Internal Medicine Blog

The Mind and Skin Connection

By: Allison Andrews, NP

Often, conditions of the skin can have a psychological aspect that also needs to be addressed. Research has shown that mental illness, stress and other psychological factors can activate or worsen skin conditions.      

Did you know that the skin is the body’s largest organ? It is a protective barrier that helps the body fight against injury and inflammation. The skin is involved in many complex biological processes, including the brain and nervous system. The brain and nervous system influence the skin’s immune cells through various receptors. When you are facing chronic negative stressors, research suggests it disrupts the function of the skin’s protective barrier, potentially leading to or exacerbating a skin condition.

Only in the past several decades have we seen the resurgence of the mind-body awareness in medicine; and only in the past decade have we seen an emphasis on understanding the interaction between the mind and the skin. Psychodermatology is a holistic view within the medical world looking into the cause and effect relationship of the mind and skin. Psychodermatologic disorders often fall into three different categories:

Psychological skin conditions are usually chronic conditions and can often be exacerbated by stress and other emotional factors.

-       Acne
-       Alopecia Areata
-       Eczema
-       Hyperhidrosis
-       Pruritis          

Secondary Psychiatric skin conditions, due to their visibility, can erode one’s self esteem, leading to social phobia’s and depression.

-       Severe Acne
-       Psoriasis
-       Vitiligo

Primary Psychiatric skin conditions are symptoms of a psychiatric disorder and recognizing them is important in the treatment of a mental illness.

-       Trichotillomania (chronic hair pulling)
-       Delusional Parasitosis
-       Body Dysmorphic Disorder
-       Dermatitis Artefacta (self-inflicted picking, cutting)

When treating all skin conditions, it is important to know that not everyone responds emotionally through the skin, nor do all people react the same way to having a skin condition. But, evidence has suggested in patients with psychological issues that intersect with a skin condition, treating both the mind and skin offers the best chance for improvement. Like I tell all my patients, take ten minutes to relax and meditate, stick to a healthy diet, go for a walk in the park; your mind and skin will thank you for it. 

Hispanic Heritage Month

With September being Hispanic Heritage Month, we would like to take this opportunity to review some facts about health trends among Hispanics by sharing  both reassuring statistics as well as risks. These statistics are the result of  factors including genetic, environmental, social, and economic, which encompass diet, risk for disease, and access to healthcare services and education. An individual’s personal characteristics and behaviors will also affect their risk.

Traditionally, Hispanic people are less likely to eat processed foods, oils, fats and sugars when compared to White Americans. This diet typically includes lots of grains, beans, fresh fruit and vegetables. They also take in a higher amount of fiber compared to White Americans. Hispanics are 14% less likely to be smokers and tend to have 35% less heart disease and 49% fewer occurrences of cancer.

However, it is also important to also focus on less healthy trends, in order to understand risk and work towards prevention. 24% of Hispanics-Americans, when compared to White Americans, have a harder time controlling their blood pressure and are more likely to be overweight. They are also 50% more likely to be diabetic. Tuberculosis is also prevalent in foreign-born Hispanics resulting in more chronic lung damage than caucasians. Evidence suggests that the poorer socio-economic positions of some ethnic groups is the main driver of ethnic health inequalities. One quarter of Hispanics in the U.S. live under the poverty line. This can result in families being unable to obtain foods used in their native diets, especially families living in regions known as ‘food deserts’ where fast and processed foods are more readily available than fruits, vegetables and lean meats.

Keeping in mind the already present favorable medical statistics, these socioeconomic disparities can be mitigated with a little more support and food education It should also be noted that the diverse cultures of Latin America also make it difficult to pinpoint specific problems and recommendations for Hispanic-Americans as a whole; not only is this due to cuisines specific to a particular country but also the genetic strengths associated with multiple generations of Latin-Americans eating the same locally available foods for hundreds of years. In fact, some studies have demonstrated that moving away from traditional cuisine towards ‘American food’ has negatively impacted the health of young Hispanic-Americans the most. The consumption of more high-sodium fast foods (big offenders are mozzarella sticks, and fried chicken and fish) and simple sugars (high fructose corn syrup, sodas, breakfast cereal) has been a major factor in worsening the health of hispanic-americans. For patients who already have diabetes, the cultural shift can tip a controlled diet into one that is uncontrolled and results in complications such is foot, eye and kidney disease. Likewise, a high-sodium diet in an already overweight patient can be the difference between normal and hypertension and the heart disease to go along with it.

Another cultural shift noticed in hispanic americans as opposed to their counterparts in Latin America is a shift to 3 meals a day - Mexicans in particular typically eat 4-5 meals a day so a shift to 3 meals a day may impact the total amount of calories being consumed leading to obesity. Another shift is breastfeeding which is less prevalent in the U.S. than most Latin American countries - immigrating families may move away from initiating breastfeeding which may have an impact on higher child obesity rates. The exclusion to this is Puerto Rico: the island actually has lower breastfeeding initiation rates than in the U.S.! Therefore families whose ancestors immigrated to the U.S. may start initiating breastfeeding more than their counterparts in Puerto Rico.

Overall, the health status of the Hispanic community shows good roots and a promising future. Hopefully with more focus on health education and weight-loss support, we should begin to see positive changes and a marked degree of improved health in the Hispanic-American population. To our Hispanic patients - please take this month as an opportunity to review your health - schedule a physical with one of our primary care providers. If your diet is not what you would like it to be, remember we have two lovely registered dietitians available to evaluate your food choices and make recommendations that can work for you. As mentioned previously, local Latin-American cultures have evolved to be healthy in their environment, so harness the knowledge of your ancestry to help you make healthy food choices in the future!

8 Steps to A Healthy Pregnancy

By: Lauren O'Brien MD

It is never too early to start thinking about optimizing your health for a future pregnancy.  Whether you are currently trying to conceive or still years away from babies, knowing this important information will help guide your path to pregnancy.

  1. Talk With Your Doctor About Preconception CareDuring an office visit, we can discuss the topics presented here, but also tailor a preconception-plan especially for you.  It is important that existing medical conditions (such as depression, anxiety, high blood pressure, diabetes and asthma) be well controlled before pregnancy.  All prescription and over the counter medications should be discussed with your doctor as some could be unsafe during pregnancy. At this visit, we could also screen for sexually transmitted diseases and be sure you are up to date with vaccinations, especially rubella and varicella.  Finally, a review of any genetic illnesses or abnormalities present in a family should be done and referral to a genetic counselor made, if necessary.
  2. Healthy Diet
    When planning for pregnancy you are “eating for two”, but in quality, not quantity.  It is important that you maintain a diet high in fruits, vegetables, lean proteins and whole grain carbohydrates.  Avoid simple sugars and high fat foods.  Though fish can be an important source of healthy Omega 3s, when planning for pregnancy we must be careful of the type and quantity of fish consumed.  Steer clear of tilefish, king mackerel, shark, and swordfish as they are known to contain high levels of mercury.  Limit tuna to 6 oz per week and salmon to 12 ounces per week.  Do not consume raw seafood or meats and be sure all hot dogs and lunch meats are heated to steaming before eating.  Having calcium and Vitamin D in your diet is important, but be sure all dairy products are pasteurized.  Finally, keep caffeine to 300mg per day or less, which comes to about 2 cups per day.

  3. Avoid Toxins
    When planning pregnancy it is important to avoid tobacco, nicotine, recreational/illegal drugs and alcohol.  It is also best to avoid certain chemicals including those in paint thinners, paints, and insect and weed killers.  Individuals with pets in the home should refrain from changing cat litter or cleaning cages from rodents.
  4. Prenatal Vitamin
    All women contemplating pregnancy should start a prenatal vitamin containing 400-800mcg of folic acid once daily at least 3 months prior to trying to conceive.
  5. Achieve a Healthy Weight
    Make exercise a priority BEFORE getting pregnant. Plan to work up to 30min of exercise 5 times a week for optimal results.  Exercise is encouraged once you are pregnant as well. It helps to keep weight gains during pregnancy in an acceptable range.  Talk with your doctor to see if the types of exercise you are doing are appropriate for pregnancy.
  6. Learn to Relax
    Knowing how to handle the everyday stresses of life is important at all times of life, but never more so than when pregnant.  Trying to conceive, pregnancy and early motherhood are all very stressful times in a woman’s life and we need the tools to keep that stress under control.  Having family support, a trusted friend or a therapist can be helpful.  In addition, yoga, mindfulness meditation and progressive relaxation can help those stressful times feel more manageable.  
  7. Detoxify Your Enviornment
    This is the perfect time to think about changing out highly chemical and toxic products in your home for more natural ones.  
  8. Get Your Partner Involved As Well
    Male partners contribute half of the baby’s genetic material.  A man’s sperm can be damaged by alcohol, drugs, tobacco, caffeine and toxins.  Making sure his health is optimized is extremely important.  Female partners need to be a strong support for a pregnant mom and set the tone for a healthy family, so making sure everyone is in the best health possible is a priority.  Partners should visit their own doctors for a check-up as well.

What You Should Know About Hepatitis

July 28th is World Hepatitis Day, created to raise understanding and awareness of what viral hepatitis is and what can be done about it.

Viral hepatitis is a term referring to any of several infections that attack your liver and cause damage to its’ cellular structure. The viruses we usually refer to when discussing viral hepatitis are: Hepatitis A, B, C, Delta and E. There are, however, other viruses that cause liver inflammation and, reversely, these five viruses can also cause damage and symptoms outside of the liver.

Viral hepatitis typically presents as an acute infection – there are some cases that are ‘subclinical’ meaning patients do not even have obvious symptoms and may go through an infection without ever knowing they had it! More commonly, however, patients present with symptoms including: fatigue, loss of appetite, nausea, vomiting, and jaundice (yellowing of the skin due to buildup of bilirubin – a pigment that your liver removes from the bloodstream when it is functioning properly). Very rarely, severe cases can even progress to liver failure, brain disease and may be fatal.

Many cases of acute hepatitis resolve within days, weeks or months. However, sometimes acute hepatitis can progress into chronic infection (this only happens with types B, C and Delta). Most often (85% of adult cases) this happens with Hepatitis C. In fact, infection with Hepatitis C can very often present only subclinically with patients experiencing only some fatigue and indigestion. Of course, the concern with these asymptomatic patients is that they may be spreading the infection without being aware of it.

The Delta virus is actually a co-infection that is only present along with Hepatitis B virus. Its presence is usually an indicator of more severe or chronic hepatitis B infection. It spreads through contact with infected blood (through injection or sexual contact)

Hepatitis A is spread primarily through infected food, water or close physical contact with another infected person. It is most common in areas with poor sanitation, such as developing countries or amongst injection drug users. This infection only presents as an acute illness and does not progress to chronic infection.

Hepatitis E is similar to A in that it does not progress to chronic infection and is typically spread through contaminated water, although you can also get this infection by eating contaminated animal products or transfusion of infected blood. This infection is most common in Asia. This infection is most dangerous for pregnant women – the virus can cross the placenta and infect the fetus. Due to immune system changes during pregnancy, pregnant women are more at risk to have severe consequences such as liver failure. Infection in the 3rd trimester can be fatal.

Hepatitis B is transmitted through infected blood or bodily fluid contact – this means both sexual and percutaneous transmission is possible. In some developing countries, dentists with inadequate sterilization equipment can be a source of infection. In general, since hepatitis B can live outside of the body for up to 7 days, any kind of intervention can potentially introduce the virus. This form of viral hepatitis can also develop into a chronic infection; an estimated 240 million people worldwide have chronic hepatitis B. Children under 6 years of age are most likely to develop chronic hepatitis B if they are infected.

Hepatitis C is a blood borne infection – you can only get it through unscreened blood transfusion, unsafe injection practices or unsterilized medical equipment. It can also travel through the placenta of an infected mother and cause infection in her baby. This form of hepatitis can be considered the most dangerous since it can often go undetected for decades as a chronic, asymptomatic infection.

Can hepatitis be cured?

We now have the medications available to clear most patients of their viral hepatitis. Most of the viral infections require only supportive therapy – making sure patients are hydrated and other symptoms – such as nausea and vomiting are reduced. Anti-viral therapies have been shown to be helpful for severe or chronic cases of Hepatitis B. We also now have treatment targeted at Hepatitis C that has made this infection curable as well.

Of course, with severe forms of hepatitis, patients have to be well enough to respond to available medications and fully recover. Some patients will also have irreversible damage from the infection, such as liver failure. Therefore, the best thing is to never become infected in the first place!

What can I do?

First and foremost you should know your status. Get tested for hepatitis B and C to ensure that you are not an asymptomatic carrier of this infection – knowing your status is the best way to protect your partners and future children.

If you are travelling out of the country, schedule a travel visit to find out if your travels will be through an area where Hepatitis A and E are common – this will alert you to be mindful of sanitation shortcomings, make sure you do not eat undercooked food or water that has not been sterilized.

If you are an injection drug user, please use safe practices by not sharing needles. You should also be mindful in any place that uses needles – if you are getting tattoos or piercing, make sure your provider uses proper sanitation techniques.

Healthcare workers are a special risk category for hepatitis infection since they are in contact with patients all the time. For this reason, make sure you are always using proper protection equipment (masks, gloves, eye shields) when working with patients.

Lastly, and most importantly – get vaccinated. Hepatitis A vaccines are available for patients travelling to endemic areas to make your trip worry-free. Hepatitis B vaccinations are available starting from birth! You can get your newborn vaccinated before they ever leave the hospital. Remember – Hepatitis B can live for up to 7 days outside of the body, so your baby can be at risk anytime they are in need of medical intervention – by vaccinating your baby, you can remove this risk-factor entirely. Healthcare workers who have not been vaccinated, should also get the vaccine series so that you can be safe and secure in your work. There is also a vaccine for Hepatitis E in China that will hopefully soon be available worldwide.

Viral hepatitis can be a mild inconvenience for some patients and a life-changing consequence for others, however, now that we have new treatments available, it is no longer a death sentence. Protect yourself by knowing your status and your options – schedule an appointment with one of our providers today!

What You Should Know About Hives

By: Monica Duvall, M.D.

 are raised, red, itchy patches of skin (also called Urticaria, welts, or wheals) that can be frustrating to experience.  Hives are commonly caused by a number of triggers, and figuring out the cause is sometimes challenging.  Hives can be the result of allergies to medicines like penicillin, or to foods like nut, soy, or shellfish.  They can be caused by viral, bacterial, or parasitic infections (especially in children), by physical contact with substances like plants (such as poison ivy or poison oak) or latex, and by insect bites or stings.  Some people can even develop hives in response to less obvious triggers, such as exposure to temperature changes, or pressure on the skin.  Regardless of the cause, treatment ofhives is usually initiated with medications called antihistamines (Loratadine, Cetirizine, Benadryl); in more resistant or diffuse cases, a short course of oral steroids may be used to reduce the swelling, itching and inflammation.  

Occasionally, hives are accompanied by a more serious type of allergic reaction called Angioedema.  Angioedema causes swelling of the face, eye area, hands feet or genitals.  This can be treated with the same medications as hives, but angioedema should always be evaluated by a health care professional to make sure it does not progress to a more serious type of allergic reaction.  Other complications of hives that require emergent attention include hives that are accompanied by throat closing or breathing difficulty; nausea, vomiting or abdominal pain; or passing out--these symptoms will not respond to regular antihistamines alone.

Although typically hives will be a self-limited affliction, with lesions coming and going in minutes to hours, and episodes lasting for a few days, in some cases, they can last for  weeks.  If hives last for six weeks or more, they are called chronic hives.  This type of hives is more difficult to manage, and often, a cause if not found.  Symptoms will usually resolve over several months, however.  Generally, hives can be successfully managed by avoidance of triggers and prompt treatment of outbreaks.  For more information about this and other skin issues, ask you health care provider.

IV Nutrient Therapy

By: Phil Kim, M.D.

Nutrient Intravenous Infusion is a concept pioneered in the 1970s by John Myers, MD, a physician from Baltimore, Maryland. These infusions are a great means to provide essential nutrients and vitamins to patients who cannot absorb them naturally or to obtain higher concentrations than could be achieved by oral means alone. A good example of this is Vitamin C which may have antiviral and antibacterial properties at concentrations higher than would be expected with regular meals. Over the past 50 years nutrient intravenous infusions have been developed to treat a variety of clinical conditions. Millions of these infusions have been used to treat patients worldwide.

Myers’ original solution has now been modified to treat symptoms related to asthma, migraines, fatigue, fibromyalgia, acute muscle spasm, upper respiratory tract infections, sinusitis, seasonal allergic rhinitis and fluid dehydration. For chronic problems, patients may receive a number of  treatments until their condition improves. It is important to note that although intravenous nutrient therapy is not meant to ‘cure’ any illnesses, it can give patients an extra boost to help fight infections, relieve pain or give you the feeling of a little additional energy to continue to recover. We all know how important it is to ‘feel’ better when we are ill, even if this does not mean we are recovered. The way we feel helps give us the strength to continue!

Under the direction of physicians, intravenous infusions are currently offered in a safe manner in an outpatient setting. Each infusion can be individualized for a specific patient’s needs. Following insertion of a small IV, the infusion takes only 30-45 minutes. We will be offering a wide range of formulations for our patients to take advantage of including hangover recovery, jet lag, fatigue and stress relief, dehydration treatment, migraine relief, cold and flu remedy, vitamin boost and hydration, a beauty enhancement formula, and a treatment to maximize athletic performance. If you’re feeling under the weather or need an extra boost, IV Nutrient Therapy may be just the thing for you! Call our office to schedule today! Services are available on Sundays from 8am till 2pm.

On the Brink of Sexual Assault Awareness Month

By: Catherine McGinty, NP

April is Sexual Assault Awareness month, so we wanted to take the time to go over this tough issue that far too many women encounter. Many people think of sexual assault as “rape,” but what most people think of as rape is only just one form of sexual assault. Sexual assault comprises of sexual acts performed by one person on another without consent through intimidation or force. This can happen when someone is cognizant, or if the victim is passed out, drunk, or on drugs and not able to make decisions for herself. People can be sexually assaulted by strangers or people they know, such as family members.

Sexual assault is very common. In the United States, one in three women will be a victim of sexual assault during her lifetime and only 10 to 15 percent of sexual assaults are reported to the police. The number of cases that are reported decreases when the woman knows their assailant.

Sexual assault can be traumatizing and debilitating, but with the appropriate resources, it does not have to be overwhelming. The first thing you should do after a sexual assault is find a safe place away from the person who attacked you, then:

  • Call a close friend or family member. Choose someone who will give you support no matter what.
  • Call 911, go to the emergency room, or call a provider here. In the emergency room, a doctor or nurse can do an exam and make sure you are OK. They can take samples of cells or fluid from your body and clothes. These samples can show who your attacker was and what he or she did.  You do not have to let the doctor or nurse do anything you do not want. We do not have the test kits available in our office to get DNA samples, so we would make sure to refer you to the appropriate center to have that done. Either way, either a provider here or at the emergency room will be able to offer you medicines that can reduce your chances of getting pregnant or an infection. Emergency contraception can work 5 days after being raped, but it works better the sooner you take it, so don’t wait. If you are older than 17, you can get some forms of emergency contraception without a prescription.
  • Do NOT try to clean up before you see a doctor or nurse. If you clean up, you might wash away proof of what happened.  This includes:
    • do not change clothes
    • do not take a shower or bathe
    • do not brush your teeth
    • do not wash the inside of your vagina or rectum (in other words, do not douche)
    • If you can wait, try not to go to the bathroom or to eat anything until after you have seen a doctor or nurse
  • Seek emotional support- someone you can talk to about what happened. We have therapists at our practice who are good resources to talk to after any traumatic event. Other options include your primary care provider, a crisis counselor, a social worker, or a sexual assault nurse examiner.
  • Talk to your provider or counselor about filing a police report. If you do not want to report the assault, you do not have to, but people often change their mind later. Either way, it could be helpful to talk to one of the providers here or a counselor. Evidence is most useful when it is collected right after the assault.  
  • Return to our office 1 to 2 weeks.  This will give us a chance to do any follow up lab work that is needed and to make sure you are doing Ok.
  • Protect others if you might have an infection For at least 3 months after being raped, if you have sex with someone, use a condom every time. This will reduce the chance that you will spread any infections you might have caught. Also, wait at least 3 months before trying to get pregnant. That way, you can find out before you get pregnant if you have an infection that could hurt the baby.
  • If it has been awhile since you have been attacked, please schedule an appointment with us anyway. It doesn’t matter if we cannot collect proof of the attack. We will be able to test and treat you for infection or pregnancy, and help you recover from the event. We can also provide you with resources to help you if you decide you would like to report the event.
As always, please contact one of the providers here for any concerns of assault or rape.

Additional resources available in the event of any sexual assault are:

  • The Sexual Assault Hotline 1-800-656-4673
  • Women Organized Against Rape: Philadelphia’s Rape Crisis Center 215-985-3333
  • Pennsylvania Victims Compensation Assistance Program (VCAP) to receive compensation for expenses incurred as a result of a crime or 1-800-233-2339

Signs & Symptoms of Lead Poisoning

By: Maria Mazzotti, D.O.

Lead poisoning presents with very non-specific symptoms such as abdominal pain, constipation, irritability, anemia, difficulty concentrating and especially in children, developmental delays, learning difficulties and vomiting. Although it seems to be more prominent in children than in adults, repeated slow exposure in adults can also be very critical. Lead exposure in adults can lead to increased risk of hypertension, renal damage and cognitive decline if gone undetected.  

Children are more likely to get it by inhaling or swallowing lead in dust.  It may also be in paint chips in houses built before 1978.  We have also learned that certain toys that are manufactured outside of the US contain lead. Finally, we were recently reminded that water that travels through lead piping could also carry dangerous amount of lead particles.

Interestingly, in adults it seems to be more likely to occur in men than women, due to occupational exposure such as in the manufacturing of batteries, cable wires, car radiators and batteries, cosmetics, tin cans, glazes, paints and ceramic ware. Obviously, if you are remodeling an older home you should be wearing a mask. It is important to tell your physician if you work in any of these environments.

It is even more important if you are pregnant or breastfeeding. If there is concern, the blood from the baby’s umbilical cord should be tested at birth or the baby’s blood at 2 weeks. Since lead poisoning can also be transmitted through breast milk, and if there is concern, it is recommended that mom and baby be tested.

Lead poisoning can be prevented. Obviously, if you are aware of lead in your house, there are lead abatement professionals that can come into the house to eliminate the lead. Nutritionally speaking, you can have a diet rich in calcium, vitamin D and iron to prevent lead poisoning. Children especially should take a multivitamin with iron on a daily basis.  

When your lead levels are high enough, you will need to undergo a treatment called Chelation. Chelation involves taking a medication that helps the elimination of lead from your body. It is important to keep in mind that since Chelation does not reverse the long-term effects of lead on learning and intelligence, patients should only be treated if they are no longer exposed to the lead environment.  

Water Quality & Lead in Philadelphia

The recent controversy in Flint, Michigan, has many wondering if lead contamination could be affecting them here in Philadelphia. According to the Philadelphia Water Department, even with skepticism surrounding testing methods, it is highly unlikely that a crisis of a similar magnitude could take place here in Philadelphia. Even so, we will share with you some resources and methods to reduce the risk of lead poisoning for you and your family.

Philadelphia’s drinking water is sourced from the Delaware and Schuylkill rivers. It is monitored and regularly tested throughout the treatment process before it reaches your faucet. This includes a corrosion control treatment to help reduce the amount of lead leached from pipes and testing for more than 100 contaminants, including lead. The Philadelphia Water Department also does lead-specific tests in more than 50 “vulnerable” homes that may have lead exposure or  lead pipes. The results help to determine if the corrosion control treatment technique is successful and verify that there is a minimal amount of lead leaching from the plumbing. Current tests shows these levels are minimal and that Philadelphia’s water quality continues to meet all State and Federal standards.

However, there is some skepticism with the way the Water Department tests for lead, saying that current testing may mask the problems. This controversy states that the testing of water differs from the way residents use tap water, and true levels are not represented in results. The removal of the aerator, a small filter,  and “pre-flushing” running cold water to clean out the system prior to testing, alter results and make levels seem safer than they are. The Philadelphia Water Department has responded saying flushed samples are not what is tested. Guidelines state residents in high-risk homes to flush their faucets in an effort to clean their pipes of the chemical, not as a method to rid potential samples of it. Increased interest in Flint and questions about Philadelphia’s water quality has led Councilwoman Helen Gym to hold  future hearings to discuss prevention of a Flint level catastrophe happening here. Gym says, "I don't think Philadelphia is Flint, but, we need to be vigilant."

There are many ways to reduce you and your family's risk of lead contamination. If you’d like to get your water tested, at-home tests are available from home improvement stores, but may not be accurate. The EPA recommends using a certified laboratory for testing. Lists of approved labs in the Philadelphia area are available from the Pennsylvania Department of Environmental Protection. Call 717-346-7200 to find a lab close to your home. Most labs will either send out a testing kit or schedule a test at your home. The PWD can also send someone to test your home.

Warm water increases the chances of leaching from your pipes, so before use, run the faucet on cold for a few minutes to flush any lead and bring fresh water into your pipes. When using tap water for drinking and cooking use cold water as well. You could also filter your water, unfortunately, commonly used filtered water pitchers may not do much to remove lead. A reverse osmosis filter is recommended if you suspect you may have lead contamination. Remember, even if you have lead plumbing it does not mean you have high levels of lead in your water, due to the city’s methods of preventing lead corrosion.

If you’d like to help the residents of Flint, Michigan, there is a multiple ways to do so. There are a number of established organizations bringing aid to those residents that are accepting donations, including The Flint Water Fund by United Way of Genesee County, The Flint Child Health & Development Fund of The Community Foundation, Catholic Charities of Shiawassee and Genesee Counties, and other organizations like Water We Fighting For. You could also support the research team, Flint Water Study, aiming to keep the residents informed about what is really happening with their water. Last but not least, you could sign the petition asking Gov. Rick Snyder to stop making Flint residents pay for poisoned water!

Shingles: What You Need To Know

By: Dr. Lauren O’Brien MD

We have all seen the commercials. A patient in obvious pain is shown with a terrible looking rash over a significant portion of his or her body. They are asking questions such as “why me?” and “what could I have done to prevent this?”. These patients have been diagnosed with shingles, and the suffering pictured can be accurate. Here’s what you needs to know about this disease and how to prevent a severe outbreak.

Shingles, also know as Herpes Zoster, is caused by the Varicella Zoster Virus (VZV). This is the same virus that causes chicken pox (varicella). After a patient has had the chicken pox or received the varicella vaccine, the VZV continues to reside in the nerve roots indefinitely. The VZV can then be reactivated, leading to a case of shingles. Any patient who has had the chicken pox or the Varicella vaccine is therefore at risk for shingles.

While most severe cases are seen in patients over the age of 60, shingles can occur at any age. Generally, individuals will only have one case of shingles in a lifetime, but recurrent cases are possible. Those who are immunocompromised are at higher risk of recurrence.  

The hallmark symptoms of shingles are pain and rash. Approximately 75% of patients have pain prior to the rash developing. This pain is usually described as burning, throbbing or stabbing and can occur days to weeks prior to skin lesions.  

The shingles rash starts as red papules (bumps) and evolves into grouped vesicles or blisters. After about 3-4 days the lesions may become pustular and will crust over at 7-10 days. Once these lesions are dry and crusted, the patient is no longer contagious. Because the virus resides in the nerve roots, the rash tends to involve a limited area on only one side of the body. The most dreaded shingles infection involves the trigeminal nerve located in the head. Infection here can lead to Herpes Zoster Opthalmicus, which can be sight-threatening. An individual with this manifestation will have lesions around one eye and the tip of the nose.

The most common complications of shingles include: post-herpetic neuralgia and bacterial superinfection of the skin lesions. Post-herpetic neuralgia is pain that persists at the sight of the rash for months to years following infection. It occurs in 5-20% of those with shingles and is more common in patients over the age of 60.

When discussing shingles with patients, the most common questions I hear relate to transmission and contagiousness of this disease.  Let me try to break it down simply for you. You cannot give someone else a case of shingles. The VZV can be passed from contact with the skin lesions and is generally not airborne in an individual with shingles. Only people who have not had chicken pox or the varicella vaccine, or are immunocompromised are at risk when in contact with a shingles patient. If one of these individuals comes in contact with the active shingles lesions, they could go on to develop chicken pox, but NOT shingles. I am often asked about pregnant women and exposure to shingles. If the pregnant woman has had chicken pox or the vaccine in the past, there is very little risk present. That being said, I would recommend that a patient with an active shingles infection avoid infants, pregnant women and the immunocompromised until lesions have crusted over. It is advised to keep the rash covered and wash hands frequently to prevent transmission.

For older patients, there is a vaccine available to help prevent shingles. Though this vaccine will not prevent 100% of cases, it has the potential to reduce the severity of an infection and prevent the dreaded post-herpetic neuralgia. This vaccine is recommended in patients 60 and over (though it is FDA approved for those over 50). It can and should be given even if a patient has had a history of shingles. Talk with your doctor to see if the shingles vaccine is right for you.

In summary, the vast majority of the population is at risk for shingles. It is most common in older patients and those with weakened immune systems. The VZV responsible for this disease can be transmitted through contact with the skin lesions, but only those who have not had chicken pox or the varicella vaccine or the immunocompromised are at risk. If you are older than 50 talk with your doctor about getting the shingles vaccine.

NCQARittenhouse Internal Medicine™ has received the highest recognition from the National Center for Quality Assurance (NCQA). What this means for our patients

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