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.

Screening, prevention important in combatting breast cancer

By Erin Tech

While family history is a risk factor for breast cancer, well more than half of breast cancer cases occur sporadically and are not hereditary, said Dr. Helen Krontiras, who provided the Dr. Joe W. and Virginia Hursey O’Neal Endowed Lecture for the College of Community Health Sciences on May 2.

Krontiras, a breast surgical oncologist and Medical Director of the UAB Multidisciplinary Breast Clinic in Birmingham, Alabama, spoke about the importance of prevention and early detection of breast cancer. She is also co-Director of the Breast Cancer Prevention and Risk Assessment Clinic at UAB.

The endowed lecture was created by Dr. Joe O’Neal, a long-time Tuscaloosa surgeon, to support the teaching of breast cancer prevention and early detection and to honor his wife, Virginia Hursey O’Neal, who died from breast cancer in 2001.

Krontiras said early detection of breast cancer has improved because of better screening.

Mammograms, which provide an x-ray picture of the breast, can be used to check for breast cancer in women who have no signs or symptoms of the disease, or to check lumps or for other signs of breast cancer. But there are limitations, Krontiras said, as a diagnosis via mammogram is more difficult for women with dense breasts. In 2013, Alabama passed the Breast Cancer Prevention Education Act, which requires that patients be informed of their breast density.

MRIs, for example a Tomosynthesis Mammogram (3-D), allows radiologists to evaluate the breast one “slice” at a time, Krontiras said. The method improves cancer detection rates and lowers screening “call backs,” she said.

For patients who can’t have an MRI, contrast-enhanced spectral mammography provides the next best means of screening, she said.

With increased screening, however, comes the potential for overtreatment, Krontiras said. Studies have shown there is the possibility for overtreatment in regard to ductal carcinoma in situ (DCIS), which is the presence of abnormal cells inside a milk duct in the breast and considered to be the earliest form of breast cancer. DCIS is noninvasive, meaning it hasn’t spread out of the milk duct to invade other parts of the breast. Some studies have suggested not taking action for DCIS.

Because “finding cancer early does not always save lives,” Krontiras said prevention is important. She recommends breast health awareness and clinical breast exams beginning at age 40, and to have a lifestyle – maintain a healthy diet, exercise, and limit alcohol consumption. Obesity, high caloric intake and lack of physical activity could be a greater cause of breast cancer than tobacco by the year 2030, she said.

Krontiras earned her medical degree and completed her residency at UAB before completing a surgical breast fellowship at Northwestern University in Evanston, Illinois. She is also a senior scientist at the UAB Comprehensive Cancer Center and her primary research interest is chemoprevention of breast cancer.

The late Dr. Joe O’Neal played a key role in the early years of the College, assisting with surgery education efforts. He earned a medical degree in 1954 from the Medical College of Alabama in Birmingham and, after completing residency training, established a surgical practice in Tuscaloosa.

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.

WVUA: Health Matters – Adult Immunizations (April 12, 2017)

Immunizations are often considered something just for children before they head to day care or school for the first time, but immunizations are important for adults, too.

Dr. Jane Weida at University Medical Center in Tuscaloosa says skipping your shots can result in some nasty consequences.

Adults should be getting a tetanus and diphtheria shot every 10 years, Weida says, and it’s a good idea to get a whooping cough booster, too.

WVUA: Health Matters – Sinusitus (April 5, 2017)

Most people develop some sinus issue or other at least once in their life.

When it strikes, it’s tempting to ask your doctor for some antibiotics, but that’s not always the correct course of action.

Dr. Ricky Friend with the University of Alabama’s College of Community Health Sciences says even the worst sinus infections are rarely bacterial, and even those association with fever, facial pain or thick green drainage usually don’t require antibiotics.

UA partnering with Pickens County to host health fair

The University of Alabama-Pickens County Partnership is partnering with Pickens County Medical Center to host a health fair Thursday, April 6, from 10 am to 2 pm.

The health fair will be held at the Pickens County Medical Center HealthPlex, located at 241 Robert K. Wilson Drive in Carrollton, Ala.

The fair will include free health screenings for blood pressure, weight and cholesterol. Participants can also have their screening results individually reviewed and explained by a health coach, who can also provide advice about how to better manage various health issues. The screenings will be provided by The University of Alabama Capstone College of Nursing faculty and nursing students.

The UA-Pickens County Partnership, which is led by UA’s College of Community Health Sciences, works to place UA students in medicine, nursing, social work, nutrition, psychology and health education – and potentially others – in Pickens County for internships and experiences. Through the partnership, the rural, underserved county is provided with additional health resources, and UA students receive real world training in their respective areas of study.

The health fair will also include speakers, hospital tours, gardening tips, food, giveaways and more. For information, contact Wilamena Daily, project coordinator for the UA-Pickens County Partnership, at wshopkins@ua.edu.

Health Notes – The confusing world of over-the-counter medications

To help people become savvy consumers in drug stores and pharmacies and wiser users of over-the-counter medications, Dr. Richard Streiffer, dean of UA’s College of Community Health Sciences and a family medicine physician, went shopping.

He recounted his shopping experience and provided helpful information in a presentation March 9 that was part of the Mini Medical School lecture series hosted by the College in collaboration with UA’s OLLI program. His presentation was titled “Over-the-counter drugs: A prescription for confusion.”

Streiffer said Americans make a lot of trips to the drug store for over-the-counter medications, about 3 billion trips annually, and there are approximately 300,000 over-the-counter medications on the market. “I want to help you be a little smarter as a consumer,” he told the audience.

He said people spend a lot of money on over-the-counter medications they might not need or that might not be effective. In addition, some of the medications can cause adverse health effects, particularly if people are taking multiple medications or have chronic health conditions, he said.

Streiffer offered strategies people can use to better gauge cost and effectiveness. His top tips: buy generic brands and read labels.

“There’s a fear of generics, but it’s really just a labeling and marketing difference,” he said. “For the most part, find the brand name and look next to it for the generic.”

He noted that a quick read of the labels on Excedrin and Excedrin Migraine showed that both contain the exact same ingredients; they are just marketed – and priced – differently.

Streiffer showed examples of men’s and women’s multi-vitamins and the only ingredient differences between the two were that the men’s blend had cayenne pepper and the women’s had dried cranberry. He added that affluent people with good diets don’t really need multi-vitamins, which can cost $25 or more per month.

Streiffer said it’s often difficult to discern differences between supplements and medications. “Talk about overwhelming, and supplements aren’t regulated,” he said.

Supplements are classified as food, so they are not regulated by the US Food and Drug Administration. They are marketed as supporters, not relievers, and might include information on labels such as “in support of sleep.”

“There is usually little scientific evidence to prove the effectiveness of supplements, and they can cause side effects,” Streiffer said. For example, ginseng has been touted for improving energy, depression and nausea, and cranberry for improving urinary track health.

“There’s no evidence for this. When something sounds too good to be true, it probably is. As a society, we are too quick to grab a pill,” Streiffer said.


Some post-menopausal issues can be reduced with healthy lifestyle choices

Osteoporosis and heart disease are some of the complications women can develop after menopause, but these can be reduced with healthy lifestyle choices, according to Dr. Cecily Collins, an assistant professor of obstetrics and gynecology at UA’s College of Community Health Sciences.

Other post-menopausal issues, such as hot flashes and vaginal and urinary symptoms, are not as easily avoided, she said.

Collins, who also practices at University Medical Center, which is operated by CCHS, provided the information in a presentation as part of the Mini Medical School lecture series hosted by the College in Collaboration with UA’s OLLI program. Her presentation was titled “Post-menopausal health issues for senior adults.”

Menopause is defined as the halting of the menstrual cycle and a time in a woman’s life when the function of the ovaries ceases. The process is gradual, and while the average age of menopause is 51 years, it can occur anywhere from age 45 to age 58, Collins said.

Symptoms of menopause can include hot flashes, vaginal and urinary symptoms and abnormal vaginal bleeding. Issues that women may develop after menopause can include osteoporosis and cardiovascular issues.

Collins explained that hot flashes, a quick feeling of heat and sometimes a red, flushed face and sweating, are “related to a withdrawal of estrogen.” There are medications that can relieve symptoms, she said, and she also recommended that women dress in layers and use air conditioning, particularly at night. Collins said alcohol and caffeine have been shown to increase hot flashes, while exercise can sometimes decrease their severity.

Vaginal dryness can be treated with hormone therapy as well as topical hormones applied directly to vaginal tissue, Collins said. Also associated with menopause are urinary symptoms, including infections, leakage and bladder irritation.

Some of the complications after menopause, including osteoporosis and cardiovascular disease, can be lessened by healthy lifestyle choices, Collins said.

When estrogen levels drop, bone density decreases, putting women at risk for fractures. Low bone density can be exacerbated by a sedentary lifestyle, smoking and excessive alcohol use. Exercise, smoking cessation and limiting alcohol intake can help, as can calcium supplements.

Some of these same lifestyle risks can increase the risk for cardiovascular issues for women who have gone through menopause, Collins said. She encouraged annual blood pressure and cholesterol checks, as well as EKGs and chest x-rays based on a health care provider recommendations.

College hosts third annual Brussels Sprout Challenge at Heart Walk

For the third straight year, UA’s College of Community Health Sciences hosted the Brussels Sprout Challenge during the American Heart Association West Alabama Heart Walk on March 25.

The College and its University Medical Center partnered with Manna Grocery and Deli in Tuscaloosa to roast and serve Brussels sprouts at the walk, which began at the Tuscaloosa Amphitheater and continued along the downtown river walk. More than 900 Brussels sprouts were distributed at the challenge.

To complete the Brussels Sprout Challenge, participants had to eat one roasted Brussels sprout at each mile marker of the 3.1 mile walk. Those who completed the challenge by eating all three Brussels sprouts were awarded a T-shirt at the end of the walk.

The College also provided handouts about the health benefits of Brussels sprouts, which include heart health and cancer protection, as well as Brussels sprout recipes.

The goal of the Brussels Sprout Challenge is to offer a challenge that promotes healthy lifestyle choices – a healthy diet and exercise – while complementing the American Heart Association’s mission to build healthier lives free of heart disease and stroke.

The mission of the College is to improve and promote the health of individuals and communities in Alabama and the region.