The Virginia Beach Premier Medical Newsletter

September, 2013

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Shingles

When we are exposed to chicken pox as children, our bodies create antibodies to attack and destroy the virus. The illness then resolves. However, one or more of the live viruses can hide in one of the nerve ganglions in the spine. After many years, the number of antibodies in the blood stream that are active against this virus will begin to decrease. When the antibody levels decrease to a certain level, then the virus that has been hiding in the nerve begins to multiply. It spreads along the nerve and causes inflammation wherever that particular nerve travels to. It can occur anywhere from the scalp to the feet, but usually occurs in the flank. It is almost always one-sided unless the person has a severe immune deficiency, in which case, it could spread to both sides. This is very rare, however.

The typical presentation is a person in their 60's or later, although it can sometimes occur in younger people. It often begins with a burning, stinging pain on one side of the body. The pain may be quite severe but not always. Then 1-4 days later, a localized rash develops in the area of the pain. The rash contains very small blisters that look just like chicken pox. They occur in clusters with a red base surrounding them. The rash almost never crosses the midline of the body and follows the course of the nerve. The little vesicles may open and drain, but then they usually dry up and begin to fade after 2 weeks and are gone after 4 weeks, leaving a small scar. Sometimes the rash never actually occurs, but the pain is very characteristic and often leaves a sensation of hypersensitive skin and/or numbness or pins-and-needles in the area.

It is important to recognize the diagnosis and treat it within the first 72 hours. If treatment can be started within that time frame, it will reduce the severity and duration of the pain that will occur afterwards. The most debilitating problem with shingles is the pain that can last for months or years after the rash is gone.

Medications that can be used to treat the acute case of shingles includes an antiviral prescription for 7 days, also gabapentin, which can help with the nerve pain and sometimes a short course of Prednisone to reduce inflammation. Strong pain medication may be required in some cases because the discomfort can be quite severe and debilitating.

The best way to treat shingles is to prevent it. Fortunately, there is a vaccine called Zostavax that can be given by your local pharmacist. We usually give this routinely to people in the age range of 50-60, and it lasts forever after that. You should get the vaccine even if you've already had shingles to prevent its recurrence. You should also get it even if you don't remember ever having had chicken pox as a child, because you probably were exposed to it and may have had a subclinical case of it and didn't know it.

The vesicles (blisters) do contain viruses, so the rash can be contagious to those who don't have any immunity to it. You should keep the area covered and use frequent hand-washing to prevent it from spreading to others. It won't spread to other areas of your own body; it will only stay within the area of the particular nerve root where it started.

Hazards of Antibiotics

However, there is now great concern that antibiotics have been used so much that the bacteria that we are trying to treat are becoming increasingly resistant to them. This is giving rise to strains of virulent, life-threatening organisms for which there is no treatment. The bacteria are producing these resistant strains faster than what medical science can keep up with. Some are even speculating that in the not so distant future, the usefulness and effectiveness of antibiotics will dwindle to the point where they will no longer be helpful in fighting infection. This will effectively revert medicine back to where it was 70 years ago with no treatment for pneumonia, urinary infections, meningitis, even the bubonic plague, to mention only a few.

The answer to this problem, many say, is to stop overusing antibiotics indiscriminately for minor illnesses that are likely caused by viruses for which antibiotics won’t work anyway. The Center for Disease Control estimates that at least one-half of all antibiotic use is unnecessary.

Other hazards of antibiotics include the risk of allergic reactions, which in rare cases, can be deadly. They can cause severe intestinal infections by changing the normal bacteria that occupy our intestinal tracts, and often contribute to yeast infections of the mouth, esophagus, urine, skin, vagina and other areas. Many antibiotics can cause liver or kidney dysfunction, severe arthritic reactions, serious hematologic disorders and even severe heart arrhythmias.

So when you call the doctor for an antibiotic, you may want to consider these things and ask whether he or she thinks you really need one. You may be trading a minor, benign, self-limited ailment for a major, life-threatening illness induced by an antibiotic. Or you may be fostering a future epidemic of infection for which there will be no treatment.

Diet Study

The Virginia Beach Diet Study, as it is called, is a collaboration between Cardiovascular Associates, LTD and the University of Virginia. The plan is to enroll 400 subjects for a 60 day period in one of four diets – Vegetarian, Mediterranean, Paleolithic and DASH.

There will be extensive blood work at the start of the diet and again at the end and then 6 months later, all at no charge. Dr. Deepak Talreja, one of the Cardiologists at Cardiovascular Associates, is spearheading the study and is actively enrolling anyone who is interested now. If you would like to participate, please call 757-395-8577.

Sciatica

Treatment of this condition is usually conservative (nonsurgical), with pain medications, steroids, anti-inflammatory agents, local heat and physical therapy. When these things fail, we usually will try an epidural steroid injection performed by a pain management specialist or interventional radiologist.

Surgery is the last resort and is usually reserved for those with prolonged incapacitating pain or significant numbness or weakness of one or both legs.

A recent study published in the New England Journal of Medicine showed that early surgery for sciatica did not prevent or control pain or disability any better than the group that had no surgery after one year.

Obstructive Sleep Apnea

Screening for this condition is fairly easy. It involves wearing an oxygen-measuring device on the finger at night, which can be done at home. If this shows that the oxygen level drops sporadically and frequently during the night, the a full sleep study should be done by a qualified sleep disorder specialist - usually a pulmonologist.

The disorder is serious because it can lead to hypertension (high blood pressure), lung disease, memory impairment, cardiac rhythm disorders and heart failure.

It can often be treated by asking your dentist to make a special dental device that can be worn at night to push the jaw forward and open up the pharyngeal area (the airway). Treatment may require sleeping with a device called CPAP (Continuous Positive Airway Pressure) that uses air pressure to keep the airway open. This requires a tight-fitting mask that is sometime hard to get used to, but if tolerated well, can make a world of difference in energy levels during the day, not to mention prevention of heart and lung disease as well.

Of course, if the patient has a problem with obesity, the best treatment is to lose weight. This works extremely well in most cases.

In some patients where the condition is severe and refractory to other treatments, the use of surgery to remove part of the soft palate is considered; and in cases that are potentially life threatening, a tracheotomy (an opening in the windpipe and insertion of a tube used for breathing) has to be performed.

If you have symptoms of excessive daytime sleepiness and your spouse frequently complains about your snoring, talk to your doctor about the possibility of testing for sleep apnea.

Pearls from the Journals?

~In Type 2 diabetics, when a fibrate is added to a statin to help reduce triglycerides, no benefit was found in reducing new coronary events or mortality rates over just using a statin alone.

~Stress testing in asymptomatic diabetic patients did not predict the future development of coronary heart disease. In other words, if you are a diabetic with no symptoms of heart disease (ie, chest pain, etc.), doing a stress test to find out if you are going to develop heart disease in the future is not helpful.

~In patients with resistant hypertension, the addition of spironolactone to the medicine regimen was effective in controlling the blood pressure in 50% of those patients.

~Fasting before testing blood for cholesterol is not absolutely necessary any longer. It has been determined that if a person is nonfasting and their LDL is no more than 10% over goal ( 100-110 range), or their triglycerides are no more than 20% over normal (150-180 range), then they are determined to be at goal and no further treatment is necessary.

~Vitamin B12 1000mcg/day taken orally prevents canker sores by about 50-75%.

~Sinusitis resolves in 2 weeks in 70% of cases without antibiotics. The use of antibiotics in these cases helps only about 15% of the time in reducing symptoms. Furthermore antibiotics do not reduce the complications of sinusitis or progression to chronic sinusitis at all. Therefore, antibiotics are not generally recommended for routine uncomplicated sinusitis unless there is fever, facial pain, purulent nasal drainage, or persistent symptoms for more than 10 days.

~The risk of being involved in a motor vehicle accident while speaking on a cell phone is about the same as having an alcohol level of 0.08 (twice the legal limit).

~Iron replacement therapy improves fatigue symptoms in premenopausal women, even when they are not anemic.

~Elderberry syrup – 15ml (one tbsp) four times a day relieves symptoms of the flu four days earlier than placebo. It works as well or better than the prescription antiviral medications (like Tamiflu).

~Zinc gluconate 10-24mg every four hours during an episode of the common cold will reduce the severity of the symptoms and reduce the length of the cold by 24 hours. Furthermore, zinc sulfate has been found to reduce the frequency of developing upper respiratory infections like the common cold by taking 10mg daily 6 days/week for 5 months, or zinc sulfate syrup 15mg daily for 7 months.

Perfume, Pets and Allergies

So, when coming into the office, in order to protect our patients and office staff, please refrain from wearing perfumes and bringing in pets. We will be forever grateful.

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