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Time to schedule your check up

How long has it been since you’ve been to the doctor for a wellness checkup. Most of us (mostly men) only go see the doctor if there is something absolutely wrong and we can’t avoid it any longer. But the advantages of seeing the doctor for a checkup when you feel good may help you out in the long-run.

We’re all familiar with the normal questions your doctor will ask about our lifestyle: smoking and drinking habits, caffeine intake, exercise habits, diet, and sexual activity. He will also update your vaccine records and administer those that need updating. A review of your family medical history will also be conducted to see if there is any change in a family member’s health.

If you know we are living a healthy lifestyle, why see your doctor for preventative care?

It’s included in your health insurance. The premium you pay every month for health insurance includes one well check-up per year.

Blood pressure screening. High blood pressure is also known as the silent killer. Even seemingly healthy people can have high blood pressure. Less than 120 over 80 is a normal blood pressure. Doctors define high blood pressure (hypertension) as 140 over 90 or higher.

Heart and respiratory rate: Heart rate values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however. Doctors can also detect an irregular heartbeat, heart murmurs or other indicators of heart disease. An exam will also check your breathing. Twelve to 16 breaths per minute is normal for a healthy adult. But breathing more than 20 times per minute (while resting) can suggest heart or lung problems.

Cholesterol screening. A lipid panel, also known as a cholesterol test is recommended every four – six years, according to the American Heart Association. Your doctor might check more frequently if you have risk factors for heart disease. Abnormal cholesterol level increase the risk for heart attacks and strokes.

HIV screening. The CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. Learn the risk factors for HIV.

Diabetes (Type 2) Screening. According to the American Diabetes Association, all patients should be screened for diabetes at three-year intervals beginning at age 45, especially people who are overweight or obese. If multiple risk factors are present, screening should be done at an earlier age and more frequently. The U.S. Preventive Services Task Force recommends that adults with high blood pressure or high cholesterol be screened for type 2 diabetes (insulin-resistant diabetes) in an effort to reduce cardiovascular disease.

Obesity Screening. Part of your check up will include getting your height and weight to determine your body mass index (BMI). BMIs of 30 or above are termed obese. A BMI of 25 to 29.9 is overweight. Normal BMIs are 18.5 to 24.9.

Colorectal cancer. At age 50, it’s time to begin regular screening for colorectal cancer. If you have an immediate family member with colorectal cancer or other risk factors you may need to be screened before age 50.

For obvious physiological reasons women and men each have their own unique sets of recommended tests as part of their annual physicals.

For women, breast cancer mammography, cervical cancer screening, and the human Papillomavirus (HPV) DNA Test are recommended.

For some women, age 40 marks the time to begin annual mammography screening for breast cancer. The American Cancer Society recommends that women ages 40 to 44 should have the choice to start mammograms if they wish to do so. Women age 45 to 54 should get mammograms every year, while women 55 and older should switch to mammograms every two years, or can continue yearly screening.

Screening for cervical cancer is recommended for women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval.

The most important risk factor for developing cervical cancer is infection with HPV. Doctors can now test for the HPV (high-risk or carcinogenic types) that are most likely to cause cervical cancer by looking for pieces of their DNA in cervical cells. The test can be done at the same time as the Pap test, with the same swab or a second swab. You won’t notice a difference in your exam if you have both tests.

For men, their annual exam may include testicular exam, a penis and prostate exam,  and a hernia exam.

In a testicular exam, a doctor can check each testicle for lumps, tenderness or changes in size. Most men with testicular cancer notice a growth before seeing their doctor. A doctor will also check a man’s penis for evidence of sexually transmitted infections such as warts or ulcers. The prostate is also examined by feeling the prostate (via the rectum) for its size and any suspicious areas.

During a hernia exam, doctors check for weakness in the abdominal wall between the intestines and scrotum.

During routine exams for both men and women, your doctor can gather information from you based on your general appearance by watching and talking to you. They can assess how healthy your skin appears, how is your memory serving you, and if you can stand and walk easily.

Doctors will also look at your throat, and tonsils, check the quality of your teeth and gums, and your ears, nose, eyes, lymph nodes and thyroid for any unusual signs.

An abdominal exam can detect the size of your liver, presence of abdominal fluid, and listening to bowel sounds. This exam also checks the tenderness of your abdomen.

Reflexes and joint health are also assessed during any annual exam to check for abnormalities.

Want to avoid the doctor for being sick? Healthy behavior like regular exercise, healthy eating and not smoking are the best prescription for preventing illnesses.

What are hernias and what causes them?

In the past two weeks, we’ve heard of two people who need hernia surgery. But what exactly is a hernia and what causes them?

A hernia is a condition in which part of an organ protrudes through the wall of the cavity containing. Oftentimes, it involves the intestine at a weak point in the abdominal wall. While some medical conditions can put pressure on the abdominal wall and cause a hernia, like:

  • Straining on the toilet (due to long-term constipation, for example)
  • Straining to urinate
  • Persistent cough
  • Cystic fibrosis
  • Enlarged prostate
  • Childbirth
  • Abdominal fluid
  • Peritoneal dialysis
  • Undescended testicles

Other times, hernias can be caused by our way of life, such as:

  • Being overweight or obese
  • Lifting heavy items
  • Poor nutrition
  • Smoking
  • Physical exertion

There are several types of hernias and some more severe than others.

Inguinal Hernias is the most common type of hernia and more common in childhood and old age. About two-thirds of people who have a hernia have this type, and it’s more common in men than in women. They occur in part of the abdominal wall called the inguinal canal where a man’s testicles must descend before birth. If the opening does not properly heal, the contents of the abdomen, such as intestine, may protrude through this opening just above the leg crease, near or adjacent to the pubic area. However, in older men, these can occur due to a weakness in the groin area.

Ventral Hernias can occur through the scar due to a past abdominal surgery — weeks, months or years after surgery. They can vary in size from small to very large and complex. If you think you have a ventral hernia, see your doctor immediately as it may widen and become very difficult to repair.

Femoral Hernias are more common in women than men and like inguinal hernias, they appear in the groin area. They are usually the result of pregnancy or childbirth.These hernias are more prone to develop strangulation of the intestines as an early complication. Once diagnosed, it’s important to have surgery to repair it sooner rather than later.

Umbilical Hernias are a bulge in the belly button region, which has a natural weakness from the blood vessels of the umbilical cord. These hernias may occur in infants and may resolve themselves by age three of four. In adults, umbilical hernias will not resolve themselves and may worsen over time. They can be caused by being overweight, excessive coughing, or pregnancy.

Epigastric Hernias occur due to a weakness, gap or opening in the muscles or tendons of the upper abdominal wall, between the breastbone and the navel. These types of hernias are more common in men than in women.

Hiatal Hernias are caused by the upper part of the stomach pushing out of the abdominal cavity and into the chest cavity through an opening in the diaphragm.These types of hernias cause acid reflux which can lead to heartburn, pain, and erosion of the esophagus. Surgery is required for this type of hernia and is more complicated.

Oftentimes hernias do not produce troubling symptoms, but abdominal complaints may mean a more serious problem is progressing.

In some cases, a hernia needs immediate surgery, for instance, when part of the gut becomes obstructed or strangulated by an inguinal hernia. A strangulated hernia happens when part of your intestine or other tissue becomes tightly trapped and the blood supply is cut off. Strangulated hernias can result in gangrene. This condition is considered a medical emergency and requires immediate surgery to undo the blockage and repair the hernia. Immediate medical attention should be sought if an inguinal hernia produces acute abdominal complaints such as:

  • Pain
  • Nausea
  • Vomiting

With the exception of an incisional hernia (a complication of abdominal surgery), in most cases, there is no obvious reason for a hernia to occur.

The risk of hernia increases with age and occurs more commonly in men than in women.

If you do think you have a hernia, seek medical attention. They are usually simple to diagnose, simply by feeling and looking for the bulge. Your doctor will advise you on whether you need surgery or if you should watch and wait for symptoms to persist. Just don’t wait too long, as you may make matters worse.

Group B Strep Awareness Month

Being pregnant is an exciting time, full of expectations of a happy and healthy baby. But for women who may become pregnant or are pregnant it’s important to know the risks and signs for Group B Streptococcus (GBS) and how it can affect your baby.

July is GBS awareness month and we want to do our part to help educate our customers about this potentially deadly infection.

GBS is a type of bacteria that is naturally found in the digestive and lower reproductive tracts of both men and women. About 1 in 4 pregnant women carry GBS.

Carrying GBS does not mean that you are unclean, nor is it considered a sexually transmitted disease or infection. However, like other infections, it can be passed between sexual partners, including through oral contact.

Most women do not have any symptoms of GBS, but it can cause vaginal burning/irritation and/or unusual discharge which may be mistaken for a yeast infection and treated incorrectly. If you have “vaginitis” symptoms, see your care provider promptly for an exam and possible GBS testing.

GBS can also cause bladder infections, with or without symptoms. Your doctor should do a urine culture for GBS and other bacteria at your first prenatal visit. GBS in your urine means that you may be heavily colonized which puts your baby at greater risk. If your urine tests positive, your provider should consider you as “GBS colonized” for this pregnancy so that you receive IV antibiotics for GBS when labor starts or your water breaks.

Call your doctor immediately if you have decreased or no fetal movement after your 20th week or if you have any unexplained fever.

It is now the standard of care in the US and several other countries for all pregnant women to be routinely tested for GBS at 35–37 weeks during each pregnancy unless their urine already cultured positive in the current pregnancy. (Since levels of GBS can change, each pregnancy can be different.) Your doctor will perform a swab test of both your vagina and rectum and receive the test results in 2–3 days. Inform your doctor if you are using antibiotics and/or vaginal medications which may cause false negative results. If you are unsure of what you are taking, bring your prescriptions and other medications with you to your appointment.

If you do test positive for GBS, be sure to keep a copy of all culture test results with you at all times. If you live far away from the hospital, or have a history or short labors, be prepared! The IV antibiotics you receive in labor take about 4 hours to be their most effective. Ask your doctor about a late third-trimester penicillin shot as a possible safeguard. Tell your doctor if you are allergic to penicillin.

Be aware of “alternative medicines”.

Garlic or tea tree oil and other alt medicines have not been proven to prevent babies from becoming infected with GBS. Some are unsafe for babies. One mother (as noted on a GBS website) followed an alternative regimen of acidophilus, echinacea, garlic capsules, vitamin C, grapefruit seed extract, and garlic suppositories to eradicate GBS from her body when pregnant. Her baby was 7 pounds, 20.5 inches and perfect at birth after a normal labor and delivery at home. He died 11 hours later from a group B strep infection in his lungs.

According to the CDC, in the United States, group B strep is the leading cause of meningitis and sepsis in newborns. GBS also causes more than 1,200 babies per year to become infected after the first week of life up to several months of age–sometimes from sources other than the mother.

No one knows how often babies are miscarried or stillborn due to GBS because many parents don’t choose to have autopsies or placental testing done for their deceased babies, and death certificates are rarely updated with the findings so prenatal-onset cases are mostly overlooked for statistical purposes.

Unfortunately, babies can be infected by GBS before birth and up to about 6 months of age due to their underdeveloped immune systems.

  • ​GBS can infect your baby even before your water breaks. GBS infections before birth are called “prenatal-onset.”
  • GBS can cause preterm labor, causing your baby to be born too early.
  • GBS infection can also cause your water to break prematurely without labor starting, causing your baby to lose a significant layer of protection.
  • It is thought that babies are most often infected with GBS as they pass through the birth canal. GBS infections within the first week of life are called “early-onset.”
  • Babies can become infected with GBS by sources other than the mother. GBS infections after the first week of life are called “late-onset.”
  • Be aware that your womb and/or C-section wound can become infected by GBS.

Early-onset neonatal sepsis usually occurs within the first 7 days of life, and is typically caused by infection with group B streptococcus. About 90% of cases present within 24 hours of birth. Of the babies with GBS:

  • 69% present with sepsis
  • 26% present with pneumonia
  • 13% present with respiratory distress
  • 11% present with meningitis

Risk factors for early-onset group B streptococcal infection:

  • Maternal infection (group B strep-positive vaginal culture at delivery)
  • Birth weight of 5.5 pounds or less
  • Gestation 37 weeks or less
  • Prolonged rupture of membranes during birth
  • Intrapartum (during the birth process) fever greater than 99.5 degrees F
  • Chorioamnionitis (inflammation of the fetal membranes due to a bacterial infection, usually occurring during a long labor.)
  • Maternal ethnicity – Black and hispanic women
  • Mothers who smoke
  • Maternal age under 20 years old
  • Frequent (more than 6) vaginal exams during labor and delivery

Late-onset group B streptococcus infection occurs from 7 to 9 days of age, through to the end of the second month of life. Late-onset infection typically presents with:

  • 100% cases of fever
  • 60% cases of meningitis

Call your pediatrician or take your baby to the emergency room immediately if he or she has any of these symptoms:

  • ​High-pitched cry, shrill moaning, whimpering, inconsolable crying, constant grunting as if constipated.
  • Fast, slow, or difficult breathing.
  • Blue, gray, or pale skin, blotchy or red skin, tense or bulging fontanel (soft spot on a baby’s head), infection (pus/red skin) at base of umbilical cord or in puncture on head from internal fetal monitor.
  • Feeding poorly, refusing to eat, not waking for feedings, sleeping too much, difficulty being aroused.
  • Marked irritability, projectile vomiting, reacting as if skin is tender when touched, not moving an arm or leg, listless, floppy, blank stare, body stiffening, uncontrollable jerking.
  • Fever or low or unstable temperature, hands and feet may feel cold even with a fever.

Sources: CDC, NIH, and GBS International.

Endo to Pull Opana From the Market Following FDA Request (via Pharmacy Times)

By: Jennifer Barrett, Assistant Editor, Pharmacy Times

Endo International has announced its plan to withdraw Opana ER (oxymorphone hydrochloride extended release) from the market, following the FDA’s request to remove the reformulated opioid pain medication in June.

Opana ER was first approved in 2006 for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

FDA officials made the withdrawal request based on a review of available postmarketing data, which showed a significant shift in the route of abuse following the product’s reformulation from nasal to injection. According to the FDA’s statement, injection abuse of the reformulated drug has been associated with a serious outbreak of HIV and hepatitis C, as well as cases of a serious blood disorder.

During the agency’s advisory committee meeting in March, a group of independent experts voted 18-8 that the reformulated medication’s benefits no longer outweighed its potential risks.

In the company’s press release, Endo announced its plans to work with the FDA to coordinate the orderly removal of the pain medication “in a manner that looks to minimize treatment disruption for patients and allows patients sufficient time to seek guidance from their health care professionals.”

References

Endo provides updates on Opana ER [news release]. July 6, 2017. Endo’s website. http://www.endo.com/news-events/press-releases. Accessed July 6, 2017.

FDA requests removal of Opana ER for risks related to abuse [news release]. June 8, 2017. FDA’s website. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm562401.htm. Accessed July 6, 2017.

Newest Drug Approvals

The FDA has recently approved the following medications:

Brineura from BioMarin was approved in April for the treatment of late infantile neuronal ceroid lipofuscinosis type 2 (CLN2). This fatal genetic neurodegenerative disease affects 1 in 12,500 live births and  Brineura is specifically indicated to slow the loss of ambulation in symptomatic pediatric patients 3 years of age and older with with late CLN2 and is indicated to improve the quality of life of the young patients.

For the treatment of adult patients with newly diagnosed acute myeloid leukemia and mastocytosis who are FLT3 positive, Rydapt from Novartis was approved in April 2017. Rydapt is specifically indicated to work in combination with certain chemotherapy for the treatment of adult patients with newly diagnosed acute myeloid leukemia who are FLT3 mutation positive. It is also indicated for the treatment of adult patients with aggressive systemic mastocytosis (ASM), systemic mastocytosis with associated hematological neoplasm (SM-AHN), or mast cell leukemia.

Patients with ocular itching associated allergic conjunctivitis, Zerviate from NicOx was approved by the FDA. This topical antihistamine reduces swelling, itching and, and dilation of blood vessels in the eye.

Kevara from Sanofi was approved in May for the treatment of active rheumatoid arthritis.

Kevzara is specifically indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs). Kevzara may be used as monotherapy or in combination with methotrexate (MTX) or other conventional DMARDs. The recommended dosage of Kevzara is 200 mg once every two weeks, administered as a subcutaneous injection.

Postmenopausal women with osteoporosis at a high risk of fracture or have a history of osteoporatic fracture, have a new treatment in Tymlos from Radius Health. Tymols was approved in April and is a human parathyroid hormone related peptide analog. Patients should receive supplemental calcium and vitamin D if dietary intake is inadequate. It is not recommended taking Tymlos and parathyroid hormone analogs for more than two years during a patient’s lifetime.

Austedo from Teva Pharmaceuticals was approved in April for the treatment of chorea associated with Huntington’s disease. Dosage is determined individually for each patient based on the reduction of chorea and their tolerability. Austedo is supplied in pill form and must be swallowed whole and must be taken with food.

For those suffering from tardive dyskinesia, Ingrezza from Neurocrine Biosciences was approved in April. Targive dyskinesia is a chronic disorder of the nervous system characterized by involuntary jerky movements of the face, tongue, jaws, trunk, and limbs, usually developing as a late side effect of prolonged treatment with antipsychotic drugs.

Radicava from Mitsubishi Tanabe Pharma was approved in May for the treatment of amyotrophic lateral sclerosis (ALS). This incurable disease is the progressive degeneration of motor neurons in the brain stem and spinal cord leads to atrophy and eventually complete paralysis of the voluntary muscles.

Alunbrig from Ariad Pharmaceutical was approved in April for the treatment of advanced ALK-positive metastatic non-small cell lung cancer.

Alunbrig is specifically indicated for the treatment of patients with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) who have progressed on, or are intolerant to, the anti-cancer drug, crizotinib.

For those patients with advanced or metastatic urothelial carcinoma, Imfinzi from AstraZeneca was approved in May. The urothelium is a type of thin tissue that lines much of the urinary tract including the renal pelvis, the ureters, the bladder, and parts of the urethra.

Imfinzi is specifically indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who:

  • have disease progression during or following platinum-containing chemotherapy.
  • have disease progression within 12 months of the first treatment or adjuvant treatment with platinum-containing chemotherapy

As with any medication, there are side-effects. Consult with your doctor about these new treatments to see if they are right for you. Talk to your pharmacist to make sure any new drug that you take does not interfere with your current medications.