August 28th, 2008 by Dr. Val Jones in Uncategorized
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There is no doubt that vaccines are life-saving, and their development is one of the most important contributions to medical science in the past century. There are about a dozen regularly recommended adult vaccines, and kids in the US receive about 16 shots before the age of 2. New vaccines are being developed all the time.
With this year’s flu season just around the corner, a recent poll suggests that only 44% of parents have their children vaccinated against influenza. I decided to interview two pediatricians about the influenza vaccine, to find out more about it.
Dr. Ben Spitalnick is Assistant Clinical Professor, Mercer University School of Medicine, Savannah, Georgia. Dr. Stacy Stryer is Revolution Health’s pediatric specialist in private practice in Virginia. She offers a post-script at the end of the interview.
Dr. Val: What is the AAP’s current recommendation regarding vaccinating children against influenza?
Dr. Spitalnik: This is the first year that the AAP (as well as the ACIP) has recommended flu vaccination for all children age 6 months to age 18 years, regardless of whether or not they fall into the “high risk” medical categories that have been used as screening parameters in recent years. In addition, they recommend vaccination of pregnant women and all health care providers. Finally, they recommend vaccination of household contacts and out-of-home providers of all children under 5 years of age, and similar contacts of children older than 5 with high risk health conditions.
Dr. Val: What percent of parents vaccinate their children against influenza?
Dr. Spitalnik: While over 80% of parents recognize that there is an influenza vaccine available, data show that only about 44% of parents have had their child vaccinated against influenza in the past. In addition, despite the AAP’s broader recommendations regarding flu vaccination, still less than half (about 48%) plan to vaccinate against the flu this coming year. While there are plenty of possible reasons why vaccination rates are so low, health providers owe it to their patients to continue to find ways to improve delivery of and education about the influenza vaccine.
Dr. Val: What did the National Parent-Child Survey uncover about parents’ attitudes towards flu vaccines?
Dr. Spitalnik: The National Parent-Child Survey certainly provided some eye-opening data. While experts recognize that getting an annual flu vaccine is the single best way to protect yourself or your child from catching influenza, the survey shows that parents rank the flu vaccine sixth in importance to prevent the flu. Specifically, parents in this survey believe that hand washing, adequate sleep, balanced diet, avoiding sick contacts, and taking vitamins are better ways to protect against the flu. This helps emphasize the point that the health care community must continue to find ways to educate the public about influenza, and more importantly, its prevention.
Dr. Val: If someone has the flu, how can they help to prevent their child from getting it?
Dr. Spitalnik: Chances are this year, as with most years, almost every child will be in close contact with someone that has the flu. While hand washing, avoiding sick contacts, and getting adequate rest and nutrition may help against the flu, the single most effective way to prevent a child from getting the flu is having the child vaccinated. While protection after vaccination is fairly quick, it is not instantaneous, so waiting until your child is exposed to the flu is not the best approach. Instead, follow the recommendations of your health care provider and get vaccinated at the right time, and don’t wait until it may be too late.
Dr. Val: How dangerous is the flu virus to children? Are there any subgroups of children at higher risk?
Dr. Spitalnik: The flu is a significant danger to children, though the public doesn’t seem to appreciate the risk, which could be why vaccination rates are so low. While many feel the flu is nothing more than a severe form of the “common cold”, in reality it can lead to very high fever, dehydration, pneumonia, and can even be fatal. In fact, Influenza is the single leading cause of vaccine-preventable disease in the U.S., with estimates between 15 million and 60 million cases in the US a year among all age groups. Influenza leads to 200,000 hospitalizations and about 36,000 deaths a year in the U.S., mostly in infants and the elderly.
There are certain subgroups of children that are at higher risk for complications from the flu. These include children with asthma or other chronic lung conditions, certain heart diseases, patients who have weakened immune systems including HIV, sickle cell anemia, kidney disease, diabetes, and others. These are groups that we offer flu vaccines to first, when the vaccine is in short supply. The list above is not comprehensive, and any patient with a specific question about their own child’s medical conditions should contact their physician.
Dr. Val: Does the recent resurgence of measles tell us anything about parents’ attitudes towards childhood vaccinations?
Dr. Spitalnik: Yes, it certainly does. Cases of measles in the U.S. are at their highest level in more than a decade, with half of these cases in patients from families that rejected the measles vaccine. Many of the other cases were from exposures to these unvaccinated patients, but in children who were not yet old enough to receive the measles vaccination. I know that some physicians are asking parents (who refuse to vaccinate their children) to find a new doctor. They’re worried that other families’ infants may be exposed in the waiting room to kids with measles.
While some parents are refusing vaccines for their kids, there is impressive data from Japan clearly demonstrating the life-saving value of vaccinating children against influenza. In the 1960’s, the death rate in Japan from pneumonia and Influenza (P&I) was approximately 10 per 100,000. Over the next decade flu vaccination in the schools was made optional and then mandatory, and by the 1980’s the death rate from P&I showed a steady decline, eventually down to 4 in 100,000 – a significant reduction. In 1987, however, parents were allowed to refuse vaccination, and in a decade death rates quickly rose back up to near their 1960’s levels.
There is clearly more we need to do to help educate our patients about vaccines, not just with influenza. Specifically, however, flu vaccine education has its own hurdles, and I hope this year we all do a better job protecting our patients from this dangerous disease.
Dr. Val: What’s the most important thing that parents should know about the flu vaccine?
Dr. Spitalnik: If I had to choose one it would be that the flu vaccine, in any form, is the single best way to protect your child from the flu, which can be a serious threat to their health, and is now recommended for ALL children age 6 months to 18 years.
In addition, parents need to know that the flu vaccine is better than ever this year: First of all, there does not appear to be any shortage of supply. Second, all 3 strains of the vaccine have been changed to help ensure stronger protection. And finally, there is more than one way to get the flu vaccination, both the traditional shot and an intranasal spray, both of which should be available from their health care provider early this flu season.
P.S. By Dr. Stacy Stryer: Dr. Spitalnick offers some very good information and advice regarding the flu vaccine. While certain high risk groups, such as infants (ages 6 months and up), children with asthma and other chronic diseases, and those who are immunosuppressed are all at a greater risk of developing severe complications if they contract the flu, it is also possible for healthy children to develop complications from the influenza virus. Dr. Spitalnick discussed the best way to prevent children from contracting the flu, which is by receiving the vaccine. There are two forms of influenza protection available, the nasal spray and the traditional injection. The nasal spray, FluMist, may only be given to children ages 2 and older, and is contraindicated for children with asthma, several chronic diseases, and severe egg allergies, yet is more protective than the injection. Good hygiene, such as frequent handwashing and keeping hands away from the face, can also help reduce the risk of contracting the flu.
*Dr. Spitalnik has been a speaker for Glaxo Smith Kline and MedImmune. Dr. Stryer has nothing to disclose.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 27th, 2008 by Dr. Val Jones in Uncategorized
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Recently, the FDA has required that supplement manufacturers accurately identify the ingredients of their products on their labels – though this mandate does not address efficacy or safety claims. Supplement manufacturers may make all sorts of claims about their products, without needing to provide evidence to support them. In fact, supplements may even contain ingredients known to be harmful. The FDA provides a short list here.
Does the FDA’s ingredient disclosure rule protect us (note that some manufacturers have until June, 2010 to comply)? I have a feeling that it is a little bit like keeping people honest with their taxes – the threat of a potential audit is supposed to galvanize citizens into proper documentation of their receipts and business expenditures, but the fact that the IRS doesn’t have the bandwidth to audit more than about 1% of the population (and they usually target those with higher incomes) means that some people “cheat” on their taxes.
The same holds true for supplement manufacturers. They know that they’re supposed to accurately represent the contents of their products on the label and engage in good manufacturing practices – but the chance of the FDA actually performing chemical tests on their product (since there are hundreds of thousands of them out there) is so low that they have no real incentive to comply. Many of them probably feel that they’ll cross that bridge when they come to it. After all, supplements are a $20 billion/year industry.
A new study in the Journal of the American Medical Association reviewed the contents of one small subtype of supplements – traditional Ayurvedic medicines. They found that 1 in 5 samples (of 193 products sold via the Internet at 25 different websites) contained lead, mercury, and/or arsenic. I hope that this sobering statistic will make consumers think twice before reaching for that next “miracle cure.”
The FDA has an excellent (though somewhat dated) review article here. In it, they recommend the following:
To help protect themselves, consumers should:
- Look for ingredients in products with the U.S.P. notation, which indicates the manufacturer followed standards established by the U.S. Pharmacopoeia.
- Realize that the label term “natural” doesn’t guarantee that a product is safe. “Think of poisonous mushrooms,” says Elizabeth Yetley, Ph.D., director of FDA’s Office of Special Nutritionals. “They’re natural.”
- Consider the name of the manufacturer or distributor. Supplements made by a nationally known food and drug manufacturer, for example, have likely been made under tight controls because these companies already have in place manufacturing standards for their other products.
- Write to the supplement manufacturer for more information. Ask the company about the conditions under which its products were made.
Interested in purchasing supplements from companies who voluntarily submit their products to rigorous testing? Try consumerlab.com Their mission is “to identify the best health and nutritional products through independent testing.”
However, in my opinion, very few supplements offer any valuable health benefits (beneficial vitamins and minerals for certain populations include Vitamin D, Calcium, folic acid, and Vitamin B12).
The American Academy of Family Physicians found no evidence to recommend a single weight loss supplement. A healthy diet combined with regular exercise is the most important “supplement” you can take for optimum health.
And one thing I’m sure of – you don’t need any extra arsenic, lead, or mercury in your diet. Be careful what you put in your body!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 26th, 2008 by Dr. Val Jones in Uncategorized
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If you’re trying to lose weight, it helps to have a specific plan. I found this out the hard way. Over the past few months I’ve watched my weight creep up very slowly into my discomfort zone. I resolved to reverse the trend by “trying harder to eat healthy food” and to “walk more.”
Seasoned dieters will point out that these vague resolutions were destined to fail, and unfortunately that’s what’s happened. However, my scale has galvanized me into action and I have prepared a very specific plan of attack. I’m going to walk 10,000 steps per day (based on my pedometer) and I’m going to follow the Atkins Diet.
Some of you may gasp, “But Dr. Val, surely you know that the Atkins Diet isn’t healthy!” Yes, that’s what I thought initially too. However, a quick review of the new Atkins Diet site suggests that it may not be as bad as we make it out to be. The old “all you can eat bacon and cheese” approach is not really what Atkins is about. Instead, it’s a staged approach to cutting down on the refined carbohydrates in our diets. The first stage (which only lasts 2 weeks) is quite strict (only 20 grams of carbs/day) but after that you can begin adding back some of the complex carbs that are important to a balanced diet. Spinach has almost no carbs – so I’m going to give Popeye a run for his money this week!
Here’s what I like about the Atkins Diet: 1) it’s really easy to follow 2) you never have to feel hungry 3) I’m an omnivore, so lean meats are enjoyable to me 4) it addresses my personal dietary issue head on: carb addiction.
What I don’t like so much is this: 1) protein can be quite expensive, so expect your grocery bill to increase on this diet 2) you must not cheat, especially in the induction phase – it will throw off the whole process 3) no more cereal or Nutella – ack!
The Atkins Diet is not for everyone – those who have a history of gout, kidney stones, osteoporosis, or kidney problems may not be good candidates as a high protein diet can trigger gouty and kidney stone attacks and can worsen osteoporosis. Also, vegetarians might find it difficult to get enough protein from carb-less sources. And finally, red meat consumption is associated with colon cancer, so if you’re planning to stay on the Atkins diet for long periods of time, try to limit the red meat intake.
However, research has shown that a very low carb diet is an effective approach to weight-loss (perhaps even more effective than other diets) and has a favorable impact on blood cholesterol, insulin, and glucose levels.
Wish me luck on my new journey – and feel free to join me in my online weight loss group so that we can do this together.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 25th, 2008 by Dr. Val Jones in Uncategorized
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As with any profession, surgery has its share of both wonderful surgeons, and not so wonderful ones. I thought I’d share an example of each that I found in my blog reading:
A Bad Surgeon
An on-call oral surgeon comes in to see a patient with Ludwig’s Angina – a serious dental infection that spreads under the jaw and can cause loss of the airway, and upon seeing that the patient is “self pay”, says we should transfer him since he is “penniless” and could never afford to follow up with him in the office! When told by the ER doc that he cannot transfer a patient for that reason, he then turfs the case to ENT – who is understandably disgusted as well, but agrees to see the patient. By the time this happens 6 hours later, his infection has worsened and he has to go the ICU, get intubated and trached due to loss of his airway. FINALLY at this point the oral surgeon takes him to the OR – he is still trached and in the ICU three weeks later – this might have been avoided if he were operated on sooner.
A Good Surgeon
We were on vacation and noticed a suspicious red swelling on my son’s leg. We made an appointment at a local pediatric care center, and the physician assistant determined it was an abscess that needed to be drained by a surgeon. The PA was very calm and reassuring, and quickly made an appointment for us with a local surgeon. We drove over to the surgeon’s office, and everyone there, from the receptionist to the nurse to the surgeon himself, was friendly and supportive. My son was extremely nervous about the prospect of having both shots and surgery, and the staff, especially the surgeon, did a great job calming him down. After it was all over, my son even commented that the surgeon was so nice, almost like a grandfather, and that he liked how he explained everything to him before he did it.
I myself have received care from both good surgeons and not-so-good ones. All I can say is that a physician’s character really does make a difference in the kind of care you’re likely to receive. When seeking a good surgeon, ask a physician whom you trust to make a recommendation. Birds of a feather flock together in healthcare and in life.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
