Friday, October 23, 2009

H1N1, seasonal FLU and YOU!

Every day I see and get calls from patients that have questions about influenza, H1N1 as well as the vaccine.

Do you have both vaccines?
I want the flu but is the H1N1 safe?
Do you do testing for the flu?
A family member has cancer on chemo, can we get the nasal vaccination?
Are people really dying from the flu?

In terms of supply, this has been rather confusing. We pre-booked with our distributor for 100 doses. A couple of weeks ago the distributor told us that we will only be getting 10 total doses. They couldn't tell us whether or not we would get the rest of our doses anytime during the season. Early in the season we did enroll through the CDC to get H1N1 vaccine and ordered 200 doses. At this point we still don't know when they will be shipped. They said we will get an email stating it has shipped and doses should arrive shortly there-after. Obviously, the larger providers who purchase in the hundreds of thousands of doses will get priority over someone like me who orders only 100 or 200. At this time, the CDC is not reporting a shortage of vaccines. I believe, the seasonal flu vaccine production has been slowed or halted and now they are working on H1N1 production. Either way we have distributed our 10 doses to patients on a list and I myself went to Wal-mart to get my vaccination.

H1N1 vaccine safety. H1N1 is no more dangerous than the seasonal flu vaccine. Yes, in the past there have been problems with a rare neurological disease like Guillane-Barre and those patients allergic to eggs associated with vaccination. If you have ever had the seasonal flu vaccine, H1N1 is no different except for the viral particle used to provide the immunity. It's like playing music on a CD player. Every CD you listen to works the same way in your CD player, but if you change the CD you hear a different song. Every year the CDC is guessing at what strain of the viruses will be most prevalent in the upcoming season and they change the CD and make a different vaccine. The most common side effects are muscle soreness and redness at the injection site. Remember, there are risks to everything in life and you must weigh the risks against the benefits and for certain populations it's a "no brainer" being vaccinated. Key people who should get vaccinated are the following: Pregnant women, those who live with a child <6months old.

Dynamed free influenza information.

Bryan Glick, DO

Thursday, October 22, 2009

A Doctors Insight on Stress and Anxiety

I see more and more patients with stress and anxiety, especially in this economic environment. Many patients present with a myriad of symptoms that usually do not correlate to one specific illness other than "stress induced anxiety" or in doctor speak, "acute stress reaction NOS." The most difficult part for myself is that I see all patients with anxiety individually and while the patient is rightly concerned, their complaints are so strikingly similar to other patients with anxiety, that at times I think, "Is it Groundhog Day?" The fear, concern and pain that they feel is real but they don't realize that it's manifested by months if not years of stress. In my practice, I have the luxury to spend at least 30 minutes with each patient to really understand their concerns, the type of treatment that they would like and the barriers that will prohibit them from initiating treatment. That being said, I still think this disease is under diagnosed and under treated. That does not mean that every patient with anxiety needs medication. I try my best to treat the patient on terms that are acceptable to them. I have found that imposing a treatment regime on any patient for any illness leads to less successful treatment courses and greater follow-up.

What can you do to treat your anxiety?
First and foremost, how is your sleep? If you can't get to sleep, thoughts racing, noises bother you, room isn't dark and cool, watching TV, waking many times through the night, or waking up early without an alarm, these are all signs that your sleep is poor. We build our day on a foundation of sleep. A good nights sleep is the only way you will have the best chance of having a good day and dealing with stress and anxiety in a more purposeful way.

Next, you have to exercise and I don't mean to lose weight. I'm talking like 15-20 minutes everyday with your heart rate over 100. This will naturally increase your serotonin levels (same as anti-depressants) which will improve your mood and your ability to handle the stress of the day. In turn, this will help you sleep better which will in turn help you handle your stress the next day. Do you get my drift?

Lastly, work on prioritization, time management and perception in your world. What do I mean by that? I mean, we all have things that must get done, need to get done and we want to get done, but you can't do that everyday. We as Americans spread ourselves so thin that we never let our bodies rest and recharge. Do you know that Americans take less vacation annually than any other country in the world and have a higher rate of heart attacks and obesity. Why do you think that is? 100 years ago if you got sick, yes you could have died from infection or trauma, but the vast majority of illnesses resolved on their own. This is the bodies ability to heal itself. There was no such things as minute clinics or urgent care. The reason why more and more patients are presenting to doctors, urgent cares, hospitals etc it multi factorial but you have to admit that when the doctor recommends rest and time off work, nobody listens. So, with this in mind, prioritize you day within reason and manage your time better, not to be more efficient or to make more money but FOR YOUR HEALTH! Think about this, when you watch your favorite sports team playing a game and they win, you're happy, and win they lose, you're sad. How is that possible? Those feelings are self imposed. You have placed that perception on yourself that since your team lost, your in a bad mood. Is it possible that you imposed undue stress on yourself at home or at work or in relationships? I think we all do it, myself included. It's not very hard to see that stress begets stress and fatigue begets fatigue. What can't optimism beget optimism and energy beget energy?

In conclusion, we all have stress and anxiety. The question is how do you deal with it and how does it end up dealing with you? If you have had longstanding anxiety, you may appropriately need medications for several months to reverse the chemical nature your brain. There are things you can do for yourself without medication like getting better sleep, exercise and adjusting the way to react to your world.

In this economic climate, when you need to be your best to keep your job and your house, you can't afford to run yourself down. Make time for yourself and HEAL THY SELF.

Just some thoughts from the other side of the exam table.

Bryan Glick, DO

Thursday, October 15, 2009

Prediction Rule Identifies Low Risk Children after Minor Head Trauma

This email came to me from Dynamed which is an evidence-based medicine resource which gives good information about avoiding unnecessary radiation in a child with a bump on the head.
At Health Quest Family Medicine we try to take the conservative approach when treating children and adults.

Computed tomography (CT) is often performed on children with head trauma to diagnose clinically important traumatic brain injuries. Attempts have been made to develop criteria that might safely avoid unnecessary procedures. The Pediatric Emergency Care Applied Research Network study (PECARN) has now developed a prediction rule that identifies children at very low risk of clinically important injury for whom CT imaging may be avoided (level 1 [likely reliable] evidence). The derivation and validation cohorts included 42,412 children 2 years old meeting all of the following criteria: normal mental status, no loss of consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture, and no severe headache. CT can be withheld in children hematoma except frontal, loss of consciousness 0-5 seconds, non-severe injury mechanism, no palpable skull fracture, and acting normally according to the parents. The rule had sensitivity of 97%-100%, specificity of 54%-60%, and negative predictive value of 99%-100% (Lancet 2009 Oct 3;374(9696):1160).

For more information, see the Decision rules for computed tomography in head injury in children topic in DynaMed.

Health Savings Accounts in Arizona

Health Savings Account (HSA) allows patients to put aside part of their income in an account to be spent on medical expenses. It is not taxed like regular income and can be spent on drug store purchases, prescription medications, eye care, dental visits and doctor’s care, including at Health Quest.