Saturday, October 24, 2015

2015 Flu Vaccine "Cattle Call"

BEVO says, "Healthy Horns get Flu Shots!"

Attention Longhorns, Aggies, and everyone else, flu season is upon us, so it's time for your annual flu vaccine.  UT students- we have completed our large flu vaccine clinics, but now you may schedule an appointment at UHS to receive your shot. 

Who should get the flu vaccine?
The Center for Disease Control and Prevention (the CDC) continues to recommend annual flu vaccines for everyone over the age of six months.

What is different this year?
Last year, the vaccine was not a great match for the strain that ended up dominating the scene (H3N2). This year's vaccine includes two type A strains, both last year's H3N2 and the H1N1 that was so intense from 2009, as well as two less well- known type B strains.

But I hate problem, ask for the vaccine that is delivered via a nasal spray! The only caveat here is that this is a live vaccine, so there are some restrictions: you must be age 2-49 years, not pregnant, have no major problems with immunity (such as having AIDS or cancer), not take aspirin daily, and not have asthma.

New this year: "Jet-Injectors" which use a "high-pressure, narrow stream of fluid" to directly penetrate the skin- no needle involved at all! The only vaccine to be delivered this way for 2015-2016 will include three (rather than four) strains of flu, the type A strains H3N3 and H1N1, along with one B strain, and recipients must be ages 18-64 years old.

What is FLU? Influenza is not a simple cold, nor is it a twenty four hour stomach virus. The flu causes fever, chills, cough, runny/stuffy nose, muscle aches, headaches, fatigue, and sometimes involves vomiting and diarrhea (more often in kids). Colds and allergies tend to bother you from the neck up- stuffy, sore throat, headache- but don't knock you down for the count, and coughs are generally less bothersome.

How is the FLU spread? This virus is spread from infected people when the cough, sneeze or talk, via tiny respiratory droplets, and the scary part is that you are contagious a full day BEFORE you develop symptoms (as well as for about a week after you feel sick.)

How can you prevent the FLU? Wash hands FREQUENTLY and get vaccinated. Get vaccinated. Get vaccinated! 

Who should NOT get vaccinated? Those with bad reactions to vaccine in the past; infants younger than 6 months; and those people with a history of an uncommon disease called Guillain-Barre. If you are sick with a fever, wait till this illness is over before getting the vaccine.

BOTTOM LINE:  Grab a friend, family member or co-worker and make time to get your FLU VACCINE!

Thursday, October 15, 2015

Newly Diagnosed Cancer? Here is Your "What to Expect" Book

October is Breast Cancer Awareness month, but every month is the right time for preventative medicine (schedule that physical and mammogram!) For me, this is a milestone year, with daily Facebook reminders that my high school classmates are turning the big 5-0. As we start this wonderful "second half"of the game of life, more and more of us are facing the challenge of a cancer diagnosis.

As a family doctor, I have too often seen the deer-in-the-headlights look on my patient's face as I shared the difficult news of a cancer diagnosis. Each time, I feel like time stops for a few moments, and like a cartoon character babbling on, my words are collecting out there in a balloon while the word CANCER echoes back and forth in my patient's reality. I have had countless friends, colleagues and relatives face this challenge as well, and in every situation, my heart aches to help them as my medical brain searches for answers. I am a family physician, so while I am well versed at diagnosing a variety of cancers, I have limited hands-on experience in treatment.

Julie Silver, MD, is a Harvard doctor who specializes in rehabilitation medicine. She faced the diagnosis of breast cancer herself at only thirty-six, right in the middle of being a busy mom, wife and full time physician and medical author. As such, she is uniquely qualified to author "Before and After Cancer Treatment: Heal Faster, Better, Stronger" and the second edition has recently been released by Johns Hopkins University Press. From my perspective, Dr. Silver's book is the perfect blend of scientific analysis of cancer treatment and practical advice on "what to expect when you have cancer." My generation loved our "what to expect" books for pregnancy and toddler years, and now we have a book that meets that practical function when the cancer bomb explodes into our lives.

Dr. Silver addresses alternative medicine, meditation, exercise, spirituality, love, relationships and goal-setting. She advocates for patients to seek second opinions and be proactive about cancer PREhabilitiation to get "as strong as possible- physically and emotionally- BEFORE you begin treatment." She incorporates her personal experiences as well as those of many others, including excerpts from a book she published with the American Cancer Society called What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope, as well as vignettes from other books and survivors.

Facing cancer often means many hours of down time, when the chemo-fatigue drains you of productive energy. Sleep is good. True rest is VERY good. Friends providing family meals and pitching in on the "invisible work" of groceries, laundry, and house maintenance is extremely helpful. Let your friend diagnosed with cancer conserve their energy for the things that matter the MOST- their family, their passions. Tuck this book in with the first meal that you provide.

BOTTOM LINE: If you (or your friend) is diagnosed with cancer, Dr. Silver's new book is a great resource to HEAL FASTER, BETTER, STRONGER. 

Friday, October 2, 2015

Mammograms, Breasts, and Exams...oh My!

Thinking PINK? October is Breast Cancer Awareness month, and pink ribbons are popping up on everything from restaurants and t-shirts to football socks. I love that as a community, we can rally around a cause to raise not only awareness, but also much needed funds for research and support of those affected.

The American Cancer Society statistics reveal that here in the United States, over 230,000 women will be diagnosed with breast cancer during 2015, and sadly, over 40,000 women will likely lose their lives to this disease. The good news is detection methods continue to improve, allowing these cancers to be diagnosed and treated earlier, leading to better outcomes and treatments that are better tolerated.

With all the changes in women's preventative health, many are confused about current recommendations for breast cancer, including health care providers. Different organizations have conflicting guidelines, which fuels the continued media controversy surrounding mammograms.

The United States Preventative Services Task Force (USPSTF) recommends routing SCREENING mammograms every other year for women ages 50-74. I emphasize "screening" because this guideline is for women with no symptoms, no concerning breast lumps and no extra risk factors. If a woman goes to the doctor with a concerning lump in her breast, imaging is most likely indicated- this is not "screening" in this situation, it is "diagnostic." The USPSTF also no longer promotes self-breast exams, because some large studies have not shown these exams to be globally beneficial. Statistically, self breast exams do not cut down on the number of deaths from cancer, and do lead to extra imaging studies (mammograms) and breast biopsies.

The American Cancer Society (ACS) still recommends annual mammograms for women forty and over, as long as they are in good health (not stopping at age 74 purely for too many birthdays, but rather only stopping if the woman has a shortened life expectancy from other serious medical issues.) ACS also still supports self breast exams for women starting in their twenties.

Given this information, do I still teach self breast exams? Right now, I am only seeing patients in an urgent care setting, so I do not have the opportunity to perform "well woman" exams. However, if I am seeing a patient with a breast-related issue that involves me doing a clinical breast exam, then YES, I do explain to patients what to expect when they perform a self-breast exam. I am not on the band wagon insisting patient MUST do these exams religiously on the first of every month (or after their period) as I used to suggest.

One of the greatest challenges in modern medicine is trying to practice evidence-based medicine that is recommended for the global good, versus a clinician's personal experience and success with individual patients. In this case, during my twenty years of private practice, I had numerous patients who found their own breast cancers during routine self-exams, and were quickly diagnosed, treated and cured- often with simple surgical lumpectomies without additional chemo therapies. Would they have been so fortunate if they had not noticed a lump and simply waited for routine screening? We don't know, but most of these women within my practice were younger than 50, so I believe many may have developed more advanced cancers. And so I am conflicted, and continue to follow evidence-based research and extended discussions about pros and cons of breast exams.

BOTTOM LINE: Talk with your doctor about your personal risk for developing breast cancer, and together discuss your prevention strategy- including frequency and timing of breast exams, imaging with mammography or other modalities, and possible genetic testing if breast cancers run in your family.