CDC: Rhode Island Hit with Widespread Flu

Published in the Woonsocket Call on January 6, 2018

The U.S. Centers for Disease Control (CDC) says it’s a no brainer as to what issue I should cover this week. Being homebound for three or four days, with the flu, and my submittal deadline looming, I pen my commentary on widespread flu activity now being reported in Rhode Island.

CDC’s Influenza surveillance (ending Week 52) reported widespread influenza “flu” activity in 24 states including Rhode Island. This CDC warning recently triggered a requirement by the Rhode Island Department of Health (RIDOH} to require unvaccinated healthcare workers in a variety of health care settings to wear masks when entering a person’s room, serving food, or participating with patients in group activities.

The masking requirement helps protect healthcare workers from catching the flu, and helps protects patients who are often dealing with other serious health issues,” said Director of Health Nicole Alexander-Scott, MD, MPH., in a statement released on January 2. “For people who have not been vaccinated yet, it is not too late. Flu vaccine is the single best way to keep yourself and the people you love safe from the flu. Getting vaccinated today will provide you with months of protection,” she says.

According to the RIDOH, typical flu symptoms include having a fever, coughing, a sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people also may have vomiting and diarrhea. People may be infected with the flu, and have respiratory symptoms without a fever.

There are many types of illnesses or injuries even less severe cases of the flu do not require a visit to the emergency room, says RIDOH, noting that less severe cases of the flu will be treated more promptly by a primary care provider or in urgent care facilities. The department notes that going to an emergency room can oftentimes result in long waits because emergency room providers prioritize more serious injuries and medical conditions.

But, when do you seek out treatment for a nasty case of the flu? RIDOH says that difficulty in breathing or shortness in health, pain or pressure in the chest and having flu-like symptoms that improve and return with a fever and worse cough are clear warning signs to go immediately to an emergency room.

CDC expects that increased flu activity in the coming weeks, noting that the average duration of a flu season for the last five seasons has been 16 weeks, with a range of 11 weeks to 20 weeks. With significant flu still to come this season, CDC continues to recommend that anyone who has not yet gotten a flu vaccine this season should get vaccinated now. It takes approximately two weeks for the protection provided by vaccination to begin.

Although 480,000 Rhode Islanders were vaccinated last year, RIDOH, says that the flu sent 1,390 Rhode Islanders to the hospital and resulted in 60 deaths (compared to 1,216 hospitalizations and 33 deaths the previous year. The state saw more flu activity during the 2017-2018 flu season than during any flu season since the 2019-2010 season, when the state experienced the state experienced the H1N1 flu pandemic.

It’s Not too Late to Get Vaccination

In kicking off Rhode Island’s annual flu vaccination campaign last October, RIDOH Director Nicole Alexander-Scott, MD, MPH, said, “A flu shot is the single best way to protect yourself and the ones you love against the flu. When you get a flu shot you are not only protecting yourself, you are also protecting the people in your life by limiting the spread of the flu.”

So, if you have not been vaccinated, consider doing so. RIDOH recommends that children older than 6 months of age should be vaccinated against the flu. Others should, too., including health care workers, pregnant women, people over age 50, nursing facility residents and persons with chronic conditions (specifically heart, lung, or kidney disease, diabetes, asthma, anemia, blood disorders, or weakened immune systems).

It’s easily to quickly get a flu shot because of its availability at doctors’ offices and pharmacies throughout Rhode Island.

In addition to getting a flu shot, here are a few simple tips that can help prevent you from getting the flu.

Wash your hands thoroughly throughout the day, using warm water and soap. If you do not have soap and water, use an alcohol-based hand gel.

According to the CDC, the flu can spread to others up to about 6 feet away, by droplets made when a person cough, sneezes or talks. So, reduce spreading the flu, just by coughing or sneezing into your elbow or into a tissue.

Avoid touching your eyes, nose, or month because germs spread this way.

Get a good night’s sleep, be physically active and look for ways to manage your stress. Also, drink plenty of fluids, and eat nutritious food.

Keep surfaces wiped down, especially bedside tables, surfaces in the bathroom, and toys for children, by wiping them down with a household disinfectant.

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Does Exercise Aid Brain Health?

The Debate’s Yet to be Decided

Published in Woonsocket Call on August 31, 2016

According to AARP’s latest health aging survey findings, age 40 and over respondents who regularly exercise rate their brain health significantly higher than non-exercisers. They also cite improvements in their memory, ability to: learn new things, managing stress, and even making decisions. On the other hand, the findings reveal an overwhelming majority of these respondents see the benefits of exercise, but only 34 percent are meeting the Global Council on Brain Health’s (GCBH) recommended 150 minutes of moderate to vigorous exercise per week.

These findings in the 37 page Survey on Physical Activity report, conducted by GfK for AARP, directly align with AARP’s Staying Sharp program, a digital platform that promotes brain health though holistic advice supported by science.

“With Staying Sharp, we sought to empower consumers with the tools needed to create a holistically brain healthy environment for themselves—along with a way to track and measure their progress,” said Craig Fontenot, VP of Value Creation. “The results of this survey only further validate the advice suggested on the platform and give us confidence that we’re providing our members with helpful, impactful information.”

The AARP survey findings, released on July 26, found that more than half (56 percent) of the age 40 and over respondents say that they get some form of exercise each week. However, only about a third (34 percent) of these individuals actually achieve the recommended 2 ½ hours of moderate to vigorous activity each week. There was little difference in reported amounts of exercise by age or gender.

The AARP online survey, with a represented sample of 1,530 Americans age 40 and over, found that walking is the most common form of physical exercise reported with 53 percent of the age 40 and respondents saying that they walk for exercise. A smaller percentage is engaging in more vigorous activity such as strength training/weight training (15 percent) or running/jogging (8 percent).

According to the survey’s findings, most of the age 40 and over respondents see the benefits to engaging in physical activity and do not find it particularly unpleasant or difficult. For example, three quarters believe exercise would improve their health, physical fitness, and quality of life.

Having willpower, enjoying exercise, identification as an “exerciser,” lack of enjoyment and feeling like you have the energy to exercise or lack money to exercise are the key factors that differentiate exercisers from non-exercisers, the researchers say.

The study found that the largest share of non-exercisers are “contemplators” in that they see the benefits and are considering taking up exercise (34 percent). About one-quarter (24 percent) are considered “non-believers” and see no need for exercise and were satisfied being sedentary. However, two in ten (19 percent) are “preparers” and say they have a firm plan to begin exercising in the near future.

Finally, the most common leisure activity that age 40 and over respondents would give up if they were to engage in exercise is watching TV/streaming movies (65%).

Removing the Barriers to Exercise

Colin Milner, CEO at the Vancouver, BC-based International Council on Active Aging, says, “These findings demonstrates the amazing and ongoing benefits of regular exercise. Our challenge, to get more people to actually move. By doing so the country and millions of individuals would improve their physical and mental health,” he notes.

Adds Milner, “The most important thing is to remember is that our bodies and brains were meant to be used. If we fail to do so they will cease to perform at the level we need or desire, and that is detrimental to our overall health and well-being.”

“Part of our challenge [to not exercising] is to remove the barriers that prevent us from leading an engaged life. A recommendation would be to list out the reasons you are not exercising or eating well, why you are feeling stressed or are not socially engaged, then set out to replace these with reasons to exercise and eat well, to be stress free and socially engaged. Once you have done this consider what steps you need to take to make this a reality,” he says. ICAA’s Webpage, “Welcome Back to Fitness” (http://icaa.cc/welcomeback.htm) gives the basics to help people begin exercising.

An avid squash player, Richard W. Besdine, MD, Professor of Medicine and Brown University’s Director, Division of Geriatrics and Palliative Medicine, preaches the importance of physical activity to all his colleagues and friends. “There are a large number of research studies documenting that exercise is good for all organs in your body,” he says, adding that that regular exercise can also reduce cancer rates, control diabetes, improve one’s emotional health and even reduce depression.

When asked about AARP’s survey findings about the impact of exercise and brain health, Besdine says he applauds the survey’s objectives of examining the relationship between physical exercise and brain health, but its findings are self-reported at best, not empirically derived.

Besdine points out that there is a growing body of studies that empirically study the relationship between exercise and brain health and findings indicate a positive impact on brain functioning. People who exercise are less likely to be cognitively impaired and those who are mildly impaired may even slow or stop the progression of their mental disorder, he says.

“Although AARP’s survey is very interesting it is very limited because it is self-report and cross-sectional, says Deborah Blacker, MD, ScD, Director of the Gerontology Research Unit at Massachusetts General Hospital who is also a Professor of Psychiatry at Harvard Medical School.

AlzRisk, part of the AlzForum, a website that reports the latest scientific findings on the advancement of diagnostics and treatments for Alzheimer’s disease, posts a scientific review of 16 scientific articles reporting on the relationship of exercise habits to the later development of Alzheimer’s disease. Blacker, AlzRisk’s leader, says that this more solid body of evidence suggests that exercise may play a modest role in protecting a person from Alzheimer’s disease, but further scientific research is required.

Like Besdine, Blacker still sees the positive benefits of exercise even if the scientific data is still coming in. “We know that physical exercise is good for preventing cardiovascular disease and diabetes. If it may also help to prevent cognitive decline, for me that is an even better reason to exercise,” she says.

The Bottom Line

“Staying physically active is one of the best things that someone can do for their physical health and mental health. Physical activity can help you lose weight, lower your blood pressure, prevent depression, and, especially for older adults, promote memory and help you think clearly,” said Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island Department of Health. “We are working hard to make sure that people from every zip code throughout Rhode Island have access to our state’s wonderful parks, beaches, and other natural resources and are getting the amount of physical activity they need to live long, full, productive lives.”

Putting the Brakes on Testosterone Prescriptions

Published in Pawtucket Times on March 30, 2015

Sophisticated mass marketing pitching testosterone to combat age-related complaints combined with lax medical guidelines for testosterone prescribing can be hazardous to your physical health, even leading to strokes and death, warns an editorial in this month’s Journal of the American Geriatrics Society.
The March 2015 editorial coauthored by Dr. Thomas Perls, MD, MPH, Geriatrics Section, Department of Medicine, Boston Medical Center in Boston, and Dr. David Handelsman, MBBS, Ph.D., ANZAC Research Institute, in New South Wales, Australia, expressed concern over commercial-driven sales of testosterone, effectively increasing from “$324 million in 2002 to a whopping $2 billion in 2012, and the number of testosterone doses prescribed climbing from “100 million in 2007 to half a billion in 2012.”

Pitting Patients Against Patients

The editorial authors see the “40 fold” increase of testosterone sales as the result of “disease mongering,” the practice of widening the diagnostic boundaries of an illness and aggressively promoting the disease and its treatment in order to expand the markets for the drug. Glitzy medical terms, like “low T” and “andropause,” showcased in direct-to-consumer product advertising pit aging baby boomers against their physicians, who demand the prescriptions, say the authors.

“Clearly, previous attempts to warn doctors and the public of this disease mongering that is potentially medically harmful and costly have not been effective, says co-author Dr. Perls.

The epidemic of testosterone prescribing over the last decade has been primarily the proposing of testosterone as a tonic for sexual dysfunction and/or reduced energy in middle-aged men, neither of which are genuine testosterone deficiency states,” observes Dr. Handelsman.

According to the National Institutes on Aging (NIA), the nation’s media has increasingly reported about “male menopause,” a condition supposedly caused by diminishing testosterone levels in aging men. “There is very little scientific evidence that this condition, also called andropause or viropause, exists. The likelihood that an aging man will experience a major shutdown of testosterone production similar to a woman’s menopause is very remote.”

The authors agree with the NIA’s assessment, but go further. They point out in their editorial that for many men, testosterone does not decline with age among men retaining excellent general health, and if it does, the decline is often due to common underlying problems such as obesity and poor fitness. Those who hawk testosterone have developed advertising that focus on common complaints among older men such as decreased energy, feeling sad, sleep problems, decreased physical performance or increased fat.

But, many times a testosterone level won’t even be obtained and the patient is told that, simply based on these common symptoms alone or with minor reductions in serum testosterone, they have “late onset hypogonadism” or that their erectile dysfunction may be improved with testosterone treatment, say the authors. But the authors also point out the true hypogonadism is the cause in fewer than 10% of men with erectile dysfunction.

FDA Enters Debate

The U.S. Food and Drug Administration’s (FDA) recent dual commission findings concluded that testosterone treatment (marketed as ‘low T’) is not indicated for age-associated decline. The benefits of this “deceptive practice” remain unproven with the risks far outweighing the perceived benefits,” says the agency. Pharmaceutical companies are now required to include warning information about the possibility of an increased risk of heart attacks and stroke on all testosterone product labels.

Health Canada, Canada’s FDA, recently echoed the FDA’s committee findings that age-related hypogonadism has not been proven to be a disease-justifying treatment with testosterone. Both agencies warn of an increased risk of blood clots in the legs and lungs and the possibility of increased risk for heart attack associated with testosterone use.

In a statement, James McDonald, the chief administration officer for the Board of Medical Licensure and Discipline, says: “There is a concern in healthcare regarding direct-to-consumer prescribing of medication. At times, the prescription is not evidence-based, and can lead to misuse. There is concern with Testosterone, a schedule 3 controlled substance,that can be used as a performance-enhancing drug. The Rhode Island Board of Medical Licensure (BMLD) investigates complaints regarding all types of misuse of prescription medications as well as complaints regarding over-prescribing.”

Drs. Handelsman and Perls also warn about another drug commonly hawked for anti-aging, growth hormone. The FDA requires that doctors perform a test to demonstrate that the body does not produce enough growth hormone. “Those who market and sell HGH for these common symptoms nearly never perform the test because if they did a properly performed test, it would almost never be positive because the diseases that cause growth hormone deficiency in adults, such as pituitary gland tumors, are very rare,” said Perls. Growth hormone is well known for its side effects, including joint swelling and pain and diabetes. Ironically, opposite of anti-aging claims, growth hormone accelerates aging, increases cancer risk and shortens life span in animal studies.

In the editorial, Perls and Handelsman call upon professional medical societies and governmental agencies to take definitive steps to stop disease mongering of growth hormone and testosterone for conjured-up deficiencies.
“These steps include the banning of ‘educational’ and product advertising of testosterone for these contrived indications,” said Perls. “Furthermore, the FDA and Health Canada should require a physician’s demonstration of a disease process proven to benefit from testosterone administration in order to fill a lawful prescription for testosterone.”

Tightening Up Prescription Guidelines

The issue of prescribing testosterone is firmly on the medical profession’s radar screen with the FDA’s recent committee’s findings and Perls and Handelsman’s pointed editorial calling for the medical profession to seriously tighten up the lax consensus guidelines in order to stop the medically inappropriate prescribing of testosterone.
Rather than pushing testosterone, wouldn’t it be a “mitzvah – a good deed- if the nation’s pharmaceutical companies ran public service commercials stressing the importance of losing weight, exercising and eating nutritious meals as a way to effectively combat age-related problems, like low libido. But, this won’t happen because it is not a revenue generator or good for the company’s bottom line.

Herb Weiss, LRI ’12 is a Pawtucket-based writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.