Tuesday, October 29, 2013

Preventing Shingles Through Vaccination

Blog contributed by Jamie Weeder, CRNP

Most of us have seen the commercials, the ones with the painful, blistering rash that burns like fire. Through personal experience, I can vouch that shingles is a horrible experience that is unlike any pain that I have ever experienced. I wanted to share my experience with individuals and use it to teach about shingles and the recommendations for vaccination.

What is shingles?
Shingles, also known as herpes zoster, is a painful rash that develops on one side of your face or body. Shingles is caused by the same virus that causes chicken pox, the varicella zoster virus. After a person has chickenpox, the virus becomes inactive (dormant) along a nerve route inside their body. The virus becomes reactivated many years later due to a decreased immune system caused by illness, medications, or stress.

Everyone that has had chickenpox is at risk for developing shingles. According to the Centers for Disease Control and Prevention (CDC), nearly 1 out of every 3 people in the United States will develop shingles. The risk for shingles increases with age and approximately 50% of shingles cases occur in people age 60 and older.

What are the signs and symptoms of shingles?

This past August on a Friday afternoon, I developed a painful aching along the right side of my jaw. I didn't think anything of the pain at the time, but the next day I realized something was wrong. The pain was getting worse and I had a red sore inside the right side of my mouth where the pain was coming from. I started to feel feverish and sick to my stomach. The pain was becoming more intense and felt like it was shooting from my jaw and into my right ear. I would like to believe that I have a good pain tolerance, but I must admit that the pain brought tears to my eyes and I would spend the next few days with an ice pack on my face to numb the pain.

Symptoms of shingles include a painful, itchy, blistering rash that presents as a band or stripe on one side of the face or body. The symptoms of pain and itching can occur between 1 and 5 days before the rash develops. In addition to the rash, people can develop fevers, chills, headaches, and nausea.

Due to my symptoms and developing more red spots inside my mouth that traveled along a line, I was started on antivirals and medication to help control the pain. A few days later the pain began to subside. Because of my age and the odd location of my rash (most rashes occur on the skin), blood work was done that confirmed that I had shingles. I remained on medication for approximately 3 weeks until the pain and rash completely resolved.

Shingles usually clears up within 2 to 4 weeks, but early treatment can help control the symptoms and resolve the disease faster. If you believe that you have shingles, contact your healthcare professional immediately as starting antivirals within 48 to 72 hours of developing the symptoms can shorten the length and severity of shingles. Early treatment can also help prevent chronic complications, such as postherpetic neuralgia which is severe pain along the rash that can last for months after the shingles rash resolves. The risk for postherpetic neuralgia increase in people over the age of 60 that are not treated for shingles.

Although rare, more serious complications of shingles include: pneumonia, hearing loss, vision loss, brain inflammation, or death depending on the severity and location where the virus activates.

How do you prevent shingles?

The only way to reduce the risk of getting shingles and postherpetic neuralgia is by getting vaccinated. Zostavax is the vaccine for shingles that the CDC recommends for individuals aged 60 and older regardless of whether they remember getting chickenpox.

Studies have shown that the risk of developing shingles after vaccination decreased by 50% and those who developed shingles had decreased severity and duration of symptoms. The U.S. Food and Drug Administration (FDA) has stated that the shingles vaccine was also effective in individuals between ages 50 and 59. If you are between the age of 50 and 59 and are interested in getting the shingles vaccine, you should speak with your healthcare professional. At this time, the shingles vaccine is not suggested for people younger than age 50 because more studies need to be completed.

Most individuals that have shingles will not develop the rash a second time, although it is possible to get shingles multiple times. Individuals that have had shingles can still get the shingles vaccine.

What are the side effects to the shingles vaccine?

The most common side effects of the Zostavax vaccine include headache and injection-site reactions. The vaccine in injected under the skin, usually on the upper arm. Possible injection-site reactions include redness, soreness, swelling, and itching. Some people may develop a chickenpox-like rash at the injection-site.

People that are allergic to neomycin should not receive the vaccine. The shingles vaccine is a live virus and should not be given to people with a weakened immune system such as those with HIV/AIDS, people taking medications to weaken their immune system such as steroids, and people receiving treatment for cancer. The shingles vaccine should not be given to women who are pregnant or may be pregnant.

It is safe to be around infants, pregnant women, and people with a weakened immune system after receiving the shingles vaccine.

How much does the shingles vaccine cost?

The cost of the shingles vaccine varies depending on your health insurance. While all Medicare Part D plans cover the vaccine, the amount that each individual pays varies. Medicare Part B does not cover the vaccine and Medicaid coverage varies. Most private health insurance plans cover the vaccine for individuals aged 60 years and older. Some private insurance plans provide coverage for individuals aged 50 to 59. For individuals that cannot afford the shingles vaccine, there are assistance programs available to make the vaccine more affordable.

Making Your Decision

As healthcare professionals, we want to provide you with education and your options for disease prevention and treatment. Deciding to get vaccinated is a personal decision that you should discuss with your healthcare provider. Due to my experience, I plan to get vaccinated when I reach the recommended age. If you have additional questions, speak with your healthcare provider or leave a comment below.

Tuesday, October 15, 2013

Does my child have allergies or a cold?

Blog contributed by Kathleen Zimmerman, MD,  Pediatrician

Does your child have a constant runny or stuffy nose?  Or have you ever thought, “my child seems to always have a cold”?  It is possible that your child may actually have allergic rhinitis.  Allergic rhinitis is also called “hay fever”, although that name is misleading because there is no fever involved.

Allergic rhinitis is very common.  It affects 1 out of every 5 people in the U.S.  Allergic rhinitis happens when your immune system overreacts to a substance in the environment, such as tree or grass pollen, animal dander, or indoor particles of dust.  This causes a release of histamines in the body.  Histamines produce the typical symptoms of allergic rhinitis, such as:  stuffy nose, runny nose, sneezing, and itching of the eyes, nose, ears, and/or mouth.  Don’t be confused – these symptoms are very similar to what is seen with a cold. However, colds are caused by a virus and should only last 10-14 days.  Allergies can last many weeks to months and tend to occur around certain triggers in the environment or during certain times of the year.

If you are concerned your child may have allergic rhinitis, discuss it with your child’s medical provider.  He or she may recommend a trial of an over the counter medication, such as an antihistamine, which can help block the symptoms discussed above.   Or they may recommend a blood or skin test to determine what, if anything, your child may be allergic to.  Often avoidance of the allergy trigger is the most important step in reducing allergic rhinitis symptoms.

For more information visit primary.pinnaclehealth.org

Tuesday, October 1, 2013

How Your Smartphone Can Help You Lose Weight

Contributed by  Betsey Miller, CRNP, PinnacleHealth Medical Group

Think about the things you do every day with your Smart phone…you might update your Facebook status, text a friend, check the score of the ballgame, play Words with Friends, check the latest headlines or check the weather forecast.   The truth is, the possibilities are endless.  But did y
ou know your Smartphone can help you lose weight?   It’s true – “there’s an app for that.”  In fact, your smartphone is the perfect tool to help you get the weight off and keep it off.  There are many great (and free!)  apps to get you started on your weight loss journey.

According to a study published by the Archives of Internal Medicine (December, 2012),  people who used a structured weight loss program via mobile technology (such as smart phone apps) to monitor their daily food intake, weight and physical activity lost an average of 9 pounds more  than people who didn’t use the technology.  And those who continued to use the technology maintained significant weight loss 12 months later. 

While there are probably many more great weight loss apps available, the three that I’m the most familiar with and that I recommend to my patients are MyFitnessPal, Sparkpeople and Lose It!   All three of these apps are completely free and do essentially the same thing.  They allow you to track your dietary intake, track your weight and log your exercise, and all of them make it super simple. 
Diets don’t work.  If you go “on” a diet, eventually you’ll go “off” the diet.  And when you do, you’ll go right back to the same old habits and gain back any weight that you lost.  There are so many “quick fix,” gimmick diets out there – the no carb diet, the cabbage soup diet, the grapefruit diet…the list goes on and on.  Let’s say, for example, that your favorite food is pizza, but you’re on a restrictive diet that doesn’t allow pizza.  What happens when you DO give in and eat pizza?  You might feel like a failure and quit.  Wouldn’t it make more sense to eat sensibly?  Couldn’t you still eat the things that you like if you eat less of them?  But how much is too much?

That’s why these apps are so great.  They function as a digitalized food log.  You enter what you eat and how much, and the app calculates the calories for you.  Many things are preprogramed, so there’s very little data entry.  Some apps even have the ability to scan a barcode on your food item to enter it that way.  Want to know how many carbs or how much fat you’ve eaten so far today?  The app will break that down for you too.  In essence, you can still eat the foods that you enjoy eating within the confines of a balanced, healthy diet. 

I often challenge my patients to pick an app, and stick with it for a minimum of four weeks.  I challenge them to enter every single food they put in their mouth for that amount of time.  What I love about this is that it gets people thinking about what they’re eating, it keeps them accountable, it gets them looking at food labels and thinking about serving sizes, and it helps them realize how much they should be eating.  After four weeks, new habits are established and it’s easy to keep going.
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These apps also allow you to enter your exercise activities and can account for any calories you burn.  You can enter your weight as often as you like and follow your trends as the weight comes off.  You can even link up with friends to keep each other motivated! 

And now, Pinnacle Health has added a new mobile app to help you make healthy decisions when you’re eating out.  Check out The Health Hub of Central PA -- an easy, convenient, and free smartphone app that helps you find healthy restaurants and fitness centers in the Central PA area. The app is designed to be completely personalized to your preferences. You can base your search on your specific diet and exercise preferences. You can view location hours, get directions, and receive a special coupon code for making your healthy choice!

Losing weight is still hard work.  There is no “quick fix.”  But now, smartphones allow us to have a personal coach in our pocket 24/7, and this does make losing weight a little easier and a lot more fun!