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January 2013 | North Georgia’s Health & Prevention Magazine

IN THIS ISSUE

Weight-loss

the best way to counter diabetes

...page 18

Going viral?

Flu watchers tap into social media

...page 2

FEATURING

GAINESVILLE HEART AND VASCULAR GROUP

PAGES 12 &13


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The Times, Gainesville, Georgia  |

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Flu watchers tap social media might By Patrick Svitek

Chicago Tribune Dr. Andrea Dugas recalled widespread skepticism at a medical conference a few years ago when a colleague suggested that social media mentions and search volume could one day forecast flu activity. “They would say, ‘How can you

use this social media to surveil flu data?’ and ‘It’s crazy’ and ‘You can’t do that,’” said Dugas, a Johns Hopkins University professor who studies flutracking.“Now it’s widely acceptable.” Chicago is experiencing what health officials have called its earliest and most active flu season in nearly a decade. The federal Centers for Disease Control and Prevention

declared earlier this month that flu activity nationwide had reached epidemic levels. Shortly after the CDC announcement, Dr. Julia Morita, medical director of the Chicago Department of Public Health, answered more than a dozen questions about the flu season on Twitter via the hashtag #FluChicago.

“Our goal is to provide relevant information as quickly as possible to as many people as possible,” department spokesman Brian Richardson said. “In order to do that effectively today, social media has to play a part.” The mayor’s office has also spread the word about the flu season online, Please see Going viral page 3


The Times, Gainesville, Georgia  |

Going viral

website. Sickweather aggregates millions of flu-related mentions on Facebook and Twitter, filtering out those that are out of context, and plots them on an interactive map. From August to October, co-foundcreating an interactive map that er Graham Dodge said he noticed a shows where vaccines are available. 70 percent increase in social media Kevin Hauswirth, Chicago’s first-ever buzz about the flu compared with social media director, said the city has past data from Google Flu Trends, shared the code behind its flu map which tracks flu-related search terms, with Boston, which declared a public and the CDC. He called the advance health emergency after an unprec- warning a public service. “We’re actually taking that data and edented spike in flu cases. turning it around and giving it back “We understand that those converto the users in a form that they can sations are happening online, and the utilize,” Dodge said. mayor’s office should be a part of Sickweather’s early read on the those conversations, especially when flu season is not the only jump the the health of the city is at stake,” Internet has gotten on the CDC. Hauswirth said. Google Flu Trends’ algorithm proThe Twitter chat and flu map duced a “strong correlation” with realcome amid several broader efforts to time flu activity in a Johns Hopkins crowdsource flu data, some of which

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Flu Near You is a website that enables users to complete a weekly health survey and then displays on an interactive map where flu sufferers are located. have been successful in sketching the contours of what local doctors agree is the worst season since the swine flu pandemic in 2009. Flu Near You is a website that enables users to complete a weekly health survey and then displays on an interactive map where flu sufferers are located. More than 44,000 people were participating in Flu Near You as of Monday afternoon. Nearly six weeks before the CDC issued a formal warning, the Baltimore-based startup Sickweather tweeted that “flu is a little early this year,” linking to its barely 1-year-old

Medicine study a year ago. “Cues from social media are actually a robust way to know what’s going on in the community,” said Dr. Richard Rothman, who worked on the widely cited investigation with lead researcher Dugas. Rothman and Dugas are now working on a model that uses both Google Flu Trends and more official data to predict flu prevalence in emergency rooms a week before it happens. “You don’t rely on just one tool,” Dugas said, noting online indicators like Google Flu Trends are not “meant to be used entirely in isolation.”

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The Times, Gainesville, Georgia  |

FDA urges lower doses of insomnia drug to combat drowsy driving By David Sell

The Philadelphia Inquirer Driving is dangerous enough without falling asleep at the wheel, so the U.S. Food and Drug Administration has urged patients and doctors to lower the bedtime doses of a common insomnia drug, which was prescribed about 40 million times in 2011. The new safety warnings are for

conference call with reporters. Before it faced generic competition, IMS Health said, two versions of Ambien had nearly $2 billion in sales in 2007 for drug maker Sanofi-Aventis, which is based in Paris, but has big operations in New Jersey and a site in Malvern, Pa. Teva Pharmaceuticals Ltd., which has big operations around Philadelphia, and Pittsburgh-based

60 million prescriptions were written for all sleeping pills in 2011. the sleep drug zolpidem, which is sold as a generic and under the brand names Ambien, Ambien CR, Edluar and Zolpimist. The new warnings came after clinical tests for a recently approved drug were coupled with tests involving driving simulators. The FDA will now require driving simulation tests be done as part of any new application for insomnia drugs. IMS Health, a health care technology and information company, said about 60 million prescriptions were written for all sleeping pills in 2011, with about twothirds of those being some form of zolpidem. Dr. Ellis Unger, a director in the FDA’s Center for Drug Evaluation and Research, urged patients to discuss the situation with doctors before changing any medication regime. “We hope less of the drug will be in the bloodstream in the morning driving hours,” Unger said in a

Mylan Pharmaceuticals, are the two largest generic drug makers and both list a generic version of zolpidem among their products. Not all sleeping pills have zolpidem, but all FDA-approved drugs have label warnings about morning drowsiness. The agency said that extended release forms of zolpidem showed the highest risk for next-morning impairment and that women were more susceptible than men because the drug takes longer to flush from their system. Usher said various reports of celebrities using Ambien around the time of car accidents did not influence the agency. “The new information was not tied to any specific case,” Usher said, without naming names. But he added in reference to reports of celebrity accidents, “We don’t know the time of the accidents, we don’t know the last dosage or whether there was alcohol or other drugs involved.”

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New year’s resolution headache Advertorial provided by Gainesville Neurology Group, LLC So now the New Year has begun and you have finally acted on that promise, that resolution, to lose weight and to exercise, only to find that your routine is a real headache! A number of people find with their new exercise program they develop generalized headache either during the workout or soon after completion of it. Usually the headache lasts a few minutes to an hour. It is often relieved by over-the-counter medication. Should this headache stop you from continuing your new found healthy lifestyle? Absolutely not! Regular exercise over time will result in many more positive health points and also reduce the occurrence of headaches of any type. You should, however, talk with your headache physician as a small percentage of people may have a potentially serious neurologic problem such as a tumor, aneurysm, or blood vessel malformation as a cause of their headache that requires

immediate medical or surgical treatment. If your physician does not find an underlying cause for your headache then the following recommendations may reduce or eliminate your headaches: 1. Make sure you are well hydrated before, during and after your routine. 2. Get a slow steady warm up prior to stepping up to your maximum intensity. 3. Realize low impact exercise,swimming, cycling, and elliptical trainers are less likely to produce headache than high impact jogging, running, tennis or racquet ball. 4. Finally, do an adequate cool down,this will take at least five minutes. Your physician can suggest medications that will decrease or prevent these headaches if all of the above measures do not result in significant relief. Armed with this information, you should be able to keep those resolutions for 2013 and be ready for the Fourth of July 10k. Clinton E. Branch, Jr., M.D., FAAN of Gainesville Neurology Group, LLC is an associate clinical professor of Neurology at Georgia Health Sciences University (formerly Medical College of Georgia).


The Times, Gainesville, Georgia  |

Good hygiene best defense against head lice

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the bugs, if you don’t leave the medication on long enough or don’t get the eggs out, in another five to seven days, new ed by this problem, but do these eggs form.” By Meredith Pruitt Awareness is an help? mpruitt@gainesvilletimes.com “Preventative shampoos? No,” important issue assoEvery year, like clockwork, a says Dr. Cindea. “The only way to ciated with head lice. school classroom will have a huge effectively get rid of head lice is People have to work to eliminate the nits, so no. None diligently to prevent outbreak of head lice. The problem is obviously there of the treatments, whether over- head lice. Still, even and happens often, but no one the-counter or prescription, is 100 with this diligent work and proper can seem to get rid of lice. Is there percent effective.” Some medicines commonly pre- treatment, little kids really anything parents can do to prevent their children from get- scribed for head lice kill the eggs, find it hard to sit but not all of them. Doctors and still while someone ting head lice? “Prevent the index case,” says Dr. school nurses work to eradicate picks through their Eugene Cindea of the Longstreet the problem, but getting rid of it hair. The best way to Clinic Center for Pediatrics.“That’s completely is virtually impossible. Why are head lice so tough to prevent head lice is really hard because little kids rub to keep up proper get rid of, completely? up against each other.” “It’s difficult to eliminate all hygiene, and make When it comes to head lice, of course, everything boils down to those eggs,” says Dr. Cindea.“Some sure that children do personal hygiene. Parents often individuals will have literally not share clothing, buy preventative shampoos to thousands of egg casings, and the hats, hair brushes, or make sure their kids aren’t affect- potential is that, even if you kill combs.

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The Times, Gainesville, Georgia  |

Too much caffeine can be a problem By Meredith Pruitt

mpruitt@gainesvilletimes.com Waking up can be a challenge, especially early in the morning. Most mornings, especially in the cold months, a hot cup of coffee is how many people start their day. Some keep going with highcaffeine energy drinks or sodas throughout the day. These work as a good power-up for the day, but at what risk? There are many effects one has to consider when loading up on caffeine. It is best, first of all, to keep caffeine in moderation. “For most healthy adults, moderate amounts of caffeine, 200 to 300 milligrams a day, or about two or three cups of coffee, present no medical problems,” says Leslie C. Davis, a registered bariatric program dietitian at Northeast Georgia Medical Center. “Caffeine is a stimulant. Over consumption of caffeine can cause anxiety, nervousness and digestive problems.” People of all ages are now hooked on caffeine, thanks to energy drinks targeted toward younger consumers and popular coffee drinks, such as those from Starbucks, with high concentrations of sugar in them. But is caffeine really appropriate and safe for everyone? “No,” says Davis, “I do not believe they are good for any-

one and can be very dangerous. There is a lack of regulation in caffeine and other ingredients in high-energy beverages.” It’s important that parents know the risks caffeine present for children. This includes arrhythmogenic potential that is associated with caffeine intake. You may not even realize when you have had had too much caffeine. Caffeine intoxication presents problems for the central nerve system and the heart. One might experience nervousness, problems with digestion or even heart palpitations as a result of caffeine toxicity. It’s true that caffeine works as a good pick-me-up during the day, but it is also possible to replace it with safer alternatives that do not present so many health risks. Even cutting back on caffeine can be helpful. Instead of drinking coffee or tea with full caffeine, try a half-caffeinated and half-decaffeinated drink. “Use green teas or herbal teas,” Davis suggests.“Be aware of cold medicines which may contain caffeine.” In a high-powered society full of coffee, energy drinks, and other stimulants, it is important to remember the health risks that come along with trying to wake up. Remember to take measures to protect yourself from the health risks that come from over consumption of caffeine.

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The Times, Gainesville, Georgia  |

Keep list of your meds in your wallet By David Sell

The Philadelphia Inquirer What’s in your wallet? Do you have a written list of the medications you take? If not, it might kill you, as it does thousands of people every year. Lack of an accurate medication list also makes it much more difficult to choose Medicare prescription drug coverage. Medicare Part D — prescription drug coverage — is a crucial and complex part of an often confusing process for many Medicare-eligible seniors. There are myriad factors in making choices about Medicare, the federal government’s health-care plan serving mostly those age 65 and older. But whatever a person’s situation, seniors and other adults taking medication on a regular basis can make better choices for themselves by taking the time — or asking for help — in compiling that list of medications. Having an accurate, up-to-date, and legible list of medications in your wallet or purse can be crucial if you end up in an emergency room, alone and unconscious. But just being awake isn’t always enough. “It’s a big problem,” said Dan Hyman, head of Internal Medicine at Cooper University Health Care, a Level 1 trauma center in Camden, N.J. Even when they are conscious, Hyman said, “people are sick, upset and don’t remember or forget to tell us.” The nonprofit and independent Institute of Medicine estimated in 2006 that there were 1.5 million “adverse drug events” a year, but guesses that the true number might be higher. Many of those are in hospitals, but many others are in homes. A study in the Lancet estimated that

7,000 people die each year from medication mistakes. Cooper gives patients in its system wallet-sized cards listing their medication, but Hyman said getting updates and information from outof-network doctors remains a challenge. Jeanmarie Perrone, an emergency physician at the Hospital of the University of Pennsylvania, said a “great proportion” of the people arriving at the emergency room can’t remember off the top of their head what medications they take, assuming that they are conscious upon arrival. “They are trying to be helpful,” she said, “but saying, ‘It’s a red pill,’ doesn’t help us at all.” Tremendous progress has been made in recording patient information in electronic records, but sharing and updating of information is still lacking, especially when patients get prescriptions from multiple doctors who are not in the same healthcare system. There are websites, computer programs, and apps for smartphones that can help patients keep track. But those appliances — along with taping it to the refrigerator in the kitchen — have their limits. For emergency purposes, several doctors and others involved said lists should include the drug name, dosage and how frequently the patient takes the drug. If there is room on the list, the reason for taking the drug, and the prescribing doctor’s name and phone number can help. Knowing all of that can help patients have more intelligent conversations with doctors. Is the brandname drug the best one or can a Please see Meds page 9

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The Times, Gainesville, Georgia  |

Meds Continued from page 8 cheaper generic suffice? It might not hurt to ask whether the provider has any financial interest in prescribing the medicine. Every list should also include overthe-counter medicines, vitamins or supplements that a person has taken recently or uses on a regular basis. “Don’t forget,” Perrone said, “the thing you read about and bought on the Internet that was going to help you with weight loss.” The Institute for Safe Medication Practices, led by philly.com health blogger Michael Cohen, has a link on its website to eight pages of medications that are easily confused with another drug of a similar name. “The reason you are seeking care might be related to an adverse effect of a medication you’re taking,” Cohen said by e-mail. “Also, current medications may impact treatment decisions. Another reason is to avoid duplicate dosing and drug interactions. For example, the doctor might want to prescribe a drug that is in the same class as one you are already taking or may interact with a current medication.” Perrone said patients frequently forget to mention one of the most commonly prescribed medications for seniors — blood thinners — and that could change emergency room treatment because of fears of internal bleeding. For example, someone not on commonly prescribed Coumadin who arrives with a “goose egg,” on his head after a fall might be allowed to go home with family, Perrone said. But a person taking the drug might need further testing or an overnight stay to be sure there is no internal bleeding. Insurers, government and private, are trying to reduce medication errors so people can avoid expensive hospital stays.

The Camden Coalition of Healthcare Providers, which is famous in health-care circles for innovative approaches to improving care and reducing costs for some of the most expensive patients, has nurses visit homes. “Sometimes we see a real mess, with piles of duplicate and outdated medicine,” nurse Jason Turi said. “We try to help them with pillboxes and lists and understand why they are taking them, inspect the medicine and communicate the list to providers.” Penn Medicine and Cooper also have personnel trying to help patients prepare proper and accurate lists, with the idea that it improves care and is accessible electronically by any caregiver, crisis or not. “The pie-in-the-sky dream,” Cooper’s Hyman said, “is if you’re here visiting from California and part of a health plan there, I can access your list of medications and see the report from the doctor you saw last week.”

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Blood clots possible at any age By Shannan Finke

make you more prone to clots, but even someone who sits for a long period of time is at risk for blood clots.” At age 24, Amber Lyle never imagFor example, Procter said, sitting on an ined she would have already suffered airplane or in a car for an extended time three blood clots and undergone mul- prevents the calf muscles from pumping tiple surgeries, stints and medications blood out of the legs. Consequently, the in attempts to prevent more clots from blood does what it should normally do. forming. “One of the jobs of the blood is to But after discovering she had a blood clot, and if it just sits there, it will clot,” mutation that made her prone to clots, Procter explained. “Stasis is a big facLyle said she will have her stints and be tor in what causes clotting, so people taking medication the rest of her life. should be getting up and moving around “Blood clots run on my grandfather’s whenever they’re sitting for an extendside of the family, so I knew it was a ed amount of time.” possibility I could get one eventually. I Dr. Dev Mangalat of the Vascular & just always hoped it wouldn’t be me,” Vein Specialists at The Longstreet Clinic Lyle said. added that inflammation and some Dr. Dan Procter from the Vascular & medical procedures, including certain Vein Specialists at The Longstreet Clinic abdominal operations, back surgeries, said blood clots can form in anyone at long bone operations and knee and hip any age. replacements could also make people “Clots can happen to anybody. It more prone to blood clots. can happen to any of us,” Procter said. In Lyle’s case, after undergoing several “There’s certain procedures that can surgeries on top of having a blood mutasfinke@gainesvilletimes.com

tion, Mangalat called her chances for clotting “the perfect storm.” “Amber had a predisposition to clotting, so any little bit of stasis, especially after any procedures she had, and she was more prone than the rest of us to clot,” Mangalat said. Lyle said she knew something was wrong when her right leg began to swell and was painful to put pressure on. “My right leg, where the clots were, was swelling a lot. It was about twice the size of my left leg,” Lyle remembered. “It was swollen, warm to touch, really red and it felt like my leg was on fire. It was extremely painful.” While these are all common symptoms of a blood clot, Mangalat added that a patient can sometimes experience fevers, as well. “If the patient is showing symptoms that are suggestive of a blood clot, their physician will probably give them an ultrasound and put them on an IV of medication to prevent additional clot-

ting. Like in Lyle’s case, we may test the patient for any genetic problems that could cause the clot, and we would transition the patient to a pill form of the medication and a compression stocking,” Mangalat explained. Blood thinners, one of the most common medications used to treat clots, typically help by preventing more clots rather than dissolving existing ones. According to Mangalat and Procter, it is the body’s natural reaction to dissolve the clot on its own. “When you form a clot, you incorporate the breakdown products in the clot itself, so as soon as you form one, your body’s already starting to break it down,” Procter said. “What the blood thinners do is keep you from forming more clots during that time.” A compression stocking, which helps keep the blood pumping in the calf muscle, and stints, which help to open Please see Blood clots page 11


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Blood clots

Continued from page 10 the vein for blood to flow normally, are also sometimes used in clot treatment. A procedure known as “clot busting” may also be used to treat a blood clot. “In certain patients, depending on where the clot is, you actually can do a procedure where you actually go into where the clot is, and within the clot, you put in a medication that actually breaks up the clot. You do that in the hospital and they have to be monitored in the intensive care unit because one of the potential complications is bleeding, and that’s what we did for Amber,” Mangalat said. The location of the clot generally will dictate whether clot busting is done. While up for debate, the general rule is that all clots from the groin up should be “busted.”

“What we don’t want is for the clot to move to the lungs, which serves as kind of a big filter. If it has already moved there, patients will come in with a shortness of breath and tightness in their chest a lot of the time,” Procter said. When Secretary of State Hillary Clinton was recently hospitalized with a blood clot in the brain after suffering a concussion, Procter said her blood thinner treatment was highly common, but it’s difficult to know whether her reported fall caused the blood clot or the blood clot caused her to fall. “Like it is with all patients, her body will work on breaking up the clot on its own, and the blood thinner medication she was on was to prevent more clots from forming,” Procter said. Fortunately for Lyle, her blood clot treatment has proven successful, and she continues to live her life normally and free of much of the pain she suffered before. “Now that I have the stints on top of the medication, I actually feel a lot better. I’m a lot better than what I was originally,” Lyle said.

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Tom Reed/The Times Calley Tidwell, right does a sonogram at the Longstreet Clinic Vascular & Vein Specialists to check for blood clots in the leg of patient Amber Lyle while vascular surgeon Dr. Dev Mangalat looks on.

Northeast Georgia Urological Associates Welcomes:

BRENT A. SHARPE, M.D.

Dr. Sharpe received his bachelors degree in chemistry from the University of North Carolina at Charlotte in 1994. After obtaining his Medical Degree from East Carolina University School of Medicine in 2000, he completed a surgical internship at Texas Tech University, where he worked under Dr. Bernard Mittemeyer whose prostatectomy technique is the basis of today’s robotic prostatectomy. Dr. Sharpe completed his Urologic Residency at Emory University in 2005 and is board certified by the American Board of Urology. Dr. Sharpe treats all urological conditions but has a special interests in prostate cancer, vaginal prolapse, kidney cancer, and erectile dysfunction. Prior to joining Northeast Georgia Urological Associates he was instrumental in expanding the minimally invasive treatment options and making these options more widely available to the patients of North Alabama. He was the area’s first and most experienced robotic surgeon, offering robotic surgery for kidney cancer, cystocele/pelvic prolapse, and kidney drainag reconstruction ( i.e. pyeloplasty ). He was also the first urologist in that area to perform complete laproscopic procedures such as kidney radiofrequency treatment of renal tumors, pyeloplasty, and pure laproscopic nephrectomy in that area. Northeast Georgia Urological Associates is pleased to have Dr. Sharpe join our treatment team and are excited to add his expertise in Urologic minimally invasive and robotic surgery in serving our patients and the people of Northeast Georgia.

770-535-0000 WWW.NGUROLOGY.COM

660 LANIER PARK DR, STE A & H • GAINESVILLE 5875 THOMPSON MILL RD, STE 140 • HOSCHTON


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Keep dry, itchy skin out of hot water mental to dry skin. “Do not use hot water,” says Dr. By Meredith Pruitt Misty Caudell of Dermatology mpruitt@gainesvilletimes.com Associates of North Georgia. It’s winter time, and we all “Use warm water to shower. know what that means — dry Hot water removes natural skin skin, all over. This time of year, oils more quickly.” everyone has to put a little Caudell also warns against more effort into taking care of taking too many showers too their skin. often. There are many common rem“Limit time in the bath or edies we may try: lotions, lip shower to 5-10 minutes, which balms and bath treatments. But will hydrate the skin,” she sugare these really the best ways gests. to help dry, itchy and cracked While many of us try to heal skin? our cracked knuckles and finThe first thing some may gertips, we tend to lather up think to do when lotions and the lotion this time of year. creams just won’t do the job is According to Caudell, this is take a nice, hot bath. However, Please see Skin page 15 hot water can actually be detri-


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Skin

menthol or pramoxine. These are more helpful when refrigerated. The first thing that most people want to do with this persistent itch is scratch, scratch not the best solution. Instead and scratch some more. This of lotion, a moisturizing cream only causes skin damage. A cold should be applied within three compress is recommended as minutes of showering to keep an alternative. In the summer time, we lather the moisture in. To heal those cracked, on sunscreen to protect our chapped lips, lip balm is benefi- skin from harmful UV rays, but cial. But no matter how tempt- not so much in the winter time. It is very important to rememing it is, don’t lick your lips. “Chronic lip licking can lead ber that these rays are just as to lip licker’s dermatitis,” says harmful to skin in the winter Caudell. “Always apply a lip as they are in the summer. It is balm at bedtime. It may be highly recommended to apply applied frequently during the sunscreen year-round to protect skin from sun damage. day as well.” No matter what time of year When dry skin sets in during the winter months, most it is or what the usual treatpeople notice the itching that ments are, we should always comes with it. Dermatologists take time to think about our suggest over-the-counter anti- largest organ, the skin, and proitch creams with camphor and tect it in the best way possible.

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Cold weather, trouble breathing way to protect the nasal passages. mpruitt@gainesvilletimes.com “The saline sprays are one good thing to do,” says Gill, “but During the winter, dry nasal people can also try a humidifier passages can prove to be a in the room where they sleep at nuisance for many people. The night. Another thing to consider cold weather air leads to nose would be Vaseline ointment.” bleeds and trouble breathing. ENT specialists recommend “Usually, the air is a little bit that patients put a small amount dryer,” says Dr. Matthew Gill of ointment on their fingertip of the Northeast Georgia Ear, or a cotton swab and gently Nose and Throat Institute. “It’s apply it to each nostril. It only also from the heaters. The dryer needs to be applied near the environment can lead to drying opening, to avoid swabbing too of the mucus membranes in the deep in the nasal passages. nose.” So, the next time the old nose Most people with a bleed- bleed comes around, think ing or dry nose reach for the about ways to protect your nearest bottle of saline spray. nasal passages from cold, dry However, this is not the only air. By Meredith Pruitt


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Rabies a concern for all warm-blooded animals By: Charles Phelps

mals never go outside’, but there’s always the opportunity that they can get outside if you leave the If you’re thinking of keeping a stray door open, or if something happens. animal you found, or even trying to There’s no excuse for a person not to pet it, you may want to think twice. have their animal vaccinated. If you One of these animals could be don’t care about yourself and your infected with rabies, a virus that animal, then you ought to care about attacks the brain of an animal.There’s your neighbors.” no cure once an animal is infected Aiken recommends that an outwith the virus. side dog or cat should be fed inside, “One thing people need to under- because food attracts stray animals stand in the state of Georgia, that that may be carrying the virus. (it’s) a law that you have to have your The virus can be spread between animal vaccinated for rabies,” said animals by scratching and biting, Rick Aiken, director of the Humane which releases it through saliva. Society of Northeast Georgia. “Some According to Valeri Love, veteripeople don’t understand that. It’s narian at the Humane Society of extremely important that they get Northeast Georgia, you can be bitten that. It’s very, very safe to have your by an animal that’s carrying the virus, animal vaccinated. It’s inexpensive, but the animal may not show the so there is really no reason not to symptoms. give your animal (the vaccination). Bobcats, foxes, bats, raccoons and “A lot of people say ‘well, my ani- skunks are the main carriers of the cphelps@gainesvilletimes.com

virus in the Northeast Georgia area, according to Aiken and Love. Love also said any warm-blooded animal can carry the disease, and that includes horses and cows. There are two forms of rabies: “dumb” and “furious,” according to Love. Cats, who Love and Aiken said are more at risk to get infected with dumb rabies, show symptoms of lying around and acting depressed. Furious rabies is the opposite. This is the case most people see when an animal goes into an attack and hostile position. Aiken and Love recommend that you not kill an animal that may have rabies, unless you’re in immediate danger, but rather call and allow animal control to take care of the animal so the proper tests can be administered to determine if the animal has rabies or not. Hall County rabies cases were high

in 2012 at 22, but even higher in the recent past, when there were 43 cases in 2008, according to Times archives. Love said Lake Lanier could be contributing to high numbers. “With Lake Lanier so close and a lot of Hall County around Lake Lanier, then that’s one of the reasons why there’s a high incidence of rabies (in the county),” Love said. “Lake Lanier is a primary water source.” Animal owners are encouraged to vaccinate their pets and livestock for rabies. Vaccines are available for $10 from 9 a.m. to 5 p.m. Tuesday through Friday at the Hall County Animal Shelter at 1688 Barber Road in Gainesville and from 11 a.m. to 3 p.m. Monday through Friday at the Humane Society of Northeast Georgia at 845 W. Ridge Road in Gainesville. Vaccines are also available from local veterinarians.


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Rabies can be fatal to humans

For The Times Veterinarian Dr. Valeri Love, with the help of Vet Tech Dan Sullivan, gives a rabies shot to a dog at the Humane Society of Northeast Georgia.

According to Rick Aiken, director of the Humane Society of Northeast Georgia, rabies can be fatal to humans if the infection isn’t treated in time.A person can be infected just like another animal could be, by bite or scratch. Aiken said if you are attacked by an animal you should seek medical care, either with your normal doctor or through an emergency room, depending on the severity of the attack. You should also contact animal control or an animal shelter about the attacking animal. In cases of suspected rabies medical care normally involves a series of shots that will attack the virus. If your animal is the aggressor and bites you, whether by accident or on purpose, then the animal will be quarantined. If your animal is the one attacked by another animal, it also will be quarantined regardless of whether it has had a rabies shot.


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Weight-loss regimen a preferred choice for countering diabetes By Melissa Healy

Los Angeles Times After all those well-intentioned New Year’s resolutions have yielded to the force of habit, many of the nation’s 79 million obese adults will have a day of reckoning with their primary care physicians. Lose weight and get active, the doctor will order, or risk developing diabetes. Then the MD will scribble a prescription. For most patients, the prescribed treatment will not be a pill.It will be a 12-week program aimed at preventing Type 2 diabetes by getting obese adults to shed as little as 10 pounds and exercise for a little more than 20 minutes a day. That regimen — the Diabetes Prevention Program — may soon become the blockbuster prescription medicine you’ve never heard of. In 2013, it is poised to become the envy of pharmaceutical companies, a new rival to programs such as Weight Watchers, and a target of opportunity for health care entrepreneurs. Led by a trained coach, it is a testament to the power of a mentor and of setting modest goals in spurring healthful behavior. And it may be a crucial first test of the Affordable Care Act’s focus on preventive health. In nearly 30 clinical trials, scientists have established that the program is far more effective at helping people lose weight and prevent or delay the onset of diabetes than “usual care” — essentially, a doctor telling a patient to slim down and get active, and then sending him on his way. But the program hasn’t been packaged in a form that health care providers can simply and cheaply offer to patients, said Dr. Jun Ma of the Palo Alto Medical Foundation Research Institute, who studies diabetes prevention.

The Diabetes Prevention Program is not rocket science. In 12 weekly sessions, a coach teaches obese subjects at high risk of developing diabetes to set goals for losing 5 percent to 7 percent of their body weight, limit the fat and calories they consume, track their food intake, get at least 150 minutes of exercise each week, and devise strategies to avoid gaining back lost pounds. In trials, subjects who attended the tightly scripted sessions and followed the regimen were far more likely than those who were on their own to reach their weight-loss goals in three months — and to keep that weight off for more than a year. By doing so, they drove down their risk of developing Type 2 diabetes by 58 percent, according to a landmark report published in the New England Journal of Medicine in 2002. The program, in short, is powerful medicine. “If you could take it as a pill, it would definitely be commercialized,” said Sean Duffy, a software designer and former Google employee who launched an online version of the program about a month ago. In June, a panel of physicians and public health experts that advises the Department of Health and Human Services gave the program a mighty push into everyday medical practice. The U.S. Preventive Services Task Force recommended that doctors refer their obese patients to “intensive, multicomponent behavioral interventions” designed to promote weight loss and physical activity. It cited only one that met its strict standards: the Diabetes Prevention Program. Under the Affordable Care Act, that carries significant weight. Starting in June, most health insurers will be required to make proven weight-loss and behaviormodification programs available

without a co-payment to obese customers with a doctor’s referral. No one yet knows whether expanded coverage of such programs can save money and head off a public health disaster. But without it, experts believe a tidal wave of Type 2 diabetes and heart disease — with a 20-year price tag estimated at $550 billion in the U.S. alone — is a virtual certainty. For all its promise, the program has remained little more than a good idea — and a pretty expensive one at that — for years. The researchers who developed it at Indiana University pegged the cost of the trial’s intensive 12-week phase and nine months of maintenance at about $1,300 per patient. To make it cheaper and more accessible, they trained a few YMCA chapters to deliver the program. Today, about 75 chapters in 28

states and the District of Columbia offer it. The Centers for Disease Control and Prevention, which has been charged with broadening access to “lifestyle change” programs, disbursed $6.75 million in 2012 to encourage health insurers, public health advocates and employer groups to offer versions of the program. But with more than 78 million people potentially in line to get it, demand far outstrips supply. Researchers like Ma have been working on ways to use technology to make the program more widely available. In a study published last month in the Archives of Internal Medicine, she and her colleagues found that putting the 12-week curriculum on an inexpensive DVD and assigning a coach to answer questions and Please see Diabetes page 22


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Long-distance caregivers face challenges By Pamela Yip

lives in Mobile, Ala. “I can call her and ask her how she is and at the moment, she’s Before my dad died in 2000, just fine, but what happens in the the most stressful thing for me middle of the night if she falls? was the geographical distance What is it I can do?” said Williams, between us. president and chief executive of He lived in Sacramento, Calif., Community Hospital Corp. in and I lived in Dallas. My mother Plano, Texas, which owns, mandied when I was 18, and I am the ages and consults with hospitals only child. across the country. As Dad got older and his health His sister lives in Mobile, but deteriorated, I always felt that we she’s on a walker. His brother were one step away from a crisis lives in Dothan, Ala., about three because of the 1,700-plus miles hours from Mobile. A paid carethat separated us. giver stays with their mother for Many people today face the seven hours during the day, but same predicament. she is alone at night. “Family care from a distance “If in the middle of the night, is a fact of life for millions of my mom were to call my sister, Americans,” according to “Miles I’m not sure my sister would be Away: The MetLife Study of Long- able to respond,” Williams said. Distance Caregiving.” “She would find somebody to “Clearly, we know that there are respond, but because she’s in more and more people who are a debilitative state herself, she in need of care, so it would make could not get in the car and run sense that there are more long- down and pick my mom off the distance caregivers percentage- bathroom floor.” wise,” said Kathy O’Brien, senior Here’s what experts advise you gerontologist at the MetLife do to overcome the distance: Mature Market Institute. “We know that many more people are CREATE A NETWORK: Let others caring for family members than who live in the same city as your ever before.” loved one be your eyes and ears. The steepest challenge is over“The important thing with coming the difficulty of being far long-distance caregiving is really from their loved ones. to be able to have an assessment “The big issue for long-distance and have a care plan in place caregivers is not really knowing where you know there are other what’s going on,” said Kay Paggi, people who can provide some a Dallas geriatric care manager.“A oversight whom you can contact lot of times, Mom and Dad really to get reports on how your family don’t want you to know what’s member’s doing,” O’Brien said. going on. They are used to being Paggi suggests getting to know the parent, the wise person, the your loved one’s neighbors independent person, the prob- “because those are the people lem-solver. They’re not going to who will call you.” tell you they’re falling every day, Consider getting your loved one even if you ask.” a personal emergency response For Michael Williams, not know- service pendant to wear that is ing is frustrating. He lives in equipped with an alarm button Dallas, and his 90-year-old moth- they can push. er, who has Alzheimer’s disease, “Obviously, the person who’s The Dallas Morning News

going to be first on the emergency call list is going to be a neighbor, because if Mom has punched the button by mistake, then the neighbor goes and looks in the window or has a key and says, ‘She’s fine,’ ” Paggi said.

does not get routine refills,” Paggi said. “You want to know what over-the-counter medications she’s taking, and you want to know what herbal teas or what supplemental foods she’s taking, because a lot of times they buy these and they take it and it interKEEP A LIST: “You want to make acts with some medication that a very detailed list of who her the doctor’s prescribing, but they doctors are, what their numbers never have told the doctor that are, what their fax numbers are, they’re taking that.” if they have a website that you could email, because you need to CONSIDER HIRING HELP: At know what medications she’s tak- some point, hiring a geriatric ing and you need to know what care manager may be something she’s being treated for,” Paggi said. to consider. “Every medication she’s taking “They really are most useful for should have a diagnosis that goes people who are long distance with it.” because a geriatric care manager Also, make friends with your can go into the home, they do loved one’s pharmacist. an assessment of the home and “Know who the pharmacy is and tell them to call you if she Please see Long distance care page 21


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Long distance care Continued from page 20 also of the function of the person,” said Gail Hunt, chief executive of the National Alliance for Caregiving. “The geriatric care manager can actually also put the care plan into place and supervise to see that the homemaker who’s supposed to come in actually does.” The cost for a geriatric care manager ranges from $100 to $150 an hour, Paggi said. USE THE WEB: “Find out tasks that can be done remotely like paying bills, especially if there’s online banking, getting all the

Medicare (mailings) and keeping up with what has been paid, what has not been paid,” Paggi said. If another family member in the same city as your loved one is the primary caregiver, consider paying for a housekeeper or sending any needed supplies to lessen the burden on the caregiver. “You ask the primary person what kind of tasks are you actually doing and see what could be done out of town,” Paggi said. GET LEGAL AUTHORITY: “There are three different things: housing, financial and medical,” said Brian Fant, a Dallas elder law attorney. “The two things that they would absolutely need is they need to have the appropriate powers of attorney in place so that they’re able to act on their behalf. Without that, they’re not going to be able to do anything.” That means having a durable financial power of attorney that

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would enable you to handle your elder’s financial affairs if he or she becomes incapacitated and a medical power of attorney that would empower you to make decisions about your loved one’s medical care if he or she isn’t able to so. Fant also advises caregivers to obtain from their elderly loved one a HIPAA authorization under the federal Health Insurance Portability and Accountability Act. That authorization would name the caregiver as the one who can have access to the senior’s medical information. Talk to your loved one about these issues before a crisis hits. “You don’t want to wait until there’s an emergency,” Fant said. “You’ve got to have planning, and you’ve got to have the cooperation of the parent.”

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your loved one face to face regularly. “You do have to make the commitment — if indeed you have the wherewithal to do it — that you’re going to be there on some regular basis,” Williams said. ON THE WEB: —The National Association of Professional Geriatric Care Managers has information on finding a geriatric care manager: http:///www.caremanager.org —The National Alliance for Caregiving is a nonprofit coalition of national organizations focused on family caregiving: http:///www.caregiving.org

Pamela Yip is a personal finance columnist for the Dallas Morning News. Readers may SHOW YOUR FACE: No matter send her email at pyip@dalhow much you do from afar, lasnews.com; she cannot make there’s no substitute for seeing individual replies.


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Diabetes

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health specialists worked with a TV production crew to create a reality-show version of the program. After the pilot aired last year in Philadelphia and Knoxville, Tenn., it took just three weeks to offer support helped 37 percent of get 700 people to volunteer for a obese participants lose 7 percent clinical trial of the TV-based proof their body weight — a rate more gram. The results of that will be than twice as high as for those published soon, said Dr. Deneen Vojta, chief clinical officer for the who got no help at all. In a related study published in UnitedHealth program. “These people lost a ton of the same journal, researchers gave obese volunteers a personal digital weight,” she said. The growing scientific consensus device to monitor their weight, diet and physical activity and had around the diabetes program has them check in with a coach every not been lost on one of the nation’s other week. The volunteers lost most ubiquitous and respected more weight than trial subjects weight-loss programs, Weight Watchers. With 20,000 meetings who were on their own. The UnitedHealth Group’s a week across the United States, Diabetes Prevention and Control Weight Watchers International has Alliance in Minnetonka, Minn., the infrastructure that the Diabetes has worked to make the Diabetes Prevention Program lacks. Like the Prevention Program available on diabetes program, its groups are demand to Comcast cable sub- run by coaches who give advice scribers nationwide. UnitedHealth and encouragement and teach Group physicians and public members to track their intake. The

Continued from page 18

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company has steadily added features — most recently a spate of food-tracking apps — as clinical trials showed their value. Weight Watchers has been lobbying the government to recognize its programs as an effective tool for diabetes prevention. The stakes are huge: If insurers were required to cover the costs of patients’ Weight Watchers memberships, the customer base could expand by leaps and bounds. In Britain, the National Health Service will pay for the company’s initial 12-week course, said David Kirchhoff, chief executive of Weight Watchers International in New York City. Given the program’s widespread presence in the U.S. and evidence of its effectiveness in clinical trials, it makes sense for insurers here to pay too, he said. Entrepreneurs are also getting in on the act. Duffy’s San Franciscobased startup, Omada Health, launched an online version of the

Disease Prevention Program called Prevent that may be the first of many digital spinoffs. Designed to win the CDC’s seal of approval, Prevent resembles a Facebook version of the Diabetes Prevention Program while preserving the privacy of customers who prefer it. Incoming members are matched to a group, and everyone works toward a goal of losing 5 percent to 7 percent of their body weight in 12 weeks under the supervision of a coach. Members’ weights are transmitted to the coach by a digital scale issued upon enrollment and weekly thereafter. Early testing has shown that as groups jell, members learn from — and lean on — one another, Duffy said. With fees of roughly $120 per month for four months, he plans to sell the program primarily to insurers and companies for use by their customers and employees. Payment will be due only after users show results, he said.


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HealthWatch January 2013

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