New Years' Resolutions: Take 2

Greek Salad at the Stash

Well, here we are at the end of January already...and how are you doing with your New Year's Resolutions? From the number of FitBits and step counts that I am seeing and hearing, I believe many people are enjoying being more active (or at least enjoying "competing" with themselves or friends over their numbers.) Perhaps the two most common health related resolutions are to increase exercise and to eat "better". What does that really mean?

First let's tackle "increase exercise". Please, focus on the INCREASE. If you are honestly doing nothing, start with walking. Consider a "FitBit" or a smart phone or a simple $10 pedometer, and start charting how many steps you take each day. Next, challenge yourself to up that number each day by 100 steps. We as a society seem to be very motivated by video-game-like challenges, so we know what it takes to "pass" each level, right? Let's apply that to our daily steps. For years, we have been pushing the "10,000" steps per day, which is approximately equal to 4 miles. My encouragement today is simply to see YOUR personal baseline, and push it up by SMALL increments each day.

Eating "better". Okay, I have blogged before about the "unhealthy vegetarian", but for those who have not yet heard my rant...here it goes. "Vegetarian" does NOT equal "HEALTHY". It certainly CAN, and even SHOULD- if that person is concentrating their food choices on- wait for it- VEGETABLES. However, especially in my current patient population of college students, "vegetarian" can mean diets of granola bars, chips, nachos, and cheese pizza. Hmm...let's count the fruits and veggies there- anyone have a calculator? LOL.

BOTTOM LINE: My 2016 Gift to you is that the last day of EVERY month, I wish for you a clean slate- a "do-over" for your NYE Resolutions. On this January 31st, why not pick a simple FEBRUARY healthy resolution? And feel free to share with us your success!

Is TEAL the New PINK?

January is Cervical Cancer Awareness month, and the color is TEAL. Did you know there are still over 12,000 women in the United States who are diagnosed with this cancer every year? And although our treatments have greatly improved, there are still over 4000 deaths from this cancer every year. The good news is that we have PREVENTION, and with this prevention, we hope to eliminate cervical cancer within our lifetime! Take this CDC Cervical Cancer QUIZ to test your knowledge.

The HPV vaccine is approved and strongly recommended for all adolescents- girls and boys- as part of their routine vaccinations at age 11-12 years. The second generation of Gardasil vaccine (Gardasil 9) now covers not the HPV strains that cause 90% of cervical cancers (as well as the two strains that cause 90% of genital warts.) If your child has started the series with the original Gardasil, they may finish out the series with the Gardasil 9 to increase the spectrum of their immunity.

YES, the vaccine is safe. YES, the vaccine is effective- extremely effective! YES, my daughters are immunized, and they are the two people my husband and I love and care about the most on this planet! Enough said.

Pap tests- are they still necessary? Yes, but NOT EVERY YEAR (and the crowd cheers)! Our current guidelines recommend Pap testing starting at age 21 years, and then every 3 years till age 65. There is also an option for 30-65 year olds to test only every 5 years when they do combined Pap and HPV testing.

Does the Pap check for all sexually transmitted infections? NO. The Pap test checks for early cervical cancer. To check for STI's such as HIV, gonorrhea, chlamydia, syphilis, and herpes, you will need additional testing (of blood, urine, and possibly a swab test performed during a pelvic exam.)

Are there support groups for women diagnosed with cervical cancer? Absolutely! For example, I'm honored to be in the picture above with Tamika Felder, the founder of a wonderful support group CERVIVOR- check out her website!

BOTTOM LINE: That magical "cure for cancer" has not yet been discovered for all cancers, but CERVICAL CANCER is preventable- let's end this disease for our children by vaccinating them now!

Out with the OLD, In with the NEW (AKA Healthy New Year's Resolution #1)

Happy 2016! Hard to believe we are nearly half way through January as I look at my home STILL filled with Christmas decorations. Many of us tackle the new year with a cleaning or de-cluttering frenzy after we pack up the holiday decor. In fact, it can be overwhelming as we survey overflowing closets, desks and kids rooms...wishing for that magic wand to neatly organize our lives. I once read an organization plan that suggested a better chance of success if you tackled ONE specific area and thoroughly completed it before you moved on- whether that was one drawer of your dresser, a single shelf of books, or even cleaning the kitchen sink itself. So...instead of the sink or coat rack, may I suggest starting with your MEDICINE CABINET? Whether this means a simple first aid kit or an entire bathroom or kitchen cabinet, let's get rid of the old and bring in a few selected new supplies.

Expired medications, in my experience, are rarely harmful in and of themselves, but they often have lost effectiveness. There is no point in saving the last few drops of prescription cough syrup from 2007...it's not going to help you any more. If you are having an allergic reaction and your diphenhydramine (Benadryl) or worse, your Epi-Pen, has expired...this is not a good time to find out how much their effectiveness has decreased! Ditto with anti-nausea medications. In general, solid tablets have extended shelf lives more than liquids. Additionally, with liquids such as eye drops, the preservatives break down, allowing potential bacterial growth (and the obvious possibility of causing rather than treating an eye infection.)

However, taking leftover "spare" single or several antibiotic pills actually MAY be harmful- because as you partially treat an infection, you make the bugs effectively only weak and dizzy, not dead...and now you have a strain of bacteria that is resistant to new antibiotics. Just say NO and toss these.

Expired bandaids? Okay, you can keep those. But compression wraps (ACE wraps)? If you have washed them a dozen times- unlikely they have enough spring left in them to do their job. High quality splints from old injuries (wrist or ankle)? I keep those as long as they can be cleaned.

Once opened, over-the-counter acne medications with benzoyl peroxide (hello, high school and college students!) TOTALLY lose effectiveness after only a couple months- explains more than a few breakouts. Toss 'em.

Bottom Line: Make a HEALTHY START in 2016 by cleaning out your MEDICINE CABINET this weekend!

Rocky Mountain HIGH...Altitude Sickness

Going skiing for winter break? Mountains are my favorite destination, but...please remember that the high altitude can come with medical challenges. Be aware of signs and symptoms of "mountain sickness" (aka. altitude sickness) and if you are susceptible to this issue, look closely at ski resort altitudes- there is a wide variation.

HOW HIGH do you have to be for altitude sickness?
There is not a set elevation for typical mountain vacations that affects everyone. Symptoms are uncommon at altitudes below 5000 feet above sea level, and fairly common above 8000 feet. If you fly to a higher elevation (such as above 8000 feet), wait a day to acclimate before you start hiking the high peaks nearby. This is very common- an estimated 75% of people visiting mountains with altitudes higher than 10,000 feet will get some degree of altitude sickness. Note that many people have a significant difference in degree of symptoms between altitudes of 9000-13,000 feet- which may explain why they "felt fine" skiing last year at a different resort.

For Colorado skiers: 
The highest ski mountains are in Arapahoe Basin and Loveland (13K), with Breckenridge barely under at 12,993'. Snowmass/Aspen, Keystone & Copper Mtns peak at roughly 12,300-12,500', with Crested Butte and Winter Park closer to 12K. Vail is 11,500 while Durango and Steamboat are around 10, 500. To get below 10K, consider Buttermilk at Aspen (max 9900) or Steamboat Springs Howelsen Ski Area at only 7,136. Obviously the ski towns themselves are not at these peak mountain summit heights, and many resorts offer lodging at a variety of elevations- consider this factor when deciding about the convenience of ski in, ski out, as sometimes you are better off further down the mountain.

When does it start?

Symptoms usually within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?

• Mild to moderate: HEADACHE, decreased appetite or nausea, insomnia, and lightheadedness
• Severe:  All of the above plus vomiting and shortness of breath
• Note that in severe forms, there can be brain swelling (High Altitude Cerebral Edema) and/or fluid collecting in the lungs (High Altitude Pulmonary Edema)- these are medical emergencies.

Treatment?

Ultimately, going to a lower elevation will relieve symptoms, but rest and hydration will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications. For mild insomnia, try over the counter melatonin.

PREVENTION:

• Increased hydration with water or sports drinks, and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
• SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
• If you have had altitude sickness previously, especially if it has occurred on multiple trips to the same elevation, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains literally take your breath away- plan ahead to prevent altitude sickness!

Was My Rapid Flu Test Accurate?

In primary care offices, we do many types of rapid testing to help us diagnose and treat patients- pregnancy tests, urine tests for infection, rapid strep tests, and of course, rapid flu tests. The accuracy of these tests definitely vary by category. Since we are entering FLU season, this post specifically addresses the Rapid Influenza Diagnostic Tests (RIDTs).

If a rapid flu test is POSITIVE, it is EXTREMELY accurate- 98-99%. This means they are very SPECIFIC tests- if it says you have it, you have a 98% chance that you really do have the flu, so the likelihood of a false positive is very low. If your rapid flu test result is NEGATIVE, however, you might still have the flu...and your doctor should rely on her clinical judgement. 
The SENSITIVITY of different brands or rapid flu tests can vary, but averages about 62%, meaning about 1/3 of the time when you DO have the flu, the test could miss it.

The most recently published meta-analysis of rapid flu tests analyzed 26 different rapid test brands, but all had similar data on accuracy-http://www.ncbi.nlm.nih.gov/pubmed/22371850. Another study published in 2015 looks back at the last seven years to assess accuracy of one major brand of rapid flu tests (Becton Dickinson RIDT)- once again, confirming extremely high accuracy if positive (99%), but having a much lower sensitivity ranging from approximately 20-60% (so missing true positives roughly half of the time).

Why do doctors even use these tests if they are not super sensitive? Because it affects our treatment plan. If we have confirmation that someone has the flu (with a positive test), then we can feel more confident in NOT prescribing an antibiotic, and limit our conversation to pros/cons of taking an antiviral medication as well as medications for symptomatic relief. This step greatly reduces unnecessary antibiotics, which is critical in an era of increasing antibiotic resistance.
Additionally, knowing a patient definitely has the flu helps us advise them about returning to work/school/activities, since we know flu stays infectious for up to a WEEK. (So STAY HOME at least several days, and until you are fever-free for at least 24 hours!)

If you had the flu vaccine, will that affect your rapid flu test?  If you had a shot- no. If your flu vaccine was the intranasal spray, there is a chance that you could have a false positive test. Studies have shown that in the first several days after receiving the nose spray vaccine, people may test positive for the flu (even though they are not infected.)

The CDC encourages doctors to treat all high risk individuals with suspected flu with antiviral medications.

Who should be treated with SUSPECTED illness? Some are obvious- anyone hospitalized, patients in nursing homes, and people with immune problems, significant chronic problems (lung or heart disease, for example) or with severe illness such as pneumonia. However, HIGH RISK also includes all otherwise healthy children under the age of two years,  adults over the age of 65, and women who are pregnant or have just delivered their baby within the past two weeks. There are also other less common subgroups that are high risk such as people who are very obese (BMI >40), American Indians or Alaska natives, and youth under 19 who are on chronic aspirin therapy.

Who should be treated with CONFIRMED illness? 
Anyone in the high risk categories above should be treated with antiviral medications if they have a positive test, because treatment definitely decreases severe complications, hospitalization and even death.

Otherwise healthy, active adults who test positive for the flu should have a discussion with their physician about taking the antiviral medications. When taken within 48 hours of the onset of flu symptoms, these drugs have been shown to decrease the duration of the flu by one or two days...which may make a big difference to a student, parent or employee. However, these medications are not without side effects, and for some people, they may aggravate flu symptoms- particularly nausea. In controlled studies, the antiviral medications only cause about 10% more nausea/headaches/fatigue than placebo, but there is no doubt that in a minority of patients, the medicine causes more side effects than they are worth. However, since you have the FLU when you are taking the medications- you already likely HAVE nausea, headache, fatigue, etc- so it is often difficult to sort out. In my family, half of us can tolerate the antiviral medications with zero problems, and half...barely keep the pills down long enough to know.

BOTTOM LINE: If you have flu symptoms, get to the doctor as soon as possible (especially if you would consider taking antiviral medications), and understand that a positive test is REALLY positive, but a negative test does not definitely rule out the possibility of the flu. 

AND...that ounce of prevention...remember to GET YOUR FLU SHOT NOW to reduce your chance of getting the flu (or to at least minimize your symptoms if you do catch it.)

Roll a Mile in Someone Else's Wheels

We've all heard the expression "to walk a mile in someone else's shoes" but this past month at Anderson High School in Austin, TX, students and faculty were given a very unique opportunity to "roll a mile in someone else's wheels" through the Wheelchair Challenge.  For one school day, participants committed to spending the day in a wheelchair.  (A $20 donation was required to nominate a participant or self-volunteer. Those people nominated had the choice to participate or "buy out" for another $20.) The purpose of this program is two-fold: one, to raise awareness about disabilities, and two, to raise money to buy powered doors for our older, not-always-wheelchair-friendly public school. Sounds simple enough, right?

Here are a few things that our daughter learned from her Wheelchair Challenge: 

1. When you are at a different level physically (sitting, not standing),  you are often unintentionally ignored and left out of the conversation.

2. Trying to open and enter through a traditional outside door while staying seated in a wheelchair is virtually impossible by yourself (even when the door is officially not heavy enough to have an ADA mandated power opener.)

3. Arms and backs get tired or strained, and hands can blister quickly when self-propelling a wheelchair..."sitting" all day is much harder than being mobile.

4. With minor modifications and supportive teachers, wheelchair-bound students can be easily included in "extras" like pep rallies.

5. Bias/stigma against wheelchairs and disabilities still exists to the extent that many people didn't take advantage of this unique opportunity purely because they didn't want to feel or seem "weak" to their peers.

Many thanks to Archer Hadley, the truly inspirational young man behind the Wheelchair Challenge. (Watch his brief video story by clicking the link on his name!)

BOTTOM LINE: OPEN DOORS- figuratively and literally, for those who are differently abled, and help expand the wheelchair challenge to YOUR community!

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 needles...no 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!