The FDA warns that the popular antibiotic sold as Zithromax, Zmax and Z-Paks can cause abnormal and sometimes fatal heart rhythms. A study was conducted over 14 years. In the 5 days of using the drug, patients were 2.5 times more likely to die from heart disease, compared to patients taking other antibiotics or none at all. Although the cause is unknown, the study suggests the drug may have an effect on the electrical activity of the heart. Patients with underlying heart conditions or low blood levels of potassium or magnesium are most likely to be at risk.

May-Jun 2013 CMA Today

The American Academy of Pediatrics has released a new set of guidelines for dealing with lice. The updated recommendation state that children with lice infestation should not be kept out of school, because the condition is not life-threatening or even very serious, and children can only transmit an infestation by sharing hats, combs or pillows.

Some school have ‘no-nit’ policies that state children are not allowed to return until all nits are removed. Will be interesting to see if policies change. Warning children of the transmission methods is a good way to protect their scalps.

In a healthy individual, antidiuretic hormone (vasopressin) is produced in the hypothalmus, stored in the posterior pituitary & secreted to maintain serum osmolality. DI results from an abnormal decrease in secretion or action of ADH. Central DI occurs when osmoreceptors located on the hypothalmus become damaged and serum osmolality can’t be maintained. In some cases it can result when the posterior pituitary can’t release ADH. Central DI can be transient, permanent or most often triphasic. The first phase of the latter lasts 4 to 5 days & is characterized by polyuria; the second phase lasts 5 or 6 days & is associated with antidiuresis as stored ADH is released; during the third phase ADH is no longer released & if not treated can lead to permanent DI.

Nephrogenic DI occurs if the kidney becomes resistant to ADH’s urine concentrating properties and is less common. It is usually related to lithium use or hypercalcemia in adults.

The signs & symptoms are the same & include polydipsia (excessive thirst), polyuria (excessive urination, more than 3 L/day), decreased urine specific gravity & decreased urine osmolality. The individual may also show signs of dehydration, restlessness & agitation due to hypernaturemia. Treatment is aimed at identifying the underlying cause of the condition.

So, a few causes of central DI include neurotrauma, cerebral anneurysm; tuberculosis, syphilis, toxoplasmosis, encephalitis, meningitis; sarcoidosis; Wolfram syndrome, and anorexia nervosa. Nephrogenic DI may be caused by medications such as amphotericin B, phenytoin, corticosteroids, anticholinergics, rifampin and aminoglycosides; alcohol; hypercalcemia or hypokalemia; sickle-cell disease, multiple myeloma, polycystic kidney disease and others.

Interesting article in January Nursing 2010

A will is the future of anything that a person values- not only money and property but also pets and token mementos  When someone dies without a will, the estate is divided in probate court, where a judge decides who gets the assets.

A power of attorney is a designation that gives another party the ability to make both legal and financial decisions in the event that a person is unable to do so. Without this document, a spouse may not automatically be able to tap funds to pay for long-term care or sell a home that the couple owned jointly.

Advance health directives include a living will, a health proxy and a HIPPA release. The living will gives written instructions on the degree of life-sustaining measures that should be taken. A health proxy appoints another party to make health-related decisions in the event that a person is unable to do so. A HIPPA release is a document that allows another person access to someone’s medical records, which is useful for insurance claims.

Other decisions that people should make about their future include; having an authorized user on bank and investment accounts and thinking about long-term-care insurance.

March 2013 realsimple.com 

The reason vitamin D has become such a hot topic in the last few years is the recent discovery that many cells in the body have a vitamin D receptor and the belief that vitamin D also plays a role in modulating the immune system. If you have sufficient levels, you are better able to fight infection and less likely to acquire autoimmune diseases, heart disease and some common cancers.

For thousands of years, we depended on the sun for required vitamin D. But for the past three decades dermatologists have been telling people to avoid direct sunlight because of skin cancer.  Add an increase in children playing indoors and you get a worldwide deficiency pandemic.

The minimum amount of vitamin D needed is 600 IU per day for an average adult.  The author of this article recommends 1500 to 2000 IU.

Most adults should assume they are deficient. The author advises that if you are obese, if on antiseizure medicines, have a gastrointestinal or intestinal-malabsorption problem or a granuloma disorder, you consult a provider prior to taking a supplement.

The vitamin D our body nmakes when it absorbs sunlight is a good source, so the author suggests sensible sun exposure in addition to taking supplements and eating food supplements with vitamin D. Ask yourself how long it takes you to develop a mild sunburn, then go outside for half that time two to three times a week between 10 and 3 during the warm months. Expose your arms and legs, but always protect your face. Skin pigment is a natural sunscreen, so those with dark-skin should stay out longer than fair-skinned people to absorb sunshine. For example Indian people tend to need two to four times more exposure and African Americans may need 5 to 10 times more.

April 2013 Realsimple.com

Many years ago, Schatzki described a smooth, benign, circumferential, and narrow ring of tissue in the lower end of the esophagus. These rings are located just above the junction of the esophagus with the stomach. These rings are very common, occurring in more than 6% of the population. The cause of these rings is not clearly understood, although some doctors believe they are caused by long term damage from stomach acid reflux.

The majority of these rings cause no symptoms, and patients are unaware of their presence. When the opening of the esophagus becomes smaller as the diameter of these rings shrink, solid, poorly chewed food that stays in chunks can get caught at the level of the ring. This occurs when the diameter of the ring reaches approximately 1 cm. The patient then experiences chest pain, or sticking sensation in the chest with swallowing (dysphagia). If the chunk of food passes into the stomach, these symptoms subside quickly and the patient can resume eating. If the food does not pass into the stomach, some patients have to induce regurgitation of the food by sticking their finger in the back of their throat before they can resume eating.

medicinenet.com

Program students participated in the Skills USA competition and won first place in Medical Terminology and Medical Math and placed in other areas. Leah and Brandice are on their way to Nationals!

Students and faculty prepared meals for children in Nicaragua or Haiti. Supposedly we packaged enough to feed 46 children three meals a day for a year!

CMA Today SeptOct 2010 reports that adults should eat a daily serving of fruit (2 cups). Fruit is packed with vitamins, minerals and dietary fiber that help ward off heart disease, diabetes, stroke and cancer. Fruits also contain phytonutrients which are naturally occurring compounds in plants that serve as antioxidants helping cells repair themselves, as well as reducing dangerous effects of free radicals. Free radicals are naturally occurring molecules that can damage cells and induce inflammation in the lining of the blood vessels. So, eat fruit.

Clinic providers have made changes in policy regarding fasting blood work. Unless your provider specifies otherwise, you will not need to fast for your lab or office visit.

There are very few tests that require a 12 hours fast. Two of the most common include a lipid panel and glucose. The lipid panel has four components and only the triglycerides are affected by one’s fasting status.

In 2008 the AHA concluded that lipid profiles change minimally in response to normal food intake.

For diabetic patients, fasting is not required to check glycosylated hemoglobin A1C. This test gives a snapshot of glucose levels over a 3 month period.

If your provider does request fasting blood work drink plenty of water, you can have beverages that contain no calories, take medications as usual with water unless you are diabetics then your diabetic meds should not be taken prior to a blood draw and bring a small snack to eat after your blood is drawn.

Spring 2013 Monitor by Entira Family Clinics