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child-immunization-macon-nc

According to a recent public health alert, California is experiencing an epidemic of pertussis, with over 5,000 cases reported this year.

Santa Cruz County has had at least 60 known cases (twice the number as last year) and probably many more cases, which have not been reported or have yet to be diagnosed.

Pertussis, also called whooping cough, is a highly contagious infection of the lower respiratory tract, involving the lungs. It usually manifests as a mild persistent cough, but can advance to a severe cough. Often in children, this cough is followed by a high-pitched intake of breath that sounds like “whoop” – thus the name “whooping cough.”

Pertussis is caused by a germ which is a bacteria and not a virus. It is passed from an infected person who sneezes or coughs and therefore spreads infected tiny droplets into the lungs of anyone who may be nearby.

Once in the lungs, the germs can cause an infection, thereby creating inflammation and narrowing of the lung’s breathing tubes. This produces the cough and the characteristic whooping sound.

Infants are particularly vulnerable because they are not fully immune to whooping cough until they’ve received at least 3 immunization shots.

This leaves those 6 months and younger at greatest risk for catching the infection.

The pertussis vaccine one receives as a child wears off in 5 to 10 years, leaving most teenagers and adults susceptible to the infection during an outbreak.

Also, more parents are choosing not to vaccinate their children, thus lowering the number of immunized individuals. This, coupled with the fact that newer vaccines are less potent than the older ones, has increased transmission of pertussis.

The diagnosis of pertussis is often delayed or missed in infants because early symptoms are often mild and the serious cough may not begin for days or even weeks later.

A severe infection in infants can be fatal, although this is thankfully rare. Three infant deaths due to pertussis have been reported in California since the beginning of the year.

One must consider pertussis for anyone with a cough lasting more than 2 weeks, especially when the person generally feels well, coughs worse at night, and has prolonged coughing spells.

The vaccine for pertussis is combined with the tetanus and diphtheria vaccines which are routinely given to children in their first years of life, and to adults every 10 years.

Besides infants, those who especially need the vaccine protection are pregnant women in their third trimester because they will soon have contact with their unprotected infant.

Mothers have been found to be the greatest source of transmitting whooping cough to the newborn. Infants can also be protected by vaccinating those people who have close contact with them.

This “family” protection has been highly successful in protecting susceptible infants.

Tests are available to diagnose pertussis. The decision whether or not to test should be left to your doctor.

Antibiotics can be effective especially when given soon after symptoms begin. After several weeks of symptoms, they are much less effective.

Family members can also be prescribed preventative antibiotics. Remember that pertussis is caused by bacteria and can usually be treated with an antibiotic, but if you just have a bad cough from something like routine bronchitis, which is caused by a virus, antibiotics are not effective.

Your doctor will be able to determine the proper diagnosis and treatment.

Bottom line: I recommend to immunize your children and keep immunizations up to date for yourselves.

Terry

I am in remission of my multiple myeloma cancer. The three months of chemotherapy last fall and winter did a great job in knocking out most of those cancerous plasma cells which were taking over my body. The stem-cell transplant I was originally to have following chemotherapy has been canceled. I will have my blood tested regularly to monitor my remission. My thanks to Dr. Michael Wu and his wonderful caring staff at the Palo Alto Medical Foundation oncology department who did a superb job treating my disease.

I discovered that one doesn’t necessarily have to leave Santa Cruz for state-of-the-art cancer care that I found right here through my group at PAMF. I sure wasn’t used to being — nor particularly enjoyed — being on the patient side of the doctor/patient relationship. It was a humbling experience and has taught me more about patients and patience along my journey.

Unfortunately, I am suffering from a fairly severe neuropathy of my feet from the chemo drugs, and this is currently adversely affecting my ability to walk normally. I do, however, feel it’s a small price to pay for my successful cancer treatment. I’m told the neuropathy should improve with time. I’ll try to be patient, (not one of my virtues however).

Another little complication I had in the past month, most likely unrelated to my cancer or treatment, is a condition of my heart called constrictive pericarditis. This occurs when the sac of tissue surrounding the heart (the percardium) becomes inflamed and tightens in on the heart, causing the heart to pump less efficiently.

This threw me into mild heart failure with significant shortness of breath, swelling of lower extremities and general fatigue. Dr. Neil Sawheny, one of my cardiologist partners at PAMF, is treating me for this unexpected complication and I seem to be responding well and improving day by day.

In general , my overall well-being is improving significantly. I feel as though my life as I once knew it is being slowly restored. Once my neuropathy shows signs of improvement, I hope to return to work at least half-time.

I’ll give myself a break to work a bit less since I’ve now been practicing medicine for the past 40 years, 27 years in urgent care Scotts Valley. I love my staff, my patients, many of whom I’ve come to know quite well. Most of all, I love the satisfaction I receive in helping make people feel better and in maintaining their good health.

My thanks to all of you who have mailed get-well cards or sent email messages for my recovery. I am a strong believer in the power of prayer and I know your prayers for me have been heard.

My personal lesson from my cancer experience is this: If you have any health symptoms that seem unusual to you or are lasting longer than you think they should, see your doctor for a work up. If everything checks out OK and your symptoms soon improve, then be thankful.

If something serious like cancer is found, the sooner it’s treated the better the outcome. This a proven fact. Also, for those many of you who are healthy, give thanks every morning that you can begin a new day.

My best wishes to you for long healthy lives.

Bone

Osteoporosis literally means “bones with holes.” It occurs from bone losing calcium faster than it can be replaced. New bone creation doesn’t keep pace with the removal of old bone. The bone is weaker, less dense, and easier to break than healthy bone.

There are come common risk factors and you they are unchangeable. For instance, your sex. Women, especially post menopausal, are much more likely to develop osteoporosis then men, but men aren’t off the hook. There are at least 2 million men with osteoporosis and this will increase as men begin to live longer. The older you get, the greater the chance of developing osteoporosis. You’re also at a greater risk if any close relatives have had osteoporosis and Caucasion and Asian women are at a greater risk.

The reduction of sex hormones, estrogen for women and testosterone for men, also contribute to osteoporosis. Dietary factors associated with osteoporosis include low calcium intake, eating disorders and stomach bypass surgery. Certain medications, especially corticosteroids such as prednisone and cortisone, can contribute to osteoporosis.

Lifestyle choices also can put you at a greater risk for osteoporosis. Smoking tobacco and drinking alcohol, especially more than two drinks a day, will put you at greater risk, as will a sedentary lifestyle and a lack of exercise.

Bone fractures, especially of the hip and spine, are the most common complications of osteoporosis. A fall can easily break a hip, causing disability and even lead to death. Spinal fractures can occur with or without an injury. Sometimes a sneeze or cough can cause a fracture.

The best way to diagnose osteoporosis is to measure bone density. This can be done by a machine that uses low levels of x-ray to measure the strength of your bones. Your doctor can order this for you.

Osteoporsis can be treated with drugs called biophosphonates. Your doctor would have a choice of one of several of these drugs to treat you. Use of the sex hormones estrogen for women and testoterone for men can also be useful in treating osteoporosis. Some controversy exists over the use of these hormones. Your doctor will explain the risks and benefits.

So, to avoid osteoporosis, avoid excessive consumption of alcohol, don’t smoke, try to avoid falls, exercise regularly, and consume adequate amounts of calcium. It is recommended that the total daily calcium intake from diet or supplements not exceed 2,000 mg. daily for people over age 50. Consume adequate amounts of vitamin D, which is necessary for your body to absorb calcium. Talk to your doctor about what dose would be best for you.

Summer-S

Over the course of my emergency/urgent care career I’ve dealt with many different injuries and illnesses seen commonly during the summer months. I’d like to share some of my thoughts on making this a very safe summer for everyone.

Sunscreen – Almost everyone who spends time out in the sun must wear sunscreen to block the harmful, damaging effects of the sun’s ultraviolet rays on our sensitive skin. Use a sunscreen that offers protection against both UVA and UVB rays and has an SPF rating of at least 30. Apply it liberally and often (at least every two hours). Parents, protect your kids’ precious skin.

Insects – Beware of the many summer bugs lurking out there. For mosquito protection, use a repellant that contains DEET, which when used as directed is safe for adults and children over 2 months of age. Regarding the stinging insects such as yellow jackets, wasps and honey bees, avoid them if they are in your vicinity. If you do get stung by a honey bee (which is the only one of the stinging insects that leaves a stinger behind in your skin), remove it as quickly as possible by any means possible. It is now okay to just pull it out with your fingers and not waste time finding something with which to scrape it off. Immediately apply ice to the sting. When out in a woody or grassy area always check your entire body for ticks when you get home. If you find one, remove it as soon as possible by getting a pair of tweezers, grabbing the tick close to the skin and pulling it straight out.

Poison oak – The best protection is to recognize it and avoid it. If you come into contact with poison oak with your skin, clothing (including shoes and shoelaces), or garden tools, wash off immediately with soap and water. Poison oak oil must be washed off of your skin within a few minutes in order to avoid the dreaded rash. Remember, all parts of the poison oak plant contain the nasty oil, including the leaves, branches and roots.

Heat – Heat exhaustion is manifested by extreme sweating, fatigue and cramps. Heat stroke (a life-threatening condition) is manifested by lack of sweating, red hot skin, and a very high body temperature. Both conditions can usually be prevented by drinking plenty of liquids and avoiding direct sunlight as much as possible, especially between the hours of 11 a.m. and 4 p.m.

Water safety – 4,000 Americans drown every year, mostly men by a factor of four times more than women. Alcohol is frequently involved. Make sure the kids are supervised in the water every single minute. Watch out for rapid currents, rip tides, rocks, and always be aware of your surroundings. Boat injuries claim another 700 American lives a year. Drive your boat sensibly, have enough life preservers on board and do not drink alcohol and drive.

Bicycling – Wear a helmet! No matter how obvious this bit of advice is, I still see people riding without a helmet and I really cringe when I see children without this life-saving protection. Head injuries are often very serious, if not deadly, and are inexcusable for lack of a helmet. Be aware of your surroundings and be in control of your bike at all times. Don’t take foolish chances.

Eating – Summer picnics can be a common source of food poisoning manifested by vomiting and/or diarrhea. Food left out too long is the usual culprit. Handling uncooked chicken or eating undercooked chicken is also a common source of this illness.

Driving – We all drive more during the summer. The cheapest form of life insurance while you are in a car is the good old seat belt. Wear it! Make sure your children are in proper age-appropriate car seats. Handheld cell phone use while driving your car can be deadly and is now illegal. Don’t break the law.

Have a very enjoyable safe summer.

eCig1

There’s been much in the news recently about e-cigarettes. The Santa Cruz City Council has just voted to update the city’s tobacco related ordinances which would ban the use of e-cigarettes where smoking is currently restricted and requiring the product to be sold only by vendors with tobacco retail licenses. Thus, Santa Cruz joins some 50 California state cities and counties in creating such restrictions.

E-cigarettes, also called vape pens or e-hookahs, are made to resemble cigarettes. They are battery-operated, which allows conversion of liquid nicotine into a vapor which enters the lungs and is easily absorbed into the blood stream. There’s no tobacco, flame, smoke, tar or carbon monoxide which is probably the only good thing that can be said for this product.

I’d like to touch upon some of the questions and concerns regarding electronic cigarettes.

Are e-cigarettes safer than regular cigarettes?

They are probably safer than cigarettes because of the lack of the above mentioned substances found in burning regular cigarettes. That being said, e-cigarettes are a nicotine delivery system, are highly addictive and ultimately harmful because of the effects of nicotine, which is a potent stimulant drug that is probably unsafe for children, pregnant women and people with certain heart conditions. These products are not regulated by the Food and Drug Administration and many are manufactured in China, a country not known for its quality control and safe products.

Can e-cigarettes help break the habit of smoking regular cigarettes?

There is no good scientific evidence that smoking e-cigarettes can effectively wean one off of regular cigarettes. In fact, one large study of 75,000 teen smokers found that those who were trying to quit smoking were less likely to succeed if they also smoked e-cigs and many actually ended up smoking more real cigarettes. Better ways of breaking the smoking habit would be to utilize the strategies of behavioral counseling, nicotine replacement products and prescription non-nicotine medication.

Are kids smoking e-cigarettes?

Since some 90 percent of long term smokers began smoking under the age of 18, it’s not hard to imagine the allure of e-cigarettes to our youth. The CDC has reported a disturbing trend that the use of e-cigarettes more than doubled among U.S. middle and high school students from 2011 to 2012. To make them more appealing to minors, manufacturers are making e-cigarettes in assorted eye catching colors and candy flavors like watermelon, cotton candy, and bubble gum.

So with no proven health benefits and with too many questions concerning safety and long term addiction, e-cigarettes should come with at least the same restrictions, warnings and health concerns as with regular tobacco cigarettes.

The bottom line is that for the sake of one’s health, I would strongly discourage the use of any and all tobacco and nicotine products.

CancerTreatment

In previous articles (February 28 and March 14) I described cancer in general terms and then discussed specific common cancers. Now I would like to describe various cancer treatments available and methods of cancer prevention.

There are a variety of treatments available today for treating cancer, including:

- Surgery. This can remove the cancer or as much of it as possible.

- Radiation. This uses X-rays to kill cancer cells.

- Chemotherapy. This uses potent drugs to kill the cancer cells.

- Stem cell transplant. This is also commonly called bone marrow transplant. This uses stem cells which are found in the bone marrow and are the precursors to all other blood cells. The cells are collected from the patient, or less commonly from a donor, and then placed back into the patient after receiving a large dose of chemotherapy or radiation. This allows for the creation of a new healthy bone marrow and immune system.

- Hormone therapy. Some cancers such as breast cancer and prostate cancer are worsened due to the effects of certain hormones in our bodies. Blocking these effects is the goal of hormone therapy.

- Targeted drug therapy. This method allows an anti-cancer drug to specifically attack a specified cancer cell.

- Biological therapy. Helps your own immune system to better recognize and fight off cancer cells.

- Alternative medicine. Not scientifically proven, yet found to be quite helpful for many patients. Such therapies include meditation, acupuncture, yoga, massage, and hypnosis.

- Vitamins and food supplements. Also unproven, but widely used with some success.

Although there is no way as of yet to prevent cancer, there are ways to reduce the risk of having cancer including:

- Stop smoking. Smoking has been associated with many types of cancer, not just lung cancer.

- Eat a healthy diet. Concentrate on fruits and vegetables and select whole grains and non-fatty proteins.

- Avoiding excessive sun exposure. Avoid mid-day sun, use sun screen liberally and avoid tanning booths.

- Get plenty of exercise. At least 30 minutes of exercise daily is a good goal.

- Avoid obesity. Maintain a healthy weight.

- Drink alcohol in moderation if you choose to drink. One dink per day for women, two drinks per day for men.

- Schedule routine screening exams. Talk to your doctor about what exams you may need depending on your risk factors.

The bad news about cancer is that it is still so very prevalent in our society. As I have personally found out, anyone can experience it. The good news is that through early detection and rapidly improving treatments, cancer patients in general have a much improved survival rate. I think that if researchers can somehow find methods to mobilize our immune systems to better recognize cancer and to successfully overwhelm it in its early stages, we may then be close to a cure for many cancers.

From my own personal experience with cancer and from many patients I have treated, my advice is that if something about your health just doesn’t seem right, don’t assume it’s nothing to worry about. Listen to your body as only you can do. Don’t take a chance. Being checked out by your doctor sooner rather than later could save your life.

cancer2

In this article I would like to summarize information for a variety of common cancers as the second of my three-part series on the disease.

-Breast: More than 225,000 new cases of breast cancer are expected this year among women and over 2,000 cases in men. Breast cancer is the most frequently diagnosed cancer in women. Increasing age is the most common risk factor. The survival rate has improved dramatically due to early detection and improving treatments.

-Prostate: Close to 250,000 new cases of prostate cancer are expected this year. It is the most common cancer for men. Increasing age is the most common risk factor. Fortunately more than 90 percent of all prostate cancers are discovered before metastasis occurs, for which there is a five year survival rate close to 100 percent.

-Lung: Some 250,000 cases of lung cancer are expected this year which accounts for more deaths than any other cancer in both men and women. Cigarette smoking is by far the most common risk factor for lung cancer, and increases depending on the number of cigarettes smoked daily and the number of years of smoking. Death rates are dropping as a greater number of people are quitting smoking.

-Colon and Rectum: Over 150,000 cases of colorectal cancer are expected this year. Fortunately, the rate is falling significantly as more people are having colonoscopies which allows for the removal of precancerous polyps. Only 65 percent of eligible adults have been screened as recommended.

-Urinary bladder: Some 75,000 cases of bladder cancer are expected this year. It is found four times more frequently in men than in women. The most common symptom is blood in the urine.

-Uterine: Almost 50,000 cases are expected this year. Early symptoms include vaginal bleeding or spotting, as well as pelvic pain. Obesity and exposure to the hormone estrogen are risk factors.

-Melanoma: Close to 80,000 people will be diagnosed with melanoma, a potentially deadly skin cancer which often metastasizes to other parts of the body. Major risk factors include family history of melanoma, the presence of numerous moles (more than 50), and exposure to ultraviolet rays mostly from sun exposure, but also from tanning booths.

-Kidney: Over 65,000 cases of kidney cancer are expected this year. There are usually no symptoms early in the disease. Tobacco use is a strong risk factor.

-Lymphoma: Close to 70,000 cases of lymphoma will occur this year. This is a cancer of lymphocytes, a type of blood cell. Symptoms include swollen lymph glands, night sweats, weight loss, fatigue, and fever.

-Leukemia: Around 50,000 cases of leukemia are expected this year. Leukemia is a cancer of the bone marrow and blood cells. Leukemia is difficult to diagnose early because symptoms often mimic other less-serious conditions.

-Pancreas: Some 45,000 cases of pancreatic cancer are expected this year. Unfortunately, there are very few symptoms early in the disease, and is therefore not detected until it has spread to other organs. By the time it is detected treatment is often unsuccessful.

-Ovary: Over 22,000 women will be diagnosed with ovarian cancer this year. Symptoms are often nonspecific and include sensations of bloating, pelvic or abdominal pain, and urinary urgency and frequency. Diagnosis is usually confirmed by a pelvic exam and ultrasound test.

-Cervical: Around 12,000 cases will occur this year in women. The most common symptom is abnormal vaginal bleeding. The Pap test is the most common screening method. The primary cause of cervical cancer is infection with the human papillomavirus transmitted by sexual intercourse. It can now be prevented by a vaccine, which is highly recommended for females and males from ages nine to 26.

In this article, I have attempted to cover the most common types of cancer. Unfortunately there is a long list of other less common cancers.

My next and final article on cancer will discuss treatment and prevention of cancer. It will publish March 28.

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