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Influenza & Pneumococcal Vaccines

Your best shot for a healthier life!

The Influenza Vaccine

Why should I get the influenza vaccine?
Influenza is a serious disease that is caused by a virus. The influenza virus is spread from infected persons to the nose or throat of others, and in the U.S., the "flu season" is from November to April each year. Influenza can cause fever, cough, sore throat, headache, chills, and muscle aches. Usually these symptoms last for only a few days, but some people may get much sicker and may even require hospitalization. Complications of influenza include pneumonia, myocarditis, or death. To help decrease the risk of catching the influenza virus, patients at risk should receive the influenza vaccine.

Who should be immunized?
Before receiving an immunization, you should check with your physician. Generally, people at risk for getting a serious case of influenza or complications (or people in close contact with them) should get the vaccine. These include:

Seniors 65 or older

  • Residents of long-term care facilities housing persons with chronic medical conditions
  • Anyone who has a serious long-term health problem with anemia (or any other blood disorders), asthma, heart disease, kidney disease, lung disease, or metabolic disease (such as diabetes)
  • Anyone whose immune system is weakened because of cancer treatment with x-rays or drugs, HIV/AIDS or other diseases that affect the immune system, or long-term treatment with drugs (such as steroids)
  • Anyone 6 months to 18 years of age on long-term aspirin treatment
  • Women who will be past the 3rd month of pregnancy during the influenza season
  • Physicians, pharmacists, nurses, family members, or anyone else coming in close contact with people at risk of serious influenza


Others who should consider getting influenza vaccine include:

  • People who provide essential community services
  • Students and staff at schools and colleges
  • Travelers to the Southern hemisphere between April and September, or those traveling to the tropics any time
  • Anyone who wants to reduce their chance of catching influenza


Who should not receive the influenza vaccine?

There are some people who should not receive the influenza vaccine. They are:

  • Anyone with an anaphylactic (life-threatening) allergy to eggs
  • Anyone experiencing moderate to severe illness at time of immunization (including moderate to severe diarrhea, vomiting, or ear infection)
  • Anyone who has had an anaphylactic reaction to a previous dose of the influenza vaccine


When should I get the influenza vaccine?

The best time to get the influenza vaccine is between September and December; however, the Centers for Disease Control and Prevention has announced a delay in the availability of the vaccine until late October 2000. A new shot is needed each year. People 9 years of age and older need one shot. Children less than 9 years of age may need two shots, given one month apart.



What is the cause of the delay and potential shortage of influenza vaccine?

One of the influenza virus components used to make the vaccine has not grown as well as expected and may cause a shortage of the vaccine. Additionally, two of the manufacturers of the vaccine are experiencing manufacturing problems.


What does the CDC recommend in response to the expected delay and possible shortage of influenza vaccine?

The CDC recommends that the influenza vaccination of individuals at high risk for complications from influenza and their close contacts should proceed routinely during regular health care visits after the vaccine becomes available.


The Pneumococcal Vaccine (PPV)


Why should I get the pneumococcal vaccine?

Pneumococcal disease is a serious disease that causes much sickness and death. In fact, pneumococcal disease kills more people in the U.S. each year than all other vaccine-preventable diseases combined. Pneumococcal disease can lead to serious infections of the lungs (pneumonia), the blood (bacteremia), and the covering of the brain (meningitis). About 1 out of every 20 people who get pneumococcal pneumonia dies from it, as do about 2 people out of 10 who get bacteremia, and 3 people out of 10 who get meningitis. Drugs such as penicillin were once effective in treating these infections, but the disease has become more resistant, making treatment of pneumococcal infections more difficult. This makes prevention of the disease through vaccination even more important.


Who should be immunized?

Before receiving an immunization, please contact your physician. Generally, the following people are candidates for the vaccine:

  • Adults 65 years of age and older
  • Anyone over 2 years of age who has a long-term health problem, such as alcoholism, cardiomyopathy, cardiovascular or pulmonary disorders (including congestive heart failure), cerebral spinal fluid leaks, chronic liver disease (including cirrhosis), COPD or emphysema, diabetes mellitus, or sickle cell disease
  • Anyone over 2 years of age who has a disease or condition that lowers the body’s resistance to infection, such as damaged spleen or no spleen, Hodgkin’s disease, immunosuppressive conditions (including HIV infection or AIDS), kidney failure, lymphoma, leukemia, multiple myeloma, nephritic syndrome, or organ transplantation
  • Alaskan Natives
  • American Indians

How many doses of the pneumococcal vaccine are needed?

Usually only one dose is needed; however, under certain circumstances a second dose may be needed. A second dose is recommended for those people 65 and older who got their first dose when they were under 65 (if 5 or more years have passed
since that dose).

A second dose is also recommended for people who have the following:

  • A damaged spleen or no spleen
  • Sickle-cell disease
  • HIV infection or AIDS
  • Cancer, leukemia, lymphoma, multiple myeloma
  • Kidney failure
  • Nephritic syndrome
  • Organ or bone marrow transplant
  • Taking medication that lowers immunity (such as chemotherapy or long-term steroids)

Children age 10 and younger may get this second dose 3 years after the first dose. Those older than 10 should get the second dose 5 years after the first dose.

Who should not receive the pneumococcal vaccine?

The following people should not receive the pneumococcal vaccine:

  • Anyone experiencing moderate to severe illness at time of immunization (including moderate to severe diarrhea, vomiting, or ear infection)
  • The safety of the pneumococcal vaccine in pregnant women has not yet been studied. There is no evidence that the vaccine is harmful to either the mother or the fetus, but pregnant women should consult with their doctor before being vaccinated. Women who are at high risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible.






Glaucoma

Glaucoma is the second most common cause of blindness in the United States. Glaucoma affects approximately 2 million Americans, but only half of these people realize they have glaucoma. Many times there are no symptoms until after eye damage has occurred and the vision is diminished.

Glaucoma is a condition characterized by progressive damage to the optic nerve in the eye. The optic nerve carries the images seen in the eye to the brain. Damage to the nerve causes a reduction in peripheral vision. As the disease worsens, blindness may occur.

Glaucoma is often caused by an increase of the pressure within the eye. This is called increased intraocular pressure. The pressure builds up in the eye when the clear fluid called the aqueous humor in the eye, is prevented from draining from the eye properly.

Greatest Risk Factors

  • Anyone over the age of 60
  • African-Americans over the age of 40
  • Family history of glaucoma

Other Risk Factors

  • Increased intraocular pressure (IOP)
  • Previous eye injury, long-term steroid use, or nearsightedness
  • Diabetes

Diagnosis of Glaucoma
Because most people with glaucoma experience no symptoms, it is very important to have frequent eye examinations for early detection.

The American Academy of Ophthalmology recommends everyone to have regular eye exams, but those with a higher risk for glaucoma should have more frequent exams.

The American Academy of Ophthalmology recommends an eye examination... ...If you
Every 3 to 5 years
  • Are age 39 or older
Every 1 to 2 years
  • Are age 50 or older
  • Have a family member with glaucoma
  • Are of African-American heritage
  • Have had a serious eye injury
  • Are taking steroid medications

Each doctor may perform different tests to detect glaucoma. Some of these tests could include:

  • Tonometry - the tonometer measures the pressure in the eye. There are two ways this can be done.
    1. Applanation tonometry - After the eye is numbed with drops, a plastic prism is lightly pushed against the eye in order to measure the intraocular pressure.
    2. Air tonometry - A puff of air is sent into the cornea to measure the pressure.
  • Gonioscopy - A special lens in placed on the eye to see if there is something blocking the drainage of the aqueous humor.
  • Visual Field Test - A visual field test allows the doctor to know how a person's vision has been affected by glaucoma.
  • Ophthalmoscopy - This allows the doctor to look directly through the pupil at the optic nerve. The color and appearance of the optic nerve can indicate if there is damage.

If glaucoma is suspected in a patient, the patient is usually referred to a practitioner who is either a member of the American Academy of Ophthalmology (AAO) or the American Optometric Association (AOA). These organizations have guidelines established for the management of glaucoma and the patient will be treated using these guidelines.

Types of Glaucoma
There are four major types of glaucoma:

  • Open-angle glaucoma
    Open-angle glaucoma is the most common form of glaucoma. It accounts for about 60-70% of all glaucomas. Usually both eyes are effected, but not necessarily equally. This type of glaucoma is a progressive deterioration of the optic nerve due to the slowly increasing pressure in the eye. There are generally no early symptoms present with this type of glaucoma. By the time the patient is aware of the failing vision, the degree of damage to the nerve is significant.
  • Angle-closure
    Angle-closure accounts for about 10% of all glaucomas. As a person gets older, the lens of the eye grows larger, resulting in the decreased ability of the aqueous humor to pass through the angle between the iris and the cornea. In some acute cases, the space can become completely blocked causing the intraocular pressure to rapidly increase. If this happens, optic nerve can damage within hours of onset.
  • Secondary glaucoma
    A previous injury or other diseases of the eye causes secondary glaucoma.
  • Congenital glaucoma
    Congenital glaucoma is present at birth and is a result of abnormal development of the structures of the eye. This type of glaucoma is hereditary and is corrected by surgery

Treatment of Glaucoma
There is no cure for glaucoma; however, it can be controlled. In most cases, medication is used to control glaucoma, but in some cases glaucoma surgery may be used to help treat the glaucoma. To prevent loss of eyesight, those with glaucoma will probably need to continue treatment for the rest of their lives. It is very important to let the doctor know if any change in vision occurs.

Medical Treatment
In most cases of glaucoma, medication will be tried first to lower the intraocular pressure or to improve the fluid drainage. The medication may be a topical product such as eye drops, inserts, or ointments or oral medications such as pills. Many times a combination of products is used for the treatment.

Topical Medications

Brand Name

Generic Name
Miotics
Carboptic®
Carbachol
Pilocar®, Pilostat®, Pilopine®, Ocusert®
Pilocarpine
Humorsol®
Demecarium

Phospholine Iodide®

Echothiophate

Carbonic Anhydrase Inhibitors

Trusopt®

Dorzolamide

Azopt® Brinzolamide

Sympathomimetics

Iopidine®

Apraclonidine

Epifrin®

Epinephrine

Propine® Dipivefrin
Alphagan® Brimonidine
Beta-Blockers
Betoptic® Betaxolol
Ocupress® Carteolol
Betagan® Levobunolol
OptiPranolol® Metipranolol
Timoptic®, Betimol®

Timolol

Prostaglandin analogues

Xalatan®

Latanoprost

Rescula® Unoprostone


Oral Medications
Brand Name Generic Name
Carbonic Anhydrous Inhibitors
Daranide® Dichlorphenamide
Diamox® Acetazolamide
GlaucTabs®, Neptazane® Methazolamide

When administering an eye drop, the patient should be taught to press his/her finger in the inside corner of the eye near the bridge of the nose to prevent systemic absorption
of the drug.

If more than one medication is being put in the eye, they need to be separated by at least
5 minutes.

Possible side effects from the medication could include:

  • Stinging or redness of the eyes
  • Blurred Vision
  • Headache
  • Changes in pulse, heartbeat, or breathing
  • Change color of iris (if using a prostaglandin analog)

Most of these side effects are not serious, and may disappear after a while. It is important for the patient to discuss any side effects with the physician.

Surgical Treatment
If the physician decides that surgery is necessary, the surgery may be either laser surgery or conventional surgery.
Laser - Most laser surgeries can be performed in the ophthalmologist office. Eye drops will be placed in the eye to numb the eye before the procedure. The recovery period from laser surgery is only a short time.
Conventional - Conventional therapy is used when laser surgery is not feasible. The recuperation time is longer than with laser surgery and there may be some restrictions after the surgery.

Some patients may still need to use glaucoma medications even after surgery because the surgery may not entirely correct the problem.

Protecting Your Vision
Glaucoma is a common disease that can effect many people. Frequent routine eye examinations are essential for early detection of the disease. If glaucoma is detected and treated early, it can usually be controlled before major vision loss occurs.

For More Information About Glaucoma...
The American Academy of Ophthalmology - www.aao.org/public/glaucoma
The American Optometric Association - www.aoanet.org
The Glaucoma Foundation - www.glaucoma-foundation.org
The Glaucoma Research Foundation - www.glaucoma.org













Challenges of Weight Management

Ninety-seven million adults in the US are considered to be overweight or obese. Since 1960, there has been an increase in the
percentage of people that are considered overweight or obese. Currently, 54.9% of people age 20 or older are considered to be
either overweight or obese. Ethnic groups, lower socioeconomic groups, and those with less education have been found to be more
likely to be overweight.

Why does obesity occur? The main reason obesity occurs is that more food is eaten than is burned off. To lose off one-pound/week
500 calories per day need to be decreased from the total caloric intake. Factors that help to promote obesity include a genetic
predisposition for obesity, an inactive lifestyle, and a high fat diet.

Why does it matter if we're overweight or obese? Obesity raises the risk for high cholesterol, high blood pressure, and diabetes.
Other risks associated with obesity include strokes, heart disease, arthritis, respiratory problems, and certain types of cancer.
Weight loss helps to decrease the risk for these conditions. Weight loss also improves self-image, confidence, mood, energy,
and endurance.

BMI, Body Mass Index, is used as an indicator of obesity. This measurement takes into account body weight and height.
To calculate your BMI:


Weight (kg)/Height (meters2)=BMI

OR

(Weight (lbs.)/Height (inches2))*705


Many web sites have a calculator that will determine your BMI for you. One such web site is Shape Up America!
(http://shapeup.org/bmi/start.htm).
Your BMI can also be determined from a chart like the one shown below.

W

100

105

110

115

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145

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155

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185

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215

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245

250

HT

                                                             

5'0"

20

21

21

22

23

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25

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29

30

31

32

33

34

35

36

37

38

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49

5'1"

19

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25

26

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27

28

29

30

31

32

33

34

35

36

37

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47

5'2"

18

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27

28

29

30

31

32

33

34

35

36

37

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45

46

5'3"

18

19

19

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21

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28

29

30

31

32

33

34

35

35

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44

5'4"

17

18

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21

21

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26

27

27

28

29

30

31

32

33

33

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43

5'5"

17

17

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22

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25

26

27

27

28

29

30

31

32

32

33

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40

41

42

5'6"

16

17

18

19

19

20

21

22

23

23

24

25

26

27

27

28

29

30

31

31

32

33

34

35

36

36

37

38

39

40

40

5'7"

16

16

17

18

19

20

20

21

22

23

23

24

25

26

27

27

28

29

30

31

31

32

33

34

34

35

36

37

38

38

39

5'8"

15

16

17

17

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

5'9"

15

16

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

32

33

34

35

35

36

37

5'10"

14

15

16

17

17

18

19

19

20

21

22

22

23

24

24

25

26

27

27

28

29

29

30

31

32

32

33

34

34

35

36

5'11"

14

15

15

16

17

17

18

19

20

20

21

22

22

23

24

24

25

26

26

27

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30

31

31

32

33

33

34

35

6'0"

14

14

15

16

16

17

18

18

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20

20

21

22

22

23

24

24

25

26

26

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28

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30

31

31

32

33

33

34

6'1"

13

14

15

15

16

16

17

18

18

19

20

20

21

22

22

23

24

24

25

26

26

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30

30

31

32

32

33

6'2"

13

13

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15

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17

17

18

19

19

20

21

21

22

22

23

24

24

25

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30

30

31

31

32

6'3"

12

13

14

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15

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17

18

19

19

20

21

21

22

22

23

24

24

25

26

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28

29

29

30

31

31

6'4"

12

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13

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15

15

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18

18

19

19

20

21

21

22

23

23

24

24

25

26

26

27

27

28

29

29

30

30

Being overweight is defined as a BMI from 25 to 29.9 kg/m2 while obesity is defined as a BMI equal or greater than 30 kg/m2.

The American Heart Association dietary guidelines are listed in the table below, and the USDA Food Guide Pyramid is also shown
below.

FAT <30% of total calories
SATURATED FAT <10% of total calories
POLYUNSATURATED FAT 8-10% of total calories
MONOUNSATURATED FAT 10-15% of total calories
CHOLESTEROL <300 mg
PROTEIN 10-20% of total calories
SODIUM 2400 mg
FIBER >30 gm
TABLE 1. Recommended daily dietary intake


USDA Food Guide Pyramid




Tips and facts about weight loss

  • Physical activity such as walking 30 minutes a day most days of the week is beneficial in weight loss and keeping the weight off
  • Physical activity is different from exercise. Physical activity includes housework, climbing stairs, walking across a parking lot
    to work, etc.
  • More than two pounds of weight loss a week is considered unhealthy
  • No less than 1,200 calories should be consumed by women daily and no less than 1,500 calories should be consumed by
    men daily to ensure that proper nutrition is maintained.
  • Five servings of fruits and vegetables a day add health benefits as well as increasing the amount of fiber eaten daily which
    makes you feel full
  • Eating fat-free and low-fat foods are better choices than food containing more fat, but calories still need to be taken into account
  • By only weighing yourself once a week you have a better chance of not becoming overly encouraged or discouraged
  • Food logs and portioning are types of behavior modification that can aid with weight loss

Fad diets - how can you tell?

To tell if a diet is a fad diet several things could be looked at. First, there are not any foods that burn fat. The way to burn fat is to
increase physical activity or decrease the amount of food consumed. Secondly, bizarre quantities of only one food or type of food
can cause a dietary imbalance and are a tip that it is a fad diet. Rigid menus, specific food combinations, rapid weight loss, and a
lack of warnings for people who have diabetes or highs blood pressure are also tips that it is a fad diet. Before starting a diet consult
a health care provider such as a physician, pharmacist, or dietician.

Herbals, Over the Counter Medications, and Nutritional Supplements - are they safe?

Herbal teas that contain senna, aloe, buckthorn, or other laxatives derived from plants can be harmful if used in excess for weight loss.
These products may cause diarrhea, vomiting, nausea, stomach cramps, chronic constipation, and even death. Ephedra
(Ma Huang), Ephedra plus Guarana, and St. John's Wort (hypericum perforatum) have also been used for weight loss.
THERE IS NOT A GREAT DEAL OF SAFETY AND EFFICACY INFORMATION ON THESE PRODUCTS
AND THEY ARE NOT REGULATED BY THE FOOD AND DRUG ADMINISTRATION
. Furthermore, these products
have been associated with dizziness, increased blood pressure and heart rate, heart attacks, and seizures. Chromium picolinate,
garcinia cambogia, chitosan, and conjugated linoleic acid have also been purported to be effective in causing weight loss.
However, there is not any evidence to back up these claims.

The use of laxatives for weight loss is dangerous and chronic use of these agents can lead to colon or heart problems. Over the
counter medications for weight loss are not very effective and can have serious effects when used in patients with diabetes, heart
disease, high blood pressure, or thyroid disease.


Prescription Medications

The most common medications indicated for weight loss include phenteramine (Fastin Weight loss is not a quick process.
Losing weight takes time and will power. However, weight loss can help prevent some of the morbidity associated with obesity.

Useful Web Sites

http://www.obesity.org

http://www.naaso.org

http://www.deliciousdecisions.org/ee/wbd_easy_main.html

American Heart Association Dietary Guidelines

http://www.americanheart.org/catalog/Health_catpage5.html

American Heart Association Dietary Recommendations



High Cholesterol

Cholesterol is a naturally occurring substance found in the diet as well as made by the liver. Cholesterol is necessary for the production of bile salts and steroid hormones. It is also used in the structure of cells and is essential for life.

Because cholesterol and other fatty substances are insoluble in water, they combine with proteins to form a soluble lipoprotein complex. The three major lipoproteins are very low density lipoprotein (VLDL), low density lipoprotein (LDL), and high density lipoprotein (HDL).

VLDL particles carry about 15-20% of the total serum cholesterol and most of the triglycerides. LDL particles contain about 60-70% of the total blood cholesterol. LDL particles carry cholesterol to blood vessels where it can be deposited and cause coronary heart disease (blockage of heart vessels). HDL particles carry cholesterol from the cells of the body to the liver for breakdown. Therefore, high concentrations of HDL particles are beneficial and protective against the formation of coronary heart disease.

The National Cholesterol Education Program (NCEP) was established in 1993 and offer recommendations for therapeutic options in treating high cholesterol. Additionally, this program lists risk factors for coronary heart disease. Ideal cholesterol levels can vary depending on other diseases (i.e. diabetes) and number of risk factors present.


Risk Factor for CHD
Positive Risk Factors:

Men: Age 45 years & older

Women: Age & older

Women with premature menopause
without estrogen replacement therapy

Family history of premature CHD

High blood pressure

Smoking

Diabetes

Negative Risk Factors:

HDL cholesterol higher than 60mg/dl
Ideal Cholesterol Levels
Total cholesterol < 200 mg/dl

HDL > 35mg/dl

LDL < 130mg/dl

Triglycerides < 200mg/dl

The first step in treating high cholesterol is usually nutritional modification and increasing physical activity. The dietary changes involve decreasing saturated fats and cholesterol consumed and increasing the intake of complex carbohydrates and fiber. Since many patients will need extensive revisions in their dietary habits, a registered dietitian can help in defining a new diet plan. The American Heart Association set up a two-part guideline diet.

Dietary Component:


Total Fat

Saturated Fat

Polyunsaturated Fat

Monounsaturated Fat

Carbohydrates

Cholesterol
Recommended Intake:
Step I



8-10% of total calories







<300 mg/day

Step II

<30% of total calories

<7% of total calories

<10% of total calories

<15% of total calories

>55% of total calories

<300 mg/day <200 mg/day


Often the entire family has to change it cooking and eating habits. Family involvement is an important factor to help the lifestyle changes stick. The following is a list of helpful cooking tips that can useful in the transition to healthy cooking.

To Lower Total Fat:

Select lean cuts of red meat
(Beef-round, eye, tenderloin)
(Pork-tenderloin, center cut)

Use reduced fat lunch meats
(<3 grams of fat per ounce)

Choose meats or fish packed in water instead of oil

Remove visible fat from soups, stews, and mixed dishes after chilling

Prepare a non meat meal using beans
or legumes once a week

Saute in broth or water instead of fat
To Reduce Saturated Fat & Cholesterol:

Limit red meat to 3 times a week

Use cholesterol-free egg substitutes or egg whites in place of whole eggs
(2 egg whites = 1 whole egg)

Instead of butter, solid shortenings, or meat
fat use sunflower, corn, soybean oil or margarine

Polyunsaturated fats (walnut oil) should be
used more than monounsaturated fats
(olive or canola oil)


Medications are available to help lower cholesterol levels. They work at different points in the cholesterol process. When medication therapy is added, the nutritional modifications and physical activity still must be followed.

The HMG CoA Reductase Inhibitors also known as "Statins"

  • atorvaststatin (Lipitor®)
  • simvastatin (Zocor®)
  • pravastatin (Pravachol®)
  • lovastatin (Mevacor®)
  • fluvastatin (Lescol®)
  • cervistatin (Baycol®)

These medications inhibit a certain step in the body’s production of cholesterol. Using these drugs can lower your body’s production of cholesterol.

HINTS and Reminders:

-The statins are to be taken at bedtime (or after the evening meal) because your body makes most of its cholesterol during the night. The only exception is Lipitor® which can be taken anytime during the day.

-It is recommended that you do not drink grapefruit juice one hour before or two hours after taking these medications.

-Let your doctor or pharmacist know if you experience any muscle pain while taking a statin. This is especially true if you are taking more than one type of cholesterol-lowering medication.

Fibric Acid Derivatives

  • clofibrate (Atromid S®)
  • gemfibrozil (Lopid®)
  • fenofibrate (Tricor®)
  • colesevelam hydrochloride (Welchol ® )

Your body has to process the fatty foods you eat. There are certain chemicals that digest the triglycerides (fats) that you ingest. Fibric acid derivatives enhance the rate at which the triglycerides are broken down. Therefore your triglycerides are decreased in addition to your total cholesterol.

Hints and Reminders

-Fibric acid derivatives can increase blood sugar. If you have diabetes, make sure you are testing the blood daily so you know how it is affecting control of your diabetes.

-Let your doctor and pharmacist know if you experience muscle pain

Bile Acid Sequestrants

  • cholestyramine (Questran®/Questran Light®)
  • colestipol (Colestid®)

Your body converts cholesterol into bile through various chemical reactions. These drugs keeps the bile in the intestines and are excreted in the feces. The amount of bile in the digestive tract is lowered so your body needs to use more cholesterol to make more bile.

Hints and Reminders

-These medications can cause stomach upset

-If you can not tolerate the texture of the powder, ask your doctor about changing to the tablet form

-Take other medications one hour before or two hours after the bile acid sequestrants because they can cause a decreased absorption of the other medications

-Drink plenty of fluids with the powder and tablet formulations

Nicotinic Acid

  • Niacin (Niaspan®/Nicolar®)

No one is sure exactly how niacin works to decrease cholesterol. It’s mechanism of action is similar to fibric acid derivatives.

Hints and Reminders
-Flushing and itching are common adverse effects of this drug, especially during the first two weeks of therapy. Often it is recommended that you take aspirin before taking the niacin to avoid this. However check with your doctor or pharmacist to make sure this is appropriate.
-Niacin can be bought over the counter but it can have serious effects. Please ask your doctor before buying this yourself

Benecol® Take Control®
Benecol® and Take Control ® are margarines that contain an ingredient that inhibits the absorption of cholesterol into the bloodstream.

Hints and Reminders
-Use three times a day with meals. The product will not work properly if it is used inconsistently

Garlic

Garlic is a member of the lily family that has been reported to lower cholesterol and blood pressure. The active compound, allicin, causes the distinctive odor and is suspected to be responsible for the health benefits. The evidence that garlic lowers cholesterol is based only on case reports. Due to this controversy, ask your doctor before taking a preparation of this herb. The FDA does not regulate herbal products so be cautious.

Fiber

Recommendations for dietary fiber for adults are 20 to 35 grams per day or 10 to 13 grams of dietary fiber per 1,000 calories. Fiber lowers LDL (bad cholesterol), but does not have any effect on the HDL (good cholesterol). Individuals with higher initial cholesterol levels tend to respond more favorably to soluble fiber (sources include oats, peas, legumes or beans) than those with lower cholesterol. Fiber is thought to decrease cholesterol by binding to and increasing the excretion of bile acids. Always look for products that list the amount of soluble and insoluble fiber because soluble is the only fiber that effects cholesterol. Add fiber slowly to your diet because it can act as an irritant if you increase the amount too quickly.




ALLERGIES

By Katrina Kalb, PharmD. Candidate
March 2, 2001

GENERAL INFORMATION:

The medical term for allergies is allergic rhinitis. The term hay fever or pollinosis is also used to describe the condition. Allergic rhinitis affects more than 30 million children and adults in the United States (20% of the population). There are two types.

  • Perennial - chronic; through the year
  • Seasonal - symptoms occuring during particular times of the year

This condition is caused by the immune system being over sensitized to certain substances. Normally, the immune system protects the body from harmful toxins, bacteria or viruses. An allergy occurs when the body reacts to substances (allergens) that are usually harmless and do not cause an immune response. Antibody production is triggered when an allergen enters the body of a person with a sensitized immune system. Histamine and other chemicals are released by tissues as part of the immune response which causes itching, swelling and mucous production.

CAUSES:

People are not born with allergies, but those with a family history are more likely to develop symptoms spontaneously after repeated exposure to allergens such as:

  • Dust mites feces
  • Pollen-tiny particles from trees, grasses and weeds

- The pollen count represents the concentration of pollen in the air in a certain area at a specific time. Pollen counts are the highest in the early morning on dry, breezy, warm days.

  • Molds
  • Animal dander
  • Common in patients with a family history of hives, asthma and/or eczema (skin rashes/dry skin)

SYMPTOMS:

Sneezing
Watery eyes
Coughing due to postnasal drip
Itching of the nose or eyes
Irritability
Runny nose

TREATMENT:

Non drug
Avoidance is the most effective treatment, but other suggestionsare:
1) use air conditioning in the summer
2) keep doors and windows closed
3) wash bedding in water that is 130 degrees F to kill dust mites
4) limit outdoor activities during peak times

- grass: afternoon and early evening

- ragweed: early midday

- mold spores: some peak in damp/rainy weather and others during warm, dry, windy condtions

Drug Treatment

CLASS
(examples)
SYMPTOMS CONTROLLED SIDE EFFECTS NOTES

Antihistamines
(Benadryl,
Chlor-trimeton, etc.)

Decrease itching, sneezing and nasal secretions Drowsiness, dry mouth Over the counter antihistamines cause sedation and drowsiness, but non-sedating antihistamines (only available by prescription) cause less side effects as their name suggests. Do not drink alcohol with antihistamines.

Decongestants
(Sudafed)

Alleviate nasal stuffiness and blockage Increased heart rate and blood pressure; insomnia Nasal decongestants should not be taken over 3 days. Products containing Phenylpropanolamine (PPA) were taken off the market by the FDA late last year due to a study which showed an increased risk of stroke with PPA, especially women.

Intranasal corticosteriods

(Nasacort AQ, Rhinocort AQ, Flonase, Nasonex)

Decrease inflammation. Control sneezing, itching, runny nose and congestion Headache, Increased risk of respiratory infection Usually take 2-3 weeks before maximum effect

Mast Cell Stabilizers
(Intal)

Inhibits substances that cause the immune reaction Local irritation Useful in preventing symptoms
Immunotherapy (allergy shots) regular injections of the allergen in increasing doses that may desensitize the patient to the antigen.
Swelling at the injection site and more serious, life threatening reactions can occur (anaphylaxis) Not for patients with compromised immune systems. Expensive. Reserved for patients with a strong history of severe symptoms and do not show an adequate response to drug therapy.

Intranasal Anticholinergics

(Atrovent)

Controls runny nose Headache, nose bleeds, nasal dryness

TAKE HOME POINTS
  • When you see "Nondrowsy" on a over the counter label, that means it contains no antihistamine
  • Always check with your pharmacist or physician before taking an over the counter product because some allergy products should not be used in patients with heart disease, diabetes or thyroid problems
  • Follow the package warnings. Over the counter antihistamines cause sedation and patients should NOT drive or operate heavy machinery while taking them
  • READ READ READ labels. You are ultimately responsible for your health. Be informed.
  • Do not share medications.

FOR MORE INFORMATION

National Institute of Allergy and Infectious Diseases www.niaid.nih.gov
Asthma and Allergy Foundation of America www.aafa.org
American Academy of Allergy, Asthma and Immunology www.aaaai.org



Flu Vaccine

Information about the Influenza Vaccination (Flu Vaccine)

Why do I need a flu vaccine?

Influenza can be a serious illness and may lead to death. The flu vaccine is one means of protecting yourself against the flu virus or if you do get the flu, the course of the illness will often be a milder case. Everyone can benefit from the flu vaccine, however those at high risk should be vaccinated first.

When is “flu season” and when should I be vaccinated?

Flu season is usually from November to April. The optimal time for vaccination in the high-risk population is October through November, however you can receive the vaccination throughout the entire flu season.

Who is considered high risk?

The populations that are considered high risk and should be vaccinated each year include:

  • People who are 65 and over
  • Residents of long term care facilities and people who are taking care of the residents

People (children and adults) with on going health problems which includes:

  • Asthma or other lung problems
  • Kidney diseases
  • Heart disease
  • Diabetes
  • Anemia
  • Other blood related disorders, such as HIV/AIDS or anyone who is taking chemotherapy
  • Other diseases or medications that affect the immune system
  • Children/Adolescents (ages 6 months to 18 years of age) who are on long-term aspirin therapy
  • Pregnant women who will be at least 3 months pregnant during the flu season-Recommended by Centers for Disease Control and Prevention but these women should be vaccinated by their OB/GYN physician

Who else should receive the vaccination?

It is highly recommended that people over the age of 50, health care workers, and children and adults who live with or take care of those who are at high risk should receive the flu vaccine.

Who should not receive the vaccination?

Talk with your physician before receiving the vaccination if you have an allergy to eggs, have had a serious reaction to the vaccine in the past or have a history of Guillain-Barre Syndrome. If you are ill or have a fever, it is recommended that you wait to get the vaccine when you are well.

Can I still get the flu even if I have been vaccinated?

There are different types of influenza and the vaccination does not cover all of them. The vaccination will cover those that are felt to be the most common forms of influenza; therefore it is possible to still get the flu even though you have been vaccinated. The importance of this is that people who have been vaccinated will often have a much milder case than those who have not been vaccinated.

Can I get the flu from the vaccine?

No, the virus from which the vaccination is made is dead. Currently this is the only type of influenza vaccination approved in the United States.

Where can I get more information?

Ask your pharmacist or physician. You can also visit the Centers for Disease Control and Prevention (CDC) web site at www.CDC.gov. Or call them at 1-800-311-3435.