Hepatitis B

We'll continue the series on hepatitis this week by focusing on hepatitis B.  Hepatitis B is another viral infection that causes inflammation of the liver.  The symptoms of hepatitis B are the same as those we previously discussed in the Health Tip on hepatitis two weeks ago. Unlike hepatitis A, the hepatitis B virus can cause an acute or chronic infection.

How do you get hepatitis B?

The hepatitis B virus is spread through contact with the blood, semen, or other body fluid of an infected person.  It is not spread by casual contact with an infected person.  It is not spread by drinking contaminated water or eating contaminated food, or sharing eating utensils.  A baby cannot get hepatitis B from breast milk.

How is the hepatitis B virus spread?

• Having unprotected sex with an infected person
• Sharing drug needles or other drug materials with an infected person
• Having an accidental needle stick with a needle that was used on an infected person
• Getting a tattoo or a piercing with tools that were not properly sterilized after being used on an infected person
• Sharing an infected person's personal items, such as a razor, nail clippers, or toothbrush
• Coming in contact with the blood or open sores of an infected person
• Being born to a mother who is infected with hepatitis B

What is the difference between acute and chronic hepatitis B?

Acute hepatitis B is a short-term infection, which may last from several weeks up to 6 months.  Most healthy adults and children older than 5 years old will have a good immune response to the hepatitis B virus, so their body is able to fight off the infection, and the infection goes away.

Chronic hepatitis B is a long-lasting infection, sometimes lasting a lifetime.  It happens when your immune system is not able to fight off the acute infection and the virus does not go away.  Only about 5% of adults who develop an acute hepatitis B infection will go on to have chronic hepatitis B.  Children are much more prone to develop a chronic infection, because their immune system is not mature.  About 90% of infants infected with hepatitis B will develop chronic hepatitis B.

What are the complications of chronic hepatitis B?

• Cirrhosis - A condition in which scar tissue replaces healthy liver tissue.  This scar tissue can block the blood flow through the liver, causing many complications. 
• Liver failure - As cirrhosis progresses over months or years, the function of the liver declines and the liver can no longer perform its important functions.  This is also called end-stage liver disease.
• Liver cancer - Chronic hepatitis B increases your chance of developing liver cancer.  If you have chronic hepatitis B, you should be screened for liver cancer at regular intervals.

What can be done to prevent hepatitis B?

• Immunization - A vaccine has been available for hepatitis B for many years, initially given to adults at high risk, such as health care workers.  In 1991, the vaccine was added to the recommended childhood vaccine schedule.  Since then the rate of new hepatitis B infections has gone down by 82%.
• Avoid the exposures that spread hepatitis B that I mentioned above.

Should you be screened for hepatitis B?

Some people do not have severe symptoms during the acute hepatitis B infection, and do not realize that they have chronic hepatitis B until they develop symptoms of liver failure.   These are some of the reasons that hepatitis B screening is recommended, if you:

• Are pregnant
• Were born in an area of the world where hepatitis B is more common (sub-Saharan Africa, parts of Asia, and the Pacific Islands), or if you did not receive the hepatitis B vaccine as an infant and have parents who were born in these areas of the world
• Are a man who has sex with men
• Are HIV positive
• Have injected drugs
• Have lived with or had sex with a person who has hepatitis B

For more information about hepatitis B, try these links…
https://www.cdc.gov/hepatitis/hbv/index.htm
https://www.mayoclinic.org/diseases-conditions/hepatitis-b/symptoms-causes/syc-20366802
If you have any questions about Hepatitis B, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Hepatitis A

I'm continuing my series on hepatitis by focusing this week on hepatitis A, which is a virus that causes a highly contagious liver infection.  This is an acute form of hepatitis, although symptoms can last up to 6 months in some cases.  Most people who become infected with hepatitis A will recover completely with no permanent liver damage.  There is no chronic form of hepatitis A.

Last week we talked about the symptoms of hepatitis, which are the same for all causes of hepatitis.

How do you get hepatitis A?
 
The most common way to contract hepatitis A is from contaminated food or water, or from close contact with a person who is infected.  The transmission is through a route called fecal-oral transmission.  This happens when an uninfected person puts something into their mouth that is accidentally contaminated with the stool of an infected person (it may not look contaminated at all).  It does not spread through sneezing or coughing.  Casual contact, such as with a coworker in an office or factory, does not spread the hepatitis A virus.

How is hepatitis A spread?

• Drinking contaminated water
• Eating raw shellfish that comes from water polluted with human waste
• Eating food handled by an infected person who doesn't thoroughly wash their hands after using the toilet
• Being in close contact with an infected person, even if they have no symptoms.  People can have hepatitis A for 15-45 days before they actually develop symptoms, and they can spread it during that time period.
• Sexual contact with an infected person
• Caring for young children infected with hepatitis A, which often includes changing diapers or otherwise helping with toileting.

What are the risk factors for hepatitis A?

• Traveling to or living in areas where hepatitis A is common
• Caring for a child who is a recent adoptee from countries where hepatitis A is common
• Being a daycare worker, or a child in daycare
• Living with someone who has hepatitis A
• Having any sexual contact with someone who has hepatitis A
• Using illegal drugs, whether injected or not

What is the treatment for hepatitis A?
 
There is no specific treatment for this infection.  Most people with hepatitis A recover within a few months without any treatment other than lots of rest and drinking plenty of fluids.  Some people do get sick enough to need hospital care, but this is typically supportive care to help with the liver problems caused by the virus, and not specifically directed at the hepatitis A virus.

What can be done to prevent hepatitis A?

• Practice good personal hygiene, including good hand washing practices.
• Be mindful of high-risk situations.  If you are in an area where there is a high risk for hepatitis A, be sure to boil water or drink bottled water, and avoid eating fruits and vegetables that could have been washed in contaminated water. 
• Avoid eating raw or steamed shellfish that come from potentially contaminated waters.
• Talk with your doctor about whether you should be vaccinated.  The vaccine is very effective but may not be ideal for everyone. 

For more information about hepatitis A try these links…
https://www.cdc.gov/hepatitis/hav/afaq.htm#overview
https://www.mayoclinic.org/diseases-conditions/hepatitis-a/symptoms-causes/syc-20367007

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

Dr. Anita Bennett MD - Health Tip Content Editor

Hepatitis

Any inflammatory condition of the liver is called hepatitis and there are many possible causes.  Hepatitis can be caused by infection, auto-immune disease, or a variety of toxic substances.  The CDC estimates that there are around 60,000 new cases of acute infectious hepatitis in the US each year, and an estimated 4.3 to 5.7 million people in the US are living with chronic infectious hepatitis.

Let's start by going over some basic information about the liver, then we will talk more about hepatitis and how it affects the liver.

What does the liver do?
The liver performs many critical functions in your body.  These functions include:

• Production of bile, which is essential for digestion
• Filtration of toxins from the body
• Storage of certain vitamins, minerals, and glycogen (a form of sugar stored to provide energy)
• Production of clotting factors, which are essential to normal blood clotting
• Production of certain blood proteins, such as albumin
• Activation of certain enzymes
• Proper breakdown of proteins, fats, and carbohydrates

What are the possible causes of hepatitis?

• Infection - Infectious causes include hepatitis viruses A, B, C, D, and E.  Mononucleosis and cytomegalovirus (CMV) can also cause hepatitis.
• Alcohol - Excessive alcohol consumption can cause acute or chronic forms of hepatitis. 
• Toxins - The filtration and breakdown of toxins by the liver means the liver is at particular risk from toxins.  Common chemical toxins that affect the liver include certain herbicides and a number of industrial chemicals.
• Medications - Several medications, both over-the-counter and prescription, can damage the liver, especially when taken in higher than recommended doses, or if combined with alcohol.  Liver tests should be monitored when taking certain medications because of this risk.
• Herbs and Supplements - Many herbs can be dangerous to the liver, including aloe vera, black cohash, cascara, chaparral, comfrey, kava, and ephedra.  There are many others.  Higher doses are more dangerous, and children are at especially high risk.
• Autoimmune conditions - In certain autoimmune diseases, the immune system mistakes the liver for a foreign object and starts to attack it.  This can cause acute or chronic hepatitis.

What are the symptoms of hepatitis?
The following symptoms come on abruptly with acute hepatitis, and more slowly with chronic forms.

• Fatigue
• Flu-like symptoms
• Jaundice - Yellow color of the skin and eyes
• Darker colored urine
• Lighter colored stool
• Abdominal pain
• Unexplained weight loss
• Loss of appetite

Hepatitis can result in acute or chronic liver failure, which can cause many other severe symptoms, and can result in death.

Over the next few weeks, I will discuss several of the causes of hepatitis individually, in more depth.  I hope this will provide important information to help you recognize the risks and potentially avoid chronic liver disease.


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

Dr. Anita Bennett MD - Health Tip Content Editor

How to Spot the Early Signs of Stroke

Stroke is the 5th most common cause of death in the US, and a leading cause of disability.  A stroke occurs when an artery that carries blood to the brain either becomes blocked by a clot, or ruptures.  When this happens, the part of the brain that is supplied by this artery cannot get the oxygen it needs.

What are the types of stroke?

• Ischemic stroke - Results from a clot in an artery, which then obstructs the flow of blood to a portion of the brain.  Most strokes are this type.
• Hemorrhagic stroke - Results from a blood vessel bursting, which prevents blood flow to a portion of the brain, and results in pressure on the surrounding brain from the buildup of blood.
• TIA - Sometimes called a mini stroke, this is actually not considered a true stroke.  It can be caused by a clot that resolves quickly.  TIA will cause signs of stroke that last for less than 24 hours, then totally resolve back to normal.  It is considered a warning sign for a true stroke.

What increases the risk for stroke?

• Age - Risk increases as you get older, particularly over age 60.
• Smoking
• Having high blood pressure, heart disease, high cholesterol, or diabetes
• Having an irregular heartbeat, particularly atrial fibrillation
• Family history of strokes 

What are the signs of a stroke?
 The early signs of stroke are actually easy to identify.  There is even an acronym to help you remember them…F.A.S.T.

• Face drooping.  One side of the face droops or is numb.  The person's smile will look uneven.
• Arm weakness.  Numbness or weakness of one arm and/or one leg (on the same side).  If you ask the person to raise both arms, one arm will drift downward due to weakness.  They may be unable to walk due to leg weakness, or may be dragging one leg when walking.
• Speech difficulty.  This can be either trouble actually speaking, or understanding.  The person's speech may sound slurred, or difficult to understand.  The words may be easily understood, but simply not make sense.  If the stroke affects a person's understanding of speech, they may think you are speaking a different language. 
• Time to call 911.  Time is brain.  Brain tissue is rapidly damaged as a stroke progresses, so the sooner you get help, the better the chances of recovery from a stroke.  If you or someone you know shows any of the above symptoms, call 911 immediately.  Make sure to note the time the symptoms first appeared (if you know), or the time you last saw the person without symptoms.  

The list above includes the most common signs of stroke.  Here are a few more that you should know.

• Sudden confusion, trouble understanding things, or trouble doing a routine task.
• Sudden and severe headache.  Sometimes this is described as a thunderclap headache.  If you suddenly have the worst headache of your life, this could be the first sign of a stroke.
• Sudden dizziness, trouble walking, loss of coordination or balance. 
• Sudden change in vision.  This can be a complete loss of vision in one eye, or loss of vision in one plane, such as inability to see to your left out of either eye.  Some people don't notice loss of vision in one eye right away.  Loss of depth perception can be a clue.  If you lose depth perception, you should cover one eye at a time, to determine if you can still see out of each eye.

Knowing the early signs of stroke can save your life or the life of someone you love.  Be prepared, and remember to call 911 immediately.  Don't waste precious time.  Time is brain!

If you have any questions about early signs of stroke, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Oatmeal Baths - A Home Remedy to Soothe Your Skin

We have all had itchy skin from time to time, whether it is from poison ivy, eczema, or dry skin.  It is always nice to have a good home remedy available that really works.  An oatmeal bath is a great alternative to anti-itch medications.  People have actually been using oatmeal to sooth irritated skin for centuries.

How does oatmeal stop the itch?

• Oatmeal contains vitamin E and other compounds which have anti-inflammatory and antioxidant properties. 
• It contains starches and beta-glucan, which act to help moisturize the skin. 
• It contains polysaccharides (a form of sugar) which act to bind water, and create a protective barrier to help keep the skin from losing excess moisture. 
• It acts as a buffering agent, to help skin maintain a balanced pH.
• It reduces the rate of histamine release from mast cells, which is part of a normal allergic skin reaction.
• It helps to cleanse the skin because it contains saponins, which have soap-like activity.

Is this the same oatmeal you eat for breakfast?

The answer is yes and no.  You don't just pour old fashioned oats into your bath.  The kind of oatmeal that you put in your bath is called colloidal oatmeal.  You can make colloidal oatmeal from old fashioned oats, the same kind you eat for breakfast.  You can also buy over-the-counter colloidal oatmeal specifically made for using in a bath.

How do you make your own colloidal oatmeal?

• You will need to start with whole, old fashioned oats, not instant oatmeal or quick cooking oats, without any sugar, salt, or flavorings of any kind. 
• Put the dry oats into a clean blender or food processor and grind them into a fine powder that is just a little more course than flour.
• Test it to see if it is the right consistency by stirring a teaspoon of the powder into a glass of warm water.  The water should turn milky white, with almost no sediment on the bottom.

How do you prepare an oatmeal bath?

• If you are using an over-the-counter colloidal oatmeal product, there will be instructions on the package.
• If you are using your own, homemade colloidal oatmeal, add ½ to 1 cup of the colloidal oatmeal to a tub of warm water.  Water that is too hot can worsen itching, so avoid hot water. 
• Limit your bath time to 15 minutes, which helps avoid losing your skin's protective oils.
• Be especially careful when getting out of the tub, because colloidal oatmeal can make the tub slippery!
• Pat your skin dry as soon as you get out of the tub, then apply a good moisturizing cream.

I would love to hear how this works for you the next time you have itchy skin.  If you have itchy skin that does not improve with this home remedy, send in your question to one of our doctors.  We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor