Thursday, January 23, 2014

Can't Stop Sneezing?

Ah, the beautiful golden mist floats above our Austin trees...ACHOO! It's cedar fever time in central Texas, and many of us are suffering. Itchy eyes, runny nose, sneezing, stuffy nose, ear pain and very sore throats are all part of the package. Often people are afraid they have the flu or strep throat, because their symptoms are so intense, but one clue with allergies is the LACK of a fever- while you might have an elevated temperature of 99-100*, allergies don't cause the 101-104* fevers and chills that infections can trigger. That being said, some of the most PAINFUL sore throats can come from "just allergies" be sympathetic to your suffering friends and family.

What is the best treatment for seasonal allergies? 
First line treatment for seasonal allergies includes both oral non-sedating antihistamines (like brand names Allegra, Claritin & Zyrtec, now all over the counter) and nasal steroid sprays (such as Nasonex, Flonase, Veramyst, etc.- require a prescription.) My personal preference for someone who truly has daily symptoms during a given season, especially with significant nasal congestion, is to start with these nasal steroid sprays. These are not "pump you up" steroids, but anti-inflammatory steroids that only act locally in the nasal membranes, creating sort of a protective barrier in your nose; blocking irritating pollens from ever causing that release of histamine that triggers all the itchy, runny, drippy symptoms. When I see a patient who suffers from nasal congestion, drainage, etc., "every" winter or spring, my plan is to get them started on these nasal steroid sprays a week or so before that season the next year, in the hope of preventing symptoms from ever starting.

There are also prescription nasal antihistamine sprays, which are very effective in drying up dripping noses, but are limited in many people by a rather nasty aftertaste. (Leaning forward as you use this type of spray can greatly reduce this side effect).

Another oral medication that works very well for seasonal allergies (when taken daily throughout a particular season) works by targeting the immune response via a "leukotriene antagonist"- don't worry about the specifics here, but know this pill effectively limits the body's allergic inflammatory response. The trade name of this drug is Singulair, and it is used both for seasonal allergies and for asthma. Many physicians use this drug as a second line of defense when the daily nasal steroids are not enough, especially if people are having too much sedation or dryness as a result of oral antihistamines.

Allergy shots from an allergist may also be a very effective option, but because they require a significant time and financial investment, we reserve this treatment for patients more severely affected.

BOTTOM LINE: If you have had a stuffy nose for weeks or are having fits of sneezing or itchy eyes, ears or throat, talk to your family doctor about treatment options both NOW and in anticipation of your next allergy season.

Thursday, January 16, 2014

Gardasil- What's Up Down Under?

The HPV (Human Papilloma Virus) vaccine, Gardasil, was FDA approved in the United States for use in young women in June, 2006, then extended for males in October, 2009. In October of 2011, the Advisory Committee on Immunization Practices (ACIP- the group that creates our national guidelines that you see posted on your doctor's office walls) extended their official recommendations to include ROUTINE VACCINATION of both boys and girls at age 11-12 years, with "catch up" immunizations for those youth  ages 13-21 who had missed getting this vaccine series.

Why are we vaccinating?
We vaccinate primarily for CANCER PREVENTION. Each year in the United States, we have over 33,300 cases of HPV-related cancers (data from CDC, 2012). About 2/3 of these occur in women, primarily with cervical cancers, but also other genital, anal and oral cancers. In men, the majority of HPV related cancers are oral, but they, too, can have genital and anal cancer, though it is less common than in females.
Gardasil also protects against the two strains of HPV that cause 90% of genital warts, and with over one million cases of this malady each year in the US, you can see what an impact prevention can make here!

How well are we doing?
Not as well as we could do...because national immunization surveys have shown that in teenagers 13-17 years old, only 53% of young women had started the series, and only 1/3 of that group had completed the series. A bit more encouraging is an improvement in the very low percentage of teenage males getting the vaccine, which was at 8% in 2011 (the first year it was considered a "routine" universal vaccine) and more than doubled to over 20% in 2012.

How effective is this vaccine? Here is the GREAT news- the HPV vaccine is unbelievably effective when given to young adults not previously exposed to HPV (with no prior sexual intimacy). The CDC's data demonstrates efficacy nearing 100% protection for women in preventing cervical, vulvar & vaginal cancers and genital warts, and 90% efficacy in men for genital wart prevention and 75% efficacy preventing early anal cancers.

What happened down under? 
From 2007-2009, Australia provided the HPV vaccine free of charge to all young women ages 12-26, and had extremely high vaccination rates as they utilized the school system to give out these shots. Follow up studies in 2011 and 2012 showed dramatic results, with 92% decline in genital warts in young women (< 21years old),  72% decline in women ages 21-30, and 81% delicate in young (< 21) heterosexual men and 51% decline in men ages 21-30. This is interesting because the young men saw improvement not because they had been immunized, but simply from the widespread immunization of all the women. Pre-cancerous cervical abnormalities also markedly declined in this short time period, and since cervical cancer typically is very slow growing, we expect to see dramatic falls in cervical cancer rates in the next few years and certainly, in the next decade.

BOTTOM LINE: HPV vaccination SHOULD BE a routine immunization for our sons and daughters- talk to your family physician about it at your next visit*

(In this day and age, I feel compelled to add two things: one, I in no way financially benefit from the makers of the Gardasil vaccine; two, yes, we chose to vaccinate our daughters.)

Monday, January 6, 2014

Resolutions for BETTER HEALTH in 2014

Happy New Year! Many people start each year with resolutions surrounding their health, so I'd like to  jump in and suggest that you put one EASY resolution at the very top of your list. This resolution should take up well less than an hour of your life, yet can make a tremendous difference in your health for here it is: GET YOUR ANNUAL FLU VACCINE!

If you have already received yours, pat yourself on the back & remember to encourage your friends and family to get theirs. I will confess that certain members of my family kept putting off their shots for a variety of reasons (including one trip to two pharmacies who were temporarily out of the vaccine last month), but we are 100% vaccinated now. My major message is two-fold: one, it is NOT TOO LATE in the season to get a flu shot, and two, just glance at the CDC's map above to see how widespread the flu has become this year! Last year, influenza caused over 380,000 people to be hospitalized. This flu season, we are seeing a resurgence of the pH1N1 strain (originally known as swine flu, though the "p" is for "pandemic", not pig). This particular strain is the type of flu that was so severe in 2009, but happily, all of the current flu vaccines DO include this strain. Note that pH1N1 can produce very severe illness, especially in young and middle-aged adults.

More questions about the flu or the flu vaccine? Check out "I Got Mine" or the CDC's "Flu Basics".

BOTTOM LINE: Start 2014 off right & GET YOUR FLU VACCINE (if you haven't yet this season).