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2013

Medical Handbook


Contents Osteoporosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Celiac disease . . . . . . . . . . . . . . . . . . . . . . . . . 26

Heart attack. . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Hearing disorders. . . . . . . . . . . . . . . . . . . . . . . 28

First aid kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Probiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Medication errors. . . . . . . . . . . . . . . . . . . . . . . 32

Cancer genetic counseling . . . . . . . . . . . . . . . 10

Quitting tobacco. . . . . . . . . . . . . . . . . . . . . . . . 34

Outdated medications. . . . . . . . . . . . . . . . . . . 12

Over-the-counter pain relievers. . . . . . . . . . . . 36

Leg vein treatment. . . . . . . . . . . . . . . . . . . . . . 14

Persistent coughing. . . . . . . . . . . . . . . . . . . . . 40

Healthy joints. . . . . . . . . . . . . . . . . . . . . . . . . . 16 Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Macular degeneration. . . . . . . . . . . . . . . . . . . 22 High blood pressure. . . . . . . . . . . . . . . . . . . . . 24

Š2013 by Home News Enterprises All rights reserved. Reproduction of stories, photographs and advertisements without permission is prohibited. Stock images provided by Š Thinkstock. Comments should be sent to Doug Showalter, The Republic, 333 Second St., Columbus, IN 47201 or call 812-379-5625 or dshowalter@therepublic.com. Advertising information: Call 812-379-5652.

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812/342-2100 | 866/281-9202 | www.vascularpartners.com 2013 MEDICAL HANDBOOK

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2013 MEDICAL HANDBOOK


A Stronger You.

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By Margie Campbell

Osteoporosis affects 10 million Americans, with an additional 20 million more at risk for the problem. It is characterized by low bone mass and a loss of bone tissue, resulting in weak and fragile bones. Although many believe it is a problem only in elderly women, half of osteoporosis-related fractures occur in women starting at age 50. Men also are at risk for osteoporosis, although the numbers for occurrence are significantly less. Our bones are a complex structure made up primarily of the minerals calcium and phosphate, and a protein called collagen. Bones can become brittle and susceptible to fracture if there is an insufficient combination of these minerals. While the leading cause of osteoporosis in women is a lack of the hormone estrogen, vices such as alcohol, caffeine and cigarette smoking also are risk factors. Menopause brings lower levels of estrogen that lead to a decrease in the amount of collagen in bone and a decrease in bone density. Unfortunately, the loss of bone density occurs over an extended period of years and is often not recognized until a fracture has resulted. The disease is fairly advanced at that time and is not immediately correctable. Besides dietary and postmenopausal contributions, medications such as steroids and anticonvulsants also are risk factors for osteoporosis. So what can you do now? Hope begins with exercise. It has been demonstrated that women who stay fit suffer less from a decrease in bone mass and density. Furthermore, the negative effects of being a couch potato are accelerated as you age. Physical activity benefits women immediately, regardless of the age you begin. In a manner similar to the way in which muscles increase in strength with exercise, bones become denser. Bones adapt to increased stresses by becoming stronger and thicker. Increased new stress (or exercise) leads to the production of new bone. Exercise is also believed to positively influence the hormonal control of bone remodeling as well. Two types of exercises are most beneficial for improving bone density — weight-bearing exercises and resistance exercises. Weight-bearing exercises rely on your ability to work against gravity. Studies have demonstrated that your body will increase bone production when your bones are supporting your weight during exercise. In particular, fast walking, stair climbing, running and hiking support your weight and will increase the strength of your bones. Although biking and swimming are excellent for cardiovascular health, they are not weight-bearing exercises and do not increase bone density. Resistance exercises involving weight lifting also require muscles and bones to increase mass and result in improved bone density. Are you already suffering from osteoporosis? It is im-

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Healthy bones result from focus on fitness

portant to consult with your family doctor regarding bone density testing before beginning an exercise program. Bone density testing is a painless procedure performed by your family doctor that is readily available and is usually covered by insurance. Remember, exercise is something that not only makes your mind and heart feel good, but your bones will benefit greatly, too. — Margie Campbell is a clinical nurse specialist with Columbus Regional Health.


Primary Care for adults

Always Welcoming New Patients

Donnamarie Darcy , M.D.

Allison Feider, NP

Christopher Iorio, M.D.

Indus S. Menon, MD

Joseph Sheehy, MD

Dennis E. Stone, MD

Alan J. Watanabe, MD

812-376-9427 • 3015 Tenth Street, Columbus, Indiana 47201 2013 MEDICAL HANDBOOK

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Heart attack What is a heart attack?

The human heart is a muscle that pumps blood. Blood containing food and oxygen to meet the heart’s own needs comes from the coronary arteries. Fatty deposits, called plaque, made of cholesterol and other substances can build up in the walls of these vessels, a condition called atherosclerosis. Over time such deposits narrow the arteries and reduce or stop blood flow to the heart. This may cause chest pain called angina pectoris. When less blood flows to the heart, the heart muscle may be damaged. If a blood clot forms in a narrowed artery and completely blocks the blood flow, part of the heart may die. Doctors call this a heart attack or a coronary thrombosis, coronary occlusion or myocardial infarction. When a heart attack occurs, the dying part of the heart may trigger electrical activity that cause ventricular fibrillation. This is an uncoordinated twitching of the ventricles that replaces the smooth, measured contractions that pump blood to the body’s organs. Many times if trained medical professionals are immediately available, they can use electrical shock to start the heart beating again. If the heart can be kept beating, and the heart muscle isn’t too damaged, small blood vessels may gradually reroute blood around blocked arteries. This is how the heart compensates; it’s called collateral circulation. The key to surviving a heart attack is to recognize the warning signals, listed below, and get immediate medical attention. — American Heart Association

Blood flows to the heart Blood supply is blocked in coronary artery Heart area is damaged

ABCs of a heart attack

l Angina (chest pain) — back pain or deep aching and throbbing in the left or right bicep or forearm. l Breathlessness — or waking up having difficulty catching one’s breath. l Clammy perspiration. l Dizziness —Unexplained lightheadedness, even blackouts. l Edema — swelling, particularly of the ankles and/or lower legs. l Fluttering (or rapid) heartbeats. l Gastric upset (or nausea). l Heavy fullness — or pressure-like chest pain, radiating to left arm or shoulder.

Take action

If you experience heart attack symptoms, don’t delay. l Call 911. l Sit or lie down. l Chew, crush or swallow an aspirin followed by a drink of water, if possible. Taking aspirin immediately at the onset of heart attack symptoms may prevent the formation of additional small blood clots blocking blood flow through clogged arteries. If that happens, heart muscle damage may be prevented or delayed, buying time to get to the hospital.

Hearts can heal

A heart attack is like a quick blow to the heart. The heart can be “stunned” by the lack of blood and oxygen. But when the blocked artery can be opened quickly, the damaged muscle gains back more of its normal function. Soon after a heart attack, small arteries near the damaged area begin to expand. They bring in blood to the area around the blocked artery. This may help limit the amount of damage. Within a few weeks or months, damaged heart cells are replaced by scar tissue as the heart heals.

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The basics in a first aid kit If you’ve ever had to turn the bathroom cabinet upside down to find a BandAid when you need it, get organized. Make a first aid kit and keep it handy. Include these items and others you know you will use: l Gauze in pads or a roll. l Adhesive tape. l Cold pack. l Disposable gloves. l Band-Aids in assorted sizes. l Hand cleaner. l Small flashlight with working batteries. l Alcohol. l Scissors. l Tweezers. l Triangular bandage. l Syrup of ipecac. l Antiseptic ointment. — American Red Cross

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People with diabetes must keep an eye on their feet By Dr. John Hladik

For people with diabetes, foot care is important in the prevention of ulcers. Diabetic foot ulcers are sores on the feet that occur in people who have diabetes, a condition where blood sugars are unusually high. About 15 percent of people with diabetes will develop diabetic foot ulcers. Foot complications are one of the most common diabetes-related causes of hospitalization. They can go untreated for a long time because people with diabetes often have nerve damage that causes them to lose feeling in their feet, making them unaware of a wound. This condition, called peripheral neuropathy, may prevent the person from noticing injuries, such as: • Sores caused by repetitive minor trauma (long walks). • Wounds caused by a single major trauma (scraping a foot, stepping on rocks, putting feet in hot water, cutting toenails incorrectly or wearing improperly fitting shoes). • Foot problems such as calluses and hammertoes. If left untreated, these injuries can turn into diabetic foot ulcers. Also, people with diabetes may have poor blood flow to their feet, slowing the healing process and increasing risk of infection and amputations. If you have diabetes, you are at risk of developing diabetic foot ulcers if: • Your blood sugars are too high. • You have nerve damage that causes loss of feeling in your feet. • You experience changes in the shape of your feet. With proper care, these serious problems can be prevented. You can start by: • Watching your blood sugars. • Attending all of your doctors’ appointments. • Examining your feet every day. • Keeping the weight off your foot and contacting your physician if you have foot sores. You can play an active role in preventing diabetic foot ulcers by talking to your health care providers. Ask your doctor: • Can you inspect my feet? • Am I at risk for developing diabetic foot ulcers? • What can I do to prevent diabetic foot ulcers?

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• How can I make sure my sores are healing? • Do I need a prescription medication? • What kind of exercise should I be doing? Diabetic foot ulcers are commonly associated with other medical problems. Tell your doctor if you have a problem that you think may affect your wound treatment. The physicians and staff at the Wound Center at Columbus Regional Health offer the most advanced options, including hyperbaric oxygen therapy, in treatment of diabetic foot ulcers and other wound types. If you have a wound that has not healed in four weeks, call 376-5373, to schedule an appointment or inquire about our services. — John Hladik is a podiatrist at the Wound Center at Columbus Regional Health.


Watch Melissa’s story or tell us what your scar means at MyScarMeans.com. #MyScarMeans

Melissa Burns,

OrthoIndy and IOH patient

2013 MEDICAL HANDBOOK

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Could cancer genetic counseling be right for you? If you are not quite sure what cancer genetic counseling is, you are definitely not alone. But there are several reasons why more people are recommended for counseling. Everyone has some chance of developing cancer. Although the majority of cancers occur sporadically, some families may carry mutated genes that increase the risk of developing certain types of cancer, including breast, ovarian, colorectal and uterine cancer. These genetic changes can be passed from generation to generation. Genetic counseling can help people at risk for a hereditary cancer condition make informed medical decisions. For example, a woman whose mother and sister both had breast cancer may want to know more about her risk and what her options may be in terms of increased breast imaging and/or preventive strategies. “The genetic counseling process is complex,” said Morgan Dally, board-certified genetic counselor with the Franciscan St. Francis Health Cancer Center. “My goal is to help families with a hereditary condition take measures to detect cancer at an earlier, more treatable stage, or prevent cancer from occurring.”

Who can benefit? If you answer yes to any of the following questions,

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talk to your doctor about a referral to a genetic counselor. • Have you or a close relative been diagnosed with cancer at an early age, such as breast or colon cancer diagnosed before age 50? • Do you have more than one blood relative with the same type of cancer? Is the same type of cancer found in more than one generation? • Has anyone in your family been diagnosed with bilateral (both sides) cancer of the breasts, ovaries or kidneys? • Has anyone in your family had more than one type of cancer? Genetic counseling provides an opportunity to discuss what it means to have an increased risk of developing cancer, options that may be available to reduce cancer risks and resources that may be helpful to you. Options might include genetic testing and/or increased screening, such as mammograms or colonoscopies beginning at an earlier age. Genetic counseling is typically covered by most health insurance companies. Check with your insurance provider for details. To schedule a genetic counseling appointment, or for more information about the hereditary cancer program at Franciscan St. Francis Health Cancer Center, call 317528-1420.


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2013 MEDICAL HANDBOOK

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Ditch those old medications By Doug Worgul

If you’d never open your refrigerator and pop the top on the milk jug — two weeks past its expiration date — and chug it down, then why would you open your medicine cabinet and pop a pill that’s two months — worse yet, two years — past its expiration date? Mary Ross, pharmacy supervisor at the University of Iowa Hospitals and Clinics, poses that not-so-rhetorical question to make a point: People tend to take the expiration dates on their food products much more seriously than expiration dates on their prescription and over-thecounter drugs. “But, over time, the chemical makeup and potency of medications changes,” Ross said. “Taking outdated medications may also mean you are taking a pill that is not going to help you. Many medications become ineffective past their expiration date. Heat, cold and moisture can also affect a medication’s potency.” Ross says this is why it’s important to check the contents of your medicine cabinet regularly. Janet Engle agrees. Engle is clinical professor of pharmacy practice at the University of Illinois at Chicago’s College of Pharmacy. “It’s important for people to realize that ignoring the expiration and labeling information on their medications or improperly storing medications may pose potentially

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Remember the Three R’s REVIEW the contents of your medicine cabinet at least once a year. REMOVE expired prescription and over-the-counter drugs. RESTOCK with new medicines. harmful risks to their health,” she said. “It is important to give your medicine cabinet an annual makeover and to make sure your medicines are stored properly and have not expired.” The American Pharmacists Association, or APhA, recommends that consumers avoid keeping certain medications in bathroom or kitchen cabinets. APhA also states that medications should always be stored according to package directions and should be kept in their original packaging. By keeping medications in their original packaging, consumers always have easy access to full dosing instructions, drug interactions, storage instructions and expiration information. — Wire Reports


2013 MEDICAL HANDBOOK

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Leg vein treatment has become painless By Donna Lecher

According to the “Handbook of Venous Disorders,” one out of three Americans over age 45 has some kind of vein disease. A leading cause of this medical condition is venous reflux disease, caused by incompetent or “leaky” valves in the greater saphenous vein running down the leg from groin to ankle. Dr. Douglas Roese, who heads Southern Indiana Surgery’s Vein Clinic, specializes in vein disorders. “Most people don’t realize there is a virtually painless, minimally invasive answer to living with unsightly, ropy veins,” Roese said. Many patients are surprised to learn there is an alternative to intensive vein stripping surgery, which can be quite painful. They aren’t even aware that vein disorders can be addressed in an outpatient office procedure that takes just a few minutes, is virtually painless and doesn’t leave scars. This procedure uses the latest generation of catheters to close off the diseased vein from the inside instead of having to strip it out. “All veins have one-way valves that keep blood from flowing backward,” Roese explained. “When these valves fail, blood pools in the legs and causes varicose veins. With advances in radio frequency technology, we can now seal the vein with a microscopic incision instead of stripping the bad vein out.” Once the vein is sealed, the body automatically reroutes blood flow through healthy veins to restore normal circulation, and the symptoms of the varicose veins quickly dissipate.

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“The procedure is essentially painless,” Roese said. “The whole process takes about 45 minutes, including the local anesthetic. Actual treatment time is two to three minutes. So far, we’ve had a great success rate.” As the summer season quickly approaches, patients can have their legs looking their best in just days. People who undergo the procedure can become active again within 48 hours and can resume normal exercise within a week. “It’s a beautiful thing,” Roese said. “I know how painful the old vein-stripping procedures could be. This procedure gets the same results but eliminates that pain.” — Donna Lecher is a nurse practitioner with Southern Indiana Surgery.


Quality surgical care. Close to home.

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2013 MEDICAL HANDBOOK

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How to keep your joints healthy for life Even youngish joints can feel creaky and painful without proper care. Luckily, lifestyle changes can help you stay active longer. “With an average life expectancy of more than 70 years, it’s more important than ever for us to protect our bodies,” says Dr. Kevin Bonner, an orthopedic surgeon who practices at Sentara Leigh Hospital in Norfolk, Va. Some tips:

Because neighbors care more.

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Our Hospice of South Central Indiana 2626 E. 17th Street • Columbus, IN 47201 812.314.8000 • 1.800.841.4938 ext.8000 www.ourhospice.org 16

2013 MEDICAL HANDBOOK


 Stay fit. Strong muscles help keep joints stable and decrease stress on cartilage, or connective tissue. Vary workouts to include both cardiovascular and strengthtraining.  Maintain a healthy weight. Every extra pound puts six to seven times that amount of pressure on your knees. That can destroy cartilage and result in painful boneon-bone contact.  Focus on posture. Slouching while sitting or standing leads to uneven weight distribution that can strain ligaments and muscles, according to the Mayo Clinic.  Avoid damaging activities. People at high risk for arthritis may want to limit high-impact exercises (moves where both feet leave the ground at once). Former athletes who have suffered knee ligament tears, for example, may benefit more from low-impact workouts such as swimming

and biking. If you’re experiencing knee pain, also avoid deep squats and lunges.  Don’t overdo exercise. Never increase workout lengths by more than 10 percent per week. If you run 10 miles one week, don’t try to do 20 the next — make it 11.  Learn proper form. Consult a coach or trainer at least once, particularly with activities requiring repetitive motions such as tennis, golf and weightlifting.  Don’t skip your warm-up. Tight muscles around a joint increase injury risk. Stretch after workouts, too.  Seek treatment. Don’t wait too long to consult a doctor about chronic joint pain or declining range of motion. You may suffer irreversible damage.

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2013 MEDICAL HANDBOOK

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Gout symptoms can be treated with diet and anti-inflammatory drugs By Jeff Tryon

If you wake you up in the middle of the night with the painful sensation that your big toe is on fire while being stabbed with a million tiny white-hot needles, congratulations. You may have gout, “the disease of kings.” You’re probably not going to be celebrating, though, because gout is extremely painful, coming in sudden, severe attacks with redness and tenderness in joints, often the joint at the base of the big toe. Once known as the disease of kings, gout was traditionally associated with the rich foods and abundant alcohol available to the ruling class — Henry the VIII was a gout sufferer, as were Benjamin Franklin, Sir Isaac Newton and Leonardo da Vinci. However, scientists now understand that gout, actually a complex form of arthritis, happens because the bodily waste product uric acid accumulates in the soft tissues around the joints in the form of needle-like crystals, according to the National Institutes of Health. Although normally eliminated by the kidneys, uric acid can overload the system when people eat, not so

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much rich foods, as those high in purines, a list that includes organ meats, game meats, dried beans and peas, asparagus, mushrooms, herring, mackerel, sardines and scallops. But the part about drinking too much alcohol is correct; unlike water, which helps flush uric acid from the body, alcohol interferes with its elimination. The inflammatory arthritis caused by the uric acid crystals leads to intermittent swelling, redness, heat, pain and stiffness in the joints. The crystals can also build up in the kidneys, causing kidney stones. About half of gout sufferers feel the first effects in the metatarsal-phalangeal joint — the big toe. But other joints and surrounding areas can be involved, including the insteps, ankles, heels, knees, wrists, fingers and elbows. The pain of gout usually begins during the night because of lower body temperature. The acute attack will probably be most painful in the 12 to 24 hours after it starts. After the initial pain decreases, joint discomfort may last a few days or a few


weeks. Further attacks may last longer and affect more joints. Gout can affect anyone, but men are more likely to get it, especially between the ages of 40 and 50. Women become more at risk for gout after menopause. The NIH estimates that 6 million adults report having had gout at some time in their lives. It is estimated that 15 million to 20 million Americans have elevated levels of uric acid, known as hyperuricemia, but do not yet have symptoms of gout. Most people who have gout are able to control the painful attacks with medicine and reduce the risk that gout will recur through lifestyle adjustments. Treatment reduces the discomfort of symptoms and decreases long-term damage to joints. Typically, a rheumatologist will use nonsteroidal antiinflammatory drugs or corticosteroids, which may be injected into the affected joint or taken orally. Although these drugs reduce the inflammation caused by the uric acid deposits, they do not affect the amount of uric acid in the body. The American Dietetic Association recommends that during a gout attack, sufferers drink 8 to 16 cups of fluid each day, with at least half being water; avoid alcohol; eat protein moderately, preferably from healthy sources such as low-fat or fat-free dairy, tofu, eggs and nut butters; and limit daily intake of meat, fish and poultry to 4 to 6 ounces. A strategy for avoiding flare-ups of gout could include regular exercise and maintaining a healthy weight. But if you need to lose weight, avoid low-carbohydrate diets, which send the body into ketosis and can increase the blood level of uric acid. Gout sufferers should limit the intake of alcohol and high-purine foods, which increase levels of uric acid. However, some risk factors for gout, such as genetic predisposition or thyroid problems, are less easily controlled, and chronic conditions such as diabetes, high cholesterol, arteriosclerosis, renal failure and high blood pressure may also increase your risk of getting gout. New research suggests that, just as certain foods promote gout, certain foods may also help prevent it. One scientific study showed that a high intake of lowfat dairy products reduced the risk of gout in men by half. The reason is not yet clear. Another suggests that vitamin C may be beneficial in the prevention and management of gout, and some studies suggest that drinking coffee, but not tea, is associated with a lower risk of gout. Symptoms that may suggest you have gout include attacks of arthritis in only one joint, often the toe, ankle or knee; more than one attack of acute arthritis; or arthritis that develops in a day, producing a swollen, red and warm joint. Sudden, intense joint pain with swollen, tender and inflamed joints that subsides in a couple of days with some lingering discomfort may be an attack of “the kings’ disease.” 2013 MEDICAL HANDBOOK

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Dr. Sorin Pusca, Cardiovascular Surgeon

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BY PARTNERING WITH IU HEALTH CARDIOVASCULAR, WE PROVIDE YOU WITH NATIONALLY RANKED HEART CARE. At Columbus Regional Health’s Heart & Vascular Center, we work with Indiana’s only program nationally ranked for heart surgery by U.S. News & World Report. We’re proud to have Dr. Sorin Pusca, a specialist in cardiovascular and thoracic surgery, on our full-time staff. Our team includes specialists from Indiana Heart Physicians – Columbus to provide comprehensive and personalized heart care seven days a week, 365 days a year.

For a top heart care program, the best source is right in Columbus.

See how we’re thinking beyond at Columbus Regional Health’s Heart & Vascular Center at crh.org/heart 2013 MEDICAL HANDBOOK

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Healthy lifestyle can help slow macular degeneration By Jeff Tryon

Most people understand that losing weight, quitting smoking and lowering cholesterol through better diet and exercise can all bring tangible health benefits. One such benefit can be retaining your vision longer and thus your ability to do things like read and drive. That’s because good health can delay the onset of a vision disorder called macular degeneration. The macula is the smallest but most sensitive part of the retina, which is located at the back of the eye. It contains light-sensing cells that provide sharp, detailed central vision. The macula accounts for about 90 percent of our vision. If it is damaged, fine points of our vision are not clear. The macula is made up of the retinal cones, which you may recall from health class when you were taught about the “rods and cones” in the back of your eye. The rods are mainly in the periphery of cells in the back of the eye and only perceive light and dark; they

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give us our night vision and peripheral vision. The cones give us everything else: clarity of vision, color vision and the ability to read and drive. Columbus ophthalmologist Dr. Max A. Henry said that macular degeneration is just the aging and deterioration of that retinal tissue. “The older you get the more you’re going to get it, and everybody is going to get it at some point in their life,” Henry said. “It usually occurs in people 60 and above. But it could happen earlier depending on the patient’s quality of life and health and the medications they’re on. “There are several different things that can all contribute to it: smoking, poor health, poor circulation, diabetes, high blood pressure or other related medical problems.” People who smoke tobacco have two to three times the risk of suffering from macular degeneration as someone who has never smoked, making it the most modifiable factor in preventing the disease.


“Usually it’s just an aging issue,” Henry said. “It’s actually called age-related macular degeneration. Until the 1980s, it was called senile macular degeneration.” There are two types of macular degeneration, “wet” and “dry.” The “wet” in wet macular degeneration is blood; it occurs when a blood vessel within the macular area bursts and you suddenly lose all your vision because the blood blocks out all the retinal tissue. Only about 10 percent of patients suffering from macular degeneration have the wet type. The “dry” type of macular degeneration is just the slow deterioration, the dying of the tissue. Henry said age-related macular degeneration starts with small deposits called drusen, which develop in the macula. “Drusen is a collection of toxic material from the cells which they are not able to get flushed away because of the aging process,” he said. “Slowly, that toxic material builds up and builds up until it kills other cells, and so it kind of spreads.” Most people with these early changes still have good vision. Macular degeneration is not painful, so it may go unnoticed for some time. Treatment options for macular degeneration include vitamin supplements, eye drops, laser treatments and inter-ocular injections. “They’ve been using the laser for macular degeneration for 20 years,” Henry said. “The inter-vitreal injection of medications has been around for about five years. That’s the most recent development. “There’s also surgery. We can go in there and do some surgeries, depending on what type of macular degeneration is occurring.” Henry said lifestyle changes will slow down the onset and the progression of macular degeneration and sometimes help to reverse it, depending on exactly what the condition is. Macular degeneration patients don’t usually experience total loss of vision. The macula makes up only about 2 percent of the retina; the remaining 98 percent, the peripheral vision is not affected. However, even though the macula provides only a small fraction of the visual information received by the eye, nearly half of the visual cortex is dedicated to processing the macular information. Henry said people most often notice the onset of macular degeneration because of problems with reading or poor quality vision in general. “A person may notice that when they see the word “there” they may miss the T and only see “here” or they may miss the T and the last E and they see it as “her” because of where the spots in the back of the eye are deteriorating,” he said. “Usually it’s the reading and things in the distance becoming blurred, and just wiping the eye does not clear it up. “With the wet macular degeneration, it would be sudden loss of vision.”

Rachel Kerschner, M.D. August 1, 2013 She joins the offices of

Stephen Loheide, M.D., Stephanie Fangman, M.D., Bruce Davison, M.D., Cheryl Harris, M.D., Nancy Scott, M.D., Kathryn McAleese, M.D., Bradey Kleman, M.D., Jennifer Hartwell, M.D.

1120 North Marr Road, Columbus, Indiana 47201

To schedule appointments – 812-376-9219 2013 MEDICAL HANDBOOK

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Take steps to lower high blood pressure

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By Barb Hull

High blood pressure. Many people have it, but few manage it well. Actually approximately 1 in 3 people, including teens and children, have high blood pressure, and most don’t even know it. People often have high blood pressure for years without knowing it. High blood pressure is frequently referred to as “the silent killer.” High blood pressure, or hypertension, is caused when the blood flow through the arteries is too high, causing damage to other parts of the body. Risk factors for high blood pressure include diabetes, smoking and being overweight, among others. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure classifies blood


pressure readings: • Normal blood pressure is systolic (top number) less than 120 and diastolic( bottom number) less than 80 mms HG (millimeters of mercury). • Prehypertension, or “pre-high blood pressure,” is systolic of 121 to 139 with diastolic of 80 to 89. • Stage 1 hypertension is when systolic is between 140 to 159 and diastolic is 90 to 99. • Stage 2 hypertension is when systolic is more than 160 or diastolic is more than 100. High blood pressure can cause or contribute to a stroke, heart attack, heart failure, peripheral arterial disease or pain in the legs with walking, damage to kidneys and even vision loss. What can you do to prevent high blood pressure? First have your blood pressure checked periodically at your physician’s office during your regular health visit. If it is high on one exam, check it at home or through a local health screening. If your blood pressure remains high, you may be counseled on diet to control blood pressure or started on medicine to lower your blood pressure. Follow a low salt diet or the DASH diet, as recommended by the American Heart Association,

which is high in vegetables, fruits, lean protein and whole grains while remaining low in salt and fat. If you smoke, you will be encouraged to quit and given support in your attempts to refrain from cigarettes. Regular aerobic exercise, such as brisk walking, swimming or riding a bike, is vital for your heart and arteries. Exercise will help in weight loss efforts for those who may have a few pounds to lose. If you have sleep apnea or if you snore, you may need to continue or begin a sleep apnea treatment plan. Keeping your blood sugar under control is important for those people who are diabetic. If started on a blood pressure medication, take the medicine as your doctor prescribes. Do not stop your medication, particularly if you are feeling well, or skip doses. Learning about high blood pressure is the first step in controlling it. You can help your doctor help you by checking your blood pressure and keeping a blood pressure log. You don’t have to have high blood pressure. — Barb Hull is specialty lead nurse at Columbus Regional Health Heart Failure Clinic.

• Acute illness Walk-ins without an appointment 7:30 a.m. - 9:30 a.m., Monday through Friday Anyone with an acute illness can walk in during these hours and be treated without an appointment.

• Our Nurse Practitioner, Sue Thomas is available for same day appointments, Monday through Friday. • Lab work and immunizations between 7 a.m. - 11 a.m., 1 p.m. - 4 p.m., Monday through Friday, without an appointment. •Same-day mammograms with the CRH Breast Health Center. Located on the Hospital Campus

Sue Thomas, Nurse Practitioner

Katrina McGillivray, D.O.

2326 18th Street, Suite 210, Columbus, IN www.columbusadultmedicine.com www.columbusgynecology.com

(812) 372-8426 New Patients Welcome

Dr. Conetsco’s former patients will be seen by

Dr. Helen Kinsey and Dr. Cynthia Mason

2013 MEDICAL HANDBOOK

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Diet restrictions reduce symptoms of celiac disease By Dr. Geoffrey S. Raymer

Celiac disease is an autoimmune disorder of the small intestine that occurs in people of all ages with certain genetic predisposition. Symptoms can include pain and discomfort in the abdomen, diarrhea and sometimes constipation. Other associated problems can include mouth ulcers, osteoporosis, symptoms suggestive of irritable bowel syndrome and increased rates of anxiety, fatigue, indigestion and musculoskeletal pain. Some individuals with celiac disease have no symptoms. Anemia and vitamin deficiencies are often noted in people with celiac disease due to the reduced ability of the affected small intestine to properly absorb nutrients from ingested food. Unintentional weight loss can result as well. Celiac disease is thought to affect ap-

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proximately 1 in 100 people in the United States. Celiac disease is caused by a reaction to gluten, a protein composite found in wheat, as well as similar proteins found in barley and rye. When affected individuals are exposed to these proteins through their diet, an immune reaction is activated that results in inflammation in the small intestine and damage to the intestinal villi, the tiny finger-like projections of the small intestinal lining that increase its surface area. This leads to problems with absorption of nutrients from ingested food, as absorption is carried out through the intestinal villi. The only known effective treatment is a lifelong diet containing no gluten. A small number of people with celiac disease also react to oats. It is felt that this is most likely due to cross contamination with other gluten containing grains in


the fields or as a part of food processing. Therefore, oats are generally not recommended in the celiac diet. Other cereals such as corn, millet, sorghum and rice, are safe for those with celiac disease to consume, as they do not contain gluten protein. Similarly, other carbohydrate-rich foods such as quinoa, buckwheat and potatoes do not contain gluten and do not cause symptoms. The diagnosis of celiac disease can sometimes be challenging. Several tests are available to assist in making the diagnosis, including blood tests, genetic testing and microscopic evaluation of the intestinal villi themselves. One of the challenges in making the diagnosis is that all of the testing methods can be affected by diet. For those affected by celiac disease and following a gluten-free diet, intestinal damage begins to heal within weeks and blood tests can normalize over months. For those who have already started on a gluten-free diet prior to confirmatory testing, it is sometimes necessary to re-expose to gluten-containing foods over several

weeks before performing the diagnostic studies to increase their accuracy. In people with celiac disease, strict adherence to the diet allows the intestines to heal, typically leading to resolution of symptoms and depending on how soon the diet is begun, can also minimize the increased risk of related complications, including osteoporosis and intestinal cancer. Individuals with symptoms suggestive of celiac disease or other related concerns should discuss those issues with their physician. In many cases, referral will be made to a gastroenterologist, a physician specializing in the diagnosis and management of disorders affecting the digestive system, including celiac disease. Proper evaluation and diagnosis can lead to effective management, symptom improvement and minimization of longterm complications. — Geoffrey Raymer is a board-certified gastroenterologist with Southeastern Indiana Gastroenterology in Columbus. He also serves as the medical director of endoscopic services at Columbus Regional Hospital.

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Screening Colonoscopy Colon Cancer Prevention Acid Reflux Difficulty Swallowing Other Digestive & Intestinal Disorders Liver Diseases and Hepatitis C

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2630 22nd Street, Columbus • (812) 372-8680 • www.columbusgastro.com 2013 MEDICAL HANDBOOK

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Audiologists assist people of all ages with hearing problems By Danielle Hewitt

Audiology is simply the study of hearing and hearing-related disorders. Audiologists are health care professionals who identify and assess individuals with hearing or balance concerns. Audiologists hold a master’s or a doctoral degree in audiology and are licensed professionals in most states, including Indiana. Audiologists can be found in hospitals, clinics, ENT offices, schools and private practices. They can have many duties, including evaluating hearing and diagnosing hearing loss; fitting and servicing appropriate amplification devices, including hearing aids and assistive listening devices; designing and implementing hearing conservation programs; designing and/or consulting on newborn hearing screening programs; providing ear molds for hearing aids, noise protection or water protection; and performing tests to evaluate and diagnose balance

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disorders. Audiologists see patients of all ages. In Indiana, all newborns must receive a hearing screening. If the newborn does not pass the screening, they are referred to an audiologist for a follow-up evaluation. Although not always possible, the goal of the audiologist is to diagnose an infant’s hearing loss by 3 months of age and for intervention to begin by 6 months of age. Because the first few years of life are a critical period for language development, earlier diagnosis and treatment of hearing loss allow infants a better chance to develop at the same rate as their normal-hearing peers. Toddlers are often seen in an audiologist’s office due to delayed speech development or chronic middle ear infections. When a speech delay is present, it is an important piece of the puzzle to know if hearing loss is a contributing factor. The treatment of the speech delay may differ if a


hearing loss is diagnosed. Middle ear infections can strike at any age; however, children are especially prone to them. The degree of hearing loss associated with middle ear infections can vary. Most often the loss is mild and temporary, but even a mild loss in a child who is developing speech is significant. Proper diagnosis and treatment can minimize any long-term effects. The frequency of teenagers being seen in an audiologist’s office is growing. This may be attributed to the widespread use of personal listening devices, such as iPods and other MP3 players. A moderately loud sound over a long period of time can be damaging to hearing. So even if the music does not seem particularly loud to the person listening to it, if they listen for hours at a time, there may be damage occurring. As a general rule, if a person standing next to the person using the music device can hear the music, it is most likely too loud. Another sign that damage to the ear is occurring is ringing in the ears. At first, this ringing might be temporary, but after

prolonged noise exposure, the ringing could become permanent. It is also true that an extremely loud sound can damage hearing instantaneously. An example of this might be a firecracker going off close to the ear or a gunshot fired close to the ear. The best prevention for noise-induced hearing loss is turning down the loud sound when possible and when not possible, using ear protection. Adults are the most common patients seen by audiologists. Hearing loss in adults can usually be related to aging, noise exposure, certain medications, head injuries and heredity; however, other causes may exist. Often, the complaint heard from adults is that they can hear a person speaking, but are unable to understand what is being said. Untreated hearing loss can lead to isolation and depression. Since there may be great options for help, it is important to have the problem evaluated by an audiologist. — Danielle Hewitt is a Columbus Regional Health audiologist.

This dental specialty treats diseases, injuries, and defects of the mouth and jaws (removal of teeth, implants, facial fractures, corrective jaw surgery).

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812-372-7312 • 800-458-3768 2013 MEDICAL HANDBOOK

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Effectiveness of probiotics is still up for debate

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By Jenni L. Muncie-Sujan

Probiotics are live organisms that live in the intestines and help decrease unfavorable bacteria and viruses, according to Cecilia Owens, clinical dietitian at Columbus Regional Hospital. She says these bacteria or yeast “latch on” to the mucosa of the gastrointestinal lining in the digestive system. “It’s really hyped right now,” says Owens of the probiotic subject. “It’s one of the hot topics of the month because of curiosity. People are asking what they can do to consider alternative treatment options.” Most people who pursue the positive effects of probiotics, she says, are those who suffer from gastrointestinal issues. She said some who may benefit from it are people who have irritable bowel syndrome or ulcerative colitis. Owens says that probiotics can also reduce the symptoms of diarrhea associated with the use of antibiotics or acute illnesses.


The benefits of probiotics come from their ability to break down B vitamins, boost the immune system by providing antibodies to fight off certain viruses, decrease allergies such as skin reactions, decrease the risk of dental caries, and reduce the problems associated with inflammatory bowel disease. Probiotic benefits can be derived from foods such as cottage cheese, buttermilk, kefir, soy sauce, miso, tempeh, acidophilus milk, pickles, fresh sauerkraut, and cereal or yogurt with the words “live and active cultures” marked on the label. They can also be found in over-the-counter supplements in tablet or capsule form. At times, Owens says, probiotics can cause some stomach or intestinal upset, such as gas or bloating, but the symptoms usually improve over time. Because calcium can decrease the effectiveness of some antibiotics, it is best to eat calciumrich foods that contain probiotics two hours before or after an antibiotic to ensure the highest

level of effectiveness. The key, she says, is to use the probiotics in conjunction with prebiotics. She describes prebiotics as a type of catalyst that feeds the probiotics, helping them thrive in the gastrointestinal tract. Owens says that when prebiotics and probiotics are paired, the pH levels of the colon are decreased, allowing an increase in absorption of calcium, magnesium and iron. Prebiotics can be administered as a sprinkled dose on foods, stirred into a liquid, taken in a capsule form or found in prebiotic-fortified foods and beverages. Found naturally, prebiotics are active in wheat, barley, rye, flax, oatmeal, onions, garlic, leeks, legumes, asparagus, leafy greens, berries, bananas and honey. One specific detail that is yet to be clarified in the probiotic-prebiotic diet is how to properly list the active strains of bacteria on food labels, Owens says. At this point, foods that contain the active bacteria can be generically labeled as being helpful for digestion, contain the ingredient acidophilus or are marketed with an “exclusive probiotic culture, bifidus regularis,” such as the terminolsee probiotics on page 38

2013 MEDICAL HANDBOOK

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Medication errors are preventable

By Jamie Hoffman

Laughing with Friends for 25 years!

at Mill Race Center

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900 Lindsey Street • Columbus, IN 47201 admin@justfriendscolumbus.com • www.justfriendscolumbus.com Continuous activities • Flexible scheduling (as needed basis) Nursing & social work support • Financial assistance available VA, Medicaid Waiver, CHOICE and private pay

“Laughter is the best medicine!” 32

2013 MEDICAL HANDBOOK

Americans are taking more medications each day than ever before. The Institute of Medicine estimates that nearly one-third of U.S. adults take five or more different medications each day. With that, the frequency of medication-related errors also continues to rise. Pharmacists are passionate about preventing medication errors, and patients can also play a huge role in their own medication safety. A medication error occurs when a patient receives the wrong medication or when he receives the right medication at the wrong dose. Unfortunately, medication errors are common and harm an estimated 1.5 million Americans each year. This results in more than $3.5 billion in extra medical costs. The good news is that there are many ways to help prevent medication errors: • When picking up prescriptions at your pharmacy, talk to your pharmacist about why you are taking each medication. Make sure that the dosage and instructions are the same as you had discussed with your doctor. If you are picking up a refill, make sure that the medication looks familiar. Ask your pharmacist if something does not seem quite right.


• Learn about your medications by reading the information that comes with each prescription. Take the time to learn about what each medication is used for, how it should make you feel and what possible side effects may occur. As you become more familiar with your medications, you lower your risk for many medication errors. • Be sure to tell your pharmacist and doctor about all of the medications you take, even over-the-counter drugs, vitamins and supplements. Many overthe-counter items can potentially interact with prescription medications, and your pharmacist will be able to check for these interactions. Some medications even have interactions with certain foods and alcohol, so be sure to discuss this with your pharmacist. • Check expiration dates on all medications and throw them away once they are out-of-date. Many expired medications lose their effectiveness, and some expired medications can even be harmful. Because putting medications down the toilet may

be harmful to the environment, please check with your local waste management program to learn about the proper way to dispose of expired medications. • Keeping track of each medication’s dose and when it should be taken is extremely important. Using a tool such as a pillbox can help you keep track of when and how to take your medications. Keeping an updated list of all of your medications is also important, and you should take this list with you to every medical visit. For a free medication list that you can keep on hand as well as a list of great tips, go to www.crh.org/medsafety. • When in doubt, ask your pharmacist. Community and hospital pharmacists want to talk to you about drug interactions, side effects and drug allergies. Talking to your pharmacist about your medications will give you the tools and knowledge you need to help prevent medication errors and keep you safe. — Jamie Hoffman is pharmacy residency coordinator at Columbus Regional Health.

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2013 MEDICAL HANDBOOK

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Successfully quitting tobacco requires combined approaches By Debra Richard

Dr. Charles Rau

Dr. David Rau

Located at the CRH campus. Accepting all insurances.

NEW PATIENTS WELCOME.

2326 18th Street, Columbus • (812) 378-7474 www.raufamilymed.com Monday-Thursday 7:00 am - 5:00 pm Friday 7:00 am - Noon 34

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“Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.” — Samuel Beckett No one likes to repeatedly fail — especially when trying to quit tobacco. On average it takes seven to 11 attempts to conquer the extremely addictive drug, nicotine. Ending tobacco dependence can be a frustrating challenge because it involves overcoming three overlapping components: physical addiction, deeply ingrained psychological dependence and multiple social patterns. But make no mistake — you can quit. Quitting is the most important thing you can do for your health immediately and long term. Success is possible, but there is no “one size fits all” approach for quitting. Individuals vary by current daily nicotine consumption, age use began, length of time used and level of motivation to quit. To boost long-term success, tobacco cessation strategies involve a variety of combined approaches. Counseling by trained health professionals in one-on-one or group sessions along with FDA-approved nicotine replacement therapies (NRT) or medications typically increases quit rates over 75 percent. The Bartholomew County Health Department generously partners with Reach Healthy Communities by providing four commu-


nity Freedom from Smoking sessions this year. Bartholomew County residents may qualify for free cessation medication while participating in the eight-week program, although enrollment is not limited to county residents only. An enrollment fee of $35 covers a participant’s workbook and relaxation CD. Regardless of quit method, all users are strongly encouraged to partner with a physician or health care provider, particularly if the user plans to use NRT. Currently, seven medications are FDA-approved for nicotine dependence: nicotine patch, gum, lozenge, nasal spray, oral inhaler, Zyban and Chantix. Counseling can also be by telephone or online. The Indiana Tobacco Quitline offers phonebased counseling at 800-784-8669. Participants receive four pre-arranged calls from a quit coach but have unlimited access to call the quit-line. Pregnant users may receive up to 10 prearranged calls. Quit coaches help develop a quit plan for each individual. Participants have the option of enrolling in the Web coach-only service at www.equit. com. This full feature Web application guides users through an evidence-based quit process.

From Our Home to Yours

Another option for additional support is the Text2Quit program — a series of text messages personalized to a participant’s quit plan. The quit-line services are free and multilingual. I have been a cessation counselor for over 10 years, and the top reasons I see for quit failures are no written plan, under-medicated (not calculating and matching current nicotine consumption with appropriate medication), misusing medication, not using medication long enough, believing medication is all the user needs to quit, not being prepared to change other behaviors, alcohol exposure and not being confident in self to quit. I have witnessed the disease, destruction and death caused by tobacco and the enormous joy when a former user conquers tobacco’s grip. “Ready to ditch tobacco? Try again. Learn. Believe. Plan. Practice. Be vigilant and succeed.” —Debra Richard For information concerning local class sessions, on-site business or organization classes, or educational programs contact Stephanie Truly at struly@crh.org or Debra Richard at 379-4927. — Debra Richard is a Healthy Communities tobacco cessation facilitator.

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www.pharmacycaresolutions.com 2013 MEDICAL HANDBOOK

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Over-the-counter pain relievers require caution By Jenni L. Muncie-Sujan

Christopher E. Stevens, M.D. Board Certified in Otolaryngology

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812-669-1490 Toll Free 855-368-3621 2345 Northpark Dr., Columbus, IN 47203 36

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Pat Cashen, owner and pharmacist at Doctors Park Pharmacy, said over-the-counter (OTC) pain relievers can be divided into three categories: aspirin, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Aspirin, Cashen says, is not used very much these days as a pain reliever. It serves primarily as a once-a-day blood thinner for people who have had strokes and is not often taken incorrectly. However, acetaminophen, found in the brand name Tylenol, can be used incorrectly by people who are unaware of its potential danger, according to Cashen. “This drug can be hard on the liver over a period of time,” says Cashen. Besides the damage that can be done in situations where people take acetaminophen too frequently, Cashen said, the danger compounds when people are sick and continue to take it. When a person is ill, he explains, the liver does not function as well because it cannot metabolize the Tylenol as quickly as normal. As a result, the acetaminophen is not adequately flushed through the system. If the maximum dose of acetaminophen is taken during sickness, Cashen says, there is a possibility of “stressing out” the liver. He warns that people can die from the resulting toxicity. NSAIDs are used for inflammation, primarily joint pain, Cashen says. Examples of NSAIDS are ibuprofen and naproxen. Cashen says studies estimate that 80 percent of people


over 65 have osteoarthritis, so the need for relief from joint pain is significant, and the use of NSAIDs is commonplace. Jamie Hoffman, a pharmacist at Columbus Regional Hospital, summarizes the danger of OTC pain relievers. “A lot of people assume that because medications are over-the-counter, they are safe,” she says. “They are, when taken as directed, but when you combine them with prescriptions, it can get a little scary.” Hoffman says that Tylenol is a “pretty safe drug,” but when combined with prescriptions such as Lortab or Percocet, the danger increases because those prescriptions also contain acetaminophen and can damage the liver. Both Cashen and Hoffman say that the industry maximum daily dosage of acetaminophen is currently at 4,000 mg, but consideration has been given to reducing it to 3,000 mg. This would help prevent organ damage from accidental interactions or overdoses. Especially with viral infections such as the flu, with aching and fever, Cashen warns customers against taking the maximum dose of acetaminophen. “For years, we thought it was extremely safe,” Cashen says, as he names another danger of acetaminophen — a negative drug interaction with the blood thinner warfarin In pediatric medicine, the industry has standardized

the strength of the drops and liquid, Cashen says, so that children are less likely to incur liver damage from the result of confusing the doses between the drops and the liquid. Prior to the standardization, parents could get a suspended liquid that was administered with a dropper. Or, for older children, they could give the liquid out of a regular medicine bottle. They were both types of liquid but were not on the same dosage chart, which was very confusing for parents. The danger of NSAIDs is that, over time, these drugs can cause bleeding ulcers in the stomach, plus the possibility of kidney stress and/or damage, Cashen says. “By the time you would have symptoms on either (liver or kidneys), you would be in a danger zone.” Hoffman said that signs of damage can be gastrointestinal bleeding, which would show up as blood in the stool, vomiting blood or black “tarry” stool. “If you’re going to take this for more than two or three weeks,” Cashen says, “you need to consult a physician.” He suggests that blood work can show whether or not bodily organs are working correctly. After reading the lab results, a doctor can adjust doses to a safe level, if needed. see OTC on page 39

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2013 MEDICAL HANDBOOK

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probiotics continued from page 31 ogy on the packaging for Activia brand yogurt. To this point in research, Owens says, scientists have found no physical danger or negative side effects from a probiotic-prebiotic pursuit. In fact, she says that a healthy diet includes many of the foods that contain the pair naturally. If a person who is already healthy attempts to incorporate specific prebiotic and probiotic foods into the diet, she says that it will show neither harm nor benefit in the gastrointestinal tract. In general, for healthy people, a probiotic diet is unnecessary, says Owens, but anyone who is pregnant, nursing or has a weak immune system should consult a physician before incorporating that emphasis into their eating schedule. “Don’t start it until you talk to your health professional,” she says. Even though the current information on probiotics-prebiotics seems to give all green lights for safety and effectiveness, she says that not enough is known on the topic to make standardized assumptions. “Scientists don’t know what bacteria work best or what doses work best,” she says. “Not all probiotics are the same.”

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2013 MEDICAL HANDBOOK

Owens explains that because the Food and Drug Administration does not regulate natural products — including probiotics — strict labeling guidelines do not exist at this point. One unknown she gives as an example is that scientists are not sure if probiotics lose their effectiveness over time. Owens says that the key words a person should spot on foods that are developed for probiotic-prebiotic benefits are “live and active cultures.” In an April 3 article titled, “Good vs. Bad Bacteria in the Gut,” Tracy Hampton wrote about the inconclusiveness of current studies on probiotics for the Journal of the American Medical Association’s website www.jamanetwork.com. “Animal studies suggest that reintroducing normal bacteria from the anaerobic genus Barnesiella into the gut might help clear vancomycin-resistant bacteria from the intestinal tract.” The word “might” seems to be key in this study. Jamie Hoffman, a pharmacist at Columbus Regional Hospital, agrees. “It’s hard because there aren’t a lot of good studies out there to prove what the benefits of probiotics can be.” While the studies are still being done, Hoffman has seen a probiotic diet make a positive difference in patients who try it after an antibiotic has killed off the good bacteria in their intestines. “More research needs to be done. It’s important to use a reputable manufacturer when buying natural products,” says Owens, explaining that the quality and potency of the active ingredients can vary from manufacturer to manufacturer, even from batch to batch of food. She stresses that manufacturer guidelines, expiration dates and storage instructions should be heeded when using products containing probiotics or prebiotics, to keep the micro-organisms active. While the final word on the benefits of probiotics has yet to be given, Owens says she has recommended probiotics as a possible solution to patients. “People who have taken probiotics/prebiotics say they feel that the multistrain bacteria or yeast seems to be more effective,” says Owens, “but it’s not proven. Always check with your doctor so interactions can be checked before starting a new treatment plan.” Once a doctor has agreed that it may be effective, Owens says, a pharmacist could help determine the appropriate plan. “They can help guide you in dosage according to which method you choose.”


OTC continued from page 37 Hoffman says people need to be aware that taking OTC pain medications when they are not needed can hurt the body. Cashen shares the solution that the industry proposes. “What we’re telling people to do if they are hurting that much and the Tylenol isn’t helping on its own: alternate the Tylenol with ibuprofen.” He explains that by alternating each, every four hours, the break between the individual pain reliever types is eight hours. “It seems to be more effective therapeutically,” Cashen says, “and it cuts down the side effects dramatically. “A lot of people who use pain pills, they are treating a symptom,” he says, adding that if the pain does not go away, a cause needs to be found instead of treating the symptom. Hoffman gives the example of chronic headaches. She recommends that they be checked out by a doctor instead of continuing to take pain pills. “It’s better to let the doctor know and see if there are options,” Hoffman says, “rather than continuing to take pills.” Glucosamine can be considered as an alternative for some, Cashen says, as it is marketed as having the ability

to reproduce lubrication in joints, especially in knees. “I like to have studies to back up what I recommend,” Hoffman says of glucosamine. “It’s expensive, and you have to be on it a while to notice a difference.” She does not completely reject the alternative. “For someone who doesn’t want to be on pain medications, it’s worth a shot,” she says. Instead of an alternative pain treatment, Cashen offers an alternative to acquiring the pain. “Don’t overdo it,” he says, referring to people who rush into a large amount of physical exertion in a small window of time. For example, he said that some people who are rather inactive over the winter sometimes try to get all their spring gardening started in one weekend and create a higher-than-normal level of pain. “If you just spread it out,” Cashen says of the large physical tasks, “you’ll feel a lot better.” Hoffman summarizes her thoughts on alternatives to pain relievers by noting that exercise and weight loss are most commonly able to improve a person’s physical condition. To prevent some of the bad consequences and drug interactions, Hoffman says, “Talking to a doctor or pharmacist and telling them what they’re taking over-thecounter is really important.”

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2013 MEDICAL HANDBOOK

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Cough sufferers have unrealistic expectations about recovery By Sally Kalson

If your cough is hanging on much longer than you expected, the problem isn’t the cough; it’s you. People expect acute coughing from a cold or flu to last seven to nine days, according to a new report, when it actually takes closer to 18 days to run its course. The perception gap leads to more doctor visits, more pointless use of antibiotics (which don’t work on viruses, the cause of most coughs), higher medical bills and more drug resistance. “There is a mismatch in what people believe and reality,” said Mark Ebell, associate professor of epidemiology at the University of Georgia College of Public Health, who analyzed data with several colleagues and published a report in the Annals of Family Medicine. When acute bronchitis persists past the point of expectations, people call their doctors. Doctors respond by overprescribing antibiotics, the authors said, and the cost of treating a virus escalates from $20 for over-the-counter cough medicine and pain relievers to $200 for office visits, tests and prescriptions. The researchers looked at 19 observational studies in the United States, Europe, Russia and Kenya. Based on untreated control groups, they found that acute coughing lasts an average of 17.8 days. They also measured patient expectations by inserting a question into the biannual Georgia Poll, a random telephone survey of 500 Georgia residents conducted by the university’s Survey Research Center. Respondents said a cough should last seven to nine days. “If someone gets acute bronchitis and isn’t better after four or five days, they may think they need to see a doctor and get an antibiotic,” Ebell said. “And when the first one doesn’t work, they come back four or five days later for another.” According to the U.S. Centers for Disease Control and Prevention in Atlanta, coughing accounts for 2 to 3 percent of outpatient clinic visits. More than half of those patients are put on antibiotics — Ebell said that number should be much lower — and of that group, half get wide-spectrum versions that can lead to resistance. “We know from clinical trials there is very little, if any, benefit to antibiotic treatments for acute cough because most of those illnesses are caused by a virus,” he said. Meanwhile, resistance due to overuse already is leading to illnesses that can no longer be treated by the drugs that used to work. Why are physicians prescribing drugs that aren’t indicated for coughs in the first place? Apparently, it’s either because patients are insisting and doctors are caving in,

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or physicians have not kept current with guidelines for prescribing antibiotics. Is there a way to tell when a cough is becoming dangerous? “If it’s been two weeks and you’re feeling sicker, if your fever returns or you have new symptoms, like wheezing you didn’t have before, or it’s harder to catch your breath,” said Amy Crawford-Faucher, a family-practice physician at the University of Pittsburgh’s family-medicine department. Coughing is disruptive, she said, but it would be better all around if patients let a cold run its course. She recommends that patients older than 6 take over-the-counter cough medicines at night to help with sleeping. “The whole world looks better if you can sleep through the night.” — Pittsburgh Post-Gazette


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Medical Handbook 2013