Saturday, October 12, 2019

When Should You Get Your Flu Shot?

Last week, public health officials urged Americans to get their flu shot early this year.  Let's talk about the reason for the warning, and whether you should get a flu shot.

You may not realize that influenza viruses are constantly mutating and changing.  Because of this, the strain of influenza virus that is common this year, may be very different from the strain that was common during last year's flu season.  This is why a new influenza vaccine, or flu shot, is necessary each year.

How is the flu shot designed or selected each year?

Flu Shots
More than 100 influenza centers in over 100 countries conduct year-round surveillance for influenza.  This involves testing thousands of influenza virus samples from patients all over the world.  The laboratories then send representative viruses to five World Health Organization (WHO) laboratories, one of which is the Centers for Disease Control and Prevention in Atlanta, Georgia.

The flu vaccine is then designed to protect against the three or four influenza viruses that research indicates are most likely to cause illness during the upcoming flu season.  In the United States, the FDA makes the final decision about which strains are included in the flu shots that are given in the U.S., with consideration given to recommendations made by the WHO, based on worldwide research.

Why are officials recommending early flu shots this year?

It may be no surprise that the Southern Hemisphere's flu season is about 6 months earlier than our flu season in the Northern Hemisphere.  Influenza season is typically during fall and winter.  Because the Southern Hemisphere experiences their fall and winter, and their flu season, during our spring and summer, we often look at the trends seen in Australia's flu season, to help us plan for our own.
 
While their flu season does not always predict the severity of our own, it can certainly provide an indication of what's to come for us.  This year, Australia's flu season started early, and is considered to be one of the worst influenza seasons that they have ever seen.

This makes our public health officials worry about our upcoming flu season.  In fact, there have already been some U.S. locations reporting scattered cases of influenza as early as September, which is considered early for our flu season.  There have even been 2 reported deaths from influenza recently.

Why does it matter if you get your flu shot?

Although the flu vaccine is not 100% effective at preventing influenza, there is research showing that the vaccine reduces the severe and sometimes even deadly complications from the flu, and can protect newborns whose mothers received the flu vaccine while pregnant.  The effectiveness at preventing disease varies from year to year, depending on how accurate the predictions were for the strains of flu virus expected.  So even though it may not prevent every case of the flu, it does prevent a number of infections, it does decrease the severity of the disease, and it will save lives.

Although last year's season, 2018-2019 was not too bad, in the 2017-2018 flu season in the U.S., the flu killed at least 80,000 people. 

Who should get a flu shot?

The CDC recommends everyone ages 6 months and older get a flu shot every flu season, including people with chronic health conditions as well as healthy people.  It is especially important for some people to get vaccinated, namely people who are at risk of developing serious complications, like pneumonia, if they get sick with the flu. This includes:
  • People who have certain medical conditions including asthma, diabetes, and chronic heart or lung disease, and the people who live with or care for them.
  • Pregnant women
  • People 65 years and older
Who should NOT get a flu shot?
  • Children younger than 6 months of age
  • People with severe, life-threatening allergies to any component of the flu vaccine
  • Some people should not be vaccinated without first consulting a doctor, including
    • Those with an allergy to eggs
    • Anyone who had Guillain-Barre Syndrome within 6 weeks of getting the flu vaccine previously
    • Anyone who has a moderate to severe illness with a fever should likely wait until they recover before getting the shot
When should you get your flu shot?

I usually recommend a flu shot by November 1st, but this year we should all get our flu shots early.  I would talk with your doctor or pharmacist about getting your flu shot as soon as you can.

If you have any questions about flu shots, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Monday, September 30, 2019

Healthy Kids Healthy Drinks

Recently four major health organizations came together to support the first-ever consensus recommendation about healthy drinks for kids. There are so many drinks available in stores these days, and many of them are advertised as kid's drinks. Unfortunately, many drinks that are advertised for kids are not actually healthy for kids. I know it was always a challenge for me as a parent, trying to combat the advertisements, as well as the availability of unhealthy drinks at every turn, from restaurants to soccer games. But it is important that we as parents make good choices for our children who are too young to make these choices for themselves.

Healthy Kids DrinksWhich organizations formed the consensus?
  • Academy of Nutrition and Dietetics
  • American Academy of Pediatric Dentists
  • American Academy of Pediatrics
  • American Heart Association
Why are these new recommendations important?

The beverages that kids drink during the first few years of their lives are a significant source of calories and nutrients, and can have a large impact on their health, not only during childhood, but throughout adulthood as well. Early childhood is the ideal time to start shaping nutrition habits and promoting healthy nutritional choices, and this is just as important for beverages as it is for foods.

What are the new recommendations?

The recommendations are divided by age, from birth through age five. You can follow the link at the bottom of the page to read the full recommendations, but I can give you a summary here.

0-6 month old babies should drink:
  • Breast milk
  • Infant formula
6-12 month old babies should drink:
  • Breast milk
  • Infant formula
  • A few sips of water during meal times with solid foods
12-24 month old babies should drink:
  • Water - 1-4 cups of water daily, depending on the weather and how active they are
  • Milk - Plain, pasteurized whole milk provides lots of nutrients which their growing bodies need. They should get 2-3 cups of whole milk per day.
2-3 years toddlers should drink:
  • Water - 1-4 cups per day which varies depending on the weather and how active they are
  • Milk - At this age, children should transition to low fat milk, either 1% milk or skim milk, about 2 cups per day.
  • Very limited amount of 100% fruit juice - Only ½ cup (4 ounces) per day. You can add water to fruit juice in order to make a little bit go further. Instead of drinking fruit juice, children should be eating fruit (fresh, canned, or frozen) with NO added sugar. Even 100% fruit juice can cause dental cavities and unwanted weight gain.
4-5 year old kids should drink:
  • Water - 1.5 to 5 cups of water a day, again depending on weather and activity level.
  • Milk - Plain, pasteurized, low-fat milk, up to 2 ½ cups a day
  • Very limited amount of 100% fruit juice - No more than ½ to ¾ cups (4-6 ounces) per day. Again, kids should be eating fruit without added sugars, rather than drinking juice.
For all age groups, kids should not drink anything that is not on the list of recommended drinks for their age, this includes:
  • Flavored milks, like chocolate or strawberry milk
  • Transition formulas, sometimes called toddler formulas or follow up formulas
  • Plant-based milks such as almond milk, soy milk, rice milk, oat milk
  • Drinks with caffeine, such as sodas, coffee, tea, energy drinks
  • Carbonated drinks, such as sodas
  • Sugar-sweetened drinks, or drinks sweetened with low-calorie sweeteners, such as sodas, fruit drinks, fruit-ades, sweetened waters, etc.
  • Sports drinks or energy drinks - No kids should drink sports drinks, even if they are playing sports.
I would encourage you to read the full recommendations by following this link:
https://healthydrinkshealthykids.org/ 

If you have any questions about healthy drinks for kids, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Monday, September 23, 2019

Gout Part II - Diagnosis and Treatment

Last week, we talked about the symptoms and causes of gout.  This week, we'll talk about the diagnosis and treatment of gout, including dietary changes.  My husband has had gout for many years, so I am very familiar with the dietary triggers for gout flares!

GoutIf you have symptoms, how is the diagnosis of gout made?
  • There are several tests that can help make the diagnosis.  Not all of them are necessary for all patients.
  • Blood test - A test that measures the uric acid level in the blood can be helpful.  However, this test is not diagnostic for some patients.
  • Joint fluid test - Your doctor can use a needle to remove fluid from the affected joint.  If urate crystals are seen under the microscope, that provides the diagnosis.  
  • X-ray - An X-ray of the affected joint may be helpful to rule out other conditions.
  • Ultrasound - An ultrasound can often detect the urate crystals in a joint or gout nodule.
What are the possible complications of gout?
  • Recurrent gout flares may cause erosion and destructive changes within affected joints.
  • Untreated gout may also cause deposition of urate crystals under the skin, causing gout nodules called tophi (tophi is pleural, tophus is singular).
  • Urate crystals may also build up in the kidneys, causing kidney stones.  
If you have gout, what lifestyle changes can you make to decrease your risk of flare-ups and complications?
  • Drink plenty of fluids, especially water
  • Limit or avoid alcohol, especially beer
  • Limit your intake of high-fructose corn syrup, especially soft drinks
  • Limit your intake of meat, fish, and poultry, but especially red meat and organ meats
  • Limit the amount of seafood in your diet, such as shrimp
  • Get more of your protein from low-fat dairy products, which seem to have a protective effect
  • Maintain a desirable body weight - If you are overweight, losing weight may decrease your uric acid levels.  However, fasting, or losing weight rapidly may temporarily increase uric acid levels.
  • Maintain a regular exercise program
What are the other treatment options for patients with gout?
  • Some people manage very well with lifestyle changes alone, at least for a while.  Medications can be used to treat acute attacks, to prevent future attacks, or to decrease the risk of complications.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) - NSAIDs include over-the-counter and prescription medications, such as ibuprofen, naproxen sodium, indomethacin, and others.  Your doctor may recommend that you take a higher dose during an acute attack, then a lower dose to help prevent flares.  Side effects include an increased risk of bleeding and ulcers.
  • Colchicine - This is a prescription medication that works effectively to relieve gout pain.  It may be taken in higher doses to help with an acute flare, and then in lower doses to help prevent recurrent flare-ups. It can have side effects (primarily gastrointestinal symptoms), especially if taken in large doses.  
  • Corticosteroids - This includes medications such as Prednisone.  They may be given in pill form, or as a shot.  We usually don't use these medications unless a patient cannot take NSAIDs or colchicine, primarily because of the risk of adverse effects associated with these drugs.
  • Medications that block uric acid production - These medications would be taken daily to try to prevent gout flares and complications.  They include allopurinol and febuxostat.  By blocking uric acid production, they can lower your blood level of uric acid.  Side effects are not uncommon.  
  • Medications that improve the removal of uric acid by the kidneys - This includes probenecid and lesinurad, which are taken daily.  They do help prevent joint flares and complications, but they increase the level of uric acid in the kidney, so they can increase your risk for kidney stones.  They can have other side effects as well.  
  • The decision about taking medications for gout should be discussed with your doctor, weighing the risk of side effects against the potential benefits of decreasing gout flares and complications.  
For more information about a low-purine diet, follow this link:
https://www.drugs.com/cg/low-purine-diet.html

Dr. Anita Bennett MD - Health Tip Content Editor