Monthly Archives: January 2015

Viral Illness

INFLUENZA UPDATE

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Influenza is a respiratory illness caused by a virus.

In 1918 a deadly outbreak of influenza known as Spanish Flu occurred. The disease killed about 50 million people around the world. Recent research done on preserved lung tissue from people who died showed the lung damage seen with bacterial infections, not viral. Researchers concluded the Spanish Flu virus caused a severe respiratory illness, complicated by bacterial infection before effective antibiotics were available.

Seasonal flu remains a serious health problem carrying the greatest risk in older people and those with lung conditions such as asthma and chronic lung disease. Ninety percent of deaths occur in people over the age of sixty-five. A bacterial pneumonia is a common occurrence with influenza. The “pneumonia shot” only prevents one type of bacterial pneumonia, pneumococcal, and is recommended for adults 65 and older.

Today, each year in the US more than 36,000 people die and 200,000 are hospitalized with the flu. Anti-viral drugs are available and shorten symptomatic periods by a couple of days. Antibiotics reduce fatalities from complicated pneumonias that often follow influenza. Getting a “pneumonia shot” only prevents pneumococcal pneumonia.

Each year the flu vaccine is formulated to stimulate immunity to the influenza viruses most likely to be present in the upcoming season. The vaccine usually covers 3-4 different viruses. While the Centers of Disease Control and Prevention (CDC) researchers do their best to match the annual vaccine with the anticipated viruses, the vaccine may not prevent all influenza illnesses because the viruses mutate and change each year.

“The CDC notes that around 70% of this season’s H3N2 viruses have been identified as “drift variants” – viruses that possess antigenic or genetic changes that make them different from the virus included in this season’s flu vaccine, meaning the vaccine’s effectiveness is reduced.”

 “… the CDC estimates that the flu vaccine has reduced an individual’s risk of visiting a doctor due to flu by 23%. This result remained after accounting for patients’ age, sex, race/ethnicity, self-reported health and the number of days between illness onset and study enrollment.”

The best way to prevent the flu is to get your immunization every year. Once you have been immunized it takes about two weeks for the body to generate a response to prevent the disease.

“Despite the low effectiveness of the 2014-15 flu vaccine, the CDC continues to recommend that all people aged 6 months and older receive the vaccine, as it may still prevent infections from some circulating influenza A H3N2 viruses and reduce severe flu-related complications.”

What to do: To protect yourself from influenza, avoid people with respiratory illnesses, avoid hand shaking, use good hand washing technique and utilize alcohol hand purifiers. Early symptoms are typically muscle aching (myalgias), fever and worsening respiratory symptoms. Isolate yourself if you develop the symptoms. Antiviral drugs must be started within 48 hours of onset of symptoms to have benefit. Call you physician for advice if you are not improving or develop shortness of breath.

Best wishes for health and avoidance of influenza.

Betty Kuffel, MD

Heart Health, Women's Heart Disease

Broken Heart Syndrome

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Takotsubo Cardiomyopathy

Losing a loved one, the sudden stress of receiving bad news, intense fear or domestic violence can break your heart. But this isn’t in the emotional sense we usually think about. There is an acute heart problem seen primarily in women of menopausal age in which the heart weakens in the face of sudden stress. The main pumping chamber of the heart balloons instead of contracts. Resulting chest pain and shortness of breath are symptoms indistinguishable from a heart attack.

The electrocardiogram shows classic ST segment elevation found in heart attacks. In addition, there is often a small sharp rise in troponin, a heart injury blood marker. In a typical heart attack caused by a blocked coronary artery, the damaged heart muscle cells leak troponin, but usually in larger amounts.

If an angiogram determines there is a blocked artery the cardiologist will likely place a stent. But in the broken heart syndrome known as Takotsubo Cardiomyopathy, instead of finding blockage, the coronary arteries are clear — the results indicate a failing heart with an odd shape. It looks like an octopus trap (a tako-tsubo).

 

The actual cause of this disorder is not known but is likely related to a surge of stress hormones that stun the heart and prevent normal muscle contraction. Takotsubo is usually seen in older estrogen-deficient menopausal women. However, younger women who lack estrogen because of surgical menopause from ovary removal are also at risk. Animal studies show estrogen appears to protect the heart in stress states.

There are no treatments shown to reverse Takotsubo. Doctors usually order common heart failure medications including beta blockers (to reduce heart rate and blood pressure), ACE inhibitors (to dilate arteries making it easier for the heart to pump) and diuretics (to remove excess fluid). It isn’t known if continuing the drugs can prevent a recurrence, but within two months, most patients fully recover. A few women are left with reduced heart function, and occasionally abnormal heart rhythms occur.

Women in this age group may also have underlying heart disease requiring medical management unrelated to the sudden stress state. Like men, women develop blockage of the major coronary arteries.

Another heart problem most often seen in women involves only small heart arteries. The large coronary arteries are clear but tiny arteriolar vessels are diseased. Microvascular disease is serious. It can lead to heart attacks and heart failure. A treadmill in combination with continuous monitoring, followed by echocardiogram to check heart function will show abnormalities. Microvascular disease is also treated medically.

Techniques used to help reduce stress hormone surges include: progressive muscle relaxation, exercise, yoga, avoiding alcohol and caffeine. Controlling anxiety is not easy and counseling may be necessary.

 

Lipstick Logic
Betty Kuffel, MD

Exercise, Healthy Eating, Heart Health, Lifestyle

Healthy Lifestyle – 2015

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MAKING CHANGES IN THE NEW YEAR

Lifestyle means different things to different people. In the past, a healthy lifestyle for hardworking farmers meant getting up before dawn to first milk cows before spending a long day of heavy labor in the fields. A breakfast of fried pork chops and eggs accompanied by homemade bread slathered with butter commonly provided the first meal of the day. A hard working man needed those heavy calories for energy to perform his daily job.

Scan old photos and it’s unlikely you’ll find a fat farmer. They ate food laden with fat and calories but they worked it off. They earned their calories. My grandfather was a farmer. I saw what he ate. My family enjoyed amazing meals, especially during threshing when friends helped friends and families helped families. Eating well was their way of life. For most of us it’s the same today—except now, many people don’t earn their calories.

The body is an efficient metabolic machine. When you eat more calories than you burn your body stores the excess as fat. So lifestyle today is different from the lifestyle of the past, and practices of the past are unhealthy today.

Exercise is the single most important activity that correlates with a long and healthy life. A close second are: your food choices and the volume of food you eat. We need to eat to live, not live to eat.

A new twenty year-long study of 70,000 women confirmed a healthy lifestyle could prevent 75% of heart attacks in young women. Death rates from heart disease in the US have slowly dropped over the past four decades, but in women ages 35-44, this is not true. The study published in the American College of Cardiology reported health habits make the difference. Women with unhealthy lifestyle choices began showing increased heart risks by age 47.

Below are seven top ways to improve your lifestyle and reduce risks for heart disease:

• Don’t smoke
• Consume a maximum of one alcoholic drink/day
• Maintain a normal body mass index (BMI)
• Watch seven or fewer hours of TV per week
• Exercise at least 2.5 hours per week (35 minutes per day)
• Eat a quality diet based on Harvard’s School of Public Health healthy eating plate.
• Have an annual physical that includes a lipid panel

Smoking: Quit. Ask your doctor for assistance if you can’t do it on your own.
Alcohol: Wine: 5 ounces, Liquor: 1.5 ounces, Beer: 12 ounces
Plate and portions: Healthy Eating
BMI: At the link below you’ll find health information and a BMI calculator to check your current BMI. For the calculation you need to know your weight in pounds and height.
http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

Make 2015 a healthy year for you and your family. Monitor your blood pressure, address your weight, add exercise every day and encourage others to do the same.

Betty Kuffel, MD and Bev Erickson

Lipstick Logic (TM)