How long does the shingles vaccine stay effective?

herpes zoster day 3

herpes zoster day 3

… that depends on your health history.

If you have an autoimmune disease, the protection against the shingles infection wanes about 5 years after receiving the shingles vaccine.  The most common autoimmune diseases in this research project was rheumatoid arthritis (40%), psoriasis (33%), inflammatory bowel disease (20%), and then other assorted autoimmune problems.

There is a long-term Shingles Prevention Study which is watching how effective the shingles vaccine is in different patient populations.

Shingles cases among UNvaccinated patients is about 1.33 cases per 100 person-years.  Vaccinated patients had about half the risk of shingles compared to nonvaccinated patients.  The researchers are looking into the benefit from a booster vaccine after initial vaccination, when this should be given, and if this is effective at preventing herpes zoster.

I’ll keep you posted.

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Homemade meals even better!

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Another reason to cook a homemade meal… lower risk of type 2 diabetes!  How fantastic is that?!

A long-term prospective study of nearly 100,000 health care professionals showed that those who ate an average of 11-14 home-prepared lunches and dinners per week had a 13% lower risk of developing type 2 diabetes compared to those eating less than 6 per week.

Looking at homemade meals a continuous variable, each home-prepared lunch or dinner eaten per week decreased the long-term risk of developing type 2 diabetes by 1-2% according to the research.

There were other benefits, such as those who ate 11-14 homemade meals per week had a 15% lower risk of developing obesity during the first 8 years of follow-up.  Men who ate in that fashion gained about 2 pounds less body weight in the first 8 years.  It was also found that those who brought their meals also consumed fewer sugar-sweetened beverages.

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Prophylactic medicine for HIV

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Of course, holding hands does not transmit HIV. I just like the intimacy of the picture. flickr.com/photos/ hebe/ 3310171434/

Did you know that there is a daily prophylactic medication that can reduce the risk of sexually transmitted HIV by 90% and drug needle transmission of the virus by 70%?  There is!

Only 1/3 of primary care doctors are aware that this medication exists.

According to the CDC (Centers from Disease Control), 40,000 people are diagnosed as HIV positive yearly in the United States.  The most at-risk groups are sexually active gay men, injectable drug users, and sexually active heterosexuals with a risk of 1:4 and 1:5 adn 1:200 respectively.

This medicine, Truvada, was approved by the US Food and Drug Administration in 2012  It is a combination of two antiretrovirals and when taken daily it has been shown to be highly effective in decreasing the contraction of HIV.  The most common side effect of the medication is nausea and it rarely causes kidney dysfunction.  Due to kidney problems, labs should be done every 3 months.

The cost of Truvada is about $10,000 yearly and is covered by Medicaid.  We must not forget that the mainstay to decreasing HIV transmission is the correct and consistent use of condoms, the reduction of high-risk behaviors, increased access to drug treatment programs and available of sterile needles to IV drug users.

Now you know.

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Kudos to my husband for a local write-up!

Dr. Mark Stovak, sports medicine physician

Dr. Mark Stovak, sports medicine physician

http://www.nnbw.com/news/20231637-113/the-right-medicine-for-any-athlete

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Cough medicine used as a drink?

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We are mid “the coughing months” where as a provider I have patients with a cough that may benefit from a codeine cough syrup.  I am growing weary of prescribing promethazine with codeine as this can be doctored into a drink.  Codeine has been known as a good cough suppressant, and when combined with an antihistamine called promethazine, this results in an effective cough syrup that has been used for decades.

Cough medicine has gained notoriety for abuse in the past few years.  This codeine syrup is the main ingredient in a popular drink among teens known as the “Purple drank” or “sizzurp.” This drink has been posted on instagram, artists post tweets about it and even sing about it in their songs.  The mixture is promethazine with codeine, lemon-lime soda, and hard candies.  It is fizzy, colorful, and sweet.  Many teens add marijuana ingestion with this drink which can cause respiratory depression and potentially death.

Physicians need to use extreme caution, continue vigilance to identify frequent flyers and teens.  We should also prescribe only small amounts of this syrup to prevent leftovers from being kept around the house, leading to unsupervised use.

I will continue to dole out this medicine as it is warranted and will warn the parents to monitor its use.  As the mother of a teen, this is an issue dear to my heart: let’s keep our children safe.

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Interested in attending medical school?

  

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Reno preventive health screenings tomorrow!

 A few words of advice, screening tests should be shared with your physician to help you navigate the questions of…

How does this result affect me?

Are the results (even if abnormal) significant?

Are my current medications correct?

Do I need any other follow-up testing?
I hope this helps… (credit to Reno Gazette Journal 1/6/16) 

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Insomnia… an interesting problem

Did you know that insomnia affects 10 to 30% of the population?

Insomnia is a specific definition, per the International Classification of Sleep Disorders (ICSD3).  You must have all four of the following: difficulty falling asleep, difficulty staying asleep, early awakening, AND daytime impairment (fatigue/poor attention/ mood disturbance/daytime sleepiness).  It must occur at least three times per week or at least one month.  And, it needs to not be related to inadequate opportunity to sleep well.

Some conditions can predispose a person to insomnia:

1.Chronic medication conditions such as sleep apnea, cancer, itchy skin, diabetes or IMG_3631-1menopause, heartburn, dementia, pain, restless legs syndrome.

2. Medications:  antidepressants, blood pressure medication, appetite suppressants, over-the-counter allergy, cough and cold medications, and sedatives.

3.  Psychiatric conditions:  anxiety, depression and post-traumatic stress disorder.

4.  Substance abuse: alcohol, illicit drugs, and tobacco.

Here are suggestions for non-drug treatment of insomnia…

Sleep hygiene.  Use the bedroom for sleep and sex only!  Exercise regularly, although not within 4 hours of bedtime.  Limit caffeine, tobacco and alcohol intake.  Maintain a regular sleep-wake cycle weekdays and weekends.

Stimulus control.  Lie down to sleep only when feeling sleepy.  Avoid wakeful activities at bedtime such as TV watching or walking on the phone.  Leave the bed if unable to fall asleep within 20 minutes and return to bed when sleepy.

Sleep restriction.  Limit time in bed to the numbers of hours actually spent sleeping, although this should be not less than five hours.  Increase sleep time gradually as sleep efficiency improves.

Relaxation training.  Imagine a calm environment.  Focus on pleasant images.  Consider meditation, yoga, progressive muscle relaxation.  Try visual or auditory biofeedback to help reduce muscle tension.

Avoid daytime naps.

Keep a sleep diary.   sleep hygiene 2

 

Good news is you cannot die from a few nights of mediocre sleep.

Work on the above issues before seeing your doctor .

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Feeling buggy? …learn about scabies.

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Scabies is  infestation of the mite Sarcoptes scabiei.  I normally tell patients that “good people get this” as EVERYONE who gets this feels icky (that’s my medical term for it).

Where does this infect your skin?  Most commonly in the skin folds, fingers, wrists.. but, it can infect anywhere.

Are there symptoms?  Yes.  Intense itching, which is usually worse at night.  Even after treatment, you may itch for up to one month.  This is due to the dead scabies mites (under the skin) causing a localized allergic reaction.  Benadryl at bedtime can help initiate sleep and decrease itching.

How to treat this?  Permethrin is a cream that is placed on the skin (chin to toes) and kept on overnight.  It’s then washed off after 8 hours.

Scabies is not life-threatening, but the severe persistent itching and (occasional) infection of the skin from scratching can be debilitating.

If you have itchy skin, see your doctor…

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This is Nevada Influenza Vaccination Week!

Why should you get the flu vaccine?  There are scores of people yearly who are ill due to the flu AND there are thousands (or sometimes TENS of thousands) of people who die each year from influenza.

Do I get my flu vaccine?  Yes, every year!  3 years ago I still contracted the flu.  The vaccine companies do their best to guess the flu types that will be present the next flu season… and sometimes they don’t guess exactly perfectly.  I was in bed for 5 days and felt awful every moment of the five days.  But, I did not die… so I will get my vaccine yearly.

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What are the symptoms of the flu?  Flu symptoms are NOT diarrhea and vomiting.  Flu symptoms are fever, cough, sore throat, runny/stuffy nose, muscle aches and feeling unable to get out of bed.

What are the benefits to getting the flu vaccine?  Less risk of death from the flu (Man!  That’s a great benefit!) and reduced risk of getting the flu, missed work, missing school, and reduced hospitalization rate.

Are some people more at risk for serious flu-related complications?  Yes!  Young children, pregnant women, people older than 65 and older people with asthma, heart disease and diabetes are more at risk for serious complications.

Flu vaccines can be given to anyone older than 6 months old.  There are different forms of the flu vaccine: a shot and a mist that goes in your nose.  The mist is fantastic in that it does not involve a “shot”, but this cannot be given to pregnant patients, immune compromised patients, asthmatics, and to kids between 6 months and 2 years of age.

No insurance?  Visit http://www.nevadahealthlink.com to find out about affordable health coverage options for the influenza vaccine.

 

Posted in General Medicine- Adults, Obstetrics, Pediatrics, Uncategorized, Vaccines, Vaccines, vaccines | Tagged , , , , , , , , , , | Comments Off on This is Nevada Influenza Vaccination Week!