Know Your Medication's Side Effects!

The left-hand column below lists the 10 most commonly prescribed medications in the U.S. in the order of the frequency that they are prescribed. In the right column are the most common side effects of these medications in no particular order.  See if you can match the medication with its most common side effects.  In some cases, there may be overlap in the side effects that these medications cause, but there will be at least one in the list of symptoms that is specific for that medication. 

Recognize that any of these medications can produce allergic reactions, with symptoms that include rash; hives; itching; difficulty breathing; tightness in the chest; and swelling of the mouth, face, lips, or tongue.  Additionally, almost all of these drugs can cause mild-to-moderate gastrointestinal upset, such as stomach pain, nausea, and vomiting.  This matching exercise does not include some of the more severe, but much less common, side effects of these medications.  The answers will be provided at the bottom of this page.

Medication		Side Effects
1.	Hydrocodone  (may be combined with acetaminophen as Vicodin)	a)	Dizziness; light-headedness; temporary blurred vision;  joint pain, swelling, warmth, or redness (especially of the big toe joint)
2.	Simvastatin (Zocor), a cholesterol-lowering statin drug	b)	Cough; diarrhea; dizziness; headache; tiredness; symptoms of low blood pressure (e.g., fainting, severe dizziness, light-headedness).
3.	Lisinopril (brand names include Prinivil and Zestril), a blood pressure drug	c)	Diarrhea in up to 10% of patients; gas; metallic taste in mouth; headache; nausea
4.	Levothyroxine (Synthroid), synthetic thyroid hormone	d)	Side effects in order of frequency are headache, abdominal pain, nausea, diarrhea, vomiting, and excess gas
5.	Amlodipine (Norvasc), an angina/blood pressure drug	e)	Constipation; headache; muscle pain, tenderness, or weakness
6.	Omeprazole (Prilosec), an antacid drug	f)	Blurred vision; constipation; difficulty breathing; dizziness; drowsiness; flushing; lightheadedness; mental/mood changes.
7.	Azithromycin (brand names include Z-Pak and Zithromax), an antibiotic	g)	Excessive sweating; diarrhea; fast or irregular heartbeat; fever; heat intolerance; mood changes (e.g., anxiety, irritability, nervousness); tremors; trouble sleeping
8.	Amoxicillin (various brand names), an antibiotic	h)	Allergic reactions have been reported in up to 10% of patients and have included rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue
9.	Metformin (Glucophage), a diabetes drug	i)	Lower leg swelling; fast, slow, or irregular heartbeat; facial flushing, and dizziness, particularly at higher dosages (e.g. 10 mg daily).
10.	Hydrochlorothiazide (various brand names), a water pill used to lower blood pressure, sometimes paired with a second anti-hypertensive medication	j)	Gastrointestinal side effects have included nausea, abdominal discomfort, vomiting, and diarrhea in up to 10% of patients.

It makes no difference if you are taking a prescription drug, an herbal remedy, or an over-the-counter supplement - all have the potential to cause side effects.  Odds are high that most readers are taking or have taken at least one of these medications.  In a study performed in 2002, an alarming one in four patients taking a prescription medication suffered observable side effects.  Be aware also that side effects may occur when certain medications are taken together or mixed with food or alcohol.  Be alert to the possibility that a symptom that develops after starting a new medication could be due to a medication side effect. 

To learn more about a medication's side effects, be sure and read the package insert or printed materials that come with a prescription medication or read the label of over-the-counter products.  You can also talk to your pharmacist or doctor if you have any questions regarding a drug's side effects.  While some side effects may be more of a nuisance that anything else, some can be quite serious and require immediate medical attention.

Answers:  1. f; 2. e; 3. b; 4.g; 5. i; 6. d; 7. j; 8. h; 9. c; 10. a

Assessing and Addressing "Belly Fat" Part 2: What are the best ways to lose "belly fat"

Last week we looked at the use of the Body Mass Index (BMI) and waist circumference measurement in assessing obesity. Frequently, people are bothered by the presence of visible (subcutaneous) abdominal fat and don't consider the dangerous health consequences of visceral fat, the fat that is deep in the abdomen surrounding the internal organs. Excessive amounts of visceral fat sets the stage for the development of the metabolic syndrome, a condition associated with high blood pressure, elevated cholesterol, and type 2 diabetes. Better known is the fact that generalized obesity increases one's risk for heart attack, stroke, and certain types of cancer.

Fortunately, there are measures that can be taken to address excess belly fat:

1. Lose weight overall. If you could stand to lose a few pounds (as most of us could), the best way to lose fat from the belly is to lose weight overall. This is best achieved by a combination of regular physical activity and caloric restriction (dieting). For most people, this is neither an easy nor a rapid process. The most lasting results from weight loss programs usually come from slow, steady progress, not from extreme diets or exercise programs. Emphasize complex carbohydrates (fruits, vegetables, and whole grains) and lean protein over simple carbohydrates such as white bread and refined-grain pasta. Pay attention to portion size. Reduce saturated fat sources of food from your diet, such as red meats and high-fat dairy products, such as cheese and butter. Dietary fat should come from foods that are higher in monounsaturated and polyunsaturated fat, such as fish, nuts, and olive oil. Use the BMI and waist circumference to monitor your progress. When these become normal for your weight and height, a marked improvement in your belly fat is almost certain.
   


2. Exercise to assist with weight loss. Many studies have shown that getting regular exercise, along with dieting, is the best way to lose weight. Weight loss occurs whenever more calories are burned than consumed. To illustrate, you need to burn approximately 3,500 calories to lose a pound of weight. If you burn 300 calories during a workout (e.g. walking 3 miles), it takes about 12 workouts to lose one pound. By cutting your caloric intake by 300 calories a day along with a 300-calorie bout of exercise, it takes half as long to lose that same pound of weight. A recent study from Duke University demonstrated that aerobic exercise (walking, swimming, cycling, etc.) was better than resistance training ("pumping iron") in reducing visceral fat and improving risk factors for heart disease and diabetes. In their study, aerobic exercise burned 67 percent more calories than resistance training. For most healthy adults, the American College of Sports Medicine (ACSM) recommends performing moderate aerobic activity, for at least 150 minutes a week or vigorous aerobic activity, such as jogging, for at least 75 minutes a week. More than this may be required during the initial stages of a weight loss program. Although not as effective in burning calories, the ACSM also recommends performing 8 to10 strength-training exercises, with 8 to 12 repetitions of each exercise, twice a week.
   


3. Establish life-long exercise and eating habits.
   
   After losing weight, continuing to eat sensibly and exercise regularly, appear to be the keys to maintaining that weight loss. That was an important finding from the National Weight Control Registry (NWCR), a study of 4,500 men and women who were successful in losing at least 30 pounds and keeping it off. After monitoring this group for 10 years, 94% of them were participating in regular physical activity. The most common form of activity, reported by 76% of participants, was walking. Most of these individuals spent approximately 1 hour per day exercising. Walking is an excellent life-long activity since it is easy on the joints and muscles and does not require special equipment or skills. A second finding of those who were successful in maintaining their weight loss is that they continued to consume a reduced calorie/low fat diet. Women in the NWCR study reported eating an average of 1,306 kcal/day (24.3% of energy from fat) and men reported consuming 1,685 kcal (23.5% of energy from fat).

Many people ask about targeting belly fat with specific exercises. The general term for this is called "spot reduction". Abdominal "crunches" for example are thought to be a way to specifically target belly fat. Unfortunately, spot reduction is almost impossible to achieve. Sit-ups, for example, are beneficial for abdominal muscle strengthening, but sit-ups alone will not get rid of the layer of fat that is covering the muscles. Nor will abdominal strengthening exercises address the deeper, visceral fat. Overall weight reduction through dieting and regular exercise is the best way to reduce ''belly fat''.

For information on weight loss diets, consider contacting our dietician at eDiet. Write to me through eFitness and I'll be happy to help with your exercise program.

Assessing and Addressing "Belly Fat" Part 1: The role of the Body Mass Index (BMI) and Waist Measurement

According to recent statistics, over two-thirds of adults in the U.S. are overweight or obese. While the "middle-age spread" is considered by many to be an inevitable aspect of aging, it should be recognized that along with an increasing waistline comes increased health risks. The development of an "apple shape" to our bodies is an indication of increased deposits of visceral fat. As compared to a more obvious "beer belly", visceral fat lies deep in the body around the abdominal organs. It is of significant concern as it has been linked to an increased risk for cardiovascular disease and type 2 diabetes. Additionally, in women it is associated with an increased risk of breast cancer and the need for gallbladder surgery.

What is the BMI and what does it tell us about our health? The body mass index (BMI) is a measure of body fat based on height and weight. The American Heart Association and National Institutes of Health consider this the primary tool in assessing obesity. The BMI calculator on the National Heart, Lung, and Blood Institute's (NHLBI) website receives 1.6 million visitors a month and ranks #1 on Google. The NHLBI has even made a BMI Calculator App available for the iPhone. Based on the results of BMI calculation, individuals are ranked from being underweight, normal, overweight or obese. In general, the higher the BMI, the greater the risk of developing certain diseases. For example, someone with a BMI of 30 or higher, would be in the "obese" category—a group that has been shown statistically to have an elevated risk of heart attack and stroke.

Shortcomings of BMI in assessing obesity. The BMI provides meaningful information in most people, but it does have some limitations in assessing obesity since it depends solely on the weight and height of a person. For example, some people are naturally stocky and have a BMI in the overweight category, when in fact their weight is due to muscle mass and a heavier bone structure rather than excess fat. The BMI can also underestimate body fat in an older person who has lost muscle mass. Conversely, even with a BMI in the normal range, someone could be carrying more body fat than is good for him or her. As a result, it is best to use a second assessment tool to get a more accurate assessment of obesity.

What measuring your waist can tell you. The recommended tool to use along with the BMI to assess body fat distribution is waist circumference. It correlates well with an individual's visceral fat and the risk of obesity-related morbidity and mortality. According to the National Institutes of Health, when the BMI is between 25 (overweight) and 35 (obese), a high waist circumference is associated with an increased risk for type 2 diabetes, high cholesterol, hypertension and cardiovascular disease.

How is the waist measurement performed? Follow these steps and consult this table to assess your risk:

1. Place a tape measure around your bare waist, just above the hip bones.
   
   
2. Make sure that the tape is level all the way around and fits snugly and not pushing into the skin.
   
   
3. Relax, breath out, and measure your waist.

Women with a waist measurement of 35 inches (89 centimeters) or more indicates an unhealthy concentration of belly fat. In men, a waist measurement of 40 inches (102 centimeters) or more is cause for concern.

How else can body fat be measured? In most instances, a combination of BMI calculation and waist measurement provides enough information to assess one's health risks due to obesity. Other ways of assessing for obesity include measuring skinfold thickness with calipers, underwater weighing, electrical impedance, and computed tomography. However, these methods tend to be impractical, expensive, or unreliable. If your personal assessment indicates that you need to work on your "belly fat", next week we'll look at some ways of doing this.

Help for Tinnitus

What is tinnitus? Tinnitus, or ringing in the ears, is a symptom that affects around 30 million people in the U.S. Of these, 1 in 5 report that their tinnitus is severe enough to be considered disabling. People with severe cases of tinnitus may find it difficult to hear, work, or even sleep. Tinnitus is not always characterized as ringing. Some people describe it as roaring, clicking, hissing or buzzing.

What causes tinnitus? Tinnitus is a symptom, not a disease. Some of the underlying problems that may be responsible include hearing loss, exposure to loud noises, and a side effect of medications. It may be surprising to some to learn that aspirin is one of the medicines most likely to cause tinnitus. Other medications that can be responsible include certain antibiotics (e.g. chloramphenicol, erythromycin, gentamicin, others), quinine and diuretics (e.g. furosemide). Tinnitus can also be a symptom of other health problems, such as allergies, anemia, arterioslcerosis (hardening of the arteries), high blood pressure, tumors (e.g. acoustic neuroma) and heart problems. In many cases, however, a specific cause is never found.

What should I do about my tinnitus? Those with the recent onset of tinnitus should undergo medical evaluation. If a specific underlying cause can be determined, it may be treatable. For example, if a minor cause such as wax accumulation in the ear canal is found, treatment can be curative.

Can the ringing itself be stopped? When no specific cause for tinnitus is found, treatment is aimed at managing the symptoms. Most individuals with tinnitus will respond favorably to one or more of the following treatments:

Self-care measures - Factors that can make tinnitus worse and should be avoided include smoking, alcohol, and caffeine. Those who are regularly exposed to loud noise at home or at work should wear earplugs or special earmuffs to protect their hearing. Since high blood pressure can cause tinnitus it is important to have this checked and treated if it is found to be too high.

Hearing aids - with tinnitus have some degree of hearing loss. For example, age-related hearing loss (presbycusis), is commonly associated with tinnitus. Use of a hearing aid will make it easier to hear as well as making the tinnitus less noticeable.

Sound therapy utilizes the principle of distraction to mask tinnitus with a less annoying sound. Electronic devices, such as white noise machines, produce sounds similar to that of radio static. This distracts the individual from hearing the noises produced by their tinnitus. Some of these devices are small enough to fit into the ear. If the tinnitus is mild, a fan or soft music may be enough to accomplish the same thing as a white noise machine.

Medications - No specific medication consistently helps to treat tinnitus. The ones that have helped in certain instances include antihistamines, antidepressants (e.g. amitriptyline and nortriptyline), and the anti-anxiety medication, alprozolam (Xanax, Niravam). Acamprosate (Campral), a drug used to treat alcoholism has shown promise as a treatment for tinnitus, but has not yet been approved for this use by the U.S. Federal Drug Administration.

What about severe or disabling tinnitus? If the above measures are unsuccessful, other treatments can be considered. Cognitive Therapy, originally developed as a treatment for depression and anxiety, uses relaxation and thought remodeling to improve the patient's attitude towards tinnitus. Cognitive Therapy does not decrease the perceived loudness of tinnitus, but has a positive effect on the way in which people cope with the problem. Tinnitus Retraining Therapy is a form of educational counseling that helps the sufferer to “habituate” or filter out the tinnitus so that it does not reach conscious perception. Transcranial Magnetic Stimulation (rTMS), a treatment occasionally used in treating depression, has shown some promise in treating tinnitus, and is currently undergoing additional clinical trials.

If you have any questions about tinnitus, please log into your account and send us your question. We are here to help.

Nine things you should know about type 2 diabetes

According to the CDC, 25.8 million children and adults in the United States - representing 8.3% of the population - have diabetes. This represents an increase of roughly 15 percent in just the past few years. Unfortunately, there is a great deal of misunderstanding about this disease, some of which can lead to a delay in diagnosis and worsening of complications. More importantly, people who can be identified as being at risk for developing diabetes may have an opportunity to prevent the disease from occurring.

1. Type 1 and type 2 diabetes have different causes. Type 1 diabetes is a disease that develops when the body's immune system attacks the pancreas resulting in a deficiency of insulin. Without insulin, the body is unable to convert sugar and other starches into energy and the blood sugar can rise to dangerous levels. A person who has type 1 diabetes must take insulin on a regular basis to live. Only about five percent of all people with diabetes have type 1 diabetes. Type 2 diabetes, affecting about 95% of diabetics, develops over time due to genetics and lifestyle factors. These factors include physical inactivity and poor diet. In type 2 diabetes, the cells don't recognize and properly use the insulin that the body produces, a problem known as insulin resistance.
   
   
2. Certain people are at higher risk of developing type 2 diabetes than others. This includes those people with: 1) a family history of the disease, 2) excess body weight, 3) low physical activity, 4) high blood pressure, 5) abnormal blood lipids (HDL under 35 mg/dL or triglycerides higher than 250 mg/dL), and 6) diabetes during a previous pregnancy. People over the age of 45 and certain ethnic groups, including African Americans, Hispanic Americans, Asian Americans, and Native Americans, are also at increased risk of developing type 2 diabetes.
   


3. Many people with type 2 diabetes do not realize that they have it. Symptoms most commonly associated with type 2 diabetes include feeling thirsty, having to urinate more than usual, staying hungry, tiredness, and losing weight without trying. Many people with type 2 diabetes, however, have no symptoms at all. According to the American Diabetes Association, about 16 million people in the United States, or approximately one-third of all people with diabetes, are unaware that they have it.
   
   
4. Before developing type 2 diabetes, most people have a condition known as "prediabetes". In prediabetes, blood glucose levels are higher than normal but not high enough to be diagnosed as having diabetes. Approximately 79 million people in the United States have prediabetes. Although prediabetes is usually not associated with symptoms, long-term damage to the body, especially the heart and circulatory system, may already be occurring.
   
   
5. Complications of diabetes can affect many areas of the body. Sugar or glucose that is not converted into energy by the cells can damage the blood vessels, heart, nerve endings, kidneys and eyes. This results in an increased risk of stroke, high blood pressure, blindness, kidney disease and amputations of the limbs. Fortunately, good control of diabetes can significantly reduce the risk of developing or worsening of complications. Consider these statistics related to diabetes-related complications:
   
   
   • Diabetes is the leading cause of blindness in adults.
     
     
   • Diabetes is the leading cause of kidney failure.
     
     
   • About 60% to 70% of people with diabetes have mild to severe forms of nerve damage.
     
     
   • The risk for stroke is 2 to 4 times higher among people with diabetes.
     
     
   • Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults who do not have diabetes.
     
     
6. Type 2 diabetes is not just an adult disease. In In the past, children with diabetes almost always had type 1, the variety that occurs when the immune system attacks the pancreas, resulting in insulin deficiency. Over the past decade, however, there has been a marked increase in the number of children and adolescents diagnosed with type 2 diabetes. Most of these cases appear to be related to a combination of obesity and physical inactivity. The actual number of children with type 2 diabetes may even be underestimated since it can remain asymptomatic and undiagnosed for a long time.
   
   
7. Diagnosing type 2 diabetes is easy. On One of the best and easiest ways to check for diabetes is by drawing blood from the arm after not eating for 8 hours and measuring the amount of glucose in the plasma. The American Diabetes Association recommends testing for diabetes every 3 years in everyone over the age of 45. The United States Preventive Services Task Force (USPSTF) recommends that people with blood pressure higher than 136/80 also be tested. Testing for diabetes should begin at a younger age in someone who is overweight and has risk factors, such as a parent with type 2 diabetes, or is a member of certain ethnic groups, including African and Native Americans.
   
   
8. A 3rd type of diabetes affects pregnant women. Known as gestational diabetes, this type of diabetes usually starts in the middle part of the pregnancy. Like type 2 diabetes, it is associated with insulin resistance and elevated blood sugar. The excess sugar in the bloodstream commonly causes the baby to grow too large (macrosomia). Potential complications of gestational diabetes include an increased risk of newborn death and stillbirth, delivery-related complications due the infant's large size, and an increased risk of the child developing diabetes later in life. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for the condition.
   
   
9. Type 2 Diabetes is often a preventable disease. The good news is that in many people with risk factors or who have prediabetes, type 2 diabetes can be prevented. In these people, moderate weight loss (10-15 pounds) along with 30 minutes of moderate physical activity (such as brisk walking) each day is often enough to prevent its development.
   

To learn more about type 2 diabetes, refer to the CDC's Diabetes and Me or see
Diabetes Basics sponsored by the American Diabetes Association.

Alcohol Abuse vs. Alcoholism

Moderate alcohol use—up to two drinks per day for men and one drink per day for women and older people—is not considered harmful for most adults (a standard drink is 12-ounces of beer, a 5-ounce glass of wine, or 1.5 ounces of distilled spirits). Many people, however, exceed this level of consumption and get into serious trouble because of their drinking. Currently, nearly 17.6 million adult Americans abuse alcohol or are alcoholics. Several million more adults engage in risky alcohol-related practices, such as binge drinking.

Alcoholism, also known as "alcohol dependence," is a disease that includes four symptoms:

• Craving - a strong need, or compulsion, to drink.


• Loss of control - the inability to limit one's drinking on any given occasion.


• Physical dependence - withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking.


• Tolerance - the need to drink greater amounts of alcohol in order to become intoxicated.

The craving that alcoholics experience may cause them to continue to drink despite serious family, health, or legal problems. Alcoholism has been shown to run in families, although having a family history of alcoholism does not mean that someone is destined to become an alcoholic also. As with other chronic illnesses, alcoholism cannot be cured, but is instead "managed". This typically involves abstinence from drinking alcohol.

Alcohol abuse constitutes many of the same traits as alcoholism, but unlike alcoholics, alcohol abusers may feel less of a compulsion to drink and may not experience withdrawal symptoms when they don't drink. Common characteristics of alcohol abuse include: (1) failing to fulfill major work, school, or home responsibilities because of drinking; (2) drinking in situations that are physically dangerous, such as while driving a car or operating machinery; (3) recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk; and (4) having social or relationship problems that are caused by or worsened by the effects of alcohol.

If you've ever wondered whether your drinking crosses the line into alcohol abuse or alcoholism, ask yourself these questions:

1. If you are a man, have you ever had five or more drinks in a day (four if you're a woman)?


2. Have you ever felt you should cut down on your drinking?


3. Have you been annoyed by people criticizing your drinking?


4. Do you ever feel bad or guilty about your drinking?


5. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Answering yes to the first question alone, or two positive responses to questions 2 through 5, indicates that you may have a problem with alcohol that needs to be addressed.

The consequences of alcoholism and alcohol abuse are serious, and in some cases, life threatening. Heavy drinking increases the risk for certain cancers, especially those of the liver, esophagus, throat, and larynx (voice box). It can lead to health problems, such as liver cirrhosis, brain damage, and harm to the fetus during pregnancy. In addition, drinking increases the risk of death from automobile crashes as well as recreational and on-the-job injuries. In purely economic terms, alcohol-related problems cost society approximately $185 billion per year. In human terms, the costs cannot be calculated.

Colorectal Cancer - Screening works!

For some time it has been known that the earlier that colon cancer is detected, the better the survival rate. For example, when colon cancer is diagnosed at an early, localized stage, the five-year survival rate is 90 percent, as compared to a five-year survival rate of only 10 percent when diagnosis is delayed until the later stages. Additionally, the earlier the diagnosis, the less invasive and dangerous the treatment becomes. If the cancer is found at a very early stage, it may be able to be removed without having to enter the abdomen surgically. More advanced stages of colon cancer usually require removal of a portion of the colon and chemotherapy.

What has been suspected, but not proven until recently, is that detection and removal of colon polyps can significantly reduce the number of deaths from colon cancer. The explanation for this is that colon cancer usually begins as a non-cancerous polyp on the inner lining of the colon or rectum. From the time the first abnormal cells start to grow into polyps, it can take up to 10 to 15 years for them to develop into colon cancer. Removal of these polyps before they have the chance to change into cancer can, in many cases, prevent colon cancer altogether. This is particularly true with a type of polyp known as an "adenomatous" polyp.

The study that demonstrated this improvement in survival was published last month in the New England Journal of Medicine. Over 2600 patients who had undergone adenomatous polyp removal by colonoscopy were followed for an average of 16 years. Over this time, there was a 53% reduction in death from colon cancer compared to expected deaths in the general population of similar age and gender. Obviously, polyp removal in this study group did not result in a complete avoidance of the development of colon cancer, but the results are significant enough to encourage widespread colorectal cancer screening.

There are a number of ways to screen for colon cancer. Colonoscopy is considered the "gold standard" for screening, but there are other methods that can also be used. A major advantage of colonoscopy is that if polyps are found during the screening, they can be removed and analyzed at that time. In addition, other methods may require more frequent screening intervals. For example, if no abnormalities are found, a colonoscopy does not need to be repeated for another 10 years. Sigmoidoscopy, which takes a less extensive look at the colon, should be repeated every five years and coupled with annual stool tests for blood.

Most medical authorities, including the United States Preventive Medicine Task Force, the American College of Physicians, and the American Cancer Society recommend that screening for colon cancer begin at age 50. Those people in high-risk groups, including African Americans, individuals with a family history of colon cancer, and someone with a personal history of inflammatory bowel disease (e.g. ulcerative colitis), may require that their screening begin at an earlier age.

Colorectal cancer, the second leading cause of cancer-related deaths for men and women in the United States, is expected to take more than 51,000 American lives this year. March is National Colorectal Cancer Awareness Month. If you are of an appropriate age, are in a high risk group, or are due for a repeat screening, take the time this month to talk to your doctor about colon cancer screening. With the knowledge that, to a large degree, colon cancer is a preventable disease, it only makes sense.

Understanding Viral vs. Bacterial Infections - Part 2, The Infections

Last week, we looked at how bacteria and viruses differed. Some of these differences, such as viruses being unable to cause harm unless they invade a living host, have a bearing on the nature of the infections that they cause, as well as the way that the infections that they cause are treated.

In some ways, the infections caused by bacteria and viruses are alike. They can each cause similar symptoms such as fever, coughing, vomiting, diarrhea, fatigue, and cramping. They are both capable of causing short-lived acute infections as well as chronic infections, that untreated, can last a lifetime. Also, viruses and bacteria lend themselves to preventive measures, such as the use of vaccines.

Bacterial infections occur when harmful bacteria enter the body. Often this happens because the organism takes advantage of a situation, such as a break in the skin or a compromised immune system. This is called an "opportunistic" infection. Some of the most common types of bacterial infections are caused by:

• Staph (Staphylococci) are bacteria that are commonly found on the skin or in the nose of healthy individuals. Some types of Staph bacteria can cause serious infections of the skin, heart, lungs, or blood stream. A particularly serious type of Staph infection is called MRSA (methicillin-resistant Staphylococcus aureus). MRSA does not respond to the typical antibiotics used to treat Staph infections.
  
• Strep (Streptococci) infections include "strep throat"; a common skin infection in children called impetigo; toxic shock syndrome; and a form of pneumonia.
  
  
• H. flu (Haemophilus influenza), despite its name, does not cause the flu. At one time, it was mistakenly considered to be the cause of influenza until it became apparent that the flu was caused by a virus. It is one of the most common causes of middle ear infections (otitis media) in children.
  
  
• E. coli (Escherichia coli) bacteria commonly live in the gastrointestinal tract of humans and even serve useful purposes, such as producing Vitamin K. A disease-producing strain of E. coli can cause food poisoning if transmitted through improperly cooked hamburger, or other food products.
  
  
• There are many other infections caused by bacteria including tuberculosis, pelvic inflammatory disease, Lyme disease, tetanus, and bacterial pneumonia.

An antibiotic is usually needed to treat bacterial infections. Antibiotics either kill bacteria, or interrupt their ability to multiply. This gives the body's defenses an opportunity to take over and fight the infection. The names of antibiotics that are effective against different strains of bacteria include the penicillins (e.g. ampicillin), cephalosporins (e.g. Keflex), tetracyclines (e.g. Vibramycin), quinolones (e.g. Cipro) and macrolides (erythromycin).

Vaccines may also be available to prevent bacterial infections. Effective vaccines have been developed for a number of bacterial infections including diphtheria, tetanus, whooping cough, meningococcal meningitis, pneumococcal pneumonia, and typhoid fever.

Viral infections include the common cold, influenza, measles, AIDS, hepatitis A & B, rabies, chicken pox and shingles. In contrast to bacteria, viruses must invade a living cell to reproduce. Once inside the host cell, the virus's genetic material (DNA or RNA) takes control of the cell and forces it to replicate the virus. The infected cell eventually dies, releasing the new viruses which go on to infect other cells. Viral infections are generally more difficult to treat than bacterial infections because the virus "hides" inside normal, living cells protecting them from treatment with antibiotics.

Because of the overlap in symptoms, it can be difficult for someone to know if a condition, such as diarrhea is being caused by a bacteria or virus. When the diagnosis is uncertain, doctors can usually tell which is responsible with a careful history and physical examination. Sometimes, special testing, such as a "culture test" to grow the specific organism, may also be used.

Many viral infections, such as the common cold, do not presently have a treatment that is directed against the virus. In particular, the antibiotics used for treating bacterial infections, are ineffective against viruses. Fortunately, many viral infections are "self-limited" and the body's immune system is able to fight off the infection. A few anti-viral drugs are available such as the ones used in treating a human immunodeficiency virus (HIV) infection, seasonal influenza, and cold sores. Another type of antiviral drug, called interferon, enhances the body's immune response to the viral infection.

Most viruses attack specific areas of the body, such as the liver, genitals, or respiratory tract. In some instances the infected cell loses control of its normal function and develops into cancer. Examples of this include cervical cancer following an infection with the human papilloma virus (HPV) and liver cancer developing from a chronic hepatitis B infection.

Over the past century, immunizations have become an effective way to prevent viral infections. In fact, the first vaccine that was developed was used to prevent the viral illness, smallpox. Other viral diseases with effective vaccines include polio, measles, chickenpox, influenza, hepatitis A & B, and human papillomavirus (HPV) infections.

Understanding Viral vs. Bacterial Infections - Part 1, The Microbes

Microbes are microscopic living organisms, such as bacteria and fungi. Although often categorized as microbes, viruses are very different. In fact, since viruses are unable to grow or reproduce unless they enter a living cell, viruses are sometimes not considered to be living creatures at all. In order to compare and contrast viral and bacterial infections, it is first necessary to gain an understanding of the microbes themselves.

Bacteria - Bacteria first appeared on the Earth billions of years ago. Through a process known as photosynthesis, they are thought to have helped produce the oxygen environment that is essential to animal life. A distinguishing feature of bacteria is that they have only one cell. Although one type of bacteria can be seen with the naked eye, most are so small that thousands could fit in the eye of a needle. There are many of types of bacteria, but most of them are of one of three different shapes- rods (bacilli), spheres (cocci), or spirals (spirilla). Within the human body, there are approximately ten times as many bacteria as there are human cells, a majority of these located on the skin and in the bowel.

A typical bacterium (the singular of bacteria) has a rigid cell wall that contains a fluid called cytoplasm within the cell. Floating in the cytoplasm is the nucleoid or genetic material of the bacterium (DNA and RNA) that allows the bacterium to reproduce itself. Some bacteria even have threadlike structures called flagella that provide propulsion.

Some people think of bacteria only in terms of being "germs", or harmful microorganisms that invade our bodies and cause disease. And in fact, many serious infectious diseases including tuberculosis, strep throat, tetanus, Lyme disease, and gonorrhoea are caused by bacteria. The disease causing varieties, however, constitute only one percent of all bacteria. Most bacteria are harmless, and a few are even beneficial to humans. For example, Lactobacillus acidophilus is a bacterium that lives in the intestines and helps us to digest food and protects against "bad" bacteria that can cause disease. Another type of bacteria in the gut provides us with Vitamin K.

In addition to their role in human health and disease, bacteria have a number of other functions. Bacteria are involved in the break down of garbage and production of compost from vegetation. Bacteria are also used in making healthy foods like yogurt and cheese. Bacteria that digest and dissolve hydrocarbons have even been used to clean up oil spills.

Viruses - As compared to bacteria, viruses are much less complex. For one thing, an average bacterium is hundreds of times larger than most viruses. Instead of being even one-celled like bacteria, viruses are considered to be non-cellular, meaning that they consist of a packet of genetic material (DNA or RNA) carried in a shell called the capsid.

The most distinguishing feature of viruses is that without the benefit of a living host, viruses are essentially dormant, meaning that they are unable to multiply or to cause any harm. When viruses encounter appropriate host cells, however, they are able to release their genetic material into the cell. Once inside, the viral genetic material takes over the host cell’s normal functioning with its own set of instructions. This shuts down the usual cell functions and directs it to produce new virus particles. In this way, the virus becomes a "parasite" on the cell with the host cell doing the work under the instructions of the virus.

Another important distinction is that unlike bacteria, most viruses do cause disease. They exist for one purpose only which is to reproduce, and in the process, they take over and ultimately destroy host cells. Viruses have evolved to infect every form of life, from animal to plant-life. In fact, the first virus to be discovered, the tobacco mosaic virus, affects the tobacco plant, rather than humans.

Viral illnesses can range from relatively mild to fatal. The common cold, influenza, cold sores, and chicken pox are viral illnesses that typically "run their course". Hepatitis B and AIDS are chronic viral illnesses that can ultimately be fatal. Rabies and Ebola are viral infections that can rapidly cause death. One of the worse aspects of viral infections is that certain viruses are capable of triggering the development of cancer. For example, along with being a well-known cause of cervical cancer, the human papilloma virus (HPV) has become the leading cause of throat cancer in this country.

With this background on the nature of viruses and bacteria, next week we'll look at the differences in the infections that are caused by these microbes.

The Decision to Decline Immunizations

The decision to postpone or decline childhood immunizations is one that has important implications for the child, his or her family, and others in the community. Recently, the Centers for Disease Control, along with the American Academy of Family Physicians and American Academy of Pediatrics, released a statement outlining the responsibilities of parents who decline to have their child vaccinated. Today's Health Tip summarizes some of the most important points from that statement.

Special considerations when an unimmunized child gets sick: When seeking medical attention for a sick child, it is essential that the health care profession learn of the child's vaccination status. This applies whether the child is seen in the doctor's office, an emergency department, or if the child is traveling in an ambulance. This is because vaccine-preventable diseases will need to be considered as a possible cause for the child's illness. Also, the child may need to be isolated to avoid spreading the disease to others. For example, an infant who is not yet old enough to be vaccinated or someone with a weakened immune system could be at risk of contracting the child's illness.

With an outbreak of a vaccine-preventable disease in the community: At the time of enrollment, a child's school or child care facility should be informed about the child's immunization status. Should a vaccine-preventable disease strike in the community, it may be necessary to remove an unvaccinated child from school or daycare. With some vaccine-preventable diseases, it may not be too late to receive protection by being vaccinated

When an unimmunized child is exposed to a vaccine-preventable disease: In this situation, the caregivers of the unimmunized child need to know the signs and symptoms of that disease. Medical attention should be sought at the first sign that the child has contracted the disease. In some cases, a medication may be available to treat the illness, such as the use of an anti-viral medication following exposure to influenza.

When traveling with an unimmunized child: Even though many vaccine-preventable diseases have become rare in the United States, they may still occur in foreign countries. For example, India, Nigeria and Pakistan continue to have polio outbreaks. Should an unimmunized child become ill with a vaccine-preventable disease, his or her parents should take measures to avoid spreading the disease to others. This could mean cancelling further travel until a doctor determines that the child is no longer contagious. Also, be aware that prior to admission into some countries, immunization against certain disease, such as Yellow Fever, may be required.

A few of the vaccine-preventable diseases that continue to cause infections in the U.S. include pertussis (whooping cough), hepatitis B, mumps, measles, and Haemophilis influenzae type B (Hib) meningitis. Before deciding to forgo immunizing their children, parents should consider the following facts regarding these vaccine-preventable diseases:

• Cases of whooping cough have been on the rise in the U.S. due to reduced immunization rates, due in part to parental concern regarding the safety of the vaccine. Prior to pertussis immunization, however, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths.
• Approximately 20% of people who contract measles require hospitalization due to complications such as pneumonia. Before measles immunization, an average of 450 measles-associated deaths occurred each year.
• Before the mumps vaccine was introduced, mumps was a major cause of deafness in children, occurring in approximately 1 in 20,000 reported cases.
• Before Hib vaccine became available, Hib meningitis killed 600 children each year and left many survivors with deafness, seizures, or mental retardation.
• Of the 2 billion persons worldwide who have been infected with hepatitis B, around 350 million become life-long carriers of the disease and can transmit the virus to others. One million of these people die each year from liver disease and liver cancer.

In the U.S., vaccines have reduced or eliminated many infectious diseases that once routinely killed or harmed many infants and children. Parents or caregivers should make the decision to postpone or decline immunizations for their children only after being fully informed of the risks and responsibilities. For more information on childhood vaccines visit the immunization section of the CDC website at www.cdc.gov/vaccines.