Archive for November, 2009

Diabetes and Influenza

Friday, November 20th, 2009

It may not be obvious why diabetes and influenza are related, but they are. One disease has to do with blood sugar and the other is an infection caused by a virus. They are related, however, and not in a good way.

People with either type 1 or type 2 diabetes who get the flu are at increased risk of hospitalization and death. The CDC says they are almost 3 times more likely to die of influenza. Diabetes can weaken your immune system, allowing the virus to damage your lungs more severely. A recent study of patients who became severely ill with influenza H1N1 showed that diabetes was the fourth most common risk factor, behind lung disease, obesity, and high blood pressure.

What should you do right now to protect yourself from influenza if you have diabetes?

First, get both the H1N1 and the seasonal influenza vaccines. Get the injection version, not the intranasal version. You are in a high-risk priority group for both vaccines, so you should be among the first to get it when it is available.

Second, if you think you are getting influenza (fever, headache, fatigue, etc), call your doctor immediately. Your doctor should consider starting you on antiviral treatment.

Third, take care of yourself during the influenza season. Take your diabetes drugs consistently, monitor your blood glucose and urine ketones frequently to keep them in the proper range, watch your diet and fluid intake, keep up your exercise and sleep habits, wash your hands frequently and try to stay away from people who might be sick. Ask the people you live and have close contact with to get the flu vaccines too, because they can protect you from getting the disease.

These are all normal, common-sense things you can do to protect yourself. If you can successfully live with diabetes, you can protect yourself from influenza.

Bronson Practices Launch Online Flu Vaccine Registration Form

Monday, November 16th, 2009

Bronson Rambling Road Pediatrics – Oshtemo and Bronson Rambling Road Pediatrics – Portage have launched a Flu Vaccine Sign-Up Form. If you or your family member are a current Bronson patient at either of these practices, please complete this online form to be notified when H1N1 and/or seasonal flu vaccine become available. This is being piloted with Rambling Road Pediatrics. Other practices will be included in the future. You may need to install Microsoft Silverlight.

The online form is being used to meet the needs of our patients and improve the efficiency of our office. Please be aware that we are receiving limited H1N1 vaccine from the health department. Thank you.

Are influenza and pneumonia connected?

Wednesday, November 11th, 2009

Yes. We are having the worst influenza season the US has seen in a long time. Many patients are being hospitalized, some are requiring time in an intensive care unit, and some are dying.

Most people with simple influenza do not require hospitalization, and they certainly don’t often die. The problem with influenza is that it leads to complications, which in some people are very dangerous. One of the serious complications of influenza is bacterial pneumonia.

The influenza virus attacks the lungs, destroys lung tissue, prevents the lungs from delivering oxygen, and causes the lungs to fill with fluid. Some bacteria then love to jump in and go to work after the virus has made the lungs defenseless against infection. We call that a secondary infection or superinfection, because it happens after the first one. Many of the patients who die with influenza are actually succumbing to bacterial pneumonia.

The most common cause of bacterial pneumonia is one species of bacteria called Streptococcus pneumoniae, nicknamed “the pneumococcus.” It is causing lots of trouble this year in patients after they get influenza. The ironic thing about this is that some of these complications may be preventable, because we have two good vaccines against the pneumococcus. There is a vaccine for children called Prevnar, and a vaccine for adults called Pneumovax. They are sometimes called “pneumonia shots,” although they really only protect you against that one type of pneumonia.

I think many more people should get the pneumonia shot than currently do. In fact, I can’t think of anyone who should not get it. The CDC says that we should get one dose as adults if we have any risk factors for pneumonia, and another dose at age 65, but the risk factors are very broad, and the CDC recomendations should be considered minimum, not maximum recommendations. If you go to your doctor to get an annual influenza immunization, ask them for your pneumonia shot if you haven’t already had one. It could save your life.

Influenza and pregnancy

Thursday, November 5th, 2009

One aspect of this year’s influenza season that may surprise you is all the attention on influenza and pregnancy. Good data show that the new H1N1 virus attacks pregnant patients at a higher rate, more pregnant influenza patients are hospitalized, more require critical care, and more are dying than we would expect with normal seasonal influenza. We don’t know what it is about the virus that causes this, but it is happening and we need to do something with it.

Obstetricians have had to become experts in managing influenza. That is new for many of them. In the past, influenza was considered part of primary care, not a problem in pregnancy. Many obstetricians did not immunize their patients against influenza, did not diagnose it, and did not treat it. That has changed this year. If you are pregnant, your obstetrician should be talking to you about influenza and making sure that you are immunized against both seasonal and H1N1 influenza, perhaps by providing the vaccines in their office for the first time.

The thinking about vaccines and pregnancy has also changed almost 180 degrees in the last several years. In the past, many doctors and patients thought that immunizing a pregnant patient was risky. Maybe the vaccine would harm the baby, or cause a complication, so doing nothing and allowing the pregnant patient do get influenza, for example, was considered the safest thing to do. Now we approach things differently. All pregnant patients are advised to be immunized against influenza. The vaccine presents virtually no risk to the mother or baby, the risk of influenza disease during pregnancy is significant, and immunization of the pregnant patient transfers some protection to the baby both before birth and also after birth if the mother breastfeeds the baby. That is a big change in thinking over just one generation of doctors and patients.

Many pregnant women go to their mothers for advice on things relating to their pregnancy. That is still a good idea, but this is one issue for which, if you do what your mother did, it might be the wrong thing.

Read CDC recommendations for pregnant women, as well as feeding your new baby

Latest influenza vaccine program update for Bronson facilities

Monday, November 2nd, 2009

Seasonal Flu Vaccine
Bronson Outpatient Pharmacy and Bronson Pharmacy Mattawan have seasonal intranasal influenza vaccine (FluMistĀ®) available for age 18 through 49. Call ahead for an appointment. More details

Bronson Home Health Care Community Flu Clinics
Medicare and Medicare Plus Blue will be billed directly, all others will be charged $30 cash or check. There are no seasonal flu community clinics being held at this time.

Bronson Physician Practices
Current Bronson patients may call their Bronson doctor’s office to make an appointment for seasonal flu vaccine.

H1N1 Vaccine
H1N1 vaccine is only available to Bronson staff and current Bronson outpatients. There is a very limited supply of H1N1 vaccine for current Bronson patients of Bronson practices. Those on the waiting list will be contacted first. The CDC recommendations are being followed due to the limited supply and H1N1 vaccine is being given to the targeted high-risk populations.

View Bronson Rambling Road Pediatrics – Oshtemo flu vaccine availability

Community Health Department Clinics
Kalamazoo County
Van Buren & Cass County