Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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7:20 AM
February 23rd, 2017

Secondhand Smoke

Dangers of Secondhand Smoke

 

 `

Scope of Problem

Smokers in the US consume over 500 billion cigarettes annually. Secondhand smoke, known technically as environmental tobacco smoke (ETS) is increasingly recognized as a health hazard to children and adults.

 

Danger to Children

9-12 million US children younger than 5 years of age may be exposed to secondhand smoke in the home. Secondhand smoke is estimated to cause an annual increase of 150,000-300,000 cases of lower respiratory tract infections in children younger than 18 months of age. It also increases the incidence of fluid in the middle ear, known as serous otitis media. Two-week old children of mothers who smoke have been observed to have diminished lung elasticity.

 

The Centers for Disease Control (CDC) estimates that maternal smoking is responsible for 700 annual cases of sudden infant death syndrome (SDS).  Further, secondhand smoke is a risk factor for the development asthma in children and increases the severity of asthma in children already afflicted with the problem.

 

Danger to Adults

Chronic obstructive pulmonary disease (COPD) in middle-aged adults seems to be correlated with their mothers’ smoking during the years of raising them. Further, an additional 3,000 cases annually of lung cancer in adults are associated with exposure to secondhand smoke. This association is strongest with small-cell lung cancer.

 

Smoke Avoidance

Smoke avoidance in public places is easier now that laws prohibit or restrict smoking in many public places. Consequently, the greatest danger of exposure to secondhand smoke occurs in the home and in personal vehicles.

 

There is little ambiguity about what constitutes exposure to smoke in a personal vehicle. However, what constitutes exposure to smoke in the home is sometimes misunderstood.

 

It is imperative that no smoking should take place in the home, whether or not the child is present at the time. Smoking cannot simply be restricted to a portion of the home. Neither can an air filtration system in the home be relied upon to eliminate exposure to secondhand smoke.

 

Addiction

Since smoke, once present, is difficult to contain, the best solution is liberation from smoking.

 

This is easier said than done, and there are good reasons. Nicotine acts on at least two areas of the brain. First, it stimulates the cerebral cortex causing a sense of increased alertness. Second, it stimulates the limbic system activating the reward center. Finally, it differs from other substances with these effects in that it does not excessively stimulate the peripheral nervous system. While other such substances cause tremors and anxiety, nicotine seems not to present these problems.

 

Nevertheless, there is help in dealing with this addiction.

 

Non-medical Aids

While most former smokers have quit independently, this does not work for everyone. Fortunately, there are many programs available. These include group support, hypnosis and self-hypnosis, behavioral aversive therapy, and gradual withdrawal.

 

One of the most underrated aids to tobacco liberation is repeated effort.

Few endeavors in life meet with unqualified success on the first attempt. Consequently, an attempt at smoking liberation that is followed by a return to smoking should not be viewed as a failure, but as a temporary success laying the groundwork for future endeavors.

 

Medical Aids

The addition of medical aids doubles the success rate in liberation from smoking. Of course, discussion with your doctor is always recommended as medical aids can have side effects as well as desired effects. The most important medical aids for liberation from smoking are nicotine patch, nicotine gum or lozenge, bupropion, and varenicline.

 

Nicotine patches slowly liberate nicotine to ameliorate withdrawal symptoms. Some of these are worn during daytime hours only in order to reduce the potential for sleep disturbance. Other patch systems are worn 24 hours a day and work for people who awaken craving a cigarette. Nicotine patches are slow onset and slow offset, requiring about 4 hours for blood levels of nicotine to rise or fall following application or removal.

 

Nicotine gums and lozenges, along with sprays and inhalers, are used intermittently and increase blood levels of nicotine within about 15 minutes of administration.

 

Bupropion is an antidepressant that is of some help in liberation from smoking. It may take 6-7 days to reach steady-state blood levels; consequently, it may be started before discontinuing smoking.

 

Varenicline attaches to the same sites of action as nicotine. Consequently, it both provides some stimulation to those sites and reduces the action of nicotine at those sites. It is considered by some to be the most effective of the medical aids.

 

Summary

Many aids, both non-medical and medical, are available to achieve liberation from smoking. These aids, in addition to effective smoke avoidance can sharply reduce the harmful effects of smoke upon the smoker as well as upon the adults and children in proximity.

 

Sources

Pharmacological interventions for smoking cessation/ an overview and network meta-analysis - Cahill 

Nicotine receptor partial agonists for smoking cessation - Cahill - 2016 - The Cochrane Library - Wi

Passive Smoking and Lung Disease.  WebMD.  Author: Timothy D Murphy, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP 

 

Thomas Falasca, DO

Secondhand Smoke

9-12 million US children younger than 5 years of age may be exposed to secondhand smoke in the home.

...See More

Secondhand Smoke

Dangers of Secondhand Smoke

 

 `

Scope of Problem

Smokers in the US consume over 500 billion cigarettes annually. Secondhand smoke, known technically as environmental tobacco smoke (ETS) is increasingly recognized as a health hazard to children and adults.

 

Danger to Children

9-12 million US children younger than 5 years of age may be exposed to secondhand smoke in the home. Secondhand smoke is estimated to cause an annual increase of 150,000-300,000 cases of lower respiratory tract infections in children younger than 18 months of age. It also increases the incidence of fluid in the middle ear, known as serous otitis media. Two-week old children of mothers who smoke have been observed to have diminished lung elasticity.

 

The Centers for Disease Control (CDC) estimates that maternal smoking is responsible for 700 annual cases of sudden infant death syndrome (SDS).  Further, secondhand smoke is a risk factor for the development asthma in children and increases the severity of asthma in children already afflicted with the problem.

 

Danger to Adults

Chronic obstructive pulmonary disease (COPD) in middle-aged adults seems to be correlated with their mothers’ smoking during the years of raising them. Further, an additional 3,000 cases annually of lung cancer in adults are associated with exposure to secondhand smoke. This association is strongest with small-cell lung cancer.

 

Smoke Avoidance

Smoke avoidance in public places is easier now that laws prohibit or restrict smoking in many public places. Consequently, the greatest danger of exposure to secondhand smoke occurs in the home and in personal vehicles.

 

There is little ambiguity about what constitutes exposure to smoke in a personal vehicle. However, what constitutes exposure to smoke in the home is sometimes misunderstood.

 

It is imperative that no smoking should take place in the home, whether or not the child is present at the time. Smoking cannot simply be restricted to a portion of the home. Neither can an air filtration system in the home be relied upon to eliminate exposure to secondhand smoke.

 

Addiction

Since smoke, once present, is difficult to contain, the best solution is liberation from smoking.

 

This is easier said than done, and there are good reasons. Nicotine acts on at least two areas of the brain. First, it stimulates the cerebral cortex causing a sense of increased alertness. Second, it stimulates the limbic system activating the reward center. Finally, it differs from other substances with these effects in that it does not excessively stimulate the peripheral nervous system. While other such substances cause tremors and anxiety, nicotine seems not to present these problems.

 

Nevertheless, there is help in dealing with this addiction.

 

Non-medical Aids

While most former smokers have quit independently, this does not work for everyone. Fortunately, there are many programs available. These include group support, hypnosis and self-hypnosis, behavioral aversive therapy, and gradual withdrawal.

 

One of the most underrated aids to tobacco liberation is repeated effort.

Few endeavors in life meet with unqualified success on the first attempt. Consequently, an attempt at smoking liberation that is followed by a return to smoking should not be viewed as a failure, but as a temporary success laying the groundwork for future endeavors.

 

Medical Aids

The addition of medical aids doubles the success rate in liberation from smoking. Of course, discussion with your doctor is always recommended as medical aids can have side effects as well as desired effects. The most important medical aids for liberation from smoking are nicotine patch, nicotine gum or lozenge, bupropion, and varenicline.

 

Nicotine patches slowly liberate nicotine to ameliorate withdrawal symptoms. Some of these are worn during daytime hours only in order to reduce the potential for sleep disturbance. Other patch systems are worn 24 hours a day and work for people who awaken craving a cigarette. Nicotine patches are slow onset and slow offset, requiring about 4 hours for blood levels of nicotine to rise or fall following application or removal.

 

Nicotine gums and lozenges, along with sprays and inhalers, are used intermittently and increase blood levels of nicotine within about 15 minutes of administration.

 

Bupropion is an antidepressant that is of some help in liberation from smoking. It may take 6-7 days to reach steady-state blood levels; consequently, it may be started before discontinuing smoking.

 

Varenicline attaches to the same sites of action as nicotine. Consequently, it both provides some stimulation to those sites and reduces the action of nicotine at those sites. It is considered by some to be the most effective of the medical aids.

 

Summary

Many aids, both non-medical and medical, are available to achieve liberation from smoking. These aids, in addition to effective smoke avoidance can sharply reduce the harmful effects of smoke upon the smoker as well as upon the adults and children in proximity.

 

Sources

Pharmacological interventions for smoking cessation/ an overview and network meta-analysis - Cahill 

Nicotine receptor partial agonists for smoking cessation - Cahill - 2016 - The Cochrane Library - Wi

Passive Smoking and Lung Disease.  WebMD.  Author: Timothy D Murphy, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP 

 

Thomas Falasca, DO

Shingles ~ What You Need to Know

Shingles is a disease that eventuates in a great deal of pain, suffering, and disability. Further, treatments are onl ...See More


Shingles ~ What You Need to Know

What Is Shingles?

Shingles is the return of an infection long forgotten from childhood. Current medical thinking is that when a childhood case of chickenpox resolves, the virus causing it does not vanish. Instead, it migrates from the skin, along the path of nerves, to a collection of nerve cells called a ganglion, which resides close to the spinal cord or brain. Then, when the immunity containing the virus in the ganglia diminishes, the virus reemerges along the distribution of the nerve causing an outbreak.

 

What Are the Symptoms?

Symptoms usually begin with an unusual feeling in a broad localized area called a dermatome. The feeling can be a sensation of tingling, itching, or, more usually, pain. Thereafter the area may become reddened and very slightly swollen. Small blisters then form in the area and the sensation may change to burning, throbbing, or stabbing. The blisters may enlarge and coalesce and the contained fluid changes from clear to cloudy. The blisters then rupture, scab over, and gradually resolve.

 

Often, this ends the episode entirely; but, sometimes there are sequelae. The most frequent of these are scars in the area and pain long after the resolution of the blisters.

 

Who Gets Shingles?

Shingles can afflict anyone who has previously been infected with chickenpox. However, certain risk factors substantially increase the possibility of being afflicted. Common risk factors include immunosuppressive therapy either for autoimmune diseases or for transplant rejection prevention, and TNF (Tumor Necrosis Factor) inhibitors such as are used in the treatment of rheumatoid disease.

 

Diseases that pose risk factors for shingles are inflammatory bowel disease, rheumatoid arthritis, chronic obstructive pulmonary disease, asthma, chronic kidney disease, lymphoma, multiple myeloma, HIV, acute lymphocytic leukemia, and depression.

 

However, the most common risk factor is age. The probability of shingles increases with age and reaches 50% in those over 85 years old. Only 10% of shingles patients are younger than 20 years old.

 

Incidence of shingles is also reported to be higher in whites by 75% and in females. 

 

Since the introduction of widespread chickenpox vaccination in 1995, the incidence of shingles may decrease as the vaccinated population ages.

 

Can You Get Shingles Without Ever Having Been Infected with Chickenpox?

Technically, no. But, practically, one may forget ever having had chickenpox, especially if the case was mild. The US Centers for Disease Control (CDC) estimates that 99.5% of those born in the US and over 40 years of age have been infected with chicken pox.

 

Additionally, shingles is possible in persons who have been exposed to the attenuated virus by chicken pox vaccination. However, the likelihood of shingles here is much less than in those exposed to the wild virus in community- acquired chickenpox.

 

Finally, children have gotten shingles because their mother contracted chickenpox when she was pregnant with them.

 

Can Shingles Recur?

Yes, shingles recurs in about 4% of shingles sufferers.

 

What Are the Consequences of Shingles?

The most common complication of shingles is post-herpetic neuralgia (PHN). It is a continuation, or sometimes reappearance after a brief respite, of the pain that accompanies the shingles episode. Occasionally the quality of the pain or discomfort changes somewhat. PHN may last for months or years. Like shingles itself, PHN also increases in likelihood with age. 50% of shingles victims over the age of 60 develop PHN.

 

A less serious complication from a shingles episode is localized bacterial infection from scratching the skin lesions. More serious but rare complications are meningo-encephalitis, ischemic stroke, spread of shingles far beyond the original restricted distribution, paralysis, and blindness, deafness, or facial weakness from shingles of the face.

 

Is There a Test for Shingles?

Although laboratory tests for shingles virus exist, they are generally used only in unusual circumstances as in cases in which the typical symptoms do not appear or cases in which an early recognition of the attack is needed because of a patient’s low immunity.

 

The physician typically diagnoses shingles from the appearance of the involved skin and the history provided by the patient.

 

What Is the Treatment for Shingles?

 

The most specific treatment for shingles is one of the antiviral drugs. These are most effective when begun within 72 hours of appearance of the rash, but they have some effect even when given later. These drugs can both shorten and soften the attack and reduce the risk of subsequent PHN.

 

Nonspecifically, there are numerous options for the treatment of the pain associated with shingles and PHN. These involve analgesics such as ibuprofen or sometimes stronger, anti-seizure medications, antidepressants, and sometimes corticosteroids. Nerve injection is also used. Sometimes a capsaicin cream or lidocaine path is helpful.

 

Of course, the best way to approach a problem is not to have it, so let us go on to discuss prevention.

 

Shingles Prevention - Chicken Pox Vaccination

 

Since shingles is reactivation of a childhood chickenpox infection, an effective approach is the two-dose vaccination against chickenpox. It will prevent chickenpox in about 90% of those vaccinated and will shorten and reduce the severity of the chickenpox infection in the rest. By herd immunity, it also reduces the community frequency of chickenpox, thus protecting those who cannot be vaccinated.

 

Shingles Prevention - Shingles Vaccination

 

Those who have already had chickenpox can also be vaccinated but with the single-dose shingles vaccine. Because the incidence of shingles, and, in those afflicted by shingles, the incidence of PHN increases substantially with age, the CDC recommends shingles vaccination for all those 60 years of age and older. The Infectious Disease Society of America is more aggressive and recommends shingles vaccination for those 50 years of age and older.

 

The shingles vaccine is not perfect, but it reduces the incidence of shingles by 70% in those aged 50-59, by 64% in those aged 60-69, and by a somewhat lesser amount in those 70 years of age and older.

 

Testing for a previous chicken pox infection is not required for shingles vaccination. Even those with a past attack of shingles can be vaccinated, since a subsequent attack of shingles is still possible. Of course, the shingles vaccination is not a treatment for a current attack of shingles or PHN.

 

Since the virus in the shingles vaccine is severely weakened, but still live, it is contraindicated in pregnancy and in those with immunodeficiency states, leukemia, lymphoma, HIV, tuberculosis, or those on immunosuppressive therapy, chemotherapy, or radiation therapy.

 

Conclusion

 

Shingles is a disease that eventuates in a great deal of pain, suffering, and disability. Further, treatments are only partially effective in many and ineffective in some. We are fortunate to live at a time when there are vaccines to substantially reduce the frequency and severity of chickenpox, shingles, and post-herpetic neuralgia. All who are candidates for these vaccinations are well advised to take advantage of them to keep our lives and senior years free of disability and pain.

 

Thomas Falasca, DO

Know Your Risk Factors

Get to know your heart better. Take it for a little walk. Just the right amount of exercise can benefit your heart en ...See More


Know Your Risk Factors

 

A Valentine present for your heart! Why not? Your faithful little friend would love some attention from you this February. How about a nice review of the things that keep your little buddy safe and happy?

 

Your tireless little ticker beats 100,000 a day against the pressure of your arteries. Your doctor calls it afterload, or more simply, blood pressure. Reduce the load on your heart, control your blood pressure. Your cardiac companion will love you for it.

 

Your feisty friend supplies your body with 1800 gallons of blood a day. But, like other parts of the body, it needs blood itself. Blood supplies this miraculous little muscle through arteries that narrow gradually or obstruct suddenly when blood cholesterol levels are elevated. You can visit your doctor to learn your cholesterol level and reduce it if it is elevated. What a wonderful Valentine favor for your heart.

 

Diabetes is the dextrose demon that damages the blood vessels feeding your precious heart. Worst of all, your heart may feel the effects before you do. But the dextrose demon can be caged. You can visit your doctor to learn your blood sugar level, and if it is elevated, you can act to reduce it. You can defend your heart from the dextrose demon.

 

Your heart and many other organs are sensitive to the effects of smoking, which is responsible for nearly 1 in every 5 deaths in the US annually. One of the best gifts you can give your heart this Valentine Day is to go smoke-free. You can visit your doctor this month to find out how going smoke-free is easier than ever.

 

Get to know your heart better. Take it for a little walk. Just the right amount of exercise can benefit your heart enormously. Your doctor can approve the appropriate exercise for you and your little bosom buddy. So you can recreate and benefit your heart all at once!

 

Another weighty issue is BMI, Body Mass Index. Your heart needs a healthy BMI for it’s best longevity. You can keep your heart beating longer by learning your BMI and maintaining it within range. Visit the link below to learn your BMI and keep your heart happy.

 

Learn Your BMI

 

So Happy Valentine Day to you and your heart and be sure to visit us soon for more useful health information.

 

Thomas Falasca, DO

Cataract Precautions

Although the cause of cataracts is not completely clear, it seems there may be measures you can take to at least post ...See More


Cataract Precautions

Although the cause of cataracts is not completely clear, it seems there may be measures you can take to at least postpone the occurrence of so-called senile cataracts. Don’t be discouraged if you do develop a cataract because it is an inevitable part of life if you live long enough.

 

Eye Exams. As a general principle, eye exams are recommended for all persons over 65 years old at least every two years, and more often for some patients. Ask your physician how often you should have an eye exam.

 

Sun Protection. Ultraviolet light may contribute to cataract formation. You can reduce this exposure by wearing broad-brimmed hats outdoors and by wearing sunglasses that block ultraviolet B (UVB) rays.

 

Be Smoke-Free. Some studies relate smoking to earlier cataract formation. This is yet another reason not to start smoking or to see your doctor about a program for quitting.

 

Control Other Health Problems. Health problems such as diabetes and collagen vascular diseases can accelerate the development of cataracts. You can reduce this risk by partnering closely with your doctor in controlling these related health problems.

 

Medications. There are a number of medications known to induce cataracts. The primary culprits are the steroids. Certainly the anabolic steroids illegally uses by some athletes are linked to cataracts. But all steroids from oral prednisone to some asthma inhalers can induce cataract formation. Even patients under the age of 40 have developed cataracts from some of the drug companies’ most heavily advertised asthma inhalers. Nevertheless, if you have been prescribed these medications, do not discontinue them without your doctor’s knowledge.

 

Eat Healthily. Fruits and vegetables are a pleasant and convenient path to good health. Additionally, there is even some weak evidence that the antioxidants in fruits and vegetables retard the development of cataracts.

 

Cataract Related Diseases. In addition to impairing vision, cataracts have many insidious effects. Cataracts can effect a change in eyeglass prescription. Usually cataracts necessitate a stronger prescription; but, surprisingly, they sometimes necessitate a weaker one. Finally, cataracts can cause certain types of glaucoma which may produce permanent blindness.

 

Cataracts Obstruct Detection of Other Eye Diseases. Just as a cataract may impair your vision out of the eye, it impairs the doctor’s view into the eye to examine structures behind the cataract. Thus, diseases of the retina and optic nerve such as diabetic retinopathy, age-related macular degeneration, retinal detachments, glaucoma, and papilledema can avoid detection because of cataracts. Cataracts may also deprive you of the benefits of high-tech diagnostics by interfering with your doctor’s use of such techniques as fluorescein angiogram and optical coherence tomography (OCT).

 

If You Do Develop a Cataract. Many cataracts are mild and do not require surgery initially, but there is no medication to eliminate the cataract. Surgery is the only option when the cataract blurs your vision or prevents the detection of other serious eye diseases. How[ever, recent years have seen great advances in cataract surgery. Although there are risks with any surgery, cataract surgery is one of the safest and most effective of all surgeries performed.

 

Cataract Surgery Is Now Refractive Surgery (LASIK and PRK). A huge advancement in cataract surgery has been the development of intraocular lens implants that can now correct near-sightedness, far-sightedness, and astigmatism. After cataract surgery, many patients do not need glasses for distance vision and some do not need them for distance or near vision because the lenses are accommodative or multifocal. In some patients cataract surgery can be combined with laser in-situ keratomileusis (LASIK) for better vision. Nevertheless, vision correcting lenses and LASIK are not covered by health insurance or Medicare so the patient should expect an additional cost.

 

Summary. You can take precautions to help reduce some of the risks of cataracts, but if vision-impairing cataracts do occur, surgery achieves excellent results in restoring vision.

 

Robert Haverly, MD

Thomas Falasca, DO

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