The Flu Vaccine

Posted on October 6, 2016 by Bradford Weiner, MD

Our New England weather has turned cooler over the past few days, reminding us that summer is coming to a close and winter is only a few months away. Soon the leaves will change into brilliant hues of yellow, orange, and red, followed by our first frost, our first snowfall, and then the start of influenza (flu) season.

Flu season usually reaches peak activity during January, February and March, but sometimes arrives as early as December.  Some important reminders about influenza:

What is the flu?

Influenza, or the flu, is a contagious viral infection. Typical symptoms of the flu include a fever (100-103F) for three to five days, shaking chills, diffuse muscle aches, and fatigue. A sore throat, cough, and runny nose may develop. Nausea, vomiting, and diarrhea may also sometimes occur.

How long does the flu last?

Typically, symptoms last for one to two weeks, but recovery may be slow. It is not uncommon to feel unwell for up to three to four weeks.

Why all the fuss over the flu?

While most people have a self-resolving illness, potential complications include pneumonia, dehydration, or an exacerbation of an underlying medical condition such as asthma, diabetes, congestive heart failure, or kidney disease, and in rare instances, death.

Who should get the flu shot?

Everyone older than 6 months. Young children, pregnant women, the elderly, and those with chronic illness are most vulnerable. Please check with your physician first if you have a fever or a severe egg allergy.

Why should I get a flu shot?

When you receive the flu vaccine, you are not only protecting yourself, but you are also protecting your family members, friends, colleagues, and other members of your community.

Does the flu shot work?

The quadrivalent flu vaccine offers protection against two strains of influenza A and two strains of influenza B. When the vaccine’s strains match those circulating in the community, the vaccine provides protection. Last year’s flu shot did not match all of the circulating strains, so people were still susceptible to the flu. Despite the lack of a perfect match, the flu shot still offered some protection and is therefore worthwhile.

Will the flu shot give me the flu?

No.  You cannot get the flu from the flu shot.  This type of vaccine contains an inactivated virus which is dead and cannot cause the flu.  Frequently, the “flu” that people develop after receiving the vaccine is another viral upper respiratory infection, but it is not influenza.  Remember, the flu shot is administered during the fall and winter months.  This coincides with the peak season of the common cold.  For those of you who develop an actual case of influenza shortly after the flu shot, you were going to get the flu anyways.  The flu vaccine takes approximately 10 to 14 days to “kick in” before it starts to provide you with protection.

How do I get the vaccine?

You may contact your physician’s office to inquire about receiving the vaccine. Many local pharmacies and some community centers offer the flu vaccine as well.

Wishing you a happy, healthy, and flu-free winter!

Brad Weiner, MD

 

This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.

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Advanced Care Planning: It’s Never Too Early

Posted on September 4, 2016 by Bradford Weiner, MD

It’s always important to plan ahead for the future.  When we are healthy and active, it’s natural to avoid thinking about what may happen if we were to develop a significant illness or injury.  However, the best time to plan how our affairs will be managed during sickness is during times of good health.  If we become seriously ill, what type of medical care do we wish to receive?  Do we seek heroic measures, comfort care, or something in between?  Who will make these decisions for us should we become incapable of making them ourselves?  Fortunately, we have several tools at our disposal that make it easier to plan for such difficult times.

MOLST Form

The MOLST (Medical Orders for Life-Sustaining Treatment) form was implemented statewide in Massachusetts in 2012.  This form was created to help individuals document their goals of care should they develop a significant, life-altering illness.  It is a legal document that guides physicians, family members, and other providers who deliver medical care.

The MOLST form represents an important advance in planning for end-of-life care.  Until this form was adopted, health care providers relied on the DNR/DNI form which asked black and white questions about cardiopulmonary resuscitation (CPR) and intubation (breathing tube, ventilator) for life-threatening emergencies.  However, as we all know, decisions related to health care involve many areas of gray, and the MOLST form recognizes some of these nuances.

While the MOLST form does include questions regarding CPR and intubation, it also addresses other less invasive forms of medical care.  These questions include whether an individual wishes to receive intravenous fluids, artificial nutrition (feeding tube), non-invasive ventilation (bi-PAP or C-PAP), or dialysis.  There are queries regarding duration of treatment and whether a person wishes to be transferred to a hospital for medical care.

The MOLST form should be completed in consultation with your physician.  For more information, please see the following link:  http://www.molst-ma.org

Healthy Care Proxy

When healthy, we are able to make informed decisions about our own medical care.  What happens to an individual who becomes cognitively impaired and is no longer able to make such decisions? A health care proxy is someone who is given the legal authority to make medical decisions on behalf of another person.  The health care proxy is not “activated” until an individual is deemed incapable of giving informed consent to medical treatment.  When selecting a health care proxy, it is important to make sure the proxy understands a person’s wishes and goals of care should a serious illness develop.

The Commonwealth of Masssachusetts offers an easy-to-complete form by which a person may appoint two health care proxies (a primary health care proxy and a back-up).  This form may be found here:  http://www.massmed.org/healthcareproxy

Living Will

After completing the MOLST form and selecting health care proxies, some individuals choose to create a living will.  A living will is a written narrative by which a person describes their goals of care should they develop a serious illness.  It serves as a guide for the health care proxy and medical providers when an individual is no longer able to express their wishes or make informed decisions regarding their own care.

Who Should Keep These Documents?

After creating these documents, it is important that these papers be made accessible to all parties who may be involved in that person’s medical care.  This includes:

  • Health care proxies (both the primary health care proxy and the back-up)
  • Medical team (physicians, hospitals, home care providers)
  • Immediate family members or close friends
  • Estate attorney

Where Do I Get More Information?

Primary care physicians are available to guide patients with their decision-making process. Attorneys who specialize in estate planning may also provide counseling.   The following websites offer helpful information:

National Institute on Aging Information Center https://www.nia.nih.gov/health/publication/advance-care-planning

Centers for Disease Control and Prevention (CDC)     http://www.cdc.gov/aging/advancecareplanning

 

Wishing you good health,

Brad Weiner, MD

 

This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.

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Summer Tick Safety

Posted on August 20, 2016 by Bradford Weiner, MD

Summertime is one of my favorite seasons.  Warm weather, endless outdoor activities, and extra hours of daylight bring the color back to our cheeks after a long winter.

Last weekend, I attended a barbeque in one of Boston’s picturesque suburbs.  Guests mingled on a patio adjacent to a well manicured backyard.  Deep blue skies, great company, and lemonade combined to make this a perfect summer day, until one guest spotted a tick crawling along her arm.  Not long afterwards, another guest discovered a tick traipsing across his neck.  These little critters quickly reminded us that the arrival of summer also heralds the arrival of peak tick activity in New England.

Starting in the spring and continuing throughout the fall, I field numerous phone calls from patients reporting of tick bites.  Many express concern about their risk for developing Lyme disease.

Lyme disease is the most common tick-borne illness in the United States, and is caused by the bacterium Borrelia burgdorferi.  In the northeastern United States, Borrelia burgdorferi is transmitted to humans by the deer tick, Ixodes scapularis.

Deer ticks often reside on tall grasses and shrubbery.   They may attach to any part of the human body, but are commonly found in difficult-to-see areas such as the scalp, behind the ears, underneath the armpits, inside the bellybutton, around the waistline, between the legs, and behind the knees.

Tick Photo

Measures to prevent tick bites include:

  • Avoid walking in tall grasses, brush, or other areas where ticks are abundant.
  • Wear protective clothing including long pants and long sleeves when entering wooded areas.
  • Apply a repellant containing DEET to skin and clothing.
  • Perform routine, full-body tick checks with a mirror after outdoor activities.
  • Bathe or shower within 2 hours following exposure to tick environments.

Generally speaking, a tick must be attached for 48 hours or longer to transmit Lyme disease.  If you find a tick attached to your skin, do not panic.  You have time to ensure proper removal.   I recommend the following steps for removal:

  • Locate a pair of fine-tipped tweezers or small forceps.
  • Grasp the tick as close to the skin as possible.
  • Pull straight upwards with firm but steady pressure.
  • Do not twist or jerk sideways. This may cause part of the tick to break off and remain in the skin.  If this happens, do not worry.  Leave it alone and your body will eventually expel the remaining tick part.
  • Cleanse the area afterwards with soap and water.

Please call your physician if you discover a tick that may have been attached for 48 hours or longer.  They may prescribe a prophylactic dose of antibiotics to reduce your chance of developing Lyme disease.

Note that it is common for some people to develop a small, raised, red rash at the location of the tick bite that is about the size of a penny.  This is not Lyme disease, and usually resolves on its own within a few days.

After removing the tick, I recommend observation for the following symptoms and signs:

Erythema migrans

  • Erythema migrans (EM) is an enlarging red rash at the site of the tick bite.  An EM rash may become quite large and may develop central clearing, creating a bulls-eye appearance.
  • Fever, chills, fatigue, muscle aches and pains, headache, or enlarged lymph nodes.
  • EM rashes located elsewhere on the body, joint swelling (such as the knee), Bell’s palsy, or palpitations.

 

Please call your physician if any of these symptoms develop.

 

Wishing you a happy and healthy summer,

Brad Weiner, MD

 

This blog is for informational purposes only. It does not replace medical care from a licensed physician.  Please contact your doctor if you have any questions or concerns.

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