As I begin my fifth year writing this column, I’d like to thank my readers for the encouraging feedback I’ve received from so many of you.

Today I’d like to share with you what I consider the highlights from some of my columns this past year.

- Diabetes: Adult-onset diabetes can be prevented by exercise, diet and weight control.

- Sugar: Sugar comes in a variety of forms and in and of itself is not unhealthy, but excessive intake of sugar leads to obesity, which contributes to poor health.

- Smoking: Smoking causes one out of five deaths each year in the United States and damages almost every organ in the body.

- Deep-vein thrombosis (blood clots): If you have had recent surgery or prolonged bed rest, recently traveled or are pregnant and you have pain or swelling in a lower leg, you might have a blood clot and need immediate medical attention.

- Senior moments: We all have “senior moments” from time to time, with occasional memory loss, but if these moments persist, worsen or interfere with daily activity, medical attention is needed.

- Radiation: We are exposed daily to radiation both natural and manmade. The more we can prevent such exposure by limiting excessive medical and dental x-rays and checking our homes for radon, the healthier we will be.

- Dizziness: This is a common condition but usually not serious. However, if symptoms are persistent or troublesome, a medical evaluation is necessary.

- Colon cancer: This cancer, if found early, has a very favorable cure rate — so talk to your doctor if you are 50 years or older, have a family history of colon cancer, or have rectal bleeding or any change of bowel habits.

- Bedbugs: When arriving home from a stay in a hotel, unpack your suitcase as far away from your bed as possible.

- Meningitis: Common symptoms include bad headache, stiff neck, nausea and vomiting; this is a serious infection, which can occasionally be deadly.

- Treatment of upper respiratory symptoms in children: Avoid over-the-counter cold and flu medications for children younger than 4 years of age, except for acetaminophen (Tylenol) and ibuprofen (Advil). Both of these medications can be used in the proper dose for treating fever or pain.

- Non-physician health care providers: Nurse practitioners and physician assistants are very well trained to care for most patients’ needs when working with their supervising physician partners.

There are many misperceptions about the appropriate use of antibiotics for the treatment of upper-respiratory infections.

As we come to the end of another year and find ourselves in the midst of the cold and flu season, I want to talk about the diagnosis and treatment of the common upper-respiratory infections. These infections include sinus infections (sinusitis), sore throats (pharyngitis), ear infections (otitis) and coughs (bronchitis).

These are the most common illnesses seen in my practice in urgent care, as well as in most acute-care practices. We physicians are constantly receiving information from current medical literature indicating that almost all of these infections are caused by viruses, which are completely unaffected by the use of antibiotics. These viral infections will usually improve with time. The big question here is how much time.

At what point does the simple viral infection become a secondary bacterial infection that can be cured with an antibiotic? That is the critical issue, and one that I’m sorry to say is difficult to determine.

We physicians have various means to confidently diagnosis such problems as appendicitis, heart attacks, ulcer disease, diabetes and others. But we have no easy, fast, or accurate method of determining at what point in time the upper-respiratory infection changes from a viral infection to a bacterial infection.

I want to say emphatically that antibiotics will not shorten the duration of an upper-respiratory infection.

Why not just give an antibiotic and hope for the best?

Simply put, antibiotics can cause problems from annoying to life-threatening allergic reactions, diarrhea and yeast infections. Just recently, overuse of antibiotics has been linked to obesity by Dr. Martin Blaser, a professor of microbiology at New York University Langone Medical Center. Antibiotics are also very costly and drive up the cost of health care when prescribed needlessly.

The most important issue is that the inappropriate use of antibiotics causes the development of “super germs” that resist treatment by almost all antibiotics. Unfortunately, unlike in past years, very few new antibiotics are being developed. The situation worries me.

What I would ask of patients with symptoms of the abovementioned respiratory illnesses is to give as much time as possible for the illness to run its course. If you have a fever or increasing pain, if you feel so sick that you can’t perform your usual routine or if you develop any other symptom that worries you, an immediate trip to your physician is justified.

Once you decide to see your doctor, you should expect the doctor to listen to your explanation of symptoms, examine you, give you a diagnosis and offer an estimate as to when you should feel better. Then let him or her advise you of the proper treatment to help you feel better.

When it comes to the common upper-respiratory infection, let us do for you what will ultimately help you, in the safest and best way, feel better.

In my November column on diabetes, I discussed the definition, symptoms, causes, risks and complications of this common disease (“Diabetes a common peril,” Page 20, Nov. 23). Today, I would like to discuss the diagnostic tests and treatments for diabetes, prevention and the impact of the disease on our society.

Before I do so, though, a reader who has a child with Type 1 diabetes has asked me to clarify a few points. Type 1 (childhood) diabetes is not caused by eating too much sugar; it is caused by the body not having enough insulin, which causes increased blood sugar. Also, a child will not “grow out of it.” Type 1 diabetes is a lifetime health issue.

Now, on to today’s topics:

Blood tests are used to diagnose diabetes. The fasting blood sugar test is the one most commonly used. It tests the amount of sugar in the bloodstream after a period of fasting. A more reliable blood test is called the A1C test and measures a person’s average blood sugar over several months.

Specific treatment for Type 1 diabetes involves the use of insulin, frequent monitoring of one’s blood sugar level and counting carbohydrates. Treatment of Type 2 diabetes involves oral diabetes medications, possible use of insulin, blood sugar monitoring, maintaining a proper diet and routine exercise.

Type 1 diabetes can’t be prevented and can only be treated with insulin. However, Type 2 diabetes can be prevented by the same lifestyle choices that also treat the condition, including:

- Eating healthy foods.

- Getting plenty of physical activity.

- Losing extra pounds, if overweight.

About 26 million Americans have diabetes, and the numbers are growing yearly. About 2 million of these diabetics have Type 1 diabetes, and the remaining 24 million have the more preventable Type 2 diabetes. Twenty-six percent of all hospital costs are related to the treatment of diabetes and its complications, costing $175 billion to $200 billion per year.

In summary, we know that Type 1 diabetes usually begins in childhood, is most often caused by genetic or other unknown factors, is not caused by a poor diet and can be treated with insulin injections. It is incurable.

Type 2 diabetes affects mostly adults and is treated and often cured by diet, exercise and preventing obesity.

About 25 million Americans have prediabetes, a precursor to Type 2 diabetes. I would advise patients to talk with their physicians at their next routine visit about being screened for this common disease.

November is National Diabetes Month. Most of us know someone with diabetes, but we may not understand just what this disease is.

Diabetes occurs when the body doesn’t make enough insulin or when the insulin becomes ineffective. Insulin is a hormone made by the pancreas that helps move glucose (blood sugar) from the blood into the cells of our bodies, where the glucose acts as a source of life-sustaining energy for our muscles and tissues. When insulin is insufficient or ineffective, the sugar level in our blood increases, causing diabetes.

There are several types of diabetes. In type 1 diabetes, one’s pancreas does not produce enough insulin. This is usually a genetic problem where one’s own immune system attacks and destroys the cells that create insulin in the pancreas. This type of diabetes often starts in childhood and has the most serious health complications.

Type 2 diabetes occurs when one’s cells become resistant to the effects of insulin, causing sugar to build up in the bloodstream. Being overweight is a major contributing factor. Genetics and environmental factors may also play a role in this type of diabetes. Type 2 diabetes is the most common type and can occur at any age. It is also preventable.

Prediabetes often precedes type 2 diabetes. This condition occurs when the blood sugar is higher than normal, but not high enough to cause any obvious health problems. It is estimated that perhaps 80 million people in the U.S. have this condition, which, if not recognized and treated, could go on to type 2 diabetes.

Symptoms of diabetes depend on how high one’s blood sugar is. These include:

- Frequent urination

- Increased thirst

- Extreme hunger

- Unexplained weight loss

Risk factors for diabetes depend on the type of diabetes. For type 1, these factors include genetics, environment, dietary habits, race and geography. Risk factors for type 2 include obesity, inactivity, family history, age and pregnancy.

Complications of diabetes take time to develop. The longer one has diabetes and the higher the blood sugar, the worse the complications. Eventually, these complications can cause significant disability and possibly early death. Diabetic complications include:

- Cardiovascular disease, especially heart attacks and strokes.

- Nerve (neuropathy) and blood vessel damage involving the legs and feet sometimes leading to amputation.

- Eye damage.

- Kidney damage, often leading to dialysis or even to kidney transplantation.

- Increased risk of Alzheimer’s disease as well as certain cancers.

My next column will cover the tests, treatment and prevention of diabetes.

November 11 is Veterans Day. Although I never had to serve in the military, I honor those who did. I especially have the highest regard for those who actually saw combat and put their lives on the line for me and my country. To you ladies and gentlemen, I give my deepest thanks.

Today I’d like to honor my favorite veteran, my late father, Dr. Stanley Hollenbeck. Dad was born in 1911 in Milwaukee, Wis., where I was also born and raised. He graduated from Marquette University School of Medicine in 1936 and began a private practice. Around that same time, he joined the Wisconsin National Guard.

With the onset of World War II, his regiment became part of the Army’s 32nd Infantry Division which was sent to Australia in May 1942. Dad left behind his new medical practice, his wife and his newborn son, my brother Stan Jr. I can’t imagine how Dad felt about leaving his comfortable life behind, especially not knowing what he would be facing, as he would be thrust into the escalating war with Japan in the South Pacific.

Dad was the commanding officer of the 14th Portable Surgical Hospital, one of the army’s first Mobile Army Surgical Hospital units, which were later popularized by Alan Alda in the TV hit series “M.A.S.H.” Dad and his crew were sent to the north coast of New Guinea near a small village called Buna, where the enemy was deeply entrenched. His unit’s bulky, hot, humid hospital tent was set up less than 1,000 yards from the front line where hand-to-hand combat was taking place.

Health conditions for the troops were among the worst in the world. The mosquitoes and flies were horrific. Almost all soldiers, including Dad, suffered bouts of malaria. Everyone had recurrent dysentery. There were also scrub typhus, dengue fever, hookworm, yaws and countless cases of “fever of unknown origin.” Troops suffered from depression and severe battle fatigue caused by the relentless hot, humid, rainy weather, the jungle and inadequate food. For every two men who were battle casualties, five were out of action from fever.

Dad and his crew often operated day and night on the young wounded soldiers. This took place in a large canvas tent by lantern light. Temperatures inside the tent could reach up to 130 degrees. All of this was done under frequent machine gun strafing and bombing by enemy fighter planes, as well as the constant threat of being overrun by enemy troops.

Dad kept a daily diary of his life in New Guinea, which was later published by his Veterans of Foreign Wars group in Milwaukee. I would like to share an excerpt from that diary. On Nov. 16, 1942, a five-boat convoy bringing desperately needed ammunition, food and medical supplies to the troops was attacked by enemy aircraft, setting all the vessels ablaze. Dad and his crew witnessed the attack from the shore.

In his diary, he later wrote: “I grabbed my medical kit, forded the river and started up the beach. I could see the boats burning fiercely as night began to fall. I was frightened to death not knowing exactly where the enemy troops would be as I walked along the jungle’s edge. I continued up the beach, checked on survivors and rendered first aid. I had the more seriously injured sent back to our hospital tent. I hurried back to get ready to operate on the wounded. We operated all night long on the men, mostly with abdominal wounds, sewing up the bullet holes in their intestines, besides treating other serious wounds. We finally finished, getting to bed at 4:30 a.m.”

From October 1942 through February 1943, Dad remained just behind the front line, operating and treating wounds on countless injured soldiers. Lives were lost, but many more were saved due to the efforts of Dad and his crew. In February 1943, the 14th Portable Surgical Hospital was awarded the Distinguished Unit of Citation, and several individual members of the unit, including my father, received the Silver Star medal for gallantry in action. He also received the rank of lieutenant colonel.

Dad told me that he and his fellow soldiers were willing to put their lives on the line, believing that a victory would end all wars and that their children would never have to do the same. Unfortunately, such a dream was not to come true. Sons and daughters are still sent to battle.

Here’s to you, Dad, of whom I am so very proud, and to all the other brave veterans living and dead. I salute you and I honor you.

Halloween will be here in a few days, and many kids will be out trick-or-treating. It’s an exciting night for all of the costumed children. To help ensure safety, I’ll share some tips from the American Society of Pediatrics, as well as some of my own thoughts.

All dressed up

- Costumes should fit properly and be bright, reflective and flame-resistant.

- Facial makeup and hats are worth considering as an alternative to a face mask that can block vision.

- If a sword, cane or stick is part of a costume, it should not be too sharp or too long.

On the trick-or-treat trail

- A parent or responsible adult must accompany young children on their rounds in the neighborhood.

- Trick-or-treaters should only go to well-lit homes and should not enter any houses.

- Groups should remain on well-lit streets and use sidewalks or the far edge of the road, facing traffic.

- Each group should carry a flashlight and a cell phone.

- Walkers should cross the street at crosswalks and never cross between parked cars.

- Older children and teens going out without an adult should let parents know where they are going, have a curfew to return and stay in a group.

Home safe home

- Clear a path to your door to avoid tripping a child.

- Keep the pathway and the doorway well lit.

- Restrain pets that might cause harm to a child.

Carving a niche

- Adults, not children, should handle pumpkin-carving knives. Children can scoop out the insides and draw a face on the pumpkin for an adult to cut out.

- A battery-powered light is safer than a candle to give jack-o’-lanterns their eerie glow. It’s best to avoid using an open flame in any decoration.

A healthy Halloween

- Youngsters should have a good meal before they collect all their sweet goodies.

- When they return home, a responsible adult should inspect the treats and discard anything that is spoiled, unwrapped or suspicious.

- Rationing candy means it may be enjoyed for many days following Halloween.

Have a happy and safe Halloween!

Halloween is soon upon us, and our little trick-or-treaters will be carrying home bags full of candy. As candy is full of sugar, I’d like to discuss the effects of sugar on our health.

The average American consumes a whopping 2 to 3 pounds of sugar a week, about 130 pounds a year. That’s up from 25 pounds per year just 20 years ago. This rapid increase in consumption is because sugar is increasingly being added to many of our daily foods, such as soda, breakfast cereal, bread, mayonnaise, peanut butter, salad dressing, canned goods and many other food products.

The main problem of eating too much sugar is that it adds extra calories to our diet; in most cases, much more than we need. Extra calories add up to weight gain and eventually to obesity, which is one of our greatest health epidemics. Obesity from eating too much sugar can cause health problems such as diabetes, high blood pressure, heart attacks and strokes.

Sugar is the main cause of dental cavities and tooth decay. It is also associated with an increase in triglycerides (a type of fat in the bloodstream), which can be another cause for heart disease.

There are many other possible — but not necessarily proven — health problems related to excessive dietary sugar, such as suppression of the immune system, hyperactivity in children, arthritis, asthma and many more diseases.

Some think that natural sugar, such as that found in fruits, dairy products and other foods, is healthy. This is true only to the extent that these foods also contain healthy amounts of vitamins, fiber and other nutrients.

Sugar is sugar, no matter what it’s called. There are brown sugar, high-fructose corn syrup, dextrose, glucose, lactose, maltose, sucrose, molasses, honey and others. They all contribute calories.

The American Heart Association says that women should get no more than 100 calories a day from added sugars. That’s about 7 teaspoons, roughly 25 grams, which is about equal to one typical candy bar. Men should get no more than 150 calories from sugar. That’s about 10 teaspoons, roughly 38 grams, the amount found in 12 ounces of soda. Most Americans get more than 22 teaspoons — 355 calories — of added sugar a day, far exceeding healthy guidelines.

The best way to cut back on added sugar is to limit, if not eliminate, soft drinks from your diet. Many other drinks are high in sugar, including ready-to-drink teas, sweetened alcoholic or caffeinated drinks, and juice drinks. To satisfy sweet cravings, try eating fresh fruit. For snacks, swap candy and sweets for air-popped popcorn, dry roasted nuts and baked tortilla chips.

Look at food labels, which list the ingredients and often give the amount of sugar measured in grams.

The bottom line is that most of us consume enough naturally occurring sugar in a well-balanced diet. The more we can cut back on candy, sodas, pastries, cakes and cookies, the healthier we will be.

Patients seeking medical care today are having more frequent exposure to non-physician providers, such as physician assistants and nurse practitioners. Both of these groups of health care practitioners are professionals licensed to practice medicine under the supervision of a physician.
They can perform a wide variety of medical duties, from basic routine medical care to highly technical procedures. They may also work as surgical assistants to a surgeon. Their patients can range from newborns to the very elderly. They can be found in virtually every medical and surgical specialty.

In rural areas that are short of physicians, they often work independently, conferring with a supervising physician as necessary and as required by law. Their responsibilities are determined by their experience, their working relationship with the supervising physician and state laws.

The first physician assistant program began in 1965 at Duke University Medical Center in North Carolina. Many of the first students in this program were Navy corpsmen who had received considerable training and on-the-job experience in the Vietnam War but had no options to use their talents upon return home to the U.S.

The nurse practitioner program began at the University of Colorado, also in 1965. Unlike physician assistants, nurse practitioners first receive their registered nurse degree and then go through further training to practice medicine under a physician’s supervision.

Both nurse practitioners and physician assistants can:

**Take medical histories and perform physical exams.

**Prescribe medication and order medical tests.

**Diagnose and treat illnesses.

**Counsel patients and promote wellness.

**Perform minor surgical procedures independently.

**Assist in surgery.

Their practice may also include administrative services, education and research.

Both groups have to pass a national certification exam, be continually reexamined after a number of years and also complete a prescribed number of continuing medical-education hours to maintain their licenses.

Physician assistants and nurse practitioners can be found serving a wide variety of medical needs in settings from remote rural areas to major urban centers. They work in physicians’ offices, hospitals, clinics, the armed forces and government agencies.

I have worked with nurse practitioners and physician assistants for the major part of my career, dating back to the mid-1970s. They have been a tremendous asset to my practice, as well as to the many physicians who call upon their talents and skills.

It’s that time of year again to start making preparations for the flu season, which can begin as early as October and last as late as May.

Influenza, the name of the virus for which the “flu” season is named, causes a highly contagious respiratory infection that often starts very quickly and may cause the following symptoms:

- Fever, headache and extreme fatigue

- Cough, sore throat and runny or stuffy nose

- Body aches and sometimes vomiting and diarrhea

The flu can cause mild to severe illness and occasionally can lead to death. Most healthy people who contract the flu recover without complications. However, some people, especially the elderly and the very young, as well as those with chronic medical conditions such as diabetes, heart disease, and asthma, are at a high risk for serious complications of the flu. One of the most deadly side effects of the flu is pneumonia, which is a very serious lung infection.

The flu usually spreads from person to person via respiratory droplets when someone who is ill coughs or sneezes. It also often spreads when a person touches some object that has the influenza virus on it and then touches the mouth, nose or eyes.

A person coming down with the flu is contagious from one day before any symptoms appear and remains contagious for up to five days after the symptoms begin.

The best way to prevent getting influenza is to get a flu vaccination. The vaccine is approved for use in people older than 6 months of age. Almost everyone can benefit from the flu shot, but it is highly recommended for the following groups:

- Pregnant women and children younger than 5 years

- People 50 years of age and older and those with chronic medical conditions

- Those who live in nursing homes or other long-term care facilities

- People who work or live with those at high risk for complications of the flu

The flu shot contains a dead virus which, when injected via a needle in the arm, will cause a person’s immune system to create antibodies to help prevent one from getting infected. This vaccine cannot give anyone the flu, but it can cause side effects of soreness, redness or swelling at the injection site, low-grade fever and aches. These side effects are usually very mild and last only a few days. In extremely rare instances, a severe reaction may occur, as is possible with any vaccination or medical procedure. Don’t get vaccinated if you have a severe allergy to chicken eggs, have ever had a bad reaction to a flu shot or are ill with a fever.

Flu shots are already available at many doctors’ offices and also are being conveniently provided by the local pharmacies CVS, Walgreens and Rite Aid for about $30 cash, with Medicare and some private insurance accepted.

I think of the flu shot as being a form of cheap health insurance. I’ve already gotten mine and hope that you will, too.

Late summer is the time we see more yellow jackets buzzing around us. These stinging insects are attracted to our delicious picnic food and are more aggressive than the common honeybee, but neither one usually attacks randomly. They sting defensively when they or their nests are threatened. They also sting when stepped on, sat upon or in some way provoked.

Yellow jackets can sting multiple times and do not leave behind their stingers. This is in contrast to the honeybee, which leaves its stinger in its victim. (It is now recommended to remove the stinger as quickly as possible, using one’s fingers to pull it out.)

Stings are very painful and are best treated by immediately placing ice over the sting. Taking the antihistamine Benadryl may also be helpful.

A reaction to the sting may occur within hours or days after the sting. It may be manifested by redness and swelling of just a small area around the sting or by a much larger reaction, often involving an entire arm or leg. This is just a toxic reaction to the venom and will resolve on its own in a matter of days. It is not an allergic reaction and, though it may feel uncomfortable, will cause no harm.

A sting on the face may cause worrisome swelling but is not dangerous. A sting inside the mouth or throat, however, can be quite serious and needs to be treated promptly. In this case, I would advise calling 911 to receive prompt evaluation and emergency treatment.

Serious, life-threatening reactions to a sting may occur within minutes or several hours. Usually, the worse the reaction, the sooner it occurs. Those who have a serious sting reaction should seek consultation with a physician who can prescribe an injectable adrenaline kit, such as an Epipen. This shot can be self-administered if one is having a potentially life-threatening reaction to a sting.

In summary, here’s what to do when stung:

- Pull the stinger out as quickly as possible, if it remains in the flesh.

- Get out of the vicinity of stinging insects, as fast and as far as possible.

- Apply ice compress to the sting.

- Take Benadryl by mouth.

- Call 911 if you experience a swollen tongue or throat with difficulty swallowing; tight breathing or shortness of breath; a feeling of faintness; or severe hives