September 2009


SwineFluRecently, I have had several patients tell me that they do not want to receive the swine flu vaccine. They offer many reasons such as they “have never received the flu shot in the past and they have been just fine” and “the vaccination has not been out long enough to know the side effects”. I have even heard that some people believe this uproar over the H1N1 virus is all propaganda by the pharmaceutical companies (see comment section) created to increase vaccine profits.

I am here to tell you that the risk with this virus is very real!

H1N1 is proposed to kill between 90,000 and 100,000 patients in this country over the coming winter months. Although it is a new vaccine, it is safe. Tens of thousands of doses have already been dispensed to both adults and pediatric patients with no overwhelming side effects. In this case, the benefit strongly outweighs the risk. The unfortunate fact about this virus, in particular, is that the young healthy individuals are more likely to die from the disease. We have no immunity, as we have never lived through a pandemic such as this current swine flu.  We have been given the opportunity to protect ourselves and I suggest that we all take it. I believe so strongly in this coverage that my four children, my husband and I will be receiving the vaccination as early as possible.

Lastly, I do want to make the point that taking the seasonal influenza vaccine is still very important. Upward of 35,000 people die each year from seasonal flu. The H1N1 virus is entirely different from the viruses contained in the seasonal flu vaccine. Seasonal flu vaccine will NOT cover H1N1 and the H1N1 vaccine will NOT cover seasonal influenza. The CDC strongly recommends receiving both vaccines.

So, please take a proactive approach to your own health care and take both vaccines!

Many of my patients with celiac disease ask whether it is OK to “cheat” on their gluten free diet.

This study titled “Small Intestinal Histopathology and Mortality Risk in Celiac Disease” just published in the Journal of the American Medical Association shows that patients may be gambling with their lives if they do so.

The study compiled all small bowel biopsies taken in Swedish patients between July 1969 and February 2008. The researchers divided patients into several groups – those with villous atrophy, those with intestinal inflammation (which the study says is equivalent to intraepithelial lymphocytes in Sweden), and those with normal mucosa. Out of 287,586 unique patients who had biopsies, celiac disease was found in 29,148, inflammation was found in 13,446, and the mucosa was normal in 244,992. The researchers also found 3,736 patients with “latent celiac disease” – meaning that they had normal intestinal biopsies and positive celiac disease serology (blood tests).

The researchers then compared death rates between these different groups of patients with death rates from the general population.

For patients with celiac disease (atrophy on biopsy), the risk of death was 39% more than the general population. Patients with inflammatory changes on their biopsies had a 72% increased risk of death, and patients with latent celiac disease had a 35% increase in risk of death.
Patients with celiac disease had a 19% greater likelihood of dying from heart disease, 55% greater likelihood of dying from cancer, 36% greater likelihood of dying from lung problems, and 65% greater likelihood of dying from other causes.
Patients with inflammatory changes on their biopsies were 35% more likely to die from heart disease, 232% more likely to die from cancer, 46% more likely to die from lung problems, and 201% more likely to die from other causes.
There were not enough patients with latent celiac disease (normal biopsies with positive blood tests) to predict cause of death in several categories, but patients with latent disease were almost three times more likely than the general population to die from respiratory problems. Cause of death was also higher in all the other categories, but did not reach statistical significance.

One other interesting thing noted in the study is that risk of death was much higher in the first year after celiac disease was diagnosed and then tended to level off with time. In fact, those with inflammatory changes on their biopsies had a risk of death almost 5 times greater than the general population in the first year after diagnosis. Those with celiac disease had a risk of death almost 3 times greater than the general population in the first year after diagnosis. The researchers believed that this discrepancy may be because the patients were likely to be more ill and have more severe symptoms leading to the diagnosis of celiac disease. Once a gluten free diet is initiated, it can take 1-2 years for the changes to resolve.

There were several interesting things I noted about the study findings.

First, if we add up all the categories, the incidence of celiac disease for patients undergoing intestinal biopsy was 29,148 + 13,446 + 3,736 out of 287,586 total patients. That totals more than 16% of patients undergoing intestinal biopsies in Sweden who had either biopsy or serologic findings consistent with celiac disease.

Second, 1.3% of patients had normal small bowel biopsies, considered the standard for diagnosis in the US, but still had positive serologic tests for celiac disease.

Third, the study shows that celiac disease is more than just a bad reaction to food. Uncontrolled celiac disease causes changes in the body that increase the risk of death. The better that we follow a gluten free diet, the more likely we are to live long healthy lives.

Finally, celiac disease awareness is increasing! See news stories about this study in:
The Los Angeles Times
Medscape
Medpage Today

A .pdf copy of the study can be found here.

I would like to welcome Be Well 365 to my office. Although not part of Sullivan Medical, Amy Novotny LMT, AMTA is a certified massage therapist who will be sharing my office space with me on a part-time basis. Amy has a strong belief in a holistic approach to patient care. She takes the time to develop a wellness plan with each patient that includes massage, reflexology and other modalities to provide total care. She will be accepting both cash payment as well as insurance, if the patient has covered benefits.

As a welcome to my new office and to Amy, we will be having an open house on October 10th, from 11am to 2 pm. We will be serving a load of gluten-free goodies as well as 5-minute sample massages. Please come and join us for the festivities. We will look forward to seeing you there!

A patient with both celiac disease and diabetes (see here for a US News article about the link between celiac disease and diabetes) recently visited me in my office. While I help manage her celiac disease, she also sees an endocrinologist to help manage her diabetes. The patient shared with her endocrinologist that she has had several episodes of contamination which lead to a breakout of Dermatitis Herpetiformis. The endocrinologist told her that if she stays on a small dose of prednisone every day, she can not only prevent her breakouts but completely cure her celiac disease.

For anyone who has heard similar statements, I am writing to tell you that this is not true. There is no medicine to treat or cure celiac disease. The only “cure” to celiac disease is a strict gluten-free lifestyle, so please do not believe otherwise. All celiac patients (including myself) have had episodes of contamination. We treat the symptoms and move on, trying twice as hard to be strict with our diets in the future.

My family and I are awaiting word on any sort of treatment for celiac disease. There are studies ongoing.

I will let you know when I get that word!

We’re already seeing some cases of influenza in the area and the swine flu is expected make a comeback in the next couple of months. Actually, the CDC has requested that we use the technical name of H1N1 virus to describe the swine flu since some people mistakenly believe that they can get the disease from being around pigs and eating bacon or other pork products.

Most of the time, H1N1 symptoms are relatively mild, including a low-grade fever, cough and sore throat. Sometimes H1N1 may just appear to be a cold, causing only nasal congestion or runny nose without a fever. Occasionally severe disease also has been reported where patients develop headaches, body aches, trouble breathing, vomiting or diarrhea.

Testing for H1N1 initially involves a nasal swab to determine whether or not influenza is present. If no influenza is present, then the patient does not have any type of influenza. If testing shows that a patient has Influenza B, H1N1 virus is unlikely. If the patient has Influenza A, the patient may have H1N1 influenza, but may also have many of the other strains of Influenza A – as are seen with seasonal influenza outbreaks. If the Influenza A is positive and H1N1 virus is suspected, a nasopharyngeal wash can be sent to the state department of health for testing, but currently Illinois is recommending testing only for hospitalized patients with severe respiratory symptoms and fever.

The good news is that a vaccine is coming. Even better news is that the vaccine will be provided by state and county health departments at NO COST. You can only be charged an “administration fee” that covers the doctor’s costs in storing the vaccine and giving you the vaccine – not a charge for the vaccine itself. I’m on the list of providers who will hopefully receive vaccine once it begins shipping.
The vaccine will be given to priority groups first, including pregnant women, household contacts of infants less than 6 months old, and health care workers.
An explanation of the distribution process for vaccines can be found here.

The best way to keep from getting sick is to practice what the IDPH calls the “Three Cs” –
Clean – properly wash your hands frequently – either with soap and water or alcohol-based cleansers
Cover – cover your cough and sneeze by coughing into your forearm
Contain – contain your germs by staying home if you are sick

For more information about the H1N1 virus, go to the Illinois Department of Public Health’s H1N1 Flu web site or the Centers for Disease Control H1N1 Flu web site.