Why is ACIP making this recommendation? It is because adults under age 60 with diabetes are twice as likely to get Hepatitis B than those of the same age without diabetes.

Hepatitis B is a virus that infects the liver and is spread through blood and other bodily fluids. It sometimes doesn’t cause much of a problem, but other times can be very serious, essentially destroying the liver. It may even lead to death.

People with diabetes use lancets to poke their fingers and test their blood sugar, and these lancets are at times used in an unsterile form, and may spread the virus.

It is OK for adults over age 60 with diabetes to get the vaccine if they so choose, but the risk of getting Hepatitis B is not increased in this group so it is not routinely recommended.

Children have had a routine recommendation for hepatitis B vaccine since 1991.

A researcher from Cornell (link to study details) performed a lunchtime experiment with 78 university staff. Groups of 3-4 staff were given a meal of pasta, apple sauce and pudding that was self-served from a counter. For some of the groups the food was then left on the counter, and for some it was then moved to the table where they were sitting.
All of the participants were told to help themselves and given 45 minutes at the table. Serving sizes, intake and food waste were measured. Participants estimated how many calories they consumed and how full they felt after eating. Here is what was found:

• Men ate 29% fewer total calories when serving bowls were moved from the table to the counter. Think about that. 29% fewer calories!
• The difference in calories eaten between groups for women was not statistically significant.
• The differences found were due to differences in how much pasta was eaten, not apple sauce or pudding.
• All of the participants in both groups thought they ate about the same number of calories.
• All of the participants thought they were equally full after eating.

I personally use this information mentally. I don’t want to subject my family to a change of serving bowl location, so I pretend that the serving bowls are not on the table. Once I fill my plate and eat, I consider the serving bowls, and therefore second helpings, off limits. Believe it or not, it actually works! The craving I have for a second helping actually goes away. At least most of the time.

This is an important question, and here is why. Prostate cancer is the most common cancer in men. By the time you are 60, you have about 60% chance of having prostate cancer, and it goes up from there. Yet even without treatment, your overall chance of dying from prostate cancer is less than 1 out of 25. Because of this big difference between the chance of getting prostate cancer and the chance of dying from it, and the fact that treatments for prostate cancer can be harmful, it is not clear that otherwise healthy men should be checking to see if they have it. There is some evidence, however, that we can prevent prostate cancer. An excellent review of the evidence in this area was recently published (Fleshner and Zlotta, Cancer 2007, Vol 110, Iss 9, p. 1889-1899), and I will summarize it here, adding some comments where helpful.

Taking preventive medicines = uncertain benefit

A testosterone-blocker called finasteride has been shown to reduce the risk of prostate cancer, but in the men who get cancer while taking it, their cancer is a more dangerous type. Anti-inflammatories like aspirin and ibuprofen have unknown benefit, yet often have side effects.

Taking Vitamin E = might reduce risk

Vitamin E seemed to reduce the risk in one study, but this has not been confirmed in other studies. Still, it is probably not harmful and may be helpful to take a daily multivitamin with E in it.

Low-fat diet = probably reduces risk

Avoiding pesticides = might reduce risk

Exposure to pesticides is associated with prostate cancer, but we are not yet sure if avoiding them reduces risk.

Selenium = might reduce risk

Also may increase the risk of skin cancer

Green Tea = conflicting research results

Soy = uncertain benefit

Lycopene = weak evidence of benefit. Not proven.

This is an antioxidant found in tomato products.

Lyme disease (named for Lyme, Connecticut where it was first described) is an infection carried by Deer Ticks that can cause a skin rash, as well as serious nerve, heart and brain problems. The infection is most common in late spring or summer and in most people the first sign is a flat or raised skin bump that slowly gets bigger, often with clearing of the rash in the middle, resembling a target. It is diagnosed by recognizing the rash, and/or blood tests. It is not spread from human to human.

According to State of Wisconsin public health officials, a warmer spring can increase tick activity and therefore Lyme disease. If you think you might have Lyme disease you should see your health care provider, but it is sometimes tricky to diagnose and difficult to treat. Therefore, it is important to reduce the chance of tick bites that cause Lyme disease in the first place.

Here is how to prevent Lyme disease (or other infections spread by ticks):

• Avoid areas where there are a lot of ticks if possible
• If you do get a tick on you, remove it as soon as possible by grabbing it with a tweezers as close to the skin as possible and slowly pulling it off (other techniques such as a smoldering match or kerosene might cause the tick to pass along the infection earlier by irritating it)
• Wear light-colored clothing so that ticks can be more easily seen and removed (the ticks don’t usually pass along the infection until they have been attached for a day or more)
• When in a tick-infested area, use tick repellent and examine yourself daily to look for and remove ticks
• There used to be a vaccine for Lyme, but it was discontinued due to some reports of joint reactions and a low demand

One of the most frequent questions I get in the Ask a Question section of Proven Health Ways is:  How do I stay healthy when traveling abroad?

Strategies to protect your health while traveling include vaccinations, avoiding times of political unrest or violence, protection from infection from insect bites, and food/water cautions. Some vaccines need at least 4-6 weeks to work well, so it is important to plan ahead.

One excellent resource for information about travelling anywhere in the world is the Centers for Disease Control (CDC) website. Go to www.cdc.gov, click on “Travelers’ Health” and then “Destinations” to see what is recommended for your planned destination.  Then call your primary care provider or travel clinic to see how you can get the vaccines you need.

As to the reader’s specific question: Yes, TWINRIX (a combined vaccine for Hepatitis A and Hepatitis B) would be a good idea before travelling to Jamaica, either in the usual schedule of 0, 1 and 6 months, or an an accelerated schedule of 0, 7 and 21 days (and a booster at 1 year).

Because she was a new patient to me, I asked for more information. I found out from her and her reliable caretakers that she had never actually been sexually active. You can imagine her relief when I told her that she did not need Pap tests because research indicates that only women who have had sexual intercourse are at significant risk for developing cancer of the cervix.

So who needs to have Pap tests done, and who doesn’t? The US Preventive Services Taskforce sums it up well:

Pap tests are strongly recommended for all women who have been sexually active and have a cervix (the part of the uterus that is tested with a Pap) .

· When should you start having Paps? Start at age 21, or three years after starting sexual activity, which ever comes first.

· How often should you have Paps? Every 3 years appears to be just as beneficial as having them every year.

· When can you stop? Since cervical cancer is less likely after middle age, stopping Pap tests at age 65 makes sense if recent tests have been done and were normal.

Check with your doctor or nurse practitioner to see if Pap tests are right for you. Visit Proven Health Ways for more information about Pap tests and other prevention activities.

• Prior recommendation: Routine mammograms every 1-2 years for women 40 years and older
• New recommendation: Age 40-49: Consider mammograms every 2 years on an individual basis, taking into account patient values and risk factors, but don’t just do it routinely for everyone. Age 50-74: Routine mammograms every 2 years.  Age 75 and over: Whether or not mammograms are helpful is unknown

These new recommendations have made quite a stir, and led to more than a little confusion among patients as well as health care providers. So how do we make sense out of a group like the USPSTF, which I have found to be more objective and thorough than most, making such recommendations like these that not everyone agrees with?

First, it is important to understand that there is no absolute right or wrong here; it is a matter of balancing the possible benefits and harms, and making a judgment. For example, I do not think anyone reading this would recommend that all women have mammograms every month starting at age 21. But why not? Wouldn’t it save more lives from breast cancer, compared to screening less often or waiting until age 40 or 50? Of course it would. But the cost of doing monthly mammograms at these young ages would be relatively high in terms of radiation exposure, biopsies for false positive tests, and money, and the benefit would be relatively small because breast cancer is very rare at younger ages.

So where do you draw the line? When should we health care providers start recommending that women have mammograms? Again, there is no right or wrong answer to this, and professional organizations have different ways of deciding what they are going to recommend. I would say that talking about it with our female patients age 40-49, rather than routinely recommending it, is a rational approach based on good research. It also involves some degree of judgment, and therefore is a position that reasonable people could reasonably disagree on.

Finally, this guideline, like all guidelines, can and should be used thoughtfully and skillfully by primary care providers in consideration of their patients’ needs and preferences. Remember, guidelines are written for populations, but applied to individuals.

To help prevent Reye’s syndrome, children should avoid taking products with aspirin in them around the time of  a respiratory infection that might be influenza. Also, if a child needs to be on aspirin long term, they should be sure to get vaccinated for influenza every year. Acetaminophen (like the brand name Tylenol) and ibuprofen (like the brand name Advil) do not seem to increase the risk of Reye’s Syndrome.

Bottom line:

We do not know for sure what the risk is, but if the past is any indication of the future, the benefit from the vaccine will be far greater than the risk, perhaps 30-40 times greater.

Guillain-Barre (pronounced GEE yen Bar RAY) syndrome, or GBS, is a rare nerve disorder that causes tingling and weakness in the arms and legs that gets worse over time.

Most people recover from GBS. Approximately 85% of patients with GBS recover fully within 6-12 months. About 7-15% have permanent nerve damage or weakness, and less than 1 out of 20 die from lung or heart effects, blood clots or widespread infection in the blood.

GBS occurs normally worldwide at a rate of 1-3 per 100,000 people each year. Most of the time GBS seems to occur after someone has an infection, commonly in the lungs or intestinal tract.

Research shows that the rate of getting GBS from the regular seasonal influenza vaccine is somewhere between zero and one extra case per million people who get the vaccine. The chance of dying from influenza is about 100 times that number, about 36,000 every year. Only about half of those who should get the vaccine do, and it remains the single most effective method of preventing this dangerous disease.

A flu vaccine for H1N1 (Swine) flu was given in 1976 and 1977, and there seemed to be a higher rate of GBS with that vaccine, about 1 additional case per 100,000 people getting the vaccine.

We do not know if the new H1N1 vaccine for 2009 will carry the same risk of GBS as the prior H1N1 vaccine did in the 1970’s. And we don’t know how widespread or dangerous the H1N1 influenza will be for sure. But if the past is any indication, not getting the vaccine will be a lot more risky than getting it.

And if you die from influenza, it is likely that it will be from getting a pneumonia on top of the influenza. So while you are at it, ask your health care provider if you should get the Pneumococcal vaccine, or check out your free Proven Health Ways Health and Wellness Guide on this webpage for more information.