What's up Doc?

Question & Answer with Danville Regional's Chief Medical Officer - Dr. Saria Saccocio

August
Pregnancy Brain...The Real Thing

May
Hearing Loss
Spring is here...and so are the mosquitoes!

April
Fibromyalgia

March
Latest Flu Season in 29 Years!

February
Common Cold Myths * Hand Sanitizer: Friend or Foe? * Hand-foot-mouth Disease * Kidney Infection (pyelonephritis) * Scarring from Minor Burns * Road to Recover After Foot Surgery * Sarcoidosis

January
Blood Type Diet: Fact or Myth? * Reflex Sympathetic Dystrophy Syndrome * Vitamin D3 * Medical Myths * Medical Pearls

August

Pregnancy Brain…The Real Thing

When a woman is pregnant, her body produces outrageous levels of progesterone and estrogen (15-40 times more). These high levels are often blamed for “pregnancy brain”. In addition, oxytocin, a hormone produced when the baby delivers, is released causing the uterus to contract upping the ante for lack of clarity postpartum. As if this wasn’t enough, sleep deprivation experienced after delivery creates more fog on the brain.

What to do? SLEEP WHEN YOU CAN! Sleep is underrated. The old adage, “sleep when the baby sleeps” only works for the first born. After that, the little rascal siblings are relentless! Don’t be afraid to ask for help. Call on your family and friends to give you a little mommy rest.

May

Spring is here...and so are the mosquitoes!

Enjoy the warm weather and the great outdoors, but be sure to protect yourself against blood-sucking insects. Did you know that only female mosquitoes have a test for human blood? Interestingly, our blood serves as a fertilizer for their eggs.

Fact or fiction? Mosquitoes prefer some human beings over others. Fact! They are attracted to people with high levels of cholesterol. This does not mean that if you are bit by a mosquito that you should rush to your doctor for a prescription of cholesterol reducing medication. It may be that you are efficient at metabolizing cholesterol.

Mosquitoes are also drawn to carbon dioxide, movement, and heat. Bigger people, as opposed to children, pregnant women, and exercisers seem to be the most appetizing victims.

While most often a mosquito bite is a nuisance, there is a risk for serious illness. They transmit illnesses including West Nile Virus, dengue fever, and malaria. Though dengue fever and malaria are rare in the US, West Nile Virus is quickly growing in numbers. Last year there were over 700 cases identified, including 11 in Virginia and North Carolina.

DEET-containing insect repellents are proven to be the most effective chemical repellant on the shelves. For those who choose to avoid the traditional chemical preventive measures, many alternatives are now sold. To name a few, soy bean oil-based, citronella, cedar, peppermint, lemongrass, and geranium products may provide short term protection. Oil of eucalyptus has been proven to be longer lasting and is safe in children 3 years and older.

Enjoy the holiday weekend, but if you happen to be the 1 out of every 10 people who mosquitoes find attractive be prepared and avoid unwanted admirers.  Protect yourself!

I Can't Hear You...What Did You Say?

According to the National Institute on Deafness and Other Communication Orders, 17% of adults suffer from hearing loss. If you fall into this category, I recommend hearing testing. The question is who do you turn to for diagnosis and treatment of hearing loss.

Both Ear, Nose, and Throat (ENT) doctors, otolaryngologists, and audiologists are trained to detect the cause of hearing loss. Once hearing impairment is determined, audiology testing is typically performed to assess the source, severity, and potential treatment. If the reason for hearing loss can be corrected with surgery, the ENT doctor performs the surgery. If a hearing device is needed, they will likely refer the patient to an audiologist. ENT physicians and audiologists often work together to ensure that patients with hearing loss receive the appropriate care.

April

Fibromyalgia

March

Latest Flu Season in 29 Years!

Snow wasn’t the only delayed event in Danville this year. This flu season is the latest to arrive in 29 years!

According to the Centers for Disease Control and Prevention (CDC), we have finally entered flu season as of February 23^rd. All 50 states in the US have now reported the flu is officially here in rising numbers. The good news is that this year’s flu severity so far is much less than previous years. There may be a couple of contributing factors:

• The most common flu virus this season is the same strain as the most common flu virus last year. There is a possibility that many individuals retained immunity and are somewhat “protected”.
• More people have been vaccinated by November of 2011 than any other year.  The flu vaccine not only helps to prevent the flu, but it also can reduce the severity of the illness.

There is no way to predict how long this flu season will last. However, research shows that in cold weather the flu virus tends to be more viable. When it’s cold outside, individuals tend to spend more time huddling indoors which can increase the risk of spreading the virus. As Spring quickly approaches, we may see more folks outdoors in warmer climate but there’s no way to tell if in the end it will make any difference.

It’s not too late to vaccinate! We are now at the peak of flu season which means the greatest risk of infection is now. Ask your doctor if you should receive the flu vaccine.

February

Common Cold Myths

• Chicken soup helps fight a cold-FACT!
  • Thins mucus and increases its clearance from the airways
  • Helps prevent dehydration, like other fluids

• Feed a cold starve a fever-MYTH!
  • Eating nutritious foods are needed to maintain a healthy immune system
  • Try the chicken soup

• Exercise is good during winter months for helping to fight off infection-FACT…EXCEPT!
  • Stress reducer
  • Boosts your immune system
  • Reduces the number of colds
  • Do not exercise vigorously if you have a fever or severe respiratory symptoms-this may worsen your condition

• Vicks vaporub on feet cures coughs
  • Mentholatum, the active ingredient, relieves congestion
  • Typically rubbed on the chest, may be used on the feet but may not have full effect secondary to distance from the respiratory system (might as well rub on your chest…unless it’s the smell that bothers you)
  • Do not use in children <2 years of age due to the potential to irritate the airways and increase mucus

Hand Sanitizer: Friend or Foe?

The fear has been that hand gels and foams may potentially increase the resistance of common bacteria to create “superbugs”. First things first…hand washing with soap and water long enough to hum the Birthday Song twice is always the best option. Hand sanitizers may not kill all germs, including some viruses and bacteria spores which can be eliminated by traditional soap and water.

However, when you’re on the go hand sanitizer is most convenient for cleaning hands that are not visibly soiled.

Alcohol-based hand sanitizers should contain at least 60% alcohol (isopropanol, ethanol, or n-propanol) in order to kill bacteria sufficiently after rubbing hands vigorously for approximately 30 seconds. Alcohol-based hand sanitizers have NOT been proven to lead to resistance to bacteria.

Non-alcohol based hand sanitizers (benzalkonium chloride, triclosan, and povidone-iodine) are also products sold in the US. Triclosan, the anti-bacterial ingredient in soaps, has demonstrated resistance in controlled studies but was not implicated in the cross-resistance of bacteria to common antibiotics such as ciprofloxacin and ampicillin. One of the risks with non-alcohol formulas is the risk of becoming contaminated with bacteria during production or during the life of the product.

The trouble is that anti-bacterial hand gels, foams, and lotions are still relatively new to the market. Current research does not implicate these hand hygiene items as dangerous. In fact, some studies indicate that hand sanitizer reduces absenteeism from school and work when used as directed by reducing upper respiratory and gastrointestinal illnesses. The truth is more research is necessary to determine the long term risks and benefits.

And yes, plain old soap and water works just as well as anti-bacterial soaps. What is important is hand hygiene awareness and best practices. So either sing your Birthday Song when lathering up or count to 30 with your favorite smelling hand gel, and most importantly…DO IT OFTEN!

Hand-foot-mouth Disease

Hand-foot-and-mouth disease is a self-limited, common viral infection in young children. A parent can expect their child to experience any one of the following: fever, sore throat, malaise, blisters in the mouth, a rash that may blister on the hands, feet, and buttocks as well as loss of appetite.

The most common complication is dehydration due to the painful sores in the mouth. If your child is unable to tolerate fluids, see your physician.

This infection is NOT treatable with antibiotics since it is a virus. Children may remain infectious for weeks. The best way to prevent hand-foot-and-mouth disease is good hand hygiene (washing hands) due to its transmission from person-to-person contact. Interestingly, adults may spread the disease without experiencing symptoms.

Kidney Infection (pyelonephritis)

• Kidney infection is a urinary tract infection (UTI) that moves upwards from the bladder to the kidneys:
  • UTI symptoms: burning upon urination, increased frequency, increased urgency, and suprapubic pain
  • Signs and symptoms of migration of infection to the kidneys: fever, chills, nausea, vomiting, and lower back or side pain
• Up to 30% of women diagnosed with a UTI have a kidney infection.
• It is absolutely necessary to contact your physician for testing and treatment. The treatment for a kidney infection is antibiotics. Antibiotics should be taken for the entire course. Stopping treatment before completion can lead to relapse of the infection and increase resistance of bacteria to antibiotics. If nausea and vomiting prevents toleration of fluids, hospitalization may be necessary for IV fluids and antibiotics.

Scarring from Minor Burns 

• Pressure treatment with gel pads made of silicone may assist in prevention of scars.
• Moisturize-keep the wound moist to assist in wound healing. Cover with a bandage and apply either antibiotic ointment or petrolatum.
• Massage-once healed apply lotion and massage 15-30 seconds daily.
• Avoid hydrogen peroxide or vitamin E as they may impair the healing process.
• Avoid sun exposure which can delay healing and even cause skin discoloration of scar tissue.

Road to Recover After Foot Surgery

The quickest way to heal after surgery is to follow the instructions given to you from your physician and follow up as scheduled. The purpose is to avoid infection and for the surgical incision to close as intended. Depending on the size and location of the incision, sutures will be removed accordingly.

No matter if sutures, staples, or surgical glue is used the general care should be the same. Always keep the site clean. If you have been told to wash the area, showering is best to avoid over soaking. Allow the area to completely air dry prior to replacing the bandage. It is typically okay to use antibacterial ointment but avoid vitamin E which has been touted in the past to speed up the healing process.  Studies have disproven this theory, and in fact vitamin E can cause skin irritation in the form of contact dermatitis.

Other medical conditions can slow the healing process, such as malnutrition and diabetes. Be sure and eat a well balanced diet and check with your physician if you have any concerns about how your overall health may affect your healing.

Get well soon! 

Sarcoidosis

Sarcoidosis is a peculiar disease that affects young to middle-aged adults. In the US, it is more common in African Americans and slightly more prevalent in women. It is thought to be an abnormal immune response that creates targets of inflammation throughout the body. The most common organs involved are the lungs, skin, eyes, and lymph nodes.

Many individuals with sarcoidosis do not have any symptoms and only discover the diagnosis by accident by having a chest x-ray. For those who do have symptoms, initially they may feel tired or experience fevers. Most symptomatic patients will develop lung involvement leading to a dry cough, wheezing, and shortness of breath. Skin nodules, red eyes, or swollen lymph nodes may even appear. The course of illness varies from a single episode to several years of progressive symptoms.

Sarcoidosis may be treated with medications that suppress the immune system, including steroids. Unfortunately there is no cure for this disease, however, only 10% of cases lead to severe disability. 

January

Blood Type Diet-Fact or Myth?

In 1996, Peter D’Amo wrote Eat Right 4 Your Typeclaiming that diets should be personalized according to blood type A, B, or O. For example, O type individuals are recommended to eat a high protein diet. According to D’Amo, the O type dates back 30,000 years and humans were considered hunters. He also states that A type individuals should eat more vegetables since this type originated from the beginning of agriculture, and B types tolerate dairy best.

There are no clinical trials or any solid scientific evidence that supports the blood type diet theory. What is recommended is a diet high in fruits and vegetables with limited fats and oils. An excellent resource for healthy eating choices is www.ChooseMyPlate.gov. A balanced diet with moderate proportions and routine exercise is the best way to maintain or lose extra pounds. Make an appointment with your doctor to discuss ways to lead a healthy lifestyle.

Reflex Sympathetic Dystrophy Syndrome

Reflex Sympathetic Dystrophy Syndrome (RSDS), is a form of a condition called Complex Regional Pain Syndrome (CRPS). It is an uncommon pain syndrome that is caused sometimes by injury or trauma, stroke, heart attack, or even infection. The severity of injury does not necessarily increase the risk of experiencing CRPS. For example, a mild ankle sprain can potentially be a trigger for developing this condition. It is thought that the immune system may be involved, but it is unclear who will suffer from CRPS and exactly why it occurs.

Most often the pain begins in an arm or a leg and can extend to the opposite limb. Initially, the patient may experience burning, swelling, sensitivity to cold, and hair and skin changes. The skin over time may change in color to be pale and white, red and shiny, or even blue.

An early diagnosis helps to prevent long term damage such as muscle or bone loss. Pain medications, anti-depressants, steroids, topical creams, anti-seizure and bone loss medications are all potential treatments for CRPS. Other helpful therapies include physical therapy, local and spinal electrical stimulation, application of heat and cold, and biofeedback or other proven stress relievers.

Maintaining movement and daily activities as much as possible is a very important factor in recovery and minimizing long term effects. If you feel you are experiencing these symptoms, contact your physician.

Vitamin D3

Vitamin D participates in the regulation of the immune system in some studies. In addition, low levels have been associated with cancer, diabetes, depression, high blood pressure, multiple sclerosis, falls and many other conditions. While adequate levels of Vitamin D are necessary, it should not be considered as the panacea or cure all for disease.

There are two forms of Vitamin D, D2 and D3. Vitamin D2 comes from plants and D3 is found in oily fish and is produced when the skin is exposed to sunlight. D3 is also the type of Vitamin D sold over-the-counter.

As of 2010, the Recommended Daily Allowance (RDA) is 600 International Units (IU) for individuals between 1 and 70 years of age as well as pregnant and breastfeeding women. For ages 71 years and older, the RDA dose is 800 IU per day. Low levels Vitamin D may require higher dosing.

There is minimal risk for toxicity when Vitamin D3 is supplemented less than 2,000 IU daily, according to the National Academy of Sciences. However, higher doses can be dangerous if not monitored by your physician.A s always, if you take supplements of any kind it is important to discuss with your doctor.

Medical Myths

• Flu vaccine causes flu
• All sinus infections require antibiotics
• Vitamin E supplement is good for your heart
• Beta carotene supplement is good for your health
• Allergies-non-drowsy medication is “better” than traditional antihistamine
• All sore throats are strep
• Chocolate causes acne
• The tryptophan in turkey makes you sleepy
• Acute back pain should be treated with rest
• Skipping breakfast is a good way to lose weight
• Second-hand smoke outside is not harmful to non-smokers
• All heart attacks present with chest pain

Medical Pearls

• Hypertension – decreasing salt intake can be just as important as taking blood pressure medicine
• Diabetes –
• uncontrolled increases your blood pressure and risk for congestive heart failure
• healthy lifestyle (exercise and healthy eating habits) just as important as taking medications
• eye exams to prevent blindness
• foot care prevents amputations
• Tobacco use
• November 17 is Great American Smokeout Day-Go tobacco free!
• Quitting takes 7-9 times
• Quit lines double chances of staying quit (1-800-Quit-Now)
• Medications double chances of staying quit
• Preparing for doctor’s visits
• Bring a relative or friend
• Bring a list
• Bring list of medications INCLUDING over-the-counter supplements and herbal therapies
• Don't hesitate to ask questions if you don’t understand
• Sudden Infant Death Syndrome (SIDS)
• Back to sleep and pacifiers proven to reduce risk
• Baby should not sleep in the bed with parents
• Exposure to second-hand smoke greatly increases risk