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January 17, 1997     Cape Gazette
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January 17, 1997

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CAPE GAZETTE, Friday, January 17 - January 23, 1997 - 27 HEALTH & FITNESS Caution advised for those vaccinated for flu By Kerry Kester Producers of the 1996-97 influenza vac- cination recently notified physicians that a component of the vaccine is weak and some patients need to be re-vaccinated. "Only five to seven percent of the nation- wide supply was weak for this vaccine, so most of the people who received it should have had a good vaccination," said Pedro Cardona, M.D., a board certified pulmonologist and internist affiliated with Beebe Medical Center. Unfortunately, he said, some of the vaccine supply went to Delaware. "We're recommend- ing re-vaccinating everyone older than CARDONA 65," said Cardona. In particular, he said, those considered at high risk should contact their physicians for the vaccinations. High risk patients, he said, are those who have problems such as lung disease, heart disease or diabetes. "Younger people had a good response to it," said Ca}dona, so unless they fall into the high risk category, they do not need to be re-vaccinated. Younger people, he said, have stronger immune systems, so although one component of the vaccine was weak, for healthy younger patients it was suffi- cient to provide protection. Ordinarily, the flu shots are 60 to 80 per- cent effective, he said. The.shot is devel- oped each year based on the strains of in- fluenza from the previous year. "There are new strains that appear contin- uously," said Cardona. "There were some new viruses that appeared this year that were not present a year ago." Concerns about acquiring the disease from the vaccine, he said, are not founded. "It's not dangerous to get a second shot. An influenza vaccination will not produce a flu," he said. Manufacturers use a killed virus to develop the vaccine; therefore, he said, it cannot produce a disease. However, he said, sometimes people may have the virus in their systems when they get the shot, be unaware that they have al- ready been infected, and may display flu- like symptoms within days of their vaccina- tions. That, he said, is just coincidence. The danger of developing a serious case of influenza, particularly for older people, said Cardona, is that the illness may be se- vere enough that a patient could also devel- op pneumonia. Pneumonia is particularly dangerous to older patients and to those who have heart or lung disease or who have diabetes. Another possible complication from in- fluenza is dehydration. "We have had some patients who have had to go to the emer- gency room for intravenous hydration, and then they were released," Cardona said. Dehydraiion severe enough to necessitate emergency care, however, is unusual. Symptoms of dehydration include fa- tigue, dry skin, dry mouth and lips and passing less urine, said Cardona. Addition- ally, he said, people should be aware that when the skin is pinched, if it remains tent- ed, the body is lacking adequate hydration. Symptoms of influenza are headaches, fever, cough, sort throat, achiness and joint aches. "There may be nausea," said Car- dona. Often, treatment does not require physician supervision. Typical methods for treating the symp- toms include keeping the body hydrated with fluids such as Gatorade, ginger ale or other clear fluids. Over-the-counter reme- dies include cough medicine and Tylenol, said Cardona. "Vitamin C does help getting over the flu more quickly," he said. "It's also good for the common cold." He recommended peo- ple with symptoms take up to 500 mg of Vi- tamin C three times daily. "Vitamin C is quite safe," said Cardona. "Usual!y with children it is not as se- vere," he said. However, treatment is the same, with emphasis on hydration. "And in children, it's important to avoid using as- pirin." Children who ingest aspirin products while they have flu symptoms are at risk of developing adverse reactions or complica- tions. Physician intervention is indicated if the symptoms last more than five days, said Cardona. Also, if the patient becomes de- bilitated, has shortness of breath or yellow- ish mucous from the lungs. Although other than an influenza vacci- nation there is not a lot that can be done preventively, people can reduce their risk of becoming infected. "The way of spreading influenza is by be- 'ing in contact with someone who has been sick," said Cardona. Frequently washing hands is a particular- ly good means for lowering the risk of be- coming ill. People spread the virus through the eyes, nose and mouth after contact with someone carrying the influenza virus. Di- rect contact from a sneeze or cough, he said, can also spread the disease. Cardona recommended people who be- lieve they may need to be re-vaccinated contact the place where they received their shot to determine whether that vaccine came from one of the recalled batches. Alcoholism prevention group warns against violence during Super Bowl dysfunction related to the excessive con- inconvenlences during the games, antisocial symptoms and become alco- The Delaware Association for Children of Alcoholics (DACOA) is advising fami- lies to become aware of the potential prob- lems of alcohol consumption during the National Football League Championship and Super Bowl games. Some authorities in the field of alco- holism and family violence see these popu- lar televised football games as being high risk times for violence and other family sumption of alcohol. Alcohol acts as a disinhibitor, causing drinkers to lose control more easily and to lash out at other family members, including wives, children, the elderly and even house- hold pets. These emotional and/or physically abu- sive episodes may occur as the result of dis- tractions, interruptions and even imagined DACOA suggests that families minimize these risks by substituting non-alcoholic drinks fo intoxicants at game functions, in- cluding home game parties. The organization also urges parents and concerne0community members to become more awe of the risks faced by children from alcoholic families. These Children can develop a variety of / holics themselves. The purpose of DA- COA is to prevent and reduce the effects of alcoholism and other chemical dependen- cies on children and families through sup- port, education and intervention. For more information on DACOA's pre- vention and intervention programs,, or to become a volunteer, contact the organiza- tion's offices at 856-6477. Depression is common amongst th e elderly female population Depression in the older woman is a common problem. After read- ing an interesting article by Leslie M. Blake, a psychiatrist at the University of Chicago concerning depression in the older woman, it dawned on me that this is a fairly common illness in the elderly fe- male population, as I have noted in my personal practice. Depression is probably the most frequent reason for psychiatric hospitalizations in the 60-75 year- old female population. A study I read estimated the lifetime risk for depression up to the age of 80 was about 8.5 percent for men and al- most 18 percent for women. Certainly depression in the el- derly is most often of a situational variety, usually due to grieving the death of a loved one, albeit most patients in this group do re- turn to their formal level of func- tion rather successfully. Howev- er, a small group becomes inca- pacitated by depression. Depressed older patients usual- ly complain to their family physi- cians that they no longer have any energy and really no longer enjoy the things they used to do. They become more and more dependent on those around them and may ap- pear to family members to be hav- ing problems with concentration, decision-making and memory. Many times this is mistaken for dementia. Although they seldom complain of suicide, many reveal feelings of hopelessness and worthlessness, a wish for life to just end and the feeling that their families would be better off with- out them. Before we label a patient as de- pressed, however, they should un- dergo a thorough medical exami- nation before receiving a diagno- sis and certainly before starting on any treatment. Many medicines and medical problems can wither contribute to depression or be misinterpreted for depression. Some of those include hypothy- roidism, anemia, or a recent heart attack. Certainly, some of the over-the- counter medicines and prscrip- tions also contribute to depres- sion, as can alcohol. To manage these patients, there are mpltiple regimens that can be employed: Cycle therapy is used fo those patients with less severe cepres- sion. / Cycle therapy seems to lbe ef- fective in this age group an! what it promotes is hope, the estgblish- ment of relationship, a sense of meaning, and a constructiv," rela- tionship with the environm nt. Anti-depressant medicati, m can enhance compliance of cycle ther- apy and in patients with sev, ;re de- pression, is very effecti e and even life saving. One thing that always ha; to be kept in mind in patients taki ng an- ti-depressant medicine is c mpli- ance. Medical compliance is defi- nitely a problem in all age  roups, but particularly in the eldel popu- lation. Sometimes this is not intq';ntion- al but is secondary to physical problems such as impaired ision, which makes it more likely that the instructions will be misread. Also, patients have a difficult time remembering whether they have taken their medicine and whether they have taken it on the correct schedule. Psychological fears such as denial of depression also enter into this, as well as fear of the side effects. These all need to be dealt with, both at the family level and at the physician level. Another factor that contributes is age-related al- terations in the way anti-depres- sant drugs are absorbed in the ei- der patient's system. This makes it more important to ensure that the dosage and scheduling is cor- rect. Coming back into vogue is elec- tro-convulsive therapy. Electro- convulsive therapy has been shown to be effective, reliable and a relatively safe method of treat- ment for depression and is often used when anti-depressants have failed or are contraindicated by a medical illness. Although major depression is common in elderly women, it is often misdiagnosed. The importance of awareness, early diagnosis, and active treat- ment intervention is extremely important in reducing morbidity and mortality and helping to re- store the patient to her functioning level. Vincent Killeen, an obste- trician/gynecologist, is presi- dent of Bayside Health Asso- ciation.