Thank you to the Rockwall Chamber of Commerce and the Professional Women’s Alliance!
A doctor’s first lesson in the treatment of patients is learning to live with humility. It was Friday clinic and I was counseling a patient about his Shingrix vaccine. “You will be fine,” I reassured him. “The vaccine is safe and effective.” I also let him know that I would be receiving my shot the same day. “Perhaps you will feel a little bit achy tomorrow, but otherwise, you should be able to go about your usual activities this weekend”. The next morning I called him to deeply apologize in case I had not properly prepared him for its side effects. I know I was not prepared! Statistically speaking, I found out that I was the one in six person who will experience the vaccine’s full side effects and I was miserable.
Thankfully, he suffered little of the side-effects the vaccine manufacturers described. I, on the other hand, had pronounced fatigue and achiness that had left me napping and uncomfortable for most of the weekend. After a couple of miserable, disgruntled, self-pity filled days I was quickly back to normal and back to work on Monday. I have no regrets about receiving my vaccine. My temporary symptoms were far-better than alternatively suffering from the burning pain of a shingles outbreak or, even worse, a post-herpetic neuralgia, a lingering chronic pain complication from a shingles viral infection.
This newer Shingrix vaccine is over 90% effective in preventing the disease while It’s predecessor, “Zostavax” was found to be only marginally effective over time and is no longer considered effective a preventative vaccination.
Shingles is caused by the reactivated chicken pox virus. It lays dormant in our body for years after a childhood infection. Surprisingly, there are some people who have had chicken pox but never experienced its classic red-blistery rash. According to the Centers for Disease Control and Prevention (CDC), approximately 99% of Americans over 40 have had chicken pox even if they do not remember an infection.
The CDC recommends all healthy adults 50 years and older receive at least two doses of Shingrix two to six months apart. If you have had shingles, received less effective Zostavax, or are not sure if you had the chickenpox, you should receive the two doses of Shingrix.
Anyone who has had a severe allergic reaction to any components of the Shingrix vaccine should avoid the immunization. Your medical provider will screen you prior to your vaccination. Example of when you should postpone the vaccination include, but are not limited to, situations such as you currently have active shingles, a fever, a severe respiratory infection, or if you are pregnant or breastfeeding. Be sure to let your medical provider know if you are on any anti-viral drugs such as acyclovir or valacyclovir as you may need to hold your medication for a few weeks prior to receiving the vaccine.
Currently, I am planning ahead for “Shingrix – the Sequel” (round #2). It will be Ibuprofen, hot baths, and no weekend plans for me. My lesson was a good one. As a medical professional, humility is a great teacher and constant companion. It enables me to communicate both sides of the vaccination experience.
We enjoyed the evening with members from Garland, Sachse, Wylie, and Murphy !
Thank you to Garland Chamber of Commerce, Wylie Chamber of Commerce, Murphy Chamber of Commerce, and Sachse Chamber of Commerce
My family always makes a fuss when it comes to our grocer’s yogurt isle. There are so many different brands of yogurt and we are all individually selective when it comes to our favorite morning food. To make matters more difficult, my family members have each opted to customize their yogurt selection based on fat content. When it comes to yogurt, my daughter is non-fat, my husband is low-fat, and I am full-fat. The question boils down to: Who has the healthiest breakfast diet? It would seem that lessdairy fat would be the best answer; however, that is not necessarily true.
Without doubt, dairy products with greater percentages of fat contain more calories which most people will want to avoid if they choose a calorie-restricted diet. However, studies found that when people purposefully reduce fat in their diets, they tend to replacethose calories with sugar and/or carbohydrates. The compensatory increase in both sugars and carbohydrate could lead to worsening effects on circulating insulin levels and lead to an increased risk for developing diabetes. A 2016 study published in the journal Circulation, Dr Dariush Mozaffarian and colleagues studied dietary fat intake in 3,333 adults over 15 years. The researchers found that people who had higher levels of three different types of full-fat dairy had, on average, a 46% lowerrisk of developing diabetes compared to people who tended toward lower fat dairy products. But what about the weight gain with full fat diets?
My family is always concerned that full-fat diet may cause them to “pinch-an-inch”. Contradictory! A study published in the American Journal of Nutritionanalyzed the effects of full-fat versus low-fat dairy on obesity. Researchers discovered that among 18,438 women, those who consumed the most high-fatdairy products lowered their risk of being overweight or obese by 8%.
According to my taste buds, the full-fat flavor of yogurt is far better than the 0% fat yogurt chosen by my daughter (let’s not even get into my whole milk habit!). By cutting back on dairy fat, you may not only be cutting back on the deliciousness but focusing on one nutrient in the diet may be less beneficial overall. So now what do I tell my daughter when she reaches for the 0% yogurt? Back away, I am going for the 5% Fage*!
*pronounced “fa-yeh” yogurt
Circulation, Volume 133, Issue 17, April 2016
The American Journal of Clinical Nutrition, Volume 103, Issue 4, 1 April 2016
“Sally’s” mother called me in a panic. My young patient had misunderstood her Vitamin D instructions and had been taking her weeklyprescribed 50,000IU Vitamin D capsule instead daily for the last fifteen days. She was experiencing nausea, headaches and mild dizziness. My first thought was, “it is just a vitamin and she is young and healthy and should be fine”. However, to be sure, I contacted Poison Control. I am so glad I did.
My Poison Control representative informed me she needed an immediate Emergency Room evaluation for electrolytes and an ECG. The Baylor Scott and White Plano emergency room doctor quickly agreed to accept Sally for immediate evaluation.
Vitamin D hypervitaminosis (vitamin D toxicity)is a potentially serious condition. It may be more common than we think. More recently medical providers are recognizing that patients have Vitamin D deficiencies. For patient with exceptionally low levels, large doses of prescribed vitamin Dmay be necessary in order to help prevent bone loss, fatigue, and muscle weakness among other complications. , Because it is a natural vitamin, many people may feel it is a benign drug. But it is not.
Vitamin D toxicity can cause a buildup of calcium in the bloodstream which can lead to nausea, vomiting and weakness, such as my patient was experiencing. If the calcium levels become too high, a patient may experience dehydration from urinary frequency, along with bone pain, and (over time) kidney stones.
Elevated calcium may even lead to electrical changes of the heart resulting in abnormal heart rhythms . Thus, necessitating the need for an ECG (electrocardiogram) for my patient in the emergency room.
I was reassured after reviewing Sally’s labs and ECG on-line. The emergency room doctor released her to home. My recommendation is to place Sally’s vitamin D on hold until February, then to place her on a daily dose of over the counter Vitamin D supplement.
My patient learned that following both verbal and written prescribing instructions is very important. I was reminded that Vitamin D weekly prescribing should be clearly understood by the patient and that Poison Control is always a great resource for all medical providers and their patients. While vitamin D replacement has several advantages, too much of a good thing can be disastrous. Always check with your medical provider if you are taking beyond your prescribed dose of any medication, including vitamins.
*Sally is used in place of patient’s name in order to protect her privacy
Garfield, the cat wonders “Is there life before coffee?” in one of my favorite cartoons. Well, Garfield, there needs to be more time before coffee to achieve peak benefits of the coveted caffeine-loaded beverage.
According to researcher Stephen Miller PhD, the best time to drink coffee may be an hour after you awaken. It seems that fully-loaded (caffeinated) coffee interferes with our natural variation of blood cortisol levels.
According to researchers, drinking that first morning cup of Joe could cause the body to produce less morning cortisol. The problem is two-fold. Caffeine would therefore be less effective as a morning “wake-me-up” and could compromise the benefits of cortisol’s stressor effect for the body.
Our stress hormone, cortisol naturally peaks in the morning. Cortisol puts our body on alert to stressors and is responsible for the “fight or flight” reaction that causes our heart rate to increase and blood pressure to respond to physical and emotional stressors. for example, if we are ill or have an accident, cortisol helps our body recover by adjusting our blood sugar, pulse rate and activating our immune response.
Help your body be at its healthy-best! Take an hour in the morning to get up, get dressed and ready to go. THEN begin your morning cup of happiness. A change in habit could lead to a positive change in health.
The herpes virus could be a cause of at least 50% of Alzheimer’s Disease cases. According to a recent paper published in the Frontiers in Ageing Neuroscience journal, the same virus that causes cold sores could be linked to an increased risk of dementia.
The HSV1 (herpes simplex virus type 1) is very common and (unfortunately) remains permanently within the body. The virus can only be resolved by the body’s natural immune system or by anti-viral drugs (which can put its actions on hold).
There is evidence that in older individuals, the HSV1 may interfere with brain cell functioning and have harmful effects on cognition leading to dementia. An estimated 5.5 million American live with Alzheimer’s (2017). Approximately 5.3 million are age 65 and older and about 2000,000 individuals are under age 65. In a different perspective: One in 10 people ages 65 and older have Alzheimer’s dementia (10%).
There is good news. It is highly probable that the disease may be less likely if affected individuals with HSV1 were provided anti-viral treatment. Better yet, HSV1 could be prevented with early childhood (infant) vaccinations carried out in a subsequent series of future “booster” vaccinations.
Your doctor can perform a blood test to determine if you have HSV1. A topic worth discussing at your next checkup.
Following an uneventful respiratory infection, a child develops sudden loss of use of one or more limbs. Some children will have neck pain. In rare instances, difficulty swallowing, urinating, or breathing could be presenting signs and symptoms. An MRI scan demonstrates abnormalities along the spinal cord. Sometimes, nerve conduction studies (nerve response tests) or testing of the fluid around the spinal column is needed for diagnosis.
Since fall 2014, the Centers for Disease Control and Prevention (CDC) have reported almost 400 confirmed cases of AFM (acute flaccid myelitis) in the Unites States. Most of the cases involve children. We do not understand why some children develop the disease and others do not. This year, over 90% of cases have been in children less than 18 years of age. To date, no deaths from AFM have been reported.
What is most concerning is the accelerated numbers of cases in the past few years. Although less thanone in a million people in the United States are diagnosed with AFM each year.
AFM affects the spinal cord which results in weakness of the extremities. Affected patients may have difficulty with control of their arms and legs and require assistance with activities of daily living (eating, walking, weight-bearing, etc.). These children will usually experience respiratory infections prior to developing severe neurological symptoms. It is likely that a virus seen in common respiratory infections may be a cause (in other words, antibiotics can not prevent the infection). The virus shares many similarities the polio virus that was rampant in the 1950’s. Polio
There is evidence that enterovirus may be a contributing factor. A specific sub-type of the virus (EV-D68) seems to have commonality among many sufferers. In the past, other viruses such as adenoviruses (responsible for the common cold among others) and West Nile virus have been responsible.
How do you prevent it? Good hand washing to minimize germ exposure. Stay up to date on vaccines and maintain protection from mosquitos; especially with recent flooding in our state and increased chances of exposure to stagnant water filled with mosquito larvae.
If your child develops sudden weakness of the limbs, it is important they seek medical attention immediately. While approximately half of all cases will see full recovery within four months, many children are left with residual weakness.