Got Asthma? Get this Vaccine!

This month I am focusing on vaccinations- the FLU vaccine, Tetanus, Pertussis, and now...the "pneumonia" vaccine.  This vaccine works against Streptococcus pneumonia, the "pneumococcal bacteria" which causes hundreds of thousands of cases of pneumonia, sepsis and meningitis in the United States every year. Before routine childhood immunization against this bacteria, there were also over 5 million ear infections per year caused by this organism. This bacteria has developed quite a bit of resistance to antibiotics, and the more serious pneumococcal diseases have a very high mortality rate ranging up to 37%, so everything we can do to prevent pneumococcal disease saves innumerable lives.

Recommendations for this vaccination USED to only be for adults over 65 or those adults who had their spleen removed or had severe immune-compromising illness. However,  in 2008, the ACIP (Advisory Committee on Immunization Practices) realized that the scientific evidence showed that adults who smoke or have asthma are at much higher risk of developing pneumococcal disease, and CHANGED the RECOMMENDATIONS to include ADULTS WHO SMOKE or HAVE ANY TYPE OF ASTHMA (exercise-induced,

There are two types of pneumococcal vaccine:  PPSV23 and PCV 13, which target the specific subtypes of this bacteria that cause the most disease.  Children receive PCV13 (trade name, Prevnar), as part of their infant series at 2, 4, 6, and 12-15 months of age.


ADULTS (19 -64) should receive the PPSV23 (trade name, Pneumovax) pneumococcal vaccination if they are a SMOKER; if they have ASTHMA or  DIABETES;  or if they have chronic lung, heart, liver or kidney disease, cochlear implants, a missing (removed) or non-functional spleen, or an immuno-compromising illness such as cancer or HIV disease.

ALL ADULTS over the age of 65 should receive a PPSV23 pneumococcal vaccine as well. If they already had a pneumococcal vaccine before the age of 65 (because they are asthmatic, or a smoker, or diabetic, etc.) then they need a BOOSTER  second vaccination at 65, or as soon as it has been at least 5 years since they received their first pneumococcal shot.

Adults with some of the more serious conditions that affect their immune system should receive both types of pneumococcal vaccine (for more details, see the CDC's Pneumonia Vaccine Q&A).

BOTTOM LINE: If you are over 65 or if you are aged 19-64 and you have asthma, diabetes or have not yet quit smoking, please talk to your doctor about getting the "pneumonia vaccine"! 

Did I Hear a WHOOP?

As a Texas Aggie, I generally love to hear a "WHOOP" (especially during football season- gig 'em, Ags!) However, as a doctor, the word or sound "whoop" triggers concerns about Pertussis, the bacteria that causes whooping cough, which has been unfortunately on the rise in our community and across the United States.

What is whooping cough?

This highly infectious respiratory disease only infects humans, and causes nearly 50 million cases of disease each year. In the United States, we only see around 40,000 documented cases/year, but certainly have many more infections that are not recognized and treated.  Smokers, asthmatics, infants, pregnant mothers and people with compromised immune systems are at the highest risk for catching pertussis, but we are also seeing outbreaks in healthy, previously immunized populations (whose immunity has worn off over the years since their last booster vaccine.)

There are several stages of whooping cough infections. The first stage is like a common cold- stuffy, runny nose, low grade temperature and a slight cough. However, the second stage is what sets this disease apart. Instead of a mild lingering cough, the cough becomes more frequent and can be intensely severe- causing fits and spasms of coughing so hard that you vomit, and occasionally creating a "whoop" sound as you suck in air after a fit of coughing. Typically people describe this as the "worst cough" they have ever had. Finally, there is a several week convalescent stage where the cough gradually decreases and fades away.

How is pertussis diagnosed?

For a variety of reasons, doctors do not often test for pertussis. The test for pertussis requires a specific nasal swab that should be immediately sent off to the health department lab for evaluation. Blood tests can help to confirm an acute case as well (checking antipertussis toxin IgG levels).

How is pertussis treated?

Short courses of azithromycin or erythromycin will eliminate the virus from the upper respiratory tract. More serious infections (especially in infants) may require hospitalization for more aggressive treatment.

Why can't I get a zpak for my cough?

The vast majority of coughs are NOT pertussis, and in fact, are not caused by ANY bacterial source. The zpak, or any antibiotic, will only help improve coughs caused acutely by a bacterial infection (such as a pneumonia). The good news here is that although coughs can hang on for up to six weeks after a viral infection or with allergies, we do have other (non-antibiotic) medications such as broncho-dilating inhalers that can help clear them up.

How can I prevent pertussis? 

In a flashback to the previous blog on TETANUS, here is your answer: All children should receive the combination vaccine DTaP (diphtheria, tetanus and pertussis) five times in early childhood, at 2, 4, 6, 15-18 months, and age 4-6 years. Then, at 11-12 years, they should receive a BOOSTER combination vaccine, called Tdap (which has lesser, booster-level doses of the diphtheria and pertussis portions, noted with the lower case letters). Finally, everyone over the age of 19 who did NOT receive that Tdap during adolescence should get a one time vaccination with Tdap "now", regardless of the interval since their last tetanus booster, which was most likely simply a Td (tetanus/diptheria booster).

What's that little "a" for in Tdap and DTaP? 

That little "a" is for "acellular" pertussis. There were concerns about side effects from the original whole cell pertussis vaccines, so scientists were able to develop a newer version of the vaccine that only used a small portion of the pertussis cell. This section of the bacteria is still "large" enough to trigger a robust immune response, yet has fewer side effects.

BOTTOM LINE: Adults who have never received a tetanus booster that contains pertussis should update their immunizations at their next check up!

When was Your Last Tetanus Shot?

Since it's time for everyone's annual FLU VACCINE, I thought I'd take a few posts and reflect on a couple other vaccines. Today, let's talk about the TETANUS vaccine.


What does the tetanus vaccine do? Most people have heard that if you "step on a rusty nail", you should make sure you are up to date on your tetanus booster. Actually, this should be true for any significant breaks in the skin such as burns, puncture wounds or "road rash".  The tetanus vaccine boosts our immunity to the bacteria called Clostridium tetani, an organism that lives all around us, but especially in the soil, dust and any areas that my be in contact with manure or saliva.

What is tetanus (the disease)? Tetanus used to be called "lock jaw", and even Hippocrates knew about this disease nearly 30 centuries ago! This disease causes intense spasms of skeletal muscles, especially the neck and jaw muscles (making it impossible to open your mouth or to swallow). The infection can be very severe, and has a high mortality rate in children (1 in 5 cases.) We rarely see this disease in the United States now, thanks to routine vaccinations, but it still occurs in roughly one million people each year around the world.

The tetanus vaccine is the "T" in the DTaP series (Diptheria, Tetanus and acellular Pertussis.) All children should receive 5 routine doses- 2, 4, 6, 12-15 months, and 4-6 years. The next recommended booster comes at 11-12 years (or up to age 18) and is a slightly different preparation, the Tdap. The Tdap is still Tetanus, diptheria and pertussis, but the diptheria and pertussis (marked by the lower case letters) are reduced strength boosters since adolescents and adults no longer require the full strength childhood versions.

New changes in Tdap recommendations are the result of recent pertussis outbreaks in the United States, and include routine vaccination for all adults ages 19 and older with a single booster of Tdap (unless the individual received Tdap as an adolescent), as well as every pregnant women in her third trimester (for each and every pregnancy).

To clarify, after the basic 5 childhood immunizations of DTaP, an adolescent should receive one Tdap (the booster vaccine) between the ages of 11-18, then simply the Td (Tetanus/diptheria) booster every ten years. All adults who have only received the Td booster should receive one dose of Tdap now, regardless of how long it has been since their last Td shot.

BOTTOM LINE: Talk with your family doctor and check to see if your immunizations are up to date!

Restless Legs Keeping You Awake?

Do your legs ache, squirm, feel antsy and seem to want to MOVE to get comfortable when you try to go to sleep at night? How about during the day- do you need to get up and walk around to relieve that same irritating sensation in your legs when you are supposed to be sitting in a meeting or parking yourself in front of a computer? Does walking around or at least moving your legs relieve the discomfort? If so, you may be one of the estimated 3-15% of the population with a disorder known as restless leg syndrome (RLS).

This disorder can be a sign of underlying issues such as iron deficiency, pregnancy, kidney problems or  drug side effects, but also may be an isolated medical problem. About half of the time, there is a family history of other blood-relatives having the restless leg syndrome. The incidence increases with age, and is more common in Caucasians.

How is RLS diagnosed?
Restless leg syndrome is primarily diagnosed by your history, with focus on four issues:

• Strong urge to move your legs
• Symptoms worse at rest
• Symptoms worse at night
• Urge relieved by movement, but come back quickly with rest

Your doctor may need to do blood tests to determine if you have a low iron level (ferritin) and/or low red blood cell count (anemia), and occasionally a formal sleep study may be necessary to fully identify RLS.

How is RLS treated?
If there is an identified cause, such as a medication or iron deficiency, then the treatment obviously targets that trigger. Medications that are more likely to cause RLS include antihistamines and decongestants, antidepressants, anti-nausea medications, seizure medications and stimulants.

If no cause can be identified, then there are several different medications which your doctor may try.
For very intermittent symptoms, a drug traditionally used for Parkinson's disease (Sinemet) can be taken on an "as needed" basis. For people who suffer from symptoms the majority or every night, other neurologic medications (Requip, Mirapex, Neurontin, Lyrica, or Neupro) may be tried on a nightly basis.

What about alternative therapies? There's always SOAP...

BOTTOM LINE: If your squirming legs are keeping you from restful sleep, don't suffer in silence- talk to your doctor and find out if you have restless leg syndrome!

Can't Sleep? You're Not Alone...

One in ten American adults have suffer from insomnia (defined as inability to adequately sleep for at least fourteen consecutive nights). Whether it is trouble with falling asleep or difficulty staying asleep (waking up either multiple times or simply way too early), this lack of restorative sleep leads to more than simply daytime fatigue. Sleep deprivation causes trouble with concentration and memory, irritability and other mood disturbances, and actually can lead to higher rates of infection, diabetes, heart disease, and cancers. As such, I'm going to spend the next several blog entries talking about insomnia issues and solutions.

While some sleep disturbances (such as sleep apnea and restless legs) will definitely require medical interventions, the good news is that a great deal of sleep issues can be significantly improved or solved with some behavioral modifications. What can you do?

Sleep Hygiene Improvements:

• Eliminate or greatly reduce caffeine- even morning coffee affects the quality of your nighttime sleep. (You can keep the coffee- but wean to decaf!)
• Exercise in the morning (or at least a few HOURS before bedtime)
• Avoid "screen time" in the two hours before bed- do your dishes/laundry/non-screen chores if necessary, read a book, play with your pets or enjoy the lost art of conversation
• Take a warm shower or bath just before going to bed
• Use ALL your senses to relax during that bath- smell, sight, sound (think lavender soaps, soft music or nature sounds, and candle light- there is a reason SPA's use all these!)
• Go STRAIGHT to bed after the shower- don't get sidetracked by housework or electronics
• Make your bedroom dark and cool (consider blackout shades and ceiling fans)
• COVER THE CLOCK (no peeking at your phone or clock to watch the minutes tick by one after another!)
• Until you are sleeping WELL again, move the pets OUT of the bedroom. 

BOTTOM LINE: If you suffer from insomnia, talk to your family doctor to try and identify the cause, and include these sleep hygiene tips along with any necessary medications to maximize your long-term success.

I Got Mine! Did You Get Yours?

As we zip into the holiday season, give yourself the GIFT of a flu vaccine NOW so you are not struck down with this illness at the busiest time of year! Flu shots have been available for a few weeks and seem to be available everywhere.  Clinics, schools, grocery stores, pharmacies and many employers are all offering flu shots these days. Add a flu shot to your grocery list- I'll bet the pharmacy there is stocked and you won't even have to add an extra stop on your weekly errands.

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

What is different this year?
This year, we have quadrivalent vaccines (that include protection against four strains- 2 influenza type  A strains, and 2 influenza type B strains) in addition to the usual trivalent vaccines. Pick one or the other, you don't need both. If you have egg allergies, make sure to ask for the trivalent vaccine that is egg-free.

But I hate needles...no problem, just 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.

Hate needles and have asthma? There is also a trivalent shot that has a tiny needle which is injected just below your skin, rather than into the muscle.


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? 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:  FLU SEASON has begun again- get vaccinated!

It's BA-ACK! Halloween Candy

Despite the 90 degree days we are still having in Texas, the calendar tells me it is already OCTOBER. Of course, the grocery stores have been featuring HALLOWEEN CANDY for nearly a month already! Did you resist? Or are you tossing in a bag of bite-sized candy on impulse as you check out?

If so, it's high time to realize that we are now officially in what I call the "treat yourself" season, as we hit the trifecta of food oriented holidays: Halloween, Thanksgiving and Christmas/Hanukkah. We tend to celebrate with nonstop EATING, and then what do we do every January? That's right, make New Year's resolutions where LOSING WEIGHT tops the list!
This year, let's THINK AHEAD...

Let's SAVE THE HALLOWEEN CANDY for...yes, HALLOWEEN! Start in the grocery store. Do NOT BUY the candy till the DAY BEFORE Halloween. It's way easier not to eat it when it is still sitting on the shelf in the grocery store, rather than sitting on your desk at work or your kitchen counter top. We all grab a small handful of treats when they are openly displayed in front of us.

Do the calories add up? You bet. Here are some of my favorites: Snack Size Butterfinger: 170 kcal, Fun Size Kit Kat- 50 kcal, and ONE single, plain M&M-4 kcal. Now, if you stop at ONE, it's really no big deal. but if you eat a handful of M&Ms each DAY for the next few weeks, or grab a couple fun size chocolate treats, BOOM-you will gain a pound right there. (Remember one pound is 3600 kcal- do the math.)

BOTTOM LINE: Don't wait for NEW YEARS to make a resolution for better health- start NOW by limiting Halloween CANDY to HALLOWEEN DAY!

PS. It's a new month, so CHANGE THOSE AIR FILTERS!