West Nile Virus

By Jared Ellis, MD
Assistant Professor of Family Medicine,
Associate Residency Director,
University of Alabama Family Medicine Residency Program

Late summer brings excitement about football, and hopes that the weather will soon cool off. However, it brings a risk that some have heard of, but few are familiar with: West Nile Virus (WNV) infection. This infection is rather common, and most cases occur in August and September (see chart below), but the diagnosis is infrequently made. For many, it only gives mild symptoms, but for a few, it can lead to devastating consequences or death. It is important to be familiar with the signs and symptoms of this infection, but even more so on how to prevent it.

WNV is not new, having been first identified in 1937 in the African county of Uganda. It was first diagnosed in 1999 in the US in New York. It has rapidly spread across the country. It is transmitted from mosquitoes that have bitten infected birds and then bite humans. Fortunately, 60-80 % of persons who contract the virus have no symptoms. 20-40 % of infected persons have only mild to moderate nonspecific symptoms, which may include fever, headache, muscle aches, swollen lymph nodes, and loss of appetite. 25-50% of these have a rash on the trunk and arms. See picture:

Studies estimate that in the US, one of every 140 to 250 persons has been infected at some point, few of whom were diagnosed. However, about 1 % of persons who get this infection develop serious neurologic (brain) effects, known as West Nile Neuroinvasive Disease (WNND). Symptoms of WNND include tremor, confusion, severe headache, weakness in one or more limbs, and coma. Of these, between 3-15% die. This is more common in younger children and older persons, and those with significant chronic diseases.

If you are concerned that you may have any form of WNV, see your doctor, and mention your concerns. Blood and other tests can be performed, but take a number of days to return. If symptoms are not severe, it may not be necessary to be tested as there is no specific treatment that cures WNV or WNND.

Awareness and prevention are the keys to avoiding this infection. Avoid mosquito bites! Avoid being outside at dusk or dawn. Wear long sleeves and long pants when outdoors if possible. Use mosquito repellants, whether applied to the body, or placed near you or those that they you can attach to yourself. Drain any standing water in your area to limit mosquito breeding. Communities with higher rates of WNV may choose to spray appropriate insecticides in key areas. All of these things may prove helpful.

Protecting UA employees, students from the flu

The annual University of Alabama flu shot campaign, an effort by UA to protect students, faculty and staff from the flu, kicks off in September and continues through early November with free flu shots provided at locations across campus, including the Quad, university buildings and student residence halls.

The goal of the flu shot campaign, which is led by UA’s College of Community Health Sciences and now in its sixth year, is to make getting a flu shot as easy and convenient as possible. The shots are free and no insurance is required, although students and employees will need to provide their Campus Wide Identification.

Last year, more than 8,000 vaccinations were given.

The shots will be administered by nurses from University Medical Center, which CCHS operates, and the University’s Student Health Center and Capstone College of Nursing. WellBAMA and UA’s Division of Financial Affairs are also partners in the flu shot campaign.

Spouses of employees can receive the free flu vaccines at the campus flu shot stations or at the Faculty-Staff Clinic in University Medical Center, and insurance is not required. Children of employees with UA health insurance can receive flu vaccinations at University Medical Center, and children of employees with non-UA health insurance can receive flu shots at the Faculty-Staff Clinic if their insurance has previously approved nurse practitioner coverage.

In addition to the campus flu shot stations, flu shots will also be provided at University Medical Center and its Faculty-Staff Clinic.

The US Centers for Disease Control and Prevention recommends everyone aged six months and older get a flu shot annually. According to the CDC, a flu vaccine is needed every year because flu viruses are constantly changing and it is not unusual for new viruses to appear. The flu vaccine is formulated each year to keep up with the flu viruses as they change.

Dr. Richard Streiffer, dean of CCHS and a family medicine physician, said flu, or influenza, is not just a bad cold but can present a serious threat to many people. While the risk for severe illness is highest for children, the elderly and those with chronic medical conditions, even healthy people who get sick can miss up to two weeks of work, and may experience serious complications and even require hospitalization.

“You want to take every opportunity to protect yourself, as we do know that flu shots work to lower the risk of getting influenza,” Streiffer said. “If we can vaccinate enough people in the community and especially at and around the UA campus, and in our families and social circles, we are starting to create a ‘herd immunity,’ which is a more effective way to protect yourself and those around you.”

Risks associated with receiving a flu shot are extremely small, and the viruses in the flu shot are inactivated so they cannot cause the flu, according to the CDC. For more information, visit http://cchs.ua.edu/flu.

Flu shots are scheduled at the following locations, and additional dates and locations are expected to be added:

Date Location Time
September 7, Thursday North Lawn Classroom Building 9 am to 4 pm
September 12, Tuesday Russell Hall 7:30 am to 11 am
September 13, Wednesday Student Health Fair, Ferguson Student Center 9 am to 4 pm
September 13, Wednesday Quad in Motion, Quad 8 am to 4 pm
September 14, Thursday Tutwiler 9 am to 4 pm
September 18, Monday Capstone College of Nursing 10 am to 1 pm
September 19, Tuesday Law School 7:30 am to 11 am
September 21, Thursday Quad, Northeast Corner (across from Smith Hall) 9 am to 4 pm
September 26, Tuesday Procurement 7:30 am to 11 am
September 27, Wednesday Quad, Northeast Corner (across from Smith Hall) 9 am to 4 pm
September 28, Thursday Presidential Two 1 pm to 4 pm
September 28, Thursday Presidential One 9 am to noon
October 4, Wednesday UA Employee Health Fair, Coleman Coliseum 6:30 am to 4 pm
October 10, Tuesday Systems Office 7 am to 10 am
October 12, Thursday Paty Hall 9 am to noon
October 17, Tuesday Reese Phifer Hall 7:30 am to 11 am
October 18, Wednesday Quad, Southwest corner (across from Graves Hall) 9 am to 4 pm
October 24, Tuesday Ferguson Center 7:30 am to 11 am
November 1, Wednesday Ridgecrest South 9 am to 4 pm
November 1, Wednesday UAPD 7:30 am to 10 am
November 7, Tuesday Gorgas Library 7:45 am to 11 am
November 8, Wednesday Mary Burke Hall 9 am to 4 pm
November 9, Thursday Quad, Southeast corner (across from Gallalee Hall) 9 am to 4 pm

University Medical Center to open Demopolis location

University Medical Center is adding a permanent location in Demopolis, AL, adjacent to the Bryan W. Whitfield Memorial Hospital, within the hospital’s outpatient facility, effective August 1, 2017.

The initiative began as a temporary response to an immediate need to help Demopolis physician, Dr. Gerald Hodge, cover his practice and to sustain the availability of care to his patients and the community in his absence. With that, clinicians from the College of Community Health Sciences—including family medicine faculty physicians, the OB fellow and a nurse practitioner—stepped in to provide interim clinical care. However, with the recent retirement of Hodge, the only local physician still providing pre-natal care following the closure of the hospital’s obstetrical unit in February 2015, it quickly became apparent that there was a significant, and growing, need for family medicine and pre-natal care in the communities immediately surrounding Demopolis. To that end, the temporary coverage has transitioned to a new, third location for University Medical Center, the practice run by CCHS.

The establishment of UMC-Demopolis is a means by which the College can help that community directly, and support the local hospital, while also developing a model that combines a full spectrum rural practice with medical education, all linked to the larger infrastructure of University Medical Center and the CCHS. Similarly, in an independent effort, administrators from the UAB Health System are working with hospital leadership to develop strategies to improve the hospital’s financial operations and viability.

The serendipity of our work in Demopolis on the physician side with that of the UAB Health System working with the hospital is unique, and strengthens the likelihood of sustained success. UAB will no doubt be very helpful in operational strategies for the hospital. But what the hospital most needs for success is more local physicians, particularly primary care docs. That will be our principal contribution to this unique three-way partnership.

—Dr. Richard Streiffer

Dean and Professor of Family Medicine, College of Community Health Sciences

While UMC-Demopolis will officially be open to patients beginning this week, the plans for further growth are still in motion. The planning and development phase will continue over the coming months, and a grand opening in the fall is anticipated.

College welcomes Bentley as assistant professor

Dr. Brett Bentley

Dr. Brett Bentley joined the College as an assistant professor of Sports Medicine in the Department of Family, Internal, and Rural Medicine.

The Tampa, Fla., native completed his undergraduate degree at the University of Florida in Gainesville, where he played baseball all four years and was a four-time member of the Academic All-SEC Team.

Bentley worked for a year at an inner-city ministry in Atlanta, Desire Street Ministries, before returning to the University of Florida for medical school. After medical school, he completed a family medicine residency at the University of South Carolina. In June, he completed a sports medicine fellowship at the College.

UMC Travel Health Services open in Faculty-Staff Clinic

A new addition to University Medical Center, Travel Health Services provides care for UA faculty, staff and their families as they prepare for international travel. Health care providers in the UMC Faculty-Staff Clinic provide individuals a comprehensive, preparatory experience that includes a consultation, advice for planning, travel-related vaccinations and medications needed in advance of departure.

 

“Nowhere is an ounce of prevention worth a pound of cure more important than when traveling abroad.”

—Dr. Tom Weida, UMC Chief Medical Officer

 

Advice on a wide range of topics is offered, from the more obvious vaccination requirements of individual countries, to conditions of food and water safety, and the activities you have planned—with each considered down to the exact region of the country slated for visit.

As UMC furthers its mission of promoting the health of individuals and communities in Alabama, it is the hope that travel health services will be expanded beyond the UA campus in the near future.

[FIND OUT MORE] about how to book appointments and associated costs, and to access required patient forms.

College, city partner to provide para-medicine program

The College and Tuscaloosa Fire and Rescue Services have partnered to provide a first of its kind in Alabama program that seeks to reduce costly hospital emergency room transports of people with low-emergency conditions.

The program is aimed at “low acuity” patients who might call 911 for back or stomach pain, fever, weakness or bleeding, for example, which might be treatable at the scene.

Under the program, nurse practitioners and social workers, and possibly psychologists, will ride with fire department first responders on low-acuity calls and offer treatment at a patient’s location, eliminating the need for an ambulance ride and a hospital emergency room visit. While care can be delivered at the scene, low-acuity patients will have the option of being transported to the hospital if they wish.

The nurse practitioners will have back-up from physicians, and the social workers can ensure that patients have the resources they need and can connect patients with primary care physicians. The psychologists can offer assistance on managing the nearly 30 percent of low-acuity calls related to mental health.

“This is a way to change how health care is delivered,” said Tuscaloosa Fire and Rescue Chief Alan Martin.

The para-medicine program is modeled after a similar Arizona program, although that program doesn’t have a university as a partner. Based on preliminary results from the Arizona program, the medical cost savings for the Tuscaloosa program could be $6 for every $1 that’s invested, said Dr. Richard Friend, chair of the College’s Department of Family, Internal, and Rural Medicine and co-director of the program along with Dr. John C. Higginbotham, chair of the College’s Department of Community Medicine and Population Health.

The para-medicine program is funded with a legislative allocation through Alabama’s Medicaid program and will use College nurse practitioners and social workers to provide care. The funding is expected to be available Oct. 1.

In fiscal year 2015, in Tuscaloosa there were 11,122 calls to 911, of which 23 percent, or 2,558, were low-emergency calls. At a cost of approximately $645 per call for an ambulance ride, treating callers at the scene would save $1.65 million.

“Trying to stop use of the emergency room for routine care is the goal,” Friend said.

Looney joins College as director of nursing

Wyndy Looney joined the College as director of Nursing for University Medical Center, which the College operates. Her responsibilities include serving as chief nursing officer, improving workflow, standardizing processes and procedures and implementing quality improvement activities.

Before joining the College, Looney was manager of Nursing Operations and Analytics at DCH Health System in Tuscaloosa, where she was responsible for day-to-day operations of the health system’s Patient Care Services division.

She has practice nursing in Alabama for 27 years.

Looney earned a Master of Science in Nursing from the University of North Alabama, graduating with academic honors. She is certified in Nursing Professional Development through the American Nurses Credentialing Center.

Her nursing experience in various clinical and community settings includes pediatrics, newborn care, labor and delivery, perioperative care, school health, nursing education and nursing operations. She has also held positions in nursing management and administration.

While at DCH Health System, which operates DCH Regional Medical Center in Tuscaloosa, Looney received the “Great Catch” Award for identifying and reducing a safety risk for hospitalized patients. She currently serves on The University of Alabama’s College of Nursing Partnership Advisory Council and the Bridger Lectureship.

In 2014, Looney was appointed by Alabama’s state health officer to serve a two-year term on a regional Perinatal Advisory Committee. In a previous administrative role, Looney successfully piloted a regional chronic care coordination program for Alabama Medicaid recipients. As part of the pilot, she developed and implemented a Newborn Transition Program, partnering with local hospitals and pediatricians to ensure that newborns received appropriate follow-up care after being discharged from the hospital.

Summer Sun Safety: Avoiding the Dangers of the Sun’s Rays

By Kim Eaton

Those beautiful golden summer rays might look quite appealing after springtime showers, but if you’re not careful, that summer sun can turn dangerous, and fast.

“Exertional heat illness is one of the leading causes of death in young athletes each year,” says Dr. Ed Geno, assistant professor in the Department of Family, Internal, and Rural Medicine at the College of Community Health Sciences. “Children and the elderly are also more at risk. The elderly do not have the same cardiovascular ability to sweat and get the heat out of their system. There are also many medications that can predispose someone to heat injury of any kind.”

There are several types of heat illness. Heat cramps and heat exhaustion are the most common, while heat stroke is the most severe. People often know when they are hot, but with heat stroke, the core body temperature is elevated above 104 degrees and those individuals can start to exhibit brain symptoms – trouble walking, seizures and hallucinations and loss of consciousness, Geno says. Other symptoms may include headache, skin redness and warmth, rapid breathing and heartbeat, diarrhea and vomiting, muscle cramps and lack of sweating.

“The severity of heat stroke is directly related to the length of time someone is hot,” Geno says. “ So, if you start having symptoms of heat crams or heat exhaustion – heavy sweating, nausea, headache, faintness, dizziness, muscle cramps – you need to stop and immediately begin cooling your body down to prevent heat stroke.”

You can do this by spraying your body with cool water or taking a cool shower; moving into the shade, an air-conditioned car or by using a fan; drinking water or sports drinks, but never alcohol; removing extra clothing; or putting a cold pack on the back of your neck or under your armpits. If you do suffer from heat stroke or see people exhibiting symptoms, they need to be treated by a physician, Geno says.

If you know you are going to be in the sun for any length of time, make an effort to avoid any kind of heat illness, he says. “You can do this by gradually increasing your exercise rather than starting at full force, and drinking enough fluids so you do not feel thirsty,” Geno says. “Wear lightweight clothing and do activities earlier or later in the day. And never leave someone in a hot car.”

WVUA: Health Matters – Sugar-Sweetened Drinks (April 26, 2017)

In the South, we love our sweet tea. But as a whole, Americans are consuming too much sugar, and a good portion of that comes from beverages.

A long-term sugar surplus leads to issues like obesity, diabetes and heart disease.

University Medical Center Registered Dietician Suzanne Henson said down here, sugar is an epidemic.

“It is not unusual to find even infants with sweet tea, sports beverages or regular sodas in their bottles,” she said. “So we have developed a group of young people who are accustomed to intensely sweetened beverages.”

Drinking so many sugar-filled beverages at a young age often means kids crave those kind of drinks over, say, water.

WVUA: Health Matters – Lower Back Pain (April 19, 2017)

Dr. Rick Streiffer with the University of Alabama College of Community Health Sciences said most people experience lower back pain at some point in their lives.

Most times, it’s treatable without a doctor’s intervention — heat, over-the-counter medications and rest go a long way to helping a hurting back.

“It is one of the most common reasons that people come in to see their family physician,” said Dr. Jimmy Robinson, also with UA’s community health sciences college.

A big contributor to lower back pain? Being overweight and physically inactive.