University Health System Weblog

Cigarette smoking is the most preventable cause of premature death. The CDC reports that every year more than 400,000 people die from cigarette smoking in the U.S. alone—with one in every five deaths in the U.S. related to smoking. Quitting is the best thing you can do for your health. Let’s face it: it’s hard to quit. It sometimes takes six to eight tries to quit for good. But with help from the medical experts at the Nevada Tobacco Users’ Helpline, your chances of success will be better.

Some of the Nasty Things Smoking Does to Your Body
The visual and olfactory signs of smoking—bad breath, the foul odor, yellow teeth—is the least of your worries if you continue to smoke. Beyond the warning label, smoking causes impotence, infertility, blindness, hearing loss, bone loss, damage to your blood vessels, premature aging and death.

Smoking is as major risk factor for cardiovascular disease. Cardiovascular disease leads to heart disease, stroke and blood clot disorders. Even if you smoke less than 10 cigarettes a day or use smokeless tobacco products, you’re at increased health risk. And smoking lower tar products don’t reduce the risks. Your body tries to repair the damage to arteries by “plastering” the arteries with cholesterol. This cholesterol, known as plaque, becomes irritated when you smoke, and it triggers inflammation and causes the body to send white blood cells to these “plaster” patches. Irritation and inflammation further causes blood clots to form on the plaque plastered tears. Blood clots later can suddenly and completely block an artery.

As for your lungs, damage begins when tobacco smoke paralyzes the cilia, which are microscopic hairs that line your bronchial tubes. Cilia are similar to a broom in your lung that sweeps germs and irritants out of the airways. Smoking interferes with the sweeping movement of cilia. Irritants, like tobacco smoke, remain in the bronchial tubes, and find their way to your alveoli, the tiny air sacs in your lungs.

Emphysema is the damage to alveoli, which transport oxygen to the blood through capillaries. This damage causes air to be trapped in these air sacs and makes exhaling very difficult. Less oxygen is transported to the bloodstream. Tobacco smoke toxins break down the elastic fibers of your alveoli, which work to help exhale the air from your lungs.

Chronic bronchitis is the inflammation and scarring of your bronchial tubes. This happens when the poisonous chemicals in tobacco smoke inflame the tissues in the bronchial tubes. This later reduces the airflow to and from your lungs, producing heavy mucus. This mucus is the ideal breeding ground for infections.

These three conditions cause chronic obstructive pulmonary disease, or COPD. Cigarette smoke is far and away the most common cause of COPD, accounting for eight out of ten cases.

Quitting Smoking has Immediate Benefits
If you quit now you won’t have to wait too long to experience the benefits. Within eight hours carbon monoxide blood-level drops, meaning more oxygen is available. At 24 hours from smoking your last cigarette, death from a heart attack decreases rapidly. At 48 hours your ability to smell and taste will improve.

Contact the Nevada Tobacco Users’ Helpline, the statewide nicotine dependence treatment program that treats all forms of tobacco dependence. Call 800-QUIT-NOW.

Elizabeth Fildes, Ed.D., R.N, is clinical director and counselor for the Nevada Tobacco Users’ Helpline and clinical assistant professor at the University of Nevada School of Medicine Department of Internal Medicine.

Type 2 diabetes is a chronic condition that affects how your body metabolizes sugar, or glucose, your body’s main source of fuel. Type 2 diabetes afflict many people in Nevada and the number of new cases is reaching epidemic proportions according to the Centers for Disease Control. The good news is that, in most cases, the disease is preventable.

But what if your family physician or internist diagnosed you with type 2 diabetes? It means your body is resistant to the effects of insulin. Insulin is a hormone that regulates how sugar is absorb into your cells. Having type 2 diabetes means your body doesn’t produce enough insulin to maintain normal glucose levels. There’s no cure, but if you’re diagnosed with type 2 diabetes, it can be managed. Eating healthy foods, engaging in regular physical activity and maintaining a healthy weight are key.

Our nutritionists in Las Vegas or Reno are experts who can work with you to develop a personalized diet that works for you. Generally speaking, an ideal diet is one that consists of two thirds fruits, vegetables and grains. The remaining third can be most anything else, although avoiding simple sugars like certain fruit juices and candies, pasta, alcohol and animal fats is highly recommended. Making these simple changes will improve your type 2 diabetes, while helping you lose weight as well. As I tell my patients, it’s not how much you eat but what you eat that’s important. Daily physical activity like walking, jogging, biking and swimming, is also critical to control your type 2 diabetes. Following general exercise guidelines works well.

Your family physician or internist will want to manage and monitor several things after your diagnosis of type 2 diabetes, such as blood pressure, cholesterol levels and triglycerides. Your kidney function is also monitored to ensure its working properly. Blood pressure monitor is especially critical to managing type 2 diabetes. Type 2 diabetics don’t usually die of blood sugar but usually die from microvascular or macrovascular disease, the most common being a heart attack. The correlation’s so great that the risk of having a heart attack in someone with diabetes is the same as if you’ve already had a heart attack. So instead of aiming for a blood pressure reading of less than 140/90, the typical goal for the diabetic patient is a blood pressure reading of less than 130/80. Most doctors will start with a diuretic as the first line of defense in blood pressure control.

Cholesterol levels should be less than 200 mg/dL, with LDL, or low-density lipoprotien, levels less than 100 mg/dL. Some medical sources even suggest an LDL level of less than 70 mg/dL. Improving HDL, or high-density lipoprotein, levels, or what’s popularly called “good cholesterol,” is also important, but hard to do. HDL levels is most affected by a consistant exercise regiment.

Remember, a good, healthy diet and regular, daily exercise are the most important factors in controlling type 2 diabetes and the disease’s destructive effects on your body.

Daniel Spogen, M.D. was named chair of the family and community medicine department at the University of Nevada School of Medicine in Reno, Nevada in October 2006. Before joining the medical school’s faculty, Dr. Spogen was in private practice for more than 20 years in northern Nevada. He helped launch fellowship programs in obstetrics and sports medicine at the medical school as well as serves as assistant student clerkship director.

Stem cell research holds the promise of developing new therapies to fight and even cure degenerative diseases and injuries like diabetes, Parkinson’s disease, cancer and spinal cord injuries by giving patients new cells that will replace damaged tissue. This research is part of a new field called regenerative medicine. Stem cell therapy would be an alternative therapy to organ donation and greatly benefit patients because there is such a scarce supply of organs. In addition stem cell therapy would prevent what some believe to be great harms to others, given existing protocols for transplant research and therapy, like cultivating animals either genetically modified or cloned for the purpose of providing organs for humans (called xenotransplantation). Stem cell therapy would greatly diminish, if not obliterate, the demand for traffic in organs and the questionable means of appropriating them, which have been documented in China and India.

Already one successful stem cell therapy is commonly used in medicine: bone marrow transplant. But the vast majority of scientists believe that the most promising therapy will be not with cells that come from a patient’s own organs, that is adult stem cells, but with less specialized, more versatile cells, namely, embryonic stem cells that come from three to five day old ex utero embryos. (Ex utero means outside of a woman’s body, for example, in a petri dish.)

Embryonic stem cell science is morally controversial. The moral objections involve the destruction of embryos and the sources of embryos.

Potential embryonic stem cell therapy needs lines of embryonic stem cells that come from the inner cell mass of a human blastocyst, a three to five day old human embryo, created and kept alive in a petri dish outside of a woman’s body. The blastocyst wall has to be broken in order for the cells to be retrieved and the embryo is destroyed as a result. Some object to this on religious grounds that human life, in the moral sense, not just the biological sense, begins at fertilization and therefore destroying a three to five day old embryo is morally equivalent to killing an innocent born human being. In this way the moral debate is reminiscent of that over abortion. But one need not be against stem cell research if one is pro-life. In fact some believe that it is permissible to destroy embryos for stem cells that are outside of a women’s body because no pregnancy is terminated.

On the other hand, one may be pro-choice but have moral objections to stem cell research because of the sources of embryos. Sources include those embryos 1. left over from fertility treatments (in-vitro fertilization), 2. created in the lab from donated gametes or 3. created through nuclear transfer. In all cases there is concern over the voluntary, informed consent of the gamete donors—as with any tissue donation or medical procedure, a person is not properly respected if he or she has not given permission for donation or enough knowledge of the possible risks and benefits of a procedure. And there is the question of what kind of compensation, if any, the donors should be given.

In the second and third cases, there is apprehension over the potential health risks of women who undergo hormone stimulation and invasive surgery to be ova donors. I should note that these are the same risks a woman undergoes if she participates in IVF (in-vitro fertilization therapy). The drugs a woman must take can cause a reaction called ovarian hyperstimulation syndrome which appears in mild, moderate or severe forms. In rare instances it has caused death.

In the third case, the morality of nuclear transfer therapy or in the vernacular, cloning, is the issue. This source is the most therapeutically promising because the cells would be the closest match to a patient’s own tissue. What critics are most worried is something called a slippery slope. Here is their argument: Should cloning for cells be allowed, it would lead to cloning for reproductive purposes, for example, to make babies and almost everyone believes that cloning for reproductive purposes is morally unacceptable. Therefore nuclear transfer therapy is morally unacceptable.

There are other moral issues involved in this frontier medicine, including the federal funding of research some citizens think is immoral, the migration of U.S. stem cell scientists to different countries over fear of prosecution and the use of scarce medical dollars for therapies that maybe only the wealthy will be able to afford. But there is no doubt that embryonic stem cell science promises to revolutionize medicine, whether at home or abroad.

Marin Gillis, L.Ph., Ph.D. is director of medical humanities and ethics at the University of Nevada School of Medicine. Dr. Gillis was born in Saskatchewan, Canada, completed a bachelor’s in philosophy and history at the University of Ottawa and holds two graduate degrees in philosophy, an L.Ph. from the Higher Institute of Philosophy KU Leuven Belgium and a Ph.D. from the University of Calgary.

The National Institute on Aging reports that more than 10 million Americans have osteoporosis and about 18 million have lost enough bone density to be susceptible to developing the disease. Most who are afflicted by the disease are women but men are also at risk. Osteoporosis causes our bones to become weak and brittle. In severe cases even mild bodily stress can cause a bone fracture. In most cases bones weaken when calcium, phosphorous and other minerals in our bones are at low levels.

How Do I Know if I Have Osteoporosis?

Osteoporosis generally doesn’t exhibit outward symptoms, so you may not know your bones are getting weaker. Osteoporosis is usually diagnosed with a bone mineral density test or DEXA scan, a special type of x-ray. Our bones are continuously changing. Our bodies replace old bone with new bone in a process called remodeling. It takes about two to three months for our bodies to complete a full cycle of bone remodeling. As we get older, your body’s process of bone remodeling continues but gradually slows, losing slightly more than it replaces. For women, bone loss increases during menopause, when estrogen levels decrease, although there are other contributing factors. Generally speaking, if you’re older than 65, you should get a bone density test. If you’re 60 to 64 years old and weigh less than 154 pounds and don’t take estrogen, you should get a bone density test.

How Can I Prevent Osteoporosis?

There are steps you can take to protect your bones. Exercise and a healthy diet are important in reducing your risk of developing osteoporosis. Physical activity, in particular weight training, is important to helping develop stronger bones, although patients with osteoporosis should consult with their doctor. In regards to food, dairy provides a rich source of calcium essential for building and maintaining strong bones. Vitamin D helps your body absorb calcium. Postmenopausal women on hormone therapy should consume at least 1200mg of calcium and 400-800IU of vitamin D a day. Postmenopausal women who are not on hormone therapy and men and women over 65 years old should take 1500mg of calcium and about 800IU of vitamin D a day. Researchers are studying vitamin D to determine the optimal daily dose.

Hormone therapy was once the standard treatment for osteoporosis in women. However, concerns about safety and other treatment options have reduced the role of hormone therapy in managing osteoporosis. Other treatments include bisphosphonates, calcitonin, parathyroid hormone and selective estrogen modulators. You should discuss your options with your family physician, internist or bone health specialist to determine the best treatment.

Osteoporosis and Men

It’s important to note that even though women are four times more likely than men to develop osteoporosis, more than two million men in the U.S. are affected, according to the National Osteoporosis Foundation. Bone loss in men develops more slowly. The National Institutes of Health calls the problem of osteoporosis in men an important health issue since it’s estimated that the number of men above age 70 will double between now and 2050. Each year, men suffer a third of hip fractures and a third of those men will not survive more than one year. Bone loss in men can be a simple result of gradual, age related bone loss, low testosterone, and medications such as prednisone that can lead to steroid excess.

Andra Prum, D.O. is an assistant professor of family and community medicine at the University of Nevada School of Medicine. She practices at the school’s Family Medicine Clinic in Las Vegas.

Pregnant women should not take any medication, including over the counter drugs and herbal supplements, without first checking with their obstetrician or health care provider. As an obstetrician I advise expectant moms on the possible risks of taking certain common over the counter drugs. When it comes to these medications, some are safer than others. There’s a lot of info out there and knowing what’s safe for you and your unborn child can be confusing. All medicine, from the common aspirin to prescription drugs, will affect your body.

Warnings

Again, its highly advisable to consult with your obstetrician before taking any type of drug. Here are some warnings on some common over the counter medicine you may not know:

• Nonsteroidal anti-inflammatory drugs like aspirin or ibuprofen (Advil, Motrin, Aleve) can cause serious blood flow problems in unborn children if used during the last third of pregnancy (after 28 weeks).
• Aspirin may increase the chance for bleeding problems in the mother and baby during pregnancy or delivery;
• Nicotine therapy drugs, like nicotine patches and lozenges, are thought to be safer than smoking, but risks are not fully known;
• Sudafed for allergy relief may not be recommended during the first trimester of pregnancy;
• Antibiotics like tetracycline and ciprofloxacin should be avoided if possible, particularly in the early stages of pregnancy;
• Isotretinoin (Accutane, Sotret, Claravis, Amnesteem), used to treat acne, can cause miscarriage or birth defects;
• Certain high blood pressure medications can cause kidney problems in the fetus;
• Some herbal remedies, like blue cohosh in particular, may be harmful;
• Common nutritional supplements like multivitamins may be harmful, as high levels of Vitamin A has been shown to cause severe birth defects if taken in large doses

If your doctor prescribed medicine for you before you got pregnant, should you continue taking them? You definitely need to discuss this with your doctor as soon as your pregnancy is confirmed. Some medications may be critically important to your health while others can be eliminated, changed or the dosage lowered to reduce any potential risk to your baby.

Guidelines

Certain remedies are usually safe for pregnant women, but of course, you should double check with your obstetrician. These include:

• Tylenol for headaches, muscle aches or mild pain pregnant, with two regular strength tablets every six hours until symptoms subside;
• Nasal sprays work well for some allergies, with two squirts in each nostril every six hours. Benadryl can be an alternative to Sudafed but use with caution as it may make you drowsy;
• Antacids like Tums, Rolaids, Maalox or Mylanta can usually be used as directed as some pregnant women experience heartburn or indigestion

How Medications are Tested

With so many medications on the market and more added each day, it’s more difficult for doctors and nurses to keep track of which drugs can be used during pregnancy. In addition to textbooks and research journals, the U.S. Food and Drug Administration (FDA) plays an important safety role. The FDA requires pharmaceutical companies to show that a specific medicine works for a certain problem and that it’s generally safe. Pharmaceutical companies must check whether birth defects or other problems occur in baby animals when the drug is given to pregnant test animals. If it causes problems, it may mean it can cause problems in human babies. Although the FDA requires these experiments and other criteria to be satisfied, drug testing and its affects is not an exact science. There’s a lot that researchers and doctors just don’t know about some medications used during pregnancy.

What are Pregnancy Exposure Registries?

Drugs are rarely tested for safety in pregnant women. However a pregnancy exposure registry can help doctors and researchers learn how medications affect pregnant mothers and their babies. A pregnancy exposure registry is a study that enrolls pregnant women who are using a certain medicine. Women sign up for the study while pregnant and their progress is followed for a length of time after the baby is born. Researchers compare the babies of mothers who used the medicine while pregnant to the babies of mothers who didn’t use the medicine. This type of study compares large groups of pregnant mothers and babies to look for possible effects. Obstetricians and their patients can use registry results to make more informed choices about using certain drugs. If you’re pregnant and using a medicine or you were using one when you got pregnant, check if there’s a pregnancy exposure registry for that medicine. The FDA has a list of pregnancy exposure registries that pregnant women can join. You can also find out more about pregnancy and medicine from the National Women’s Health Information Center at 800-994-9662.

Conclusion

My advice, and I can’t stress this enough, is to let your doctor or obstetrician know about any and all medications and drugs you’re taking while pregnant. Better yet, bring the bottles with you to your pre-pregnancy checkup. If you’re not pregnant yet but you’re planning to have a baby, it’s a great idea to discuss your health and your medications with your doctor before you conceive. That way both you and your baby will have the best chance of a smooth pregnancy, a happy birth and healthy life.

Paul Stumpf, M.D. heads the ob/gyn department at the University of Nevada School of Medicine. Dr. Stumpf is board certified in obstetrics, gynecology and reproductive endocrinology.

Thankfully most children won’t need to meet me in my role as a pediatric surgeon. But unfortunately a small number of kids have a medical condition requiring surgical care. In today’s post, I’m going to cover the typical presentation and symptoms related to three abdominal conditions that may need surgery: appendicitis, volvulus and intussusception.

Appendicitis

The appendix is a non-essential structure attached to the part of the colon known as the cecum, usually located in the right lower portion of the abdomen. Inflammation of the appendix, or appendicitis, is the most common reason for emergency surgery in children. The lifetime risk of appendicitis is about nine percent for boys and seven percent for girls. Appendicitis most commonly develops in children 12 to 18 years old but can develop at any age. Appendicitis happens when the lumen of the appendix becomes blocked, causing a build-up of secretions and pressure inside the appendix, which leads to bacterial growth, tissue swelling, inflammation and ultimately impairment of the blood supply to the appendix’s wall. Appendicitis commonly causes abdominal pain, nausea, vomiting, a loss of appetite and low-grade fever. The abdominal pain associated with appendicitis classically begins as a poorly localized mid-abdominal pain followed minutes or hours later by sharp pain that localizes to the right lower portion of the abdominal wall. Unfortunately many experience less typical symptoms of appendicitis and as a result, appendicitis can be a difficult diagnosis to confirm. Early diagnosis and treatment is key to decreasing the risk of serious complications. In many cases findings during a physical exam and simple blood tests will help confirm a diagnosis, although some children may require x-rays as well.

Volvulus

Volvulus is twisting of the intestine that frequently impairs blood supply to the affected area of the intestine. Volvulus is commonly associated with malrotation, when the intestine doesn’t position normally in a child’s abdomen during development, causing the base of the intestine to be narrowed and making the intestine prone to twisting. Malrotation may not cause symptoms before twisting. Usually volvulus happens in the first weeks of life. Midgut volvulus however can happen at any age including before birth or later in life. Common symptoms include vomiting yellow or green discharge, abdominal pain in older children or irritability in infants. Later symptoms include extreme sleepiness and blood in the stool. Early diagnosis and treatment are critical to prevent permanent injury or loss of the intestine. Unfortunately, the symptoms may be nonspecific and may be due to other less life threatening conditions. Prompt medical evaluation however should be sought when a child develops bilious emesis and severe abdominal pain. A special radiographic study called an upper gastrointestinal contrast series can help diagnose malrotation.

Intussusception

An intussusception is movement of one segment of the intestine into an adjacent segment. In intussusception the trapped bowel becomes swollen and its blood supply is compromised. This condition most commonly occurs in five to nine month old infants. Often an intussusception will follow gastroenteritis or an upper respiratory tract infection. The classic symptom of intussusception is episodic, severe abdominal pain. Affected infants frequently scream in pain and draw up their legs during an episode lasting a few minutes then seem normal between episodes. Other symptoms include vomiting that may become bilious, passage of blood through the rectum and lethargy. The symptoms can be nonspecific but a history of severe, episodic abdominal pain should be a concern. Parents should seek medical advice. A special radiographic test called a contrast enema can confirm the diagnosis and in many cases can be used to push back or reduce the intussuscepted intestine, avoiding the need for surgery. The success rate with contrast enema reduction depends on early recognition and treatment.

Summary

Abdominal conditions requiring emergency surgical care are uncommon in children. Unfortunately many of these conditions may present with symptoms difficult to distinguish from less life-threatening illnesses. Severe or persistent abdominal pain, especially pain that has a unique pattern or associated with bilious vomiting, should raise concern about a potentially serious problem and should prompt immediate medical attention.

John Gosche, M.D., Ph.D. has practiced medicine for more than 20 years. He is professor and chief of the pediatric surgery division at the University of Nevada School of Medicine. His academic experience includes teaching surgery and pediatrics at Yale University. Dr. Gosche is board certified in general surgery and pediatric surgery. He practices in Las Vegas.

In an emergency room, a 15 year old girl is lying on a gurney, staring fixedly at the ceiling. By her side sits her scrawny boyfriend of 16, holding her hand. Behind the gurney, the girl’s mother is standing, stroking her daughter’s hair, repeatedly mumbling, “Why Nicole, why? Why did you do this?” Nicole just had her stomach pumped after overdosing on Tylenol. Although she’s no longer at risk of organ damage, a psychiatrist has been called in to decide whether she needs to be admitted to a mental hospital.

Depression in teenagers is a more common affliction than previously thought. In fact, years ago many would have denied its existence altogether: Adolescent turmoil and normal moodiness would have been held up as explanations for any young person in emotional distress. The troubling increase in teenage suicides and suicide attempts over the past few decades has brought the issue to the forefront and made mood disorders in adolescents a major public health concern. Recent statistics reveal that in girls aged 13 to 18, almost six percent are diagnosed as suffering from clinical depression. In boys of the same age, the percentage is about four and a half.

Clinical depression is the key term here. The old notion that adolescents tend to be emotionally labile is obviously accurate: As most of us recall, growing up is a distressingly tough job, and heartbreak and despair are part of that painful transition from childhood to adult independence. But episodes lasting four to six months when the expressed mood is continuously dejected or downcast, when crying spells are accompanied by withdrawal from activities usually enjoyed, when the young person no longer socializes with friends, school performance suffers, and the future is seen as bleak: This kind of sustained gloom should concern parents, teachers and friends.

Even long periods of emotional distress do not necessarily mean that someone suffers from major depressive disorder, but it should send a signal that something’s wrong. The teen may have gotten into drugs or there may be peer conflicts or school trouble that’s more than he or she can handle. But the possibility of a first episode of major depression should also be kept in mind. Failure to intervene can exact a high price: Suicidal behavior, school failure and substance abuse are common complications. And the probability of a chronic recurrent condition is of great concern: About 70 percent of kids with depression grow up to have major depression as adults.

Ideally parents have managed to maintain a level of communication with their teenagers that lets them find out about their daughter’s or son’s troubles. It is very common, and no cause for parental self-blame, that the adolescent prefers to conduct a more in-depth discussion with a professional. The professional, such as a child and adolescent psychiatrist, or a behavioral pediatrician, or a youth counselor, comes with less baggage than any family member, and offers teens a degree of confidentiality that makes it easier to share fears and embarrassing thoughts or fantasies.

If the discovery that their child suffers from major depressive disorder expectedly comes as a shock to the parents, it is worth emphasizing that depression is amenable to effective treatments. Although it is often a chronically recurrent illness, adequate clinical management is likely to lead to long-lasting or even permanent remission.

For the affected teen, the engagement in a therapeutic relationship with a mature and trained mental health professional can be a critical ingredient towards recovery. However, in itself it is not sufficient for recovery if the emerging illness is, indeed, major depressive disorder. Systematic psychotherapy with adjunctive antidepressant medication, is required. One of the effective psychotherapies is a technique called cognitive behavioral therapy, another is interpersonal therapy. In neither of these does the patient lie on a couch, spending years trying to recall childhood memories.

Rather, in cognitive behavioral therapy he or she learns to systematically shift his or her perspective on their predicament, so as to appreciate a sense of mastery of life’s challenges over time. This is called reframing: The patient is trained, consciously, to consider and then adopt an alternative view of the identified circumstances and emotions that underlie their despair. If the treatment is managed by a skilled clinician the gains can often be accomplished in as little as twelve to twenty sessions i.e. four months or less. In interpersonal therapy, the focus is on problems in relating to others – identifying misinterpretations of others’ behavioral cues, correcting the perceptions and practicing interactions based on the newly acquired skills at decoding those around the patient.

Psychotropic medication in kids is often feared by well-meaning parents and clinicians alike. None of us like the idea of our children being on medications, let alone drugs that work on the brain. Very specifically, concerns about increased suicidal thoughts in adolescents on certain antidepressants have been widely published over the past few years, causing even greater hesitancy to prescribe such medications in young patients. However, it’s well established by now that the advantages of a carefully tailored and monitored medication treatment improve the prognosis greatly, especially if the medication is used in conjunction with psychotherapy.

The psychotherapies, as outlined above, reduce the risk of a situation triggering a cascade of self-defeating emotional reactions. The medication realigns the imbalanced state of neurochemicals that bring the emotional pain into consciousness. The data base for the effectiveness of antidepressant medication is solid enough that the U.S. Food and Drug Administration has explicitly approved one particular antidepressant, fluoxetine, as an effective and safe medication in the treatment adolescent depression.

So, going back to our scenario in the first paragraph: Should Nicole get on Prozac and into psychotherapy at this point? Not necessarily. The diagnosis of major depression takes more than a bedside glance. Her overdose may have been an impulsive reaction to a crisis in her relationship with her boyfriend, and a brief course of counseling on how to handle such difficulties may be all it takes. The important point is to use an incident of this sort as a starting point for a careful assessment. Just like other illnesses, psychiatric disorders have a better prognosis if they are caught early, before they become chronic or have led to complications.

Ole Thienhaus, M.D. leads the psychiatry department at the University of Nevada School of Medicine. He will become dean of the School of Medicine beginning July 1, 2008. He lives in Reno and Las Vegas, commuting every week between the medical school’s two campuses, treating patients in urban and rurual communities. Before joining the School of Medicine, Dr. Thienhaus was vice chair of psychiatry at the University of Cincinnati College of Medicine. He was born in Germany.

Dr. Thomas Hunt, an associate professor of family medicine at University Health System, the clinical practice of the University of Nevada School of Medicine, appeared on KVBC-TV’s Health Line 3 story on financial help for former atomic test site workers. He was also quoted in the May 2008 edition of HRSA Inside, a newsletter of the Health Resources and Services Administration.

Dr. Hunt, as program director for the Nevada Radiation Exposure Screening and Education Program, or RESEP for short, is at the forefront of an effort to raise awareness about the need for cancer screening people who lived or worked near Nevada nuclear weapons testing facilities during the 1950s.

Under the Radiation Exposure Compensation Act, passed by Congress in 1990, people directly affected by federal nuclear weapons testing may be eligible for up to $75,000 in compensation. However, navigating the bureaucracy to access those funds can be quite confusing. For that reason, the Nevada RESEP Project Team will provide assistance.

To be eligible for the screening, Nevada citizens must have direct ties to above ground nuclear testing whether it be as an employee at the test site or a resident in a ‘downwind’ county. Those eligible can contact the Family Medicine Clinic in Las Vegas at 702-992-6887 or by email.

The school holds several clinics a year near sites affected by the nuclear testing.

Today I have a guest blogger, Dr. Kami Larsen, a Las Vegas pediatrician at University Health System. She writes on the importance of child vaccines and provides facts that every parent should seriously consider if they’re thinking of not having their children immunized. This was originally an editorial that appeared in several community newspapers in Las Vegas some months ago that coincidentally preceded a recent Time article on this very topic. Following is Dr. Larsen’s article:

In my practice as a pediatrician, I encounter concerned parents every day. Many times their concerns are about common illnesses, diet and sleep patterns. Lately however the same question keeps recurring—How safe are my child’s vaccinations?

It’s a question I hear over and over and typically I can spend 30 minutes or more informing families about this. The truth is that in recent years the Web has made it easier for families to find information about vaccinations. The problem however is that not all of this information online is complete, accurate or up-to-date and some information can even be harmful to your child’s safety.

Most parents want to do what’s right for their child, and so do most pediatricians. In recent decades, vaccines have played an unbelievable role in decreasing the number of serious illnesses, hospitalizations and deaths in children. Without childhood vaccinations, thousands of kids each year would die from illnesses like measles, chicken pox and whooping cough. Due to this dramatic decline, many people believe that these illnesses that pediatricians vaccinate against have been wiped off the face of the earth. Unfortunately this simply isn’t true. We still have outbreaks of measles, pertussis (or whooping cough) and other vaccine preventable diseases. Just this winter (2007), Clark County (or metropolitan Las Vegas) faced an outbreak of mumps.

As parents we tend to have a false sense of security and assume that the miracles of modern medicine will keep our children out of harm’s way. For our parents and grandparents the reality of infectious disease is only a memory away. Before immunizations 20,000 cases of paralytic polio were reported each year. These epidemics left thousands of children in braces, wheelchairs and iron lungs.

Before measles immunization was available, now part of the MMR vaccine, nearly everyone in the U.S. got measles. What we tend to forget is that about 450 children each year died from the infection. Up to 20 percent of those infected with the virus are hospitalized and encephalitis with concurrent brain damage may result. Many of the cases we see today are a result of travelers visiting the U.S. and carrying the infection with them. In a city like Las Vegas, the number of visitors is large and outbreaks among residents who aren’t immunized are common.

Pediatricians also commonly see outbreaks of whooping cough, another serious illness. Unfortunately the most serious complications of this infection are in children. According to the Centers for Disease Control and Prevention, between 1990-96, 57 people died from pertussis—49 were babies (less than six months old). The coughing fits associated with the illness are so severe that many children can’t eat, drink or sleep. They may end up with pneumonia, seizures and even brain damage.

This is just the beginning of the story. Today our children are fortunate enough to have vaccines that prevent against several forms of meningitis, hepatitis, tetanus, chicken pox and other life-threatening infectious diseases. Many of these illnesses are viral and can’t be treated with antibiotics. I can’t count the number of times I’ve heard a parent say to me, “We all had chicken pox and survived.” The truth is not everyone who’s had chicken pox has survived. Disease that once were common aren’t today. That is the benefit of immunizations.

Despite this many parents recently have decided against vaccinating their children for multiple reasons. However more often bad information is behind these decisions.

There’s a misconception that vaccinations cause autism. It’s important to note that there has never been a scientific link between autism and childhood vaccinations. Many proponents of this theory blame thimerosal, a preservative commonly used in the past. In 2001 a recommendation to remove thimerosal from immunizations was passed. The only immunization currently in use containing thimerosal is the inactivated influenza vaccine.

Any medication has the risk of side effects and this holds true for vaccines. However, in general, the risks are minimal and the risk of a serious side effect are rare. Concurrently the risks associated with acquiring the illnesses I mentioned above outweigh those of immunizations.

It’s important that parents get accurate information and facts. Helpful information is easily accessed online at the American Academy of Pediatrics or from your child’s pediatrician.

As a mother of two, I’m faced with the same decisions as any other parent. Each day I fight to protect my children and help nurture them into happy and healthy adults. Don’t gamble with your child’s health. Talk about immunization with your child’s pediatrician today.

According to the American Heart Association high blood pressure affects 70 million Americans—and more than one in three don’t even know they have it. If undiagnosed or untreated, hypertension can lead to the hardening of arteries, which can lead to heart attack, stroke, kidney failure and death. An internist or family physician can help you monitor your blood pressure and help you take the necessary steps to keep your blood pressure at a healthy level to prevent possible heart disease.

But for patients with heart disease, there may still be steps you can take to a healthier heart. Cardiac rehabilitation is a medically supervised program to help patients with heart conditions recover following a heart attack or heart surgery. It’s generally divided into phases that include monitored exercise, nutrition counseling, emotional support and education on lifestyle changes.

According to Dr. Thomas J. Hunt, a family doctor with University Health System in Las Vegas, a heart rehabilitation program generally begins while the patient is hospitalized and continues after the patient goes home. It’s a customized program that can significantly increase one’s chances of survival following a heart attack. Today through improved programs and close monitoring, cardiac rehabilitation is an option for people of all ages and patients with many types of heart conditions including coronary artery disease, peripheral arterial disease and angina, or who have undergone procedures like a cardiomyopathy, coronary bypass surgery or heart transplant.

Although more patients are able to participate and benefit from cardiac rehab, Dr. Hunt advises that it’s not appropriate for everyone. Dr. Hunt says a patient needs to undergo a doctor’s thorough evaluation to find out if a patient is a good candidate for heart rehab.

Components of heart rehabilitation

Medical evaluation
Both initial and ongoing medical evaluations allow your doctor to assess physical abilities, medical limitations and other conditions you may have. Your doctor will explore your risk factors for cardiovascular disease, stroke or high blood pressure and use these findings to personalize cardiac rehab for you.

Physical activity
Exercise is a critical component of rehabilitation therapy. According to Dr. Hunt, no longer is bed rest necessarily recommended if you have a serious heart condition. Exercise improves one’s cardiovascular fitness and can include walking, cycling, rowing or jogging. Strength training is also usually part of the program. If you’ve never exercised, your doctor will design a program that moves at a safe, comfortable pace.

Lifestyle changes
Changes in your lifestyle is an important component of the rehabilitation process. Guidance on diet and nutrition will help you shed extra weight and teach you to make healthier food decisions that reduce the intake of fats, salt and cholesterol. You will receive support on beating unhealthy habits such as smoking or consumption of excess alcohol. You will also learn how to manage the pain or fatigue that may accompany your heart condition. Current AHA guidelines advise on getting cholesterol levels to a healthy level as part of cardiac rehabilitation—reducing your low density lipoprotein, or bad cholesterol, less than 100 milligrams and ideally under 70 milligrams is an important goal.

To learn more about controlling your high blood pressure and heart health, speak to an internist at our Patient Care Center in Las Vegas or Internal Medicine and Multispecialty Clinic in Reno or a family doctor at our Family Medicine Clinic in Las Vegas or Family Medicine Center in Reno.