptoms of an allergic reaction, such as swelling of tissues, sneezing, wheezing, coughing and other reactions. The allergic reaction typically continues: these newly released mediators recruit other inflammatory cells to that site, resulting in additional inflammation. Many symptoms of chronic allergic disease—such as swelling, excessive mucus and hyperresponsiveness to irritating stimuli—are the result of tissue inflammation due to ongoing exposure to allergens. It is not yet fully understood why some substances trigger allergies and others do not, nor why every person does not develop an allergic reaction after exposure to allergens. Symptoms of atopic dermatitis, also called eczema, often result from allergen exposure to the skin as reported by the NIH. Dermatitis symptoms include itching, reddening, and flaking or peeling of the skin. Symptoms begin in childhood for 80% of those with atopic dermatitis. Dermatitis often precedes other allergic disorders; over 50% of those with atopic dermatitis also develop asthma. Urticaria, or hives, another allergic skin reaction, is characterized by itchy red bumps that can occur in clumps and be either large or small. Hives are often triggered by infection, certain foods or medications. Foods commonly associated with hives include nuts, tomatoes, shellfish and berries. Medications include penicillin, sulfa, anti-seizure medications, phenobarbital and aspirin. Asthma is a chronic lung disease that affects more than 17 million Americans and is characterized by coughing, chest tightness, shortness of breath and wheezing. Allergic rhinitis is considered a risk factor in developing asthma: up to 78% of those with asthma also have allergic rhinitis. When an individual experiences asthma symptoms, the inflamed airways become constricted so it becomes more difficult to breathe through the narrowed air passages. For people with allergies, inhaling allergens may produce increased inflammation of the airway lining and further narrowing of the air passages. Asthma may also occur as a result of other stimuli, such as respiratory tract infections or exposure to irritants.

Individuals, according to the NIH, who have allergies to specific foods may have severe and possibly life-threatening reactions if they eat them. The most common food allergy triggers are the proteins in cow's milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts. Food allergy occurs more frequently in children than adults. Many of these children may lose their sensitivity to particular foods over time. Foods and other allergens, including penicillin, insect stings and latex, can trigger a severe, systemic allergic reaction called anaphylaxis. Anaphylaxis is caused by swelling throughout the body, and can involve several organ systems. Symptoms of anaphylaxis include a feeling of warmth, flushing, tingling in the mouth or a red, itchy rash. Other symptoms may include feelings of light-headedness, shortness of breath, severe sneezing, anxiety, stomach or uterine cramps, and/or vomiting and diarrhea. In severe cases, patients may experience a drop in blood pressure that results in a loss of consciousness and shock. Plus, without immediate treatment with an injection of epinephrine (adrenalin), anaphylaxis may be fatal.

The National Institute for Immunology says that an allergist is best qualified to treat allergic diseases. To determine if you have an allergy, your allergist will take a thorough medical history and perform an exam. If indicated, he or she will then perform allergy skin testing, or sometimes blood testing, to determine precisely which substance is causing your allergy. Once your allergy triggers are identified, your physician can help you establish a treatment program. The first step is to minimize your exposure to your particular allergens to whatever extent possible. Your physician may also prescribe medications to reduce allergic symptoms as well as inflammation. Immunotherapy, also known as allergy shots, may also be recommended to modify your immune response. For many patients, immunotherapy can help diminish their reactions to allergens.

In summary, an allergic reaction is a complex chain of events that involves many cells, chemicals and tissues throughout the body. While there is not yet a cure for allergic disease, there are many treatments available to lessen symptoms. See your allergist to determine the best course of treatment.

Until next time. Let me know what you think.

Health Care and Hurricane Ike

Americans, by nature, are a giving people. Our nation is known for its generosity. When disaster strikes, individuals and families are quick to offer money, time, and resources to help those in need. Our government, although it has its faults, has learned to step up the plate to help those in need, both foreign and domestic. Even though many like to complain about inefficiences with the federal, state and local government and their respective agencies, when crunch time comes, help is on the way. A case in point was the response to Hurricane Ike which struck the Texas Gulf Coast on Saturday morning, September 13. Massive efforts have been taken by the State of Texas, the Cities of Galveston and Houston, and other entities to help citizens get assistance for food, shelter, and essential life saving information.

And, yet, still there were thousands of people who refused to evacuate or heed the warnings about the real possibility of significant, catastrophic destruction, loss of life, and no electric power for several days and weeks. Putting your life in jeopardy simply to ignore "certain death" as described by the weather bureau is not a wise decision. How can anyone reasonably justify riding out a hurricane only because they don't want the government telling them what to do, or because they fear loss of property more than loss of life? Furniture, homes, and most material items can be replaced. Life cannot.

In the brief days now following Hurricane Ike, electric companies are working around the clock with most workers spending 16 hour shifts to get the power back to over 4 million people. Phone companies are scrambling to get cell towers replaced and repaired so customers can use their phones to call and send text messages. Utilities for water, sewage, gas and electric are working hard to help repair basic services. Police, firefighters, EMTs, and emergency personnel are stretched almost beyond capacity to make sure that those who need help can get it. The military, including the National Guard and the Coast Guard are facilitating rescue and recovery to thousands of affected people on the Gulf Coast. FEMA is working along with the State of Texas and local government agencies to get assistance to those who were displaced including those who evacuated and those who did not. The American Red Cross is spending millions of dollars to feed and house those who fled Hurricane Ike's destructive wind, rain, and flooding. Other charitable organizations including churches and faith based groups, such as Texas Baptist Men, are helping as much as possible by providing temporary shelter, food, water and ice, and other items.

And the clean up is underway on a huge scale. With estimates among the three major catastrophe modeling firms ranging from $6 billion to $18 billion according to an article released on MarketWatch, losses from Hurricane Ike will be material to both the primary insurers located in the U.S. and to the global reinsurance industry, according to Fitch Ratings in a new insurance industry report. If initial loss estimates are accurate, Ike could be the third largest insured loss from a hurricane, behind only Hurricanes Katrina and Andrew. Americans faced with such overwhelming catastrophe can be thankful that the nation has the resources to help recover. Although it is difficult emotionally, financially, and some times physically to deal with a natural disaster of such huge proportion, there is always hope. Generosity will continue until the affects of Hurricane Ike have been largely addressed. And, there also will be long term issues to fix.

The Center for Disease Control (CDC) has very good information about protecting your health following a hurricane, including some general safety items:
1.) Have at least two fire extinguishers, each with a UL rating of at least 10A, at every cleanup job.
2.) Wear hard hats, goggles, heavy work gloves, and watertight boots with steel toe and insole (not just steel shank) for cleanup work.
3.) Wear earplugs or protective headphones to reduce risk from equipment noise.
4.) Use teams of two or more people to move bulky objects. Avoid lifting any material that weighs more than 50 pounds (per person).
5.) When using a chain saw, operate the saw according to the manufacturer's instructions, wear appropriate protective equipment, avoid contact with power lines, be sure that bystanders are at a safe distance, and take extra care in cutting trees or branches that have gotten bent or caught under another object. Use extreme caution to avoid electrical shock when using an electric chain saw.
6.) If there has been a backflow of sewage into your house, wear rubber boots, rubber gloves, and goggles during cleanup of the affected area.
7.) In hot weather, try to stay cool by staying in air-conditioned buildings, taking breaks in shaded areas or in cool rooms, drinking water and nonalcoholic fluids often, and wearing light and loose-fitting clothing. Do outdoor activities during cooler hours.
8.) Remove and discard items that cannot be washed and disinfected (such as mattresses, carpeting, carpet padding, rugs, upholstered furniture, cosmetics, stuffed animals, baby toys, pillows, foam-rubber items, books, wall coverings, and paper products).
9.) Remove and discard drywall and insulation that has been contaminated with sewage or flood waters.
10.) Thoroughly clean all hard surfaces (such as flooring, concrete, molding, wood and metal furniture, countertops, appliances, sinks, and other plumbing fixtures) with hot water and laundry or dish detergent.

Concern about hygeine and water issues according to the CDC should also be followed:
1.) After completing the cleanup, wash with soap and water. If there is a boil-water advisory in effect, use water that has been boiled for 1 minute (allow the water to cool before washing). Or you may use water that has been disinfected for personal hygiene use (solution of 1/8 teaspoon of household bleach per 1 gallon of water). Let it stand for 30 minutes. If the water is cloudy, use a solution of 1/4 teaspoon of household bleach per 1 gallon of water.
2.) If you have any open cuts or sores that were exposed to floodwater, wash them with soap and water and apply an antibiotic ointment to discourage infection. Seek immediate medical attention if you become injured or ill.
3.) Wash all clothes worn during the cleanup in hot water and detergent. These clothes should be washed separately from uncontaminated clothes and linens.
4.) If the building is flooded, the waters may contain fecal material from overflowing sewage systems and agricultural and industrial waste. Although skin contact with floodwater does not, by itself, pose a serious health risk, there is risk of disease from eating or drinking anything contaminated with floodwater.
5.) To reduce cold–related risks when standing or working in water which is cooler than 75 degrees F (24 degrees C), wear insulated clothes and insulated rubber boots, take frequent breaks out of the water, and change into dry clothing when possible.
6.) Local authorities will tell you if tap water is safe to drink or to use for cooking or bathing. If the water is not safe to use, follow local instructions to use bottled water or to boil or disinfect water for cooking, cleaning, or bathing.

Much more information about dealing with carbon monoxide, hazardous waste and materials, electrical and structural safety issues, and other health precautions can be found on the CDC website. Additionally, assistance to deal with post-traumatic stress is also available for issues related to the following: Difficulty communicating thoughts, difficulty sleeping, difficulty maintaining balance, easily frustrated, increased use of drugs/alcohol, limited attention span, poor work performance, headaches/stomach problems, tunnel vision/muffled hearing, colds or flu-like symptoms, disorientation or confusion, difficulty concentrating, reluctance to leave home, depression, sadness, feelings of hopelessness, mood-swings, crying easily, overwhelming guilt and self-doubt, and fear of crowds, strangers, or being alone.

Hurricane Ike was not the storm of the century as it had been predicted prior to its landfall; but like every hurricane, especially one the size of Ike, this storm wreaked havoc in the billions of dollars and disrupted the lives of millions of families and individuals. For many of those people, life will never be the same again. They are suffering financial and emotional loss, and will continue to deal with the aftermath for some time to come. Some of those people will deal with the stress of loss well, and some will not. Health care for the short term is extremely important to the victims of this hurricane, especially for evacuees who were critically ill and required immediate attention. Those who are on medications have prescription needs, and those who suffer both mental and physical disorders have critical needs for their medical providers and health care facilities to meet. Immediately following a disaster like Hurricane Ike, the health care industry must forego business as usual and step up treatment that provides assistance without the standard red tape. Also, Americans must provide compassion to those in need during disaster recovery. Helping out also means helping others up.

Until next time. Let me know what you think.

Health Care and 9/11

Seven years ago today, on a beautiful late summer day, Americans were going about business as usual in the early morning hours of September 11, 2001. Commuters were riding the train to work, hoping to get to their destination before they were late to the office. Moms were shuttling kids to daycare. Secretaries were beginning to type up the day's activities and coordinating memos for their corporate executive officers. Coffee was brewing at the local cafe while waitresses were taking the next breakfast order to be put into the chef. Children were riding the bus to school, on their way to start another day of learning in the new academic year. The nation was preparing for another day of activity at home, at school, at the office. It was a gorgeous morning with brilliant blue skies over much of the country. Typical scenes on a typical day, nothing out of the ordinary and nothing unusual to be expected. No one who woke up that morning to get ready for the day's events realized that the world was about to change--forever.

September11News.com reports succinctly that 2 hijacked jetliners hit the World Trade Center in New York, and a third slammed into the Pentagon outside Washington. A fourth hijacked plane crashes into a field in Pennsylvania. Trading on WallStreet is stopped. The Federal Aviation Administration halts all flight operations at the nation's airports for the first time in U.S. history. U.S. military is placed on high alert. President Bush addresses the nation and vows to "find those responsible and bring them to justice." Hundreds of New York City firemen and policemen sent to rescue WTC workers are lost when the WTC Twin Towers collapse. Reaction from international leaders is swift as world leaders react withoutrage over the attacks. Over 3,000 men, women and children are gone in a single day--the first attack of magnitude on American soil. Images of flames and mass destruction are broadcast and repeated in video loops for the entire day. The nation stopped in its tracks, stunned beyond belief that the U.S. would be hit by terrorists in an unprovoked and horrific attack.

Wikipedia also gives a very concise and detailed overview of the day's events. On that morning, terrorists affiliated with al-Qaeda hijacked four commercial passenger jet airliners. The hijackers intentionally crashed two of the airliners into the Twin Towers of the World Trade Center in New York City, killing everyone on board and many others working in the building, causing both buildings to collapse within two hours, destroying at least two nearby buildings and damaging others. The hijackers crashed a third airliner into the Pentagon. The fourth plane crashed into a field near Shanksville in rural Somerset County, Pennsylvania, after some of its passengers and flight crew attempted to retake control of the plane, which the hijackers had redirected toward Washington, D.C. There are no known survivors from any of the flights.

Wikipedida goes on to report that excluding the 19 hijackers, 2,974 people died in the attacks. Another 24 are missing and presumed dead. The overwhelming majority of casualties were civilians, including nationals of over 90 different countries. In addition, the death of at least one person from lung disease was ruled by a medical examiner to be a result of exposure to dust from the World Trade Center's collapse, as rescue and recovery workers were exposed to airborne contaminants following the buildings' collapse. According to the 9/11 Commission Report, hundreds were killed instantly by the impact, while the rest were trapped and died after the tower collapsed. As many as 600 people were killed instantly or were trapped at or above the floors of impact in the South Tower. At least 200 people jumped to their deaths from the burning towers, landing on the streets and rooftops of adjacent buildings hundreds of feet below and died instantly on impact. A total of 411 emergency workers who responded to the scene died as they attempted to implement rescue and fire suppression efforts. The New York City Fire Department (FDNY) lost 341 firefighters and 2 FDNY paramedics. The New York City Police Department lost 23 officers. The Port Authority Police Department lost 37 officers. Private EMS units lost 8 additional EMTs and paramedics. In addition to all this carnage, thousands of private citizens died with a horrible ending--some instantly and some suffering excrutiatingly gross pain until death. The city of NY was only able to identify remains for approximately 1,600 of the victims at the World Trade Center. The medical examiner's office also collected "about 10,000 unidentified bone and tissue fragments that cannot be matched to the list of the dead."

Additionally, according to Wikipedia, the thousands of tons of toxic debris resulting from the collapse of the Twin Towers consisted of more than 2,500 contaminants, including known carcinogens. This has led to debilitating illnesses among rescue and recovery workers, which many claim to be directly linked to debris exposure. Health effects have also extended to some residents, students, and office workers of Lower Manhattan and nearby Chinatown. There is also scientific speculation that exposure to various toxic products in the air may have negative effects on fetal development. There will be significant short term and multiple long term issues related to health care for this event that took place seven years ago today. No one will ever really know how many Americans will develop cancer or other diseases related to this event, and the cost of taking care of them will continue to go on for years to come. Reports also indicate that over 70,000 people in NYC still suffer from post-traumatic stress due to 9/11.

Today, the country paused this morning at the exact time of the attack to pay homage to those who died. Ground Zero in New York City will have a somber ceremony to honor the victims and their families. Dignitaries all over America will make speeches, give testimonies about that day's memories, and salute those who were first responders to the scenes. The Pittsburgh Business Times reported that services commemorating the seventh anniversary of the crash of Flight 93 will be held Wednesday and Thursday in Shanksville, Somerset County, Pennsylvania. And, the University of Pittsburgh’s Army Reserve Officers’ Training Corps will render a 21-gun salute as part of the memorial at a service in Pittsburgh. At the Pentagon this morning, the ceremony dedicated a memorial to the 184 victims killed when American Airlines Flight 77 struck the building's west wall. An American flag was raised smartly to the top of a flagpole, then slowly lowered to half-staff, and the band played the national anthem. The President and others spoke about tragedy and heroic acts. Earlier, a bagpiper walked alone across the Pentagon memorial playing "Amazing Grace."

When you start to question why America is in a war against terrorism, remember the day that changed a people, a nation, a world. Nothing will ever be the same again. Americans have much to celebrate, and much for which to be thankful. Americans must be vigilant. Americans must remember our history, and what sacrifices have been made to keep the nation safe. Take time to hug your kids and your family. Call your friends and tell them you have been thinking about them and wish them well. Love your spouse, and tell them what they mean to you. Say a prayer to God that expresses thanks for His blessings, asks forgiveness for any unkind actions and thoughts towards others, and seeks His protection. Most of all, Americans can never forget---never, never, never forget.

Until next time. Let me know what you think.

Health Care and Retail Clinics

Commonly referred to as "Doc in a Box," retail health clinics have been getting a bad rap this year from the American Medical Association, certain government agencies, and other critics. Companies like Walgreen's and Wal-Mart have embraced the concept wholeheartedly and are on a campaign to increase penetration in the health care marketplace with easily accessible locations for consumers to receive certain health care treatment at an affordable price. Largely due to the number of uninsured in America, the retail health clinic does meet a specific need. And, many of them also do actually accept most insurance plans. Critics claim that patients cannot get the same quality of care as in a private physician's office or fully staffed medical clinic. However, the public usually sees this complaint as sour grapes because of the amount of money that doctors are losing due to overpriced procedures. Americans want access to medical care, but they don't want to pay a fortune for it.

According to the website Salon.com, the medical establishment is opposed to drop-in clinics in Wal-Marts and other retail stores. But self-interested doctors need to get over their archaic ways of doing business. According to the StarTribune.com in Minneapolis-St. Paul, MinuteClinic is the first and still the biggest chain of retail clinics, where nurse practitioners treat common ailments in a retail setting. According to the article, going to a MinuteClinic is cheaper for patients than going to a physician's office or urgent care. A study published in the journal Health Affairs found prices charged by all providers rose by double digits over the four years tracked, a trend that went against the conventional wisdom that more providers leads to more competition and lower prices. The study is the first to compare costs per episode of care -- which includes not just the medical exam but also lab and pharmacy costs -- for sore throats, ear infections, sinus infections, pinkeye and urinary-tract infections.

However, the report issued this week by Health Partners on Pioneer Press suggests patients get their money's worth when they use MinuteClinics instead of family doctors for the treatment of sore throats, ear infections and other common maladies. Some critics have argued they end up increasing overall costs because many patients go to them first but go to their family doctors later for the same problems. Researchers looked at the total cost of care a patient received for an entire "episode" or individual illness rather than an individual procedure or treatment. The result: The total cost of a patient treated at a MinuteClinic for one of five basic illnesses was $51 cheaper on average than a patient treated at urgent care and $55 cheaper than a patient treated by a primary-care doctor. Pharmacy costs were also slightly lower for the patients using MinuteClinics. One key difference is that patients with chronic conditions such as asthma or diabetes were much more likely to see their regular doctors. The cost difference won't mean much to most insured patients who simply pay copays for basic medical visits. But it is significant for employers and insurers who pay the bills and for the growing number of patients with health savings accounts who benefit financially when they seek cheaper care.

Retail health clinics provide simple, nonemergency services to walk-in patients, regardless of insurance status. They are much cheaper than a traditional doctor's visit because they're generally staffed by nurse practitioners and/or physicians assistants. These clinics have extended hours including nights, weekends, and sometimes even holidays. They charge a set price for common services, everything from sports physicals to treating ear infections. Currently, there are about 1,000 such clinics in the United States, according to the Convenient Care Association, but that number is expected to increase to as many as 1,500 by the end of this year as reported by the ConsumerReports.org website. Supporters of retail clinics, like the Convenient Care Association, say they help take pressure off primary care physicians and emergency rooms by taking care of simpler cases and that retail health clinic services are limited to routine physicals and simply treated illnesses and injuries, referring more complicated cases to traditional health care providers. And, supporters also say retail health clinics empower consumers by providing additional transparency, convenience and choice.

However, doctors are naturally nervous about the rapid growth of retail clinics, according to feedback on Salon.com. Many medical groups, like the American Academy of Family Practice and the American Academy of Pediatrics, have published position papers opposing retail clinics. Their basic argument is that retail clinics run counter to the concept of "a medical home," a place where patients receive care for any and all of their problems. They worry that patients will have no sensible place to follow up their test results, and that putting a clinic in a mall or a Wal-Mart could expose shoppers to people with a contagious illness. The medical community needs a second opinion. Retail clinics are good for American healthcare. By giving doctors a run for their money, they force doctors to do something they don't do well: innovate. At their best, retail clinics can make doctors look like smart entrepreneurs instead of a self-interest group futilely trying to protect archaic ways of doing business.

Retail clinics are thriving according to Salon.com. They provide excellent access. After all, what's more convenient than showing up any day, night or weekend to have your sore throat checked? No telephone time spent on hold trying to make an appointment, no shuffling your personal schedule to get there. Then there's cost. Retail clinics operate on a fee-for-service basis. Most charge a maximum of $50, which is significantly cheaper than the $100-plus your insurance company (or you, if you carry an increasingly popular high-deductible insurance plan) will pay when see your doctor for the same concern. That relative savings makes retail clinics a great place to go if you're uninsured and have a minor medical problem. This desire to pay out of pocket is a not-so-subtle sign that consumers are asserting their purchasing power in the health sector, just as they would with other goods and services. A 2005 Wall Street Journal/Harris poll confirms this: Eighty percent of retail clinic users expressed satisfaction with the cost of services; 89% were satisfied with the quality of care; 88%, with the staff's qualifications (usually nurse practitioners).

Salon.com also reports that the success is due to a few reasons. First, retail clinics don't do everything. Literally, a customer has to choose what he or she wants from a menu of choices posted on a marquee. Choices are limited to simple, easy-to-handle medical problems like sore throats, allergies and cold sores or a request for routine flu or pneumonia vaccinations. No acute medical problems, like injuries or asthma, are addressed. All decisions are made using very strict decision trees, leaving no room to treat issues beyond or outside of them. Also, Clinics make no claim to be a medical home. Statistics support the safety of this approach. there's nothing complicated about communicating with a patient's primary doctor. Specialists and emergency rooms routinely send letters or faxes to primary care offices to inform them about a patient, his or her diagnosis, prescribed treatments and a follow-up plan. Retail clinics have made efforts to do the same. So rather than writing position papers opposing retail clinics, medical organizations ought to use them to encourage bold innovation. Technology is also helping. An increasing number of offices are adopting an electronic medical record, one that allows patients to e-mail their doctor or chat live over video.

Of course, there are potential pitfalls. Should walk-in clinics expand to become a medical home by offering physical exams and other comprehensive services like treating injuries, they stand to do patients a disservice. Time will tell whether the rate of errors is any different than in standard practice; but as long as the clinics continue to keep services strictly limited, this risk will remain relatively low. Regardless of those red flags, though, retail clinics in their current format have found a unique and useful niche in medicine. Competition in the marketplace makes us better business people, better consumers, and better Americans.

Until next time. Let me know what you think.

Health Care and MRSA

Over the past couple of years, Americans have been dealing with an increasingly more vicious health bug--MRSA. According to the Mayo Clinic, MRSA infection is caused by Staphylococcus aureus bacteria — often called "staph." MRSA stands for methicillin-resistant Staphylococcus aureus. It's a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA can be fatal. Most MRSA infections occur in hospitals or other health care settings, such as nursing homes and dialysis centers. It's known as health care-associated MRSA, or HA-MRSA. Older adults and people with weakened immune systems are at most risk of HA-MRSA.

More recently, another type of MRSA has occurred among otherwise healthy people in the wider community. This form, community-associated MRSA, or CA-MRSA, is responsible for serious skin and soft tissue infections and for a serious form of pneumonia. Staph bacteria, according to the CDC, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections. The CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, men who have sex with men, and prisoners. Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene.

The Center for Disease Control (CDC) also reports that people with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA. People with HIV should follow the same prevention measures as those without HIV to prevent staph infections, including practice good hygiene, cover wounds (e.g., cuts or abrasions) with clean dry bandages, avoid sharing personal items such as towels and razors, and contact their doctor if they think they have an infection. In the outbreaks of MRSA, the environment has not played a significant role in the transmission of MRSA. MRSA is transmitted most frequently by direct skin-to-skin contact. You can protect yourself from infections by practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (e.g., clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after use.

Most staph and MRSA infections are treatable with antibiotics as indicated by the CDC. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time. However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider. If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.

The Mayo Clinic reports that both hospital- and community-associated strains of MRSA still respond to certain medications. In hospitals and care facilities, doctors often rely on the antibiotic vancomycin to treat resistant germs. CA-MRSA may be treated with vancomycin or other antibiotics that have proved effective against particular strains. Although vancomycin saves lives, it may become less effective as well. Some hospitals are already seeing strains of MRSA that are less easily killed by vancomycin. In some cases, antibiotics may not be necessary. For example, doctors may drain a superficial abscess caused by MRSA rather than treat the infection with drugs. Hospitals are fighting back against MRSA infection by using surveillance systems that track bacterial outbreaks and by investigating products such as antibiotic-coated catheters and gloves that release disinfectants. Still, the best way to prevent the spread of germs is for health care workers to wash their hands frequently, to properly disinfect hospital surfaces and to take other precautions, such as wearing gowns and gloves when working with people infected with resistant bacteria. In the hospital, people who are infected or colonized with MRSA are placed in isolation to prevent the spread of MRSA. Visitors and health care workers caring for people in isolation may be required to wear protective garments and must follow strict hand-washing procedures.

The Mayo Clinic offers several suggestions to prevent the spread of MRSA:
--Ask all hospital staff to wash their hands or use an alcohol-based hand sanitizer before touching you — every time.
--Make sure that intravenous tubes and catheters are inserted under sterile conditions, for example, the person inserting them wears a gown, gloves and mask and sterilizes your skin first.
--Wash your hands. Careful hand washing remains your best defense against germs. Scrub hands briskly for at least 15 seconds, then dry them with a disposable towel and use another towel to turn off the faucet. Carry a small bottle of hand sanitizer containing at least 60 percent alcohol for times when you don't have access to soap and water.
--Keep personal items personal. Avoid sharing personal items such as towels, sheets, razors, clothing and athletic equipment. MRSA spreads on contaminated objects as well as through direct contact.
--Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal. The pus from infected sores may contain MRSA, and keeping wounds covered will help keep the bacteria from spreading.
--Shower after athletic games or practices. Shower immediately after each game or practice. Use soap and water. Don't share towels.
--Sit out athletic games or practices if you have a concerning infection. If you have a wound that's draining or appears infected — for example, is red, swollen, warm to the touch or tender — consider sitting out athletic games or practices until the wound has healed.
--Sanitize linens. If you have a cut or sore, wash towels and bed linens in a washing machine set to the "hot" water setting (with added bleach, if possible) and dry them in a hot dryer. Wash gym and athletic clothes after each wearing.
--Get tested. If you have a skin infection that requires treatment, ask your doctor if you should be tested for MRSA. Doctors may prescribe drugs that aren't effective against antibiotic-resistant staph, which delays treatment and creates more resistant germs. Testing specifically for MRSA may get you the specific antibiotic you need to effectively treat your infection.
--Use antibiotics appropriately. When you're prescribed an antibiotic, take all of the doses, even if the infection is getting better. Don't stop until your doctor tells you to stop. Don't share antibiotics with others or save unfinished antibiotics for another time. Inappropriate use of antibiotics, including not taking all of your prescription and overuse, contributes to resistance. If your infection isn't improving after a few days of taking an antibiotic, contact your doctor.

MRSA can be life threatening if not treated in a timely fashion. Simple prevention methods will help keep the risk of getting the disease. Use common sense when in a common area. If you get it, see a doctor right away and finish the course of treatment as prescribed. Don't let a bug get you that you can prevent.

Until next time. Let me know what you think. Thanks.

Health Care and Gingivitis

According to the most recent statistics offered by the American Dental Association, about half of the American population does not have a dental plan. That's a whole bunch of unhealthy teeth and gums, not to mention potentially more serious health issues. One of the most serious problems related to oral health is gingivitis, and according to New York dentist, Dr. Robert Schwartz, Gingivitis is the most common periodontal disease, affecting 90% of the population. It is an infection of the gums caused by bacteria that form plaque.

According to Dr. Schwartz, in small amounts (when it is newly formed), plaque is invisible and relatively harmless. But when left to accumulate, it increases in volume and the proportion of harmful bacteria grows. These bacteria release toxins that result in inflammation of the gum tissue. Eventually, the plaque hardens and forms hard deposits called calculus or tartar. If not properly treated, gingivitis may progress to periodontitis, a periodontal disease in which there is loss of the bone that supports the teeth.

The Mayo Clinic reports that gingivitis is both preventable and treatable. Although factors such as medications and lowered immunity make you more susceptible to gingivitis, the most common cause is poor oral hygiene. Daily brushing and flossing and regular professional cleanings can significantly reduce your risk of developing this potentially serious condition. If you already have gingivitis, professional cleaning can reverse the damage. If not treated, gingivitis can progress to more-serious gum diseases, such as periodontitis, and eventually to the destruction of bone and to tooth loss. Because early-stage gum disease is seldom painful, you can have gingivitis without even knowing it. Often, though, you're likely to have warning signs such as:
--Swollen, soft, red gums.
--Gums that bleed easily, even if they're not sore. Many people first detect a change in their gums when they notice that the bristles of their toothbrush are pink — a sign that gums are bleeding with just slight pressure.
--A change in the color of your gums from a healthy pink to dusky red.

Gingivitis, also according to the Mayo Clinic, begins with plaque. This invisible, sticky film, composed primarily of bacteria, forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth removes plaque, but it re-forms quickly, usually within 24 hours. Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus), a white substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. What's more, you usually can't get rid of tartar by brushing and flossing — you'll need a professional cleaning to remove it. The longer plaque and tartar remain on your teeth, the more they irritate the gingiva, the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily.

More information online from the Mayo Clinic goes on to say that although plaque is by far the most common cause of gingivitis, other factors can contribute to or aggravate the condition, including:
1.) Drugs. Hundreds of prescription and over-the-counter antidepressants and cold remedies contain ingredients that decrease your body's production of saliva. Because saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, this means that plaque and tartar can build up more easily. Other drugs, especially anti-seizure medications, calcium channel blockers and drugs that suppress your immune system, sometimes can lead to an overgrowth of gum tissue (gingival hyperplasia), making plaque much tougher to remove.
2.) Viral and fungal infections. Although bacteria are responsible for most cases of gingivitis, viral and fungal infections also can affect your gums. Acute herpetic gingivostomatitis is an infection caused by the herpes virus that frequently leads to gum inflammation and to small, painful sores throughout your mouth. Oral thrush, which results when a fungus normally found in your mouth grows out of control, causes creamy white lesions on your tongue and inner cheeks. Sometimes these lesions spread to the roof of your mouth, your tonsils and your gums.
3.) Other diseases and conditions. Some health problems not directly associated with your mouth can still affect your gums. People with leukemia may develop gingivitis when leukemic cells invade their gum tissue. Oral lichen planus, a chronic inflammatory disease, and the rare, autoimmune skin diseases pemphigus and pemphigoid can cause gums to become so severely inflamed that they may peel away from the underlying tissue.
4.) Hormonal changes. During pregnancy, your gums are more susceptible to the damaging effects of plaque. The problem is compounded if you have morning sickness — nausea and vomiting may make it hard to brush your teeth regularly.
5.) Poor nutrition. A poor diet, especially one deficient in calcium, vitamin C and B vitamins, can contribute to periodontal disease. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. Vitamin C helps maintain the integrity of connective tissue. It's also a powerful antioxidant that counters the tissue-destroying effects of free radicals — substances produced when oxygen is metabolized by your body.

Gingivitis, according to eMedicineHealth.com, can be managed simply with good oral hygiene and regular dental appointments. Good mouth and teeth care, regular dental follow-up, and treatment of underlying illnesses are necessary for preventing gingivitis. Removing the source of the infection is primarily how simple gingivitis is treated. By brushing teeth regularly with a toothbrush and fluoride toothpaste approved by dentists, plaque build-up can be kept to a minimum. Flossing is another means of removing plaque in between teeth and other areas hard to reach. Regular check-ups with a dentist are also important. A dentist is able to remove plaque that is too dense to be removed by a toothbrush or dental floss. Severe gingivitis may require antibiotics and consultation with a physician. Antibiotics are medications used to help the body's immune system fight bacterial infection and have been shown to reduce plaque. By reducing plaque, bacteria can be kept to a level manageable by the human immune system. Taking antibiotics is not without risks and should only be done after consultation with a dentist or doctor.

According to eMedicineHealth, for simple gingivitis, work with your dentist. A concerted effort between good home dental hygiene and regular dental visits should be all that is required to treat and prevent gingivitis. If gingivitis continues despite the effort to prevent it, contact your doctor to investigate the possibility of an underlying illness. Gingivitis can usually be managed at home with good dental hygiene. If gingivitis turns into the most severe periodontal infection, acute necrotizing ulcerative gingivitis (ANUG), commonly referred to as trench mouth, treatment at a hospital may be required. ANUG not only affects the gums but may spread to adjacent tissues of the face, neck, and bone. Bleeding, loss of periodontal architecture, and pain all characterize ANUG. The breath takes on a fetid odor, the teeth become loose, and the lymph nodes of the neck are often swollen. People with ANUG often have fever and complain of a generalized weakness reflecting widespread infection. Like gingivitis, ANUG usually affects people with underlying immune system situations such as malnutrition, HIV, or cancer. Therapy involves getting rid of the oral bacteria with antibacterial mouthwashes, oral antibiotics, periodontal treatment, and treatment of the underlying illness.

Gingivitis can be easily treated with everyday common sense health care maintenance. Good oral health makes sense. Avoid the problems associated with this oral disease by taking care of your mouth, teeth, and gums. See a good dentist on a regular basis. Take care of your oral health--brush, floss, rinse. Your smile makes life much nicer.

Until next time. Let me know what you think.

Health Care and Second Hand Smoke

Smoking has long been considered to be cool. It was especially glamorized in the movies in the 1930's up until the last couple of decades. Unfortunately, the adage that smoking is cool is a lie that has been propagated by the tobacco industry for decades. The website AllAboutLifeChallenges.org states that the world has been deceived into believing the lie that smoking is socially acceptable and cool. Smoking is hazardous to the health of both the smoker and the bystanders. Passive smoking increases the risk of lung cancer and heart disease; this can hardly be socially acceptable. Another myth of smoking is that a smoker is sophisticated. However, a repulsive smell, yellow fingers and teeth is not a badge of sophistication. Dying of lung and heart disease or cancer won’t promote your popularity.

Consider the short-term effects of smoking:
--Smoking makes you smell bad, gives you bad breath, and stains your teeth.
--Smoking lowers hormone levels.
--Smoking causes cavities.
--Smoking lowers hormone levels.
--Colds last longer and smokers get sick more often.
--Most people would rather date a non-smoker.
--Smoking costs a lot of money.
--Smoking begins damaging your body the moment you start.

Second Hand smoke has been proven to be extremely dangerous also as a major health hazard according to the American Lung Association (ALA). Secondhand smoke, also know as environmental tobacco smoke, is a mixture of the smoke given off by the burning end of a cigarette, pipe or cigar and the smoke exhaled from the lungs of smokers. It is involuntarily inhaled by nonsmokers, lingers in the air hours after cigarettes have been extinguished and can cause or exacerbate a wide range of adverse health effects, including cancer, respiratory infections, and asthma.

The ALA also provides info on issues related to second hand smoke:
--Second hand smoke has been classified by the Environmental Protection Agency (EPA) as a known cause of cancer in humans (Group A carcinogen).
--Second hand smoke exposure causes disease and premature death in children and adults who do not smoke. Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic, including formaldehyde, benzene, vinyl chloride, arsenic ammonia and hydrogen cyanide.
--Second hand smoke causes approximately 3,400 lung cancer deaths and 22,700-69,600 heart disease deaths in adult nonsmokers in the United States each year.
--Nonsmokers exposed to second hand smoke at work are at increased risk for adverse health effects. Levels of secondhand smoke in restaurants and bars were found to be 2 to 5 times higher than in residences with smokers and 2 to 6 times higher than in office workplaces.
--Since 1999, 70% of the U.S. workforce worked under a smoke-free policy, ranging from 84% in Utah to 49% in Nevada. Workplace productivity was increased and absenteeism was decreased among former smokers compared with current smokers.
--States are passing laws about second hand smoke. Eighteen states - Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Ohio, Rhode Island, Washington and Vermont - as well as the District of Columbia prohibit smoking in almost all public places and workplaces, including restaurants and bars. Montana and Utah prohibit smoking in most public places and workplaces, including restaurants; bars will go smokefree in 2009. New Hampshire prohibits smoking in some public places, including all restaurants and bars. Four states - Florida, Idaho, Louisiana and Nevada - prohibit smoking in most public places and workplaces, including restaurants, but exempt stand-alone bars. Fifteen states partially or totally prevent (preempt) local communities from passing smokefree air ordinances stronger than the statewide law. Iowa, Nebraska and Oregon have passed legislation prohibiting smoking in almost all public places and workplaces, including restaurants and bars, but the laws have not taken effect yet.
--Second hand smoke is especially harmful to young children, and causes 430 sudden infant death syndrome (SIDS) deaths in the United States annually.
--Second hand smoke exposure may cause buildup of fluid in the middle ear, resulting in 790,000 physician office visits per year.
--Secondhand smoke can also aggravate symptoms in 400,000 to 1,000,000 children with asthma.
--In the United States, 21 million, or 35% of, children live in homes where residents or visitors smoke in the home on a regular basis. Approximately 50-75% of children in the United States have detectable levels of cotinine, the breakdown product of nicotine in the blood.
--Research indicates that private research conducted by cigarette company Philip Morris in the 1980s showed that secondhand smoke was highly toxic, yet the company suppressed the finding during the next two decades.
--The current Surgeon General’s Report concluded that scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke. Short exposures to secondhand smoke can cause blood platelets to become stickier, damage the lining of blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk of heart attack.

The ALA is particularly adamant about how second hand smoke affects children:
1.) Children who breathe secondhand smoke are more likely to suffer from pneumonia, bronchitis, and other lung diseases.
2.) Children who breathe secondhand smoke have more ear infections.
3.) Children who breathe secondhand smoke are more likely to develop asthma.
4.) Children who have asthma and who breathe secondhand smoke have more asthma attacks.
5.) There are an estimated 150,000 to 300,000 cases every year of infections, such as bronchitis and pneumonia in infants and children under 18 months of age who breathe secondhand smoke. These result in between 7,500 and 15,000 hospitalizations!

Pediatrician Dr. Vincent Ianelli reports that understanding the effects of second hand smoke on our kids may help you give up smoking. Fortunately, most mothers understand the negative effects that smoking while they are pregnant can have on their unborn baby. These effects can include having a small or underweight baby, and having a baby with abnormal lung function. Mothers who smoke are also more likely to have a premature baby and according to the American Academy of Pediatrics, 'long-term cognitive and behavioral problems including lower intelligence and attention deficit disorder with or without hyperactivity.'

Although they may stop smoking during their pregnancy, many of these mothers do start smoking again after their baby is born according to Dr. Ianelli. This postnatal exposure to smoke by their children is also bad though. Being exposed to someone that smokes, even if they just smoke outside the home, is thought to increase a child's chance of having ear infections, allergies, asthma, wheezing, pneumonia and frequent upper respiratory tract infections. Smoke can also trigger asthma attacks in many children and they are often worse than in children who aren't exposed to someone that smokes. And infants who are exposed to a caregiver that smokes, or a mother that smoked while she was pregnant, are up to 4 times more likely to die of Sudden Infant Death Syndrome (SIDS). So improve your own and your child's health by getting some help quitting smoking.

The ALA also provides great tips on protecting you and your family from the effects of second hand smoke:
--Don't smoke in your home; and, ask other people not to smoke in your home, especially baby-sitters or others who may care for your children.
--Choose children's day care centers, schools, restaurants and other places you spend time in that are smoke-free.
--Ask smokers to go outside while they smoke.
--If someone must smoke inside, limit them to rooms where windows can be opened or fans can be used to send the smoke outside.
--Help people who are trying to quit smoking.
--Let family, friends and people you work with know that you do care if they smoke around you.
--In your car, do not smoke or allow others to smoke while the windows are rolled up.
--In restaurants and bars, ask to sit in the non-smoking area.
--Make sure your child's day-care, school and after-school programs are smoke-free.
--Ask your employer to make sure you do not have to breathe other people's smoke at work.

Smoking and second hand smoke are dangerous. Neither one of them certainly isn't cool. In addition to being a bad habit, your health and family will suffer long term results that will lead to very expensive medical issues both in the short term and later in life. If you smoke, STOP. If you know someone who does, try to help them quit. Smokers don't like to have their habit stepped on, but it is in their best interest and for the benefit of our national health.

Until next time. Let me know what you think.