Month: January 2018

Are Allergies Preventable? You May Be Surprised

By Mark A. Kelley, MD |1/30/18
Founder, HealthWeb Navigator

Chances are you or someone you know has experienced an allergic reaction at some point. The statistics are eye-opening:

Allergies affect as many as 30% of American adults and 40% of children in the U.S. An estimated 20% of Americans have hay fever; about 4% of children and adults have a food allergy; and 10-20% of children and 3% of adults have significant skin allergies. Also common are allergies to dogs and cats.

Thankfully medical science can prevent and even eliminate some of these conditions. But how?

Our immune system is finely tuned to recognize and repel invaders, especially bacteria and viruses. An allergy develops when the body’s immune system detects a foreign protein and reacts to its presence.

Take the example of pollen. Most people have no problems with pollen. However, anyone with seasonal rhinitis (like me) suffers through the pollen season with a runny nose and cough.

Peanuts are the source of another common allergy. Most people have no problem with peanut products, but for others, peanut consumption can be dangerous. When exposed to a peanut product, these patients can develop serious breathing problems within minutes. Without treatment, this reaction can lead to life-threatening shock.

Of course, the best defense against an allergy is to avoid exposure to the agents that trigger it. Never eat peanuts if you are allergic; stay away from grass and flowers in pollen season; and give away your pet if you are allergic to it.

But sometimes these steps are impractical. For the peanut allergy, any food can be risky because peanut products are common in many foods. In pollen season, staying inside may be impossible if you work outside. As for a cat or dog allergy, patients are very reluctant to part with their pets.

Another way to fight an allergy is to “teach” the body to be more tolerant to allergens. The key is to introduce the offending proteins to the immune system in very small doses. This therapy of “allergy shots” has been around for decades. Small injections of the offending allergy protein (like ragweed) tone down the immune system so that any future reaction produces minimal symptoms. This approach is called “immunotherapy.”

For decades, this tolerance-building approach has been widely used for common allergies such as pollen and animal dander. With new technology, the allergens can now be delivered more easily, either under the tongue or orally, instead of by injection.

New evidence suggests that tolerance develops naturally in early childhood. From birth to about 4 years of age, the immune system seems to have a learning curve about how and when to react to allergens like animal dander and peanuts.

It was once thought that if children had less exposure to allergens, they wouldn’t be as likely to develop an allergy. For years, parents were advised to keep peanuts and other complex food away from children until the age of four. Similar advice pertained to exposure to pets.

Recent research has changed this thinking. New studies have shown that infants introduced to oral peanut extract before the age of one have much lower rates of peanut allergy. In other studies, children who grow up around domestic animals and pets have much lower rates of animal allergies and hay fever. This research suggests that childhood exposure to some allergens teaches the immune system tolerance and reduces the likelihood of developing some allergies.

Most mild allergies are easily treated and prevented. However, others are more serious, their therapies more complex. It is wise to discuss any allergies with your doctor and, if necessary, consult an allergy specialist.

Is Therapy Worth It? Here’s What You Should Know.

By Kay O’Laughlin, Ed.D. |1/25/18
Licensed Psychologist

Some of the reasons people start psychotherapy might surprise you. The most obvious reasons for seeing a therapist include:

• Relationship problems

Overwhelming sadness or depression

Grief over death or other serious losses

• Intense anxiety

Thoughts of hurting oneself or others

But people also choose to see a therapist when they feel stuck or lost. For example, having no sense of direction about a career path or feeling that something is missing from life.

Others decide to talk to a therapist when they realize they are using addictive behaviors to cope with stress and it’s not working. The addiction may be overeating, overusing alcohol, misusing drugs, or even compulsively over-exercising. Of course, the trap is that such behaviors create new problems instead of solving the old ones.

Therapy helps to identify negative thought patterns, misperceptions, and unhelpful behavior patterns—and then make plans for changing them.

You may wonder what therapy is and whether it really helps. Psychotherapy is generally known as “talk therapy,” though today many therapists incorporate specialized approaches such as cognitive-behavioral techniques, EMDR, guided imagery, mindfulness, and forms of deep relaxation.

Interestingly, research tells us that the most crucial factor in successful therapy is a positive connection between the client and therapist, meaning that the client feels the therapist both understands and empathizes. The American Psychological Association reported major research showing that 50% of people in therapy improved noticeably after eight sessions, and 75% improved noticeably by the six-month point. In recent years numerous rigorous studies have shown therapy has positive effects on one’s overall health and immune system.

So, in a nutshell, therapy helps most people who give it a try.

Therapists include psychologists, psychiatrists, psych nurse practitioners, social workers, pastoral counselors, and licensed mental health counselors. All of these disciplines involve licensing at a state level. Your insurance company keeps a list of providers in their network, but you should also ask whether they cover out-of-network therapists. Your doctor may be familiar with local therapists and able to recommend someone in particular.

If you need medication, a psychiatrist or psych nurse practitioner can prescribe. They may also do talk-therapy, but some prefer to work in conjunction with therapists from other fields. Often primary care doctors are comfortable with first-level medication for anxiety and depression.

All therapists help clients deal with relationship issues and solve problems. When you first meet a therapist, notice whether that person actively listens to you, seems to understand, and helps you formulate a roadmap of where you want to go and how to get there. You should feel comfortable and safe in the office environment.

One of the benefits of therapy is having time during a week devoted solely to you—how often does that happen in your busy life?

Often, people who are nervous about starting therapy soon find themselves looking forward to each session. One of the biggest surprises for many clients is how much they enjoy therapy and the sense of growing strength, clarity, and focus. I tell my new clients that the work may be intense at times, but along the way we’ll also find humor and reasons to laugh.

Are you considering talk therapy as an option? Check out these websites to help you find a therapist online.

Hospitals Take Aim at Generic Drug Companies

By Mark A. Kelley, MD |1/22/18
Founder, HealthWeb Navigator

In a previous blog, I mentioned how the prices of many generic drugs have skyrocketed. In some cases the price of a single pill has increased over 500%.

But help may be on the way. Recently several large and respected non-profit hospital systems indicated that they will “fire a shot across the bow” of the generic drug business. That would be a game-changer.

Why has the price of generics skyrocketed?

Some large drug companies have purchased (or outcompeted) generic drug manufacturers. This has created a monopoly for some widely used and long-standing products, such as the EpiPen and the albuterol inhaler. In effect, the companies can set whatever price the market will bear. In many cases, the market (i.e patients) has no choice but to accept these prices since no one else makes the drugs.

As if that strategy were not enough, some analysts have suggested another motive. By raising the price of generics and controlling the supply, monopolies could also introduce new “copycat” drugs that resemble the generics and are protected by patents. Both of these maneuvers could improve the stock market value of these drug manufacturers.

The issue is that prescription drugs operate in a market that does not include the patient. Health insurance companies negotiate drug prices and then pass them on to employers and their employees. Compared to hospital costs, most generic drugs are minor costs for the employer. Furthermore, through deductibles, any new drug costs can be passed on to the patient.

Federal regulation might seem like be a good way to solve this problem. Most other developed countries set drug prices for their national health programs. However, Congress has historically forbidden the federal government to set drug prices for Medicare. Regulating the pharmaceutical industry seems unlikely.

What can a hospital consortium do? The hospital industry spends billions of dollars on drugs to treat patients in the hospital and in ambulatory practice. Most insurance plans pay hospitals a fixed price per hospital admission. If drug prices rise, either the insurance company must pay more or the hospital loses money. Lately the drug prices have jumped, especially for generics.

On the ambulatory side, the scenario is no different. Hospitals with outpatient practices are under increased pressure to reduce costs. Among the largest is prescribed drugs.

Another problem for hospitals is the shortage of many commonly used drugs whose patents have expired. Companies simply are not interested in keeping high inventories to meet the challenges of demand.

A nationwide hospital consortium could have tremendous market leverage since these facilities care for millions of patients. Currently, the consortium has enrolled 300 hospitals. That market power could be used to negotiate reasonable prices with the pharmaceutical industry. However, such a plan is complicated and might face legal and regulatory challenges.

The other option is for the consortium to create a nonprofit company that makes generic drugs and sets fair and reasonable prices. That is bold move that would create a true free market. Generic drugs account for almost 80% of all prescribed medications.

Rather than rely on for-profit manufacturers, hospital systems and their patients would have access to the same drugs at lower prices. In effect the providers would eliminate the middleman by controlling the supply of most drug products.

It is unclear how this proposal will evolve because it threatens the status quo. There is sure to be opposition—but not from patients. They will root for any plan that protects them from more out-of-pocket spending.

We need to reduce health care costs and, for once, here is an approach that offers an innovative and sensible solution for patients everywhere.

It’s an idea whose time has come.

Why Everyone Should Get a Flu Shot (Yes, Even You)

By Mark A. Kelley, MD |1/15/18
Founder, HealthWeb Navigator

According to the Centers for Disease Control, we are in the midst of a significant flu season. Headlines tend to amplify danger, but when it comes to the flu, there is reason to worry. After all, the 2012-2013 flu season killed an estimated 56,000 Americans.

Influenza is highly contagious. Even those with mild symptoms can infect others in the first day of their illness. And once the flu virus is in the community, it can spread quickly.

There are two viruses that cause influenza: Type A and B. Type A changes its molecular appearance frequently. That means a strain that caused an epidemic one year may not be the next year’s culprit.

Sometimes a new flu strain emerges that is particularly aggressive and has a higher mortality rate. These frequent changes in the flu virus mean that humans cannot develop long-lasting immunity to its infection.

The solution is to provide a new vaccine each year that protects against the strains of virus that seem most likely to cause a new epidemic. But that prediction is imperfect. It takes six months to develop the vaccine, and in that time the targeted viruses may mutate. Some years, the vaccine hits the target and provides excellent protection. In other years—the aim is not as good.

For most healthy people, the flu is usually an inconvenient sickness from which they recover. But there are exceptions. Even healthy people can die from the flu.

Who’s At Risk and Why?

Children are particularly at risk, as are the elderly, pregnant women, and those with chronic illness. These groups account for most of the flu-related deaths every year.

So what makes the flu so deadly?

Research suggests that the flu virus can overwhelm those with weakened immune systems. Normally, our immune system fights off infection pretty well. But for children—whose immune systems aren’t fully developed—and adults over the age of 65, the immune system loses some of its effectiveness. Patients with chronic disease and pregnant women are especially susceptible to the additional stress.

These weaknesses allow the flu more time to invade the body before the immune system can stop it. The most common complication is pneumonia, which can lead to other infections elsewhere. These series of events can also lead to organ failure, long hospitalization, and even death.

Thankfully medical science is able to create the flu vaccine, reducing the flu-risk for millions of Americans.

Why You Should Get the Flu Vaccine

Here are some quick facts about this live-saving vaccine:

1. The flu shot reduces flu-related adult hospitalization by 57%, and as much as 70% in the elderly. For children, the flu vaccine reduces mortality by a whopping 65%.

2. Even if you get the flu, the vaccine will reduce the length of illness and reduce the risk of complications. And you will likely get back on your feet sooner.

3. The flu vaccine helps you protect others. If you are a healthy young or middle-aged adult, you will likely survive the flu—but you will also expose the rest of your family to the virus. Vulnerable family members are more likely to have complications from the flu, and have higher risks of hospitalization and even death. No one wants to expose loved ones to such danger.

The flu vaccine comes with little risk and protects all of us, particularly our children, the elderly, and those with health challenges. If you are healthy, the flu may not pose a great danger to you. But if you pass the virus on to someone who is vulnerable, it may threaten their life.

That alone is a good reason to get a flu shot every year.

Should I Get the Shingles Vaccine?

By Mark A. Kelley, MD |1/11/17
Founder, HealthWeb Navigator

I have seen more and more friends and patients who have suffered with shingles. For no apparent reason, a very painful rash appears, most often on the chest or abdomen. The rash eventually disappears but the pain can last for weeks.

Fortunately, this condition can be prevented.

What Causes Shingles?

Shingles can’t be “caught,” and you can’t get shingles if you’ve never had chickenpox. Both chickenpox and shingles are caused by the varicella zoster virus.

In chickenpox, the virus spreads through the body because the patient has no immunity to it. Once immunity develops and controls the virus, the patient recovers.

However, some of the virus hibernates in our nerve cells, locked away by our immune system. As we age, our immune system is not as effective in keeping the virus in check.

For some folks, the zoster virus emerges and spreads along the nerve cells, causing them to become painfully inflamed. The result is a localized rash that resembles chickenpox. Weeping fluid from the rash contains live zoster virus and can cause chickenpox in anyone who has never been exposed to zoster, such as infants.

With shingles, the body usually fights off the virus successfully. However, it takes a long time for the inflamed nerves to settle down and for the pain to subside. Ask anyone who has had shingles and you will be impressed with how disabling the pain can be.

Roughly 1 in 4 adults will develop shingles at some point during their lifetime. Those odds increase with age.

In a healthy person, shingles is usually not life-threatening, but it can lead to chronic pain or, if it affects the eye, can cause blindness. More serious complications, including death, can occur in patients whose immune systems are weakened by anti-inflammatory drugs, chemotherapy, or chronic disease.

What Are My Options?

Currently there are two injectable vaccines that can prevent shingles.

Zostavax is a single injection that delivers a weak form of varicella zoster. That exposure awakens the immune system to quickly fight off the virus. This vaccine prevents shingles in about 50% of patients, but that protection is only good for about 5 years. However, for immunized patients who develop shingles, the vaccine reduces the severity of the symptoms.

Shingrix is a new vaccine that was engineered to look like the zoster virus to our immune system. Since it is not a real virus, it cannot cause any infection. The vaccine requires two separate shots and may be more effective than Zostavax. In numerous trials, the Shingrix vaccine has protected over 90% of elderly patients from shingles for about 8 years. Zostavax, on the other hand, has protected only half of similarly aged patients. Shingrix is approved by the FDA but will not be available until later this year.

Is the Shingles Vaccine Right for Me?

The CDC’s current recommendation is that every adult over the age of 60 should be immunized with Zostavax, whether or not they have had chickenpox. The reason is that most American adults have antibodies to varicella, suggesting they were once infected with the virus. There has been no consensus on whether to recommend periodic booster shots. Younger patients with immune systems weakened by disease or treatments may also be considered for the vaccine.

These recommendations may change to favor the newer vaccine Shingrix, because it appears to be more protective. No formal policy has yet been published, although one is expected later this year.

The retail price for both vaccines is about the same. The single shot of Zostavax costs about $220, and the two shots of Shingrix together are estimated to cost about $240. Insurance or discount coupons may cover some or all of this cost. It pays to check with your insurance company and shop around.

I think the shingles vaccine makes sense for most patients over the age of 60. It substantially reduces the risk of developing a very painful condition that can last weeks. We now have one—and soon two—safe, effective vaccines.

Consult your physician to see if and when the shingles immunization is right for you.

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