General Practice Medicine

Dec. 22, 2008 -- As children everywhere make last-minute changes to their lists for Santa, emergency physicians are giving adults their own list to consider: a dozen ways to stay safe during the holidays.

Each year, an estimated 11,000 people are treated in hospital emergency departments because of some type of decoration-related injury, Nick Jouriles, MD, president of The American College of Emergency Physicians, says in a written statement.

"We will always be there to treat you, no matter when you come in," Jouriles says, "but we hope you won't have to celebrate the holidays in the hospital!"

The organization offers the following holiday safety tips:

1. Beware of Booze. If you drink alcohol, do so in moderation. Always have a designated driver.
2. Unwrap Responsibly. Be careful when opening gifts. Don't use a razor blade, if scissors will suffice.
3. Watch What You Eat. Don't eat food that has been sitting out for a long time. Always cook food thoroughly and store it safely. (Every year, 76 million people in the U.S. get sick from contaminated food.)
4. Hang Lights With Care. Use a proper-sized ladder when hanging decorations, and don't do it alone. Have another adult help, especially to hold the ladder.
5. Sled Safely. Wear a helmet, choose low-traffic areas, and avoid obstacles, including shrubs.
6. Detect Carbon Monoxide. Carbon monoxide, an odorless gas, kills people in the winter when furnaces and heaters are turned on. Install detectors and check to make sure they are working. Clean out fireplaces and make sure fireplaces, heaters, and stoves have proper ventilation.
7. Don't Overload Sockets. Don't cram too many decoration plugs into an electrical socket. Overload is a fire hazard and can also cause electrical shock to a person.
8. Beware of Falling Ornaments. Make sure all holiday decorations and Christmas trees are securely anchored and that young children can't pull them over.
9. Remember the Helmet: If your child is receiving a bike, skateboard, or scooter for the holidays, don't forget to include a helmet and other safety gear.
10. Keep Aspirin at the Ready. If you feel chest pains, chew an aspirin and go to the emergency room.
11. Don't Over-Shovel. Shoveling snow can cause heart attacks. Avoid it if you are out of shape, elderly, or have a history of heart problems.
12. Don't Overdo at Dinner. Don't over-indulge (especially salt) if you have high blood pressure or heart problems.

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SOURCE:

News release, The American College of Emergency Physicians.

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Dec. 22, 2008 -- Santa takes to the skies soon, and it's common courtesy to leave a little something for the big guy when he comes calling in the wee hours.

You could go the traditional milk-and-cookies route. Or you could take a different tack, picking useful gifts for St. Nick's 24-hour journey -- and throughout the new year. Here are some ideas:

1. Vitamin D pills. Vitamin D is the "it" vitamin nowadays, and North Pole winters are probably too skimpy on sunlight to make enough vitamin D.
2. Melatonin for jet lag. Melatonin supplements might help Santa get sleep when he's back home.
3. A mug of cocoa. It's got caffeine to keep Santa perky, polyphenols for his heart, and warmth to make him even more generous.
4. Rose-colored glasses, so that every child looks nice, not naughty.
5. A serving of nuts. We're not Santa's doctor, but his big belly could put him at risk for metabolic syndrome, and eating some nuts daily might help his ticker.
6. Gel inserts for his boots, since he'll be tiptoeing around for 24 hours.
7. An aromatherapy kit, in case the reindeers' smell gets to be too much. Lavender is soothing, and a 2005 study showed that cinnamon or peppermint might ease driver fatigue.
8. A blood glucose monitor, so he doesn't overdo the cookies. Blood glucose monitors are for people with diabetes, but even if Santa isn't diabetic, he shouldn't overindulge in sugar.
9. A Wii Fit so he's in fighting shape for 2009. Being physically active is a plus at any size. And in case he's not into virtual fitness, throw in a pedometer so he can count his steps.
10. Honey to soothe his throat after all that ho-ho-ho'ing. Honey might also kill bacteria, in case Santa picks up some germs en route.
11. A spa gift certificate for himself and Mrs. Claus, for some quality couple time.

One thing Santa doesn't need -- a GPS device. Rudolph, your job is safe.

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SOURCES:

WebMD Health News: " Supplement Your Knowledge of Vitamin D."

WebMD Health News: "Warm Hands, Warm Heart?"

WebMD Health News:" Metabolic Syndrome? Nuts!"

WebMD Health News: " Traffic Stress? Cinnamon, Peppermint May Help."

WebMD Health News: " Obese and Healthy?"

WebMD Health News: "Humble Honey Kills Bacteria."

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Dec. 19, 2008 -- New guidelines have been issued by the nation's gastroenterologists that are aimed at easing the abdominal pain, diarrhea, and other symptoms of irritable bowel syndrome (IBS), which afflicts millions of Americans.

The guidelines, issued by the American College of Gastroenterology, also offer hope to patients who've struggled with the condition and found satisfactory treatments lacking.

IBS is diagnosed in people whose symptoms include abdominal pain, bloating, gas, diarrhea, and constipation, or a combination of these symptoms. Though sometimes confused with inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, IBS is a separate condition.

IBS care uses up more than $20 billion a year in direct and indirect expenditures, according to William Chey, MD, professor of medicine and director of the Gastrointestinal Physiology Laboratory at the University of Michigan Health System. He developed the guidelines in conjunction with Philip Schoenfeld, MD.

"The last time the American College of Gastroenterology published guidelines for the management of IBS was in 2002, and the College recognized that in the span of five to six years there has been a remarkable explosion in knowledge that's become available that's helped us to understand the cause and management of IBS," Chey says in a news release.

Tests and Treatments for IBS

According to the new guidelines:

• Patients with symptoms typical for IBS -- and without alarm features like rectal bleeding, low blood count due to iron deficiency, weight loss, or a family history of colon cancer, IBD, or celiac disease -- do not need extensive testing before being diagnosed.
• IBS patients with diarrhea, or a combination of constipation and diarrhea, should be screened with blood tests for celiac disease, a disorder in which patients can't tolerate the gluten protein found in wheat or other grains.
• When IBS patients have alarm features or are over 50 years old, they should have further tests (such as colonoscopy) to rule out other bowel disease such as IBD and colon cancer.
• IBS patients and their doctors should consider treatments involving antidepressants, which have been shown to offer relief.
• The drug Amitiza helps with women who have IBS with constipation; the non-absorbable antibiotic rifaximin can ease IBS and bloating as a short-term treatment. And Lotronex, a drug that affects serotonin receptors, can be considered for patients with severe IBS with diarrhea.
• Certain anti-spasm treatments may offer short-term help with abdominal pain from IBS. These include hyoscine, cimetropium, and peppermint oil.
• A probiotic called Bifidobacteria may help some IBS patients.

According to the guidelines, women are twice as likely as men to suffer from IBS, which often begins in young adulthood. Gastroenterologists have found that dietary changes have proved helpful, including the addition of dietary fiber supplements such as psyllium.

Chey says IBS can be managed in most patients with counseling, dietary and lifestyle interventions, and use of both over-the-counter and prescription medications.

The guidelines suggest many treatments might be tried, though the authors concede no single magical answer has yet been found to eliminate symptoms in IBS patients. But the guidelines offer hope for people with IBS that their doctors can try a number of methods to reduce discomfort, and that some of the steps that can be taken seem to work.

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SOURCES:

News release, University of Michigan Health System.

Brandt. L. American Journal of Gastroenterology, January 2009; vol 104.

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Dec. 19, 2008 -- Sure, you sneeze when you've got a cold. But some sneezes may happen just by thinking about sex or having an orgasm, British doctors report.

Mahmood Bhutta, a specialist in ear-nose-and-throat surgery at England's Wexham Park Hospital, writes of a colleague who once had a patient who "described uncontrollable fits of sneezing" immediately after having any sexual thought.

That patient, who was a middle-aged man, had no other symptoms. He said he'd had those sneezing fits immediately after thinking sexual thoughts throughout his adult life.

Bhutta and his colleague decided to do a little research, and they figured that since the condition might be embarrassing, it might not get reported -- except in Internet chat rooms.

So the researchers googled "sex, sneeze, OR sneezing" twice in 2007, and came up with reports by 17 people -- men and women -- who reported sneezing right after thinking sexual thoughts, and reports by three people of sneezing after orgasm.

Long before the Internet -- back in the 19th century -- there were reports of rare people who sneezed when sexually excited, but "there was no credible reason given for the phenomenon," Bhutta's team writes.

Bhutta's paper doesn't settle why some people sneeze when they think sexual thoughts or when they have an orgasm. But the researchers suggest that sexual thoughts or orgasm might trigger the body's subconscious nervous system, which could lead to sneezing in some people.

The report appears in the Journal of the Royal Society of Medicine.

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SOURCE:

Bhutta, M. Journal of the Royal Society of Medicine, Dec. 1, 2008; vol 101: pp 587-591.

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Dec. 19, 2008 -- A flu strain now spreading in the U.S. is resistant to the flu drug Tamiflu, the CDC today warned in an official health advisory to doctors.

Flu is a dangerous and sometimes deadly disease. But the Tamiflu-resistant strain isn't any more or less dangerous than other flu strains.

The Tamiflu-resistant virus is the flu bug most commonly seen so far this year. It's been detected in 12 states so far, mostly in Hawaii and Texas.

Tamiflu resistance wasn't unexpected. What was surprising was the rapid rise of Tamiflu resistance in this particular flu bug. Last year, about 11% of type A H1N1 flu bugs were resistant. So far this year, 49 out of 50 H1N1 viruses have been resistant.

Even so, it's still very early in the flu season. There's no way to know whether the Tamiflu-resistant flu bug will be this year's predominant cause of flu.

"There is no crystal ball here," CDC Director Julie Gerberding, MD, tells WebMD. "We can't predict if this strain will end up being the most important one this year. It could fizzle out. ... We're giving a 'heads-up' to the clinicians, but we are not making drastic changes in our treatment and prevention recommendations."

Three different flu bugs are in circulation among humans. The resistant bug is the type A H1N1 strain. There's also the type A H3N2 strain, and one type B strain.

The current flu vaccine protects against all three of these viruses -- and the current flu vaccine is an excellent match for the drug-resistant bug, Gerberding says.

Fortunately, the Tamiflu-resistant flu bug is still sensitive to Relenza, an alternative flu drug of the same basic type as Tamiflu. And the bug may also be sensitive to the older flu drugs Flumadine and Symmetrel, although resistance to these drugs has been steadily increasing among type A flu bugs.

Flu drugs can be used both to treat and to prevent the flu:

• Treatment with flu drugs must begin no later than two days after symptoms appear. The earlier that treatment begins, the shorter and less severe the illness.
• Prevention with flu drugs is used in households, hospitals, or facilities (such as nursing homes) where people have been exposed to someone who has the flu.

Tamiflu has been the most attractive treatment because it is taken in pill form and can be given to children as young as 1 year old.

Relenza comes in an inhaler. Children younger than 7 can't use it for treatment, and those younger than 5 can't use it for prevention. Moreover, Relenza sometimes causes lung spasms, so it can't be used by people with lung problems.

Ironically, the CDC's Tamiflu warning is not going to make a huge difference in how patients are treated because too few people get treated with flu drugs, says Joseph S. Bresee, MD, chief of the epidemiology and prevention branch of the CDC's flu division.

continued...

"Even among hospital patients with the flu, more than half do not receive antiviral therapy," Bresee tells WebMD. "[Tamiflu] and [Relenza] are relatively underused at this point."

Bresee suggests that the current warning might actually increase use of flu drugs by making doctors more aware of how to use them.

Here's what the CDC now recommends:

• Doctors should keep track of the subtypes of flu virus circulating in their areas. The CDC offers weekly updates based on reports from local and state health agencies.
• When testing patients for the flu, doctors should consider using tests that can tell type A flu from type B flu.
• Use Tamiflu alone only if the main flu bugs in the area are type A H3N2 or type B.
• If drug-resistant virus is circulating in the area, use Relenza. In patients unable to take Relenza, doctors may use a combination of Tamiflu and Flumadine (or Symmetrel if Flumadine isn't available).

But here's the best advice: It's not too late to get a flu shot (or sniff, via the inhaled FluMist vaccine). Flu season rarely peaks before February -- and lots of people come down with the flu as late as March or April. So if you've been putting off getting your flu shot, now is the time to act.

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SOURCES:

CDC Health Advisory, Dec. 19, 2008.

Julie Gerberding, MD, MPH, director, CDC.

Timothy M. Uyeki, MD, medical epidemiologist, influenza branch, CDC.

Joseph S. Bresee, MD, chief of epidemiology and prevention, influenza branch, CDC.

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