Category Archives: Dr. Croft’s Blog

Smell the Flowers, or Maybe Not…

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Asthma is a disease of the lungs that causes difficulty breathing.  It is a very common disease in children, although some may have symptoms that persist throughout their lifetime.  Others may develop it as an adult.  The symptoms of asthma are wheezing, shortness of breath, tightness in the chest, and commonly a nighttime or early morning cough.  Although the disease of asthma may not be always active, it is constantly present.  It only becomes prevalent when the lungs become irritated.  Unfortunately there is no cure for asthma, but there are a number of medications that can treat it.  It is also commonly seen to run in family bloodlines.

All wheezing is not necessarily asthma, but common recurrences of these symptoms that are associated with the presence of upper respiratory infections may provide suspicion.  Other triggers of asthma include respiratory allergies, inhalant exposures and, for some, physical exercise or exertion.  Anyone with asthma should avoid tobacco smoke.  There are tests such as spirometry or pulmonary function tests that can be ordered to help decide if asthma may be an underlying health problem.

The air channels in the lungs start with a large main airways, or bronchi.  As these airways branch out through the lungs, the size becomes smaller and smaller until they terminate at the alveoli, similar to branches of a bare tree.  When an acute asthma attack occurs, the airways in the lungs become inflamed, the airways congest and spasm making it difficult to breathe from restricted air flow.  If triggers are recognized, avoidance is extremely important if possible.  Some irritants cannot be avoided however, such as seasonal pollens.

There are medications for asthma.  The initial treatment usually starts with “rescue” inhalers that are used when symptoms occur.  These work by relaxing airway spasm and opening the channels.  If the need for this medication continually increases over time, there are additional medications taken on a daily basis to help reduce flare ups from the start.  These medications typically reduce chronic inflammation and airway spasm and thickening.  These long term control medications do not help acute exacerbations, but many times can markedly reduce the frequency and severity of asthma attacks.  It is important for those taking asthma medication to use it properly.  Some patients may reduce or stop their prescription when symptoms are controlled thinking their asthma is resolved, but put themselves at great risk for exacerbations of a potentially fatal disease with improper use of their prescriptions.

Bradford Croft, DO

East Flagstaff Family Medicine

What’s That Again?

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As June is National Alzheimer’s Awareness Month, this is a good time to highlight this form of dementia.   As of last year, the CDC estimates that there were 5.8 million people in the US living with Alzheimer’s.  As the number of cases double every five years after 65, it is expected that the diagnosis will triple to almost 14 million by 2060.

As the brain succumbs to Alzheimer’s, the centers that control language, thought and memory become impaired.  The usual characteristics that may develop begin with mild memory loss, evolving into difficulty in carrying on conversations and challenges with recognition of the environment.  It has been shown that physical changes can occur well before objective findings develop, which is not a normal process for the ageing brain.

Although there are no specific risk factors assuring the development of the disease, there are some predictors of Alzheimer’s.  The most common begins with age.  Although it can develop earlier, the usual age of diagnosis develops after age 60.  There is an increased likelihood of disease if there is a positive family history, but not an assurance.   It is thought that adequate exercise, a healthy diet, limited alcohol intake and not smoking may bear favorably on not developing Alzheimer’s, as has also already been shown to improve health outcomes in cancer, diabetes, and heart disease.

As there is no “usual” presentation of early Alzheimer’s, sometimes the individual becomes aware of subtle changes in mentation.  In other scenarios, it becomes evident to family and friends of such changes as the patient remains oblivious or is in denial when challenged with these observations.  The CDC posts the following ten warning signs of dementia as scenarios that warrant evaluation:

  1. Memory loss that disrupts daily life:forgetting events, repeating yourself or relying on more aids to help you remember (like sticky notes or reminders).
  2. Challenges in planning or solving problems:having trouble paying bills or cooking recipes you have used for years.
  3. Difficulty completing familiar tasks at home, at work, or at leisure:having problems with cooking, driving places, using a cell phone, or shopping.
  4. Confusion with time or place:having trouble understanding an event that is happening later, or losing track of dates.
  5. Trouble understanding visual images and spatial relations:having more difficulty with balance or judging distance, tripping over things at home, or spilling or dropping things more often.
  6. New problems with words in speaking or writing:having trouble following or joining a conversation or struggling to find a word you are looking for (saying “that thing on your wrist that tells time” instead of “watch”).
  7. Misplacing things and losing the ability to retrace steps:placing car keys in the washer or dryer or not being able to retrace steps to find something.
  8. Decreased or poor judgment:being a victim of a scam, not managing money well, paying less attention to hygiene, or having trouble taking care of a pet.
  9. Withdrawal from work or social activities:not wanting to go to church or other activities as you usually do, not being able to follow football games or keep up with what is happening.
  10. Changes in mood and personality:getting easily upset in common situations or being fearful or suspicious.

Alzheimer’s does not have a cure, but there are treatments available.  It is important to seek medical care at the first concern of dementia, particularly as there may be other reasons to develop dementia other than Alzheimer’s.  There are various forms of testing that may include lab, imaging as well as cognitive evaluation.  Neurocognitive screening, such as the Montreal Cognitive Assessment (MoCA) is standardized and reproduceable, as well as other formal evaluations which will help determine the severity and progression of dementia.

A diagnosis of Alzheimer’s dementia is important to make early and accurately, as the process is progressive and unrelenting.   Accommodations will need to be made: future planning, arranging financial and legal issues, addressing safety concerns, making eventual living arrangements and developing a support network.   Should there be concerns of developing dementia regarding you or your family, your first stop should be with your primary care provider.  Early intervention is critical to best outcome,

Bradford Croft, DO

East Flagstaff Family Medicine

One Stroke May Be Three Strikes

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May is National Stroke Awareness month.  Responsible for one out of six deaths in the U.S. in 2018, the signs of stroke are worth being aware.  On average, according to the CDC, a stroke happens nationally once every forty seconds, and there is a death every four minutes, totaling almost 800,000 cases per year.  Stroke is responsible for more long-term disability than any other disease in the U.S.

A stroke occurs when there is a compromise of circulation to the brain.  There are common health problems that increase the risk of developing a stroke.  High blood pressure, elevated cholesterol, diabetes, smoking, and obesity are the major contributory health risks.  About one in three Americans have at least one of these health concerns, and one out of every four patients have already had a stroke previously.  Although the likelihood of stroke increases with age, the CDC notes that about one third of hospitalized patients are under sixty-five.  Stroke risk doubles every decade after the age of fifty-five.

Most strokes are ischemic, caused by blocked circulation.  A cerebral thrombosis is a clot that develops in a blood vessel in the brain and clogs circulation at that area of the brain.  A cerebral embolism is a clot that forms in a remote part of the body, commonly in the heart or upper body.  As it follows the circulation to the brain, it then lodges in a vessel in the brain, stopping further circulation.  A common heart problem that causes this is known as atrial fibrillation, as clots repeatedly develop in the heart due to this rhythm irregularity.

Less common but equally devastating is a hemorrhagic stroke.  Rather than a blockage, this stroke is caused by bleeding in the brain.  Examples would be from a leaking blood vessel or one that has burst or ruptured.  A brain aneurysm has potential to break and bleed, as it can be a naturally occurring weak spot.

Time is of the essence in treating stroke.  Those patients who have been treated within the first three hours of the development of symptoms often have less disability at three months after the stroke.

F.A.S.T is an easy mnemonic to spot the development of a stroke.

F: face drooping.  Ask the person to smile and look for drooping on one side of the face.

A: arm weakness.  Have the person raise both arms and look for one side to drift downward.

S: speech difficulty.  Slurred or difficult speech, have the person repeat a short sentence correctly.

T: time to call 911.  Even if symptoms may resolve, early intervention is critical.

In addition to FAST, there are other symptoms of stroke that should be considered.  This includes a sudden numbness or weakness of the leg; sudden trouble with understanding or confusion; sudden difficulty seeing with one or both eyes; acute trouble with balance, walking, incoordination, or loss of balance; and sudden severe headache with no known cause.

A transient ischemic attack, or TIA, has all the features of a stroke except for the duration and damage.  The same mechanism of stroke occurs, but spontaneously clears in a short period of time without any neurologic compromise.  Nonetheless, there is medical evaluation that needs to be done.   Should you experience a TIA, seek medical care urgently as one in three will evolve into a full-blown stroke within a year.

Bradford Croft, DO

East Flagstaff Family Medicine

Along Comes the Wind

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As we endure the spring season, there are many common allergens indigenous to northern Arizona that evolve throughout the year.  Those allergy sufferers may complain of itchy, watery eyes; stuffy or runny nose; sinus pressure; ear congestion and scratchy throat.  And for those with asthma, the complaints may commonly include tight chest, difficulty breathing, cough, wheezing and shortness of breath, sometimes severe.

The Asthma and Allergy Foundation of America estimates that there are 50 million of us who have allergies.  Allergic conditions are the sixth leading cause of chronic illness in the U.S.  The longer you are here, the more likely you will be to acquire allergies with repeated exposures season after season.  Although common allergens include seasonal pollens, there are also a host of year round irritants including dust mites and animal dander that can be addressed with some proactive awareness and avoidance.  This time of year from February through the end of spring, the juniper and cedar trees pollens are in abundance in northern Arizona.   These can be an overwhelming source of irritants, some of the most significant of common allergens to many.

Common over-the-counter medicines can be used for allergy treatment.  Antihistamines reduce the histamine reaction responsible for sneezing, itching, runny nose and hives. This medicine is the foundation of allergy management, including seasonal and indoor allergies.  Nasal corticosteroids are nose sprays that reduce swelling and irritation producing sinus pressure, stuffy, runny and itchy nose.  Decongestants are also commonly used.  As their action is to dry congestion, it may sometimes worsen symptoms in our dry climate of the southwest.  Many medicines are “all-in-one” which have additional combined drugs.  Please read these ingredients, as there may be unnecessary and possible contraindicated components for some, including aspirin and other NSAIDs.  As well, there may be other medications included for cough, congestion and other symptoms of upper respiratory infections that may not be appropriated for those who suffer from environmental allergies.

There are additional levels of prescription intervention including mast cell stabilizers, leukotriene inhibitors, and oral steroids to name a few. Possibly allergy testing and hyposensitization treatment may be needed if symptoms are not controlled with the previously mentioned medications.   With early intervention and preventive treatment, many of these complaints may be minimized.  Reducing the health risk of allergy and its association with asthma can markedly improve both the financial and personal cost of uncontrolled disease.  If you have such symptoms, a visit to your primary care provider may be appropriate to evaluate, discuss and initiate the appropriate care for your complaints.  For these health problems, as with many others, early intervention is optimal to best outcome.

Bradford Croft, DO

East Flagstaff Family Medicine

 

Cancer – Who is at Risk?

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Colorectal cancer (cancer of the colon and rectum) continues to be the second leading cancer-causing death of both men and women in the U.S.  It is, however, the third most common cancer diagnosed in our country.  The only more common cancers in men are that of prostate and lung, and women are breast and lung.   According to the most recent statistics of the CDC, 141,125 people were diagnosed with colorectal cancer in 2017 with 52,547 deaths.  Of every 100,000 people, there are 37 diagnosed with colorectal cancer and 14 deaths.

Colorectal cancer begins in early stages as growths or polyps that develop in the large bowel.  The most common polyps are adenomatous.  These are not initially cancer by nature but are likely to turn into a cancer over time.  There are also inflammatory, hyperplastic, and villous polyps ranging from minimal to significant risk of evolving into colon cancer.  As cancer evolves, one may eventually have complaints of blood in the bowel movement, persisting abdominal pains or cramps, or unexplained weight loss.  Although these symptoms are not exclusive to colon cancer, immediate medical help should be sought if these complaints are present.  Early on, there may be absolutely no symptoms at all.

Although there are no absolute reasons that individuals develop colon cancer, there are some risk factors to consider.  As we age, our probabilities increase.  According to the CDC, more than 90% of cancers occur in those over fifty.  As such, the general recommendations are that men and women begin routine screening soon after turning fifty.  There is an increased incidence for those with underlying inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease.  If you have a family history (mother, father, sister, or brother) with a diagnosis of colon cancer discovered before age 50, or if you have a genetic syndrome such as familial adenomatous polyposis or hereditary non-polyposis colorectal cancer, you may have an increased risk and require screening earlier than the routine recommendation of 50 years old.

As March is Colorectal Cancer Awareness Month, your family physician can help you evaluate Colon your risk and screening options and may provide preliminary testing in office.  There are several screening tests.  Most involve the evaluation of a stool specimen, such as the guaiac-based fecal occult blood test (gFOBT) which tests for the presence of blood, the fecal immunochemical test (FIT) that measures antibodies that indicate bleeding, and the FIT-DNA test, checking for altered DNA combined with the antibody test. Although a positive screening test is not an assurance of cancer, it is a marker for timely evaluation.

Colonoscopy is a procedure that checks for cancer in the rectum and entire colon.  With the patient under sedation, a long, thin, flexible scope is used to painlessly visualize the bowel and remove polyps as well as biopsy areas of suspicion.  This is also the procedure commonly used if any of the previous screening tests return as positive.  Usually, this screening test is only needed once every ten years as opposed to annually for the less reliable gFOBT and FIT, or every three years for FIT-DNA, commonly marketed as Cologuard.

Additional techniques include capsule endoscopy (swallowing a camera in a pill) and virtual colonoscopy (a series CT radiology pictures combined to provide an image of the bowel).  As relatively new procedures, they may not be covered by insurance or available in your area.  Along with recommendations from your doctor, check with your insurance coverage to determine which tests may be choices for your screening evaluation.

Bradford Croft, DO

East Flagstaff Family Medicine, LTD

 

The Heart of the Matter

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As every February is American Heart Month, we should take a moment to consider our cardiovascular risks.  Heart disease is responsible for one out of every four deaths in the United States to the tune of 2,200 every day.  It is the leading cause of death for African Americans, Hispanics and whites.   Those at greater risk of coronary heart disease are individuals with high blood pressure, elevated cholesterol and smokers.  For those with diabetes, the risk further significantly increases.  Over half of our population has at least one of these health problems.

The most common form of heart disease is coronary artery disease.  As cholesterol plaques build up in the arteries that serve the heart, the vessels narrow and blood supply diminishes.  Sometimes producing chest pain or pressure, this angina may be the first indication that heart disease exists.  Over time, this poor circulation may weaken the heart muscle leading to failure of the pump known as heart failure.  Another outcome may cause irregularities of the heart rate or arrhythmia.   The most common presentation, however, is that of a heart attack.  Otherwise known as a myocardial infarction, the plaque formation causes a clot in the artery and blocks the vessel, damaging the heart muscle downstream of the blockage.

The best odds of survival from a heart attack are with early intervention.  Knowing the signs and symptoms greatly improves the possible outcome of survival.   Chest pain or pressure is a commonly recognized symptom, but pain in the neck, jaw, arms or shoulders, back or stomach may also be signs of heart attack.  Some additional concerns include shortness of breath as well as nausea, cold sweats and lightheadedness.   Most people are aware of chest pain being a sign of heart attack.  Only about one in four, however, is aware of all the signs and knows to call 911 when someone is having an acute attack.

If you do not know your risks, you should take advantage of your health care annual wellness exam.  This evaluation will measure blood pressure, blood sugar and cholesterol levels.  Being overweight, poor diet, physical inactivity and smoking increases your risk.  If you have a family history of heart disease, your risks are also increased.  If you have known heart disease or are at great risk, additional studies may be warranted including chest x-ray or specific cardiac diagnostics.

If you have risk factors, be aggressive to treat and control your diseases.  You can reduce your risk of coronary artery disease and heart attack with medications when appropriate to control blood pressure, cholesterol, poor circulation, irregular heartbeats as well as diabetes.  The biggest challenge for most requires lifestyle changes including better eating habits, increasing physical activity and quitting tobacco.  You are betting your life that you can do it, so don’t be a gambler.

Bradford Croft, DO

East Flagstaff Family Medicine

Happy New Year Is Up to You

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New Year’s resolutions are commonly made with good intention, but are they less likely to stick?  Perhaps the impact of the COVID pandemic this year will be reflected in the kinds of resolutions we are making.  Do we have more uncertainties?  Will there be greater resolve to our decisions?  Over half of the US population is expected to be making resolutions accordingly to the Western Connecticut Health Network.  It is human nature to set goals at the start of something new.  But statistically, less than ten percent of us will likely continue our challenges beyond a few months.

For many, common goals may be to lose weight, get more exercise, quit smoking, or save money.  The likelihood of our failure will come from three common psychological issues: difficulty breaking old habits, inability to focus on specific outcomes, and problems identifying our purpose.  We must develop new habits at the same time as we eliminate our old bad habits.  Stopping smoking means eliminating smoking as a daily activity.  Losing weight means changing our dietary habits and increased effort to exercise.

Our old habits have many facets that make them challenging to break.  A smoking habit is influenced by lifestyle, places you go and people you associate with, the physical addiction to nicotine and the associated rituals such as alcohol, coffee or just plain emotions.  Many get easily frustrated if their goals do not occur in short order.  The serious quitter will commonly have initial failures before their efforts gain traction, and some may give up with the initial stumble.

Things that may help us achieve our purpose include developing a concept such as why we may want to lose weight as opposed to just an arbitrary number of pounds.  Rather than that specific weight loss goal, work on a purpose of gradually losing weight over time which will require changing both eating habits as well as increasing your exercise.  Do not put a time stamp on it.  The more excited you get over introducing these concepts, the more likely it will work.  For example, plan to exercise four days a week, but start at only fifteen-minute sessions.  As this pattern becomes a habit, increase your time to twenty, then up to thirty minutes.  Put half of your normal serving on your dinner plate, but still allow yourself to have limited seconds.  Drink a glass of water with each setting.  These compromises should not provide significant hardship but provide a level of self-satisfaction with each day’s accomplishment.

Lastly, make your intentions known.  Let family, friends or co-workers become a part of your purpose.  Those likeminded individuals can provide encouragement, perhaps even to participate with you as your base support.  We are much more likely to meet our goals if there is some level of accountability that we set, either to ourselves or to others.  Pick a positive plan for an effort you would like to make, develop a process to get there, give yourself time to accomplish, and do not quit at your first stumble.  Give it your best shot!

Bradford Croft, DO

East Flagstaff Family Medicine

 

Beating the Holiday Blues

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As we approach the holiday season, the colors we associate with the times are typically reds and greens.  But if you are one of the many who identify more with the blues, you are not alone.  The “Holiday Blues” are temporary feelings of anxiety or depression through the Christmas and New Year weeks.  As, by nature, they are feelings related to the holiday season, they commonly recede after the holidays are over.  Differing from clinical depression or anxiety, these issues are transient by nature, but still important to recognize.

Many of us experience high spirits and happiness. But a subset of these same people may also suffer from some degree of holiday blues, and symptoms may vary in intensity. Commonly, feelings of fatigue, stress, irritability, bloating, exhaustion, and sadness may be perceived.  For many, work stressors increase before the actual holiday times.  Many carry this extra stress with them as they experience time crunches with their schedules and overspending their budgets.  Others have issues with priorities of their social commitments, discontent with the increasing commercial pressures of the season, and the strain of family gatherings.  There is also the contribution of the physiologic response due to the shortest days and colder climate of the season, medically known as Seasonal Affect Disorder, or SAD.

We are as well facing our first Pandemic Holiday Season, which is a definite contributor to our upcoming emotional strain.  After months of thirsting for social exposures and comradery, we are additionally encouraged to now restrict holiday gatherings, be it avoiding travel or limiting the number of holiday celebrants to the immediate “pod” family.  Many of us have restricted employment or have lost our jobs altogether.  As the federal stimulus money is nothing more than a faint memory, so many are financially constrained, lucky to pay the rent or groceries let alone seasonal gifts.  For those of us who will be missing family due to these constraints, there are some who will be missing family forever now, those who have succumbed to the disease.  With all these strikes against us, can we make it through the upcoming holidays?

Recognition of these symptoms may warrant a visit to your doctor.  Although it is not common to need medication to weather through these issues, there may be help with learning some behavioral management skills.  Being aware that your feelings may be a normal response to the times, there are some activities that may improve your coping skills.  Limiting your alcohol intake may offer a substantial improvement to your responses.  As one or two beverages may be acceptable, more than that at any one time may worsen the tendency of depression.  Reaching out to a friend and being honest about your feelings and concerns may garner some support.  Regular exercise can improve you attitude as both a stress reliever as well as removing you from the immediate environment that you are associating with your melancholy.  Even making a short walk daily will contribute to keeping the blues at bay.  Treat yourself to an activity you enjoy daily.  Reading a chapter of a book, soaking in a hot tub, listening to a favorite musical artist, even for no longer than twenty or thirty minutes a day has shown to be significant.

It is important to be realistic regarding your outcomes.  Not every holiday will be picture perfect.  Try not to compare this upcoming season to holidays past.  We grow older, family moves away and relocates, new people enter our life, things change.  If you can recognize these signs or symptoms as they develop, this self-awareness can lead to your active control or avoidance of seasonal depression.  It will take some effort, however. Enjoy the day, avoid unrealistic expectations with a pinch of reality in your expected outcomes, and do not let past performance be a predictor of future outcomes.  Despite all these positive recommendations, should you feel the grasp of the holiday blues becoming oppressive, contact your health care professional at your first opportunity, even for a telemedicine visit.  These are certainly challenging times for all of us, so please reach out if you need some support.  We are all in this together.  That said, Merry Christmas and Happy New Year to you all. But that is up to you.

Bradford Croft, DO

East Flagstaff Family Medicine

Weighing In On the Holidays

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The “holiday season” is synonymous to many of us with the “eating season”. If COVID hasn’t been enough to promote sedentary weight gain already, we have this to look forward to next.   Starting at Thanksgiving, our feeding frenzy extends relentlessly through Christmas and New Year’s, and continues to perpetuate all the way through the football playoffs into the February Super Bowl.  And every holiday deserves a feast!  Not just the holiday dinners, but also the endless numbers of seasonal snacks and treats at home and the workplace all contribute to the caloric avalanche we experience through the winter months.   No wonder it is not a surprise that most people gain the most weight every year in the month of December.   They also commonly do not lose all of those acquired winter pounds.  Maintaining just two of those extra pounds each season makes you twenty pounds heavier in a decade.

The answer is, of course, calories.  Some fun facts are that, on average, the adult male needs 2500 calories to maintain his current weight.  The average female needs only 2000 calories per day.  It only takes an extra 500 calories each day to gain a pound every week.  Imagine that the typical holiday dinner alone packs a usual 3000 calories, and with appetizers and drinks may top 4500 calories for just that meal and up to 7000 for the day.  “Not bad”, you say.  “There are only a couple of excessive meals during that season in which I indulge”.

However, add the onslaught of holiday snacks, those extra calories may be easy to accrue.  A couple of calorie counts for example: a slice of pumpkin pie is 279, slice of pecan is 532, cherry pie is 304 and apple pie alamode is 414 calories.  Not a pie person?  How about cookies, then.  Each sugar cookie from Subway is 220 calories.  Beer is anywhere from 64 calories in the ultralight to 200 for a hearty IPA.  Wine may range anywhere from 110 to 300 calories per glass depending on sweetness and alcohol content.  If you are considering the playoff parties, a serving of beef nachos is 430 calories, a chili cheese hotdog is 340, one pork rib is 370 and a half dozen chicken wings is 616 calories (www.calorieking.com).

The point is not so much the specific calorie count, but rather the ready availability of “extracurricular” food and treats in which we mindlessly and consistently indulge.  Adding this onslaught of calories consumed throughout the “season”, one could readily pack on two, five or even ten extra pounds this year.

Your awareness of these points may make it easier not to go overboard this year.  Some tips include limiting your choices to eating only your favorite foods.  You do not have to try one of everything.  Serve yourself smaller portions, as most holiday foods are rich and should readily fill you up.  Only eat one helping at a service.  If you feel you must have more, drink a big glass of water and set your timer for twenty minutes.  It is likely by then that meal has caught up, and you will not be hungry for a second helping.  Finally, eat slowly, taste every bite and enjoy these special treats.  Celebrate the holidays and enjoy your time with family and friends.  With social distancing and COVID precautions, of course.

Bradford Croft, DO

East Flagstaff Family Medicine

Flu Season 2020-2021 – It’s that Time of Year Again

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In the pandemic of COVID-19, health care has a new face given limitations on access of medical services and products.  Although social distancing and health hygiene is at an all-time high, we still need to beware of the impact of the influenza season looming this winter.  With personal awareness there may be less opportunity for influenza, but it will still be present and potentially deadly in combination with COVID. Here is some disease information that you should know.

Influenza is a respiratory infection that causes fever, cough, sore throat, and nasal congestion.  Additional symptoms include headaches, muscle aches and fatigue.  Although these complaints are similar to the common cold, the severity is typically much worse.  Not only can the intensity be serious enough to cause weeks of lost work or school, but the infectiousness can be so powerful as to impact a workplace or school from a single source.  Influenza can cause complications which kills thousands of Americans every year, more commonly those with chronic health problems, the elderly and very young, similar to the COVID-19.  However, anyone can suffer a complication of this illness, sometimes requiring hospitalization with significant lost time from daily routines, or even resulting in death.  Fortunately, there is treatment for influenza with early intervention, unlike COVID.

A severe outbreak may commonly last up to eight weeks regionally and can often infect one out of every three people in a community.  Hand washing and hygiene are always important, but the single best prevention of influenza is the seasonal immunization.  Appropriate for almost everyone six months or older, it is especially important for those with any chronic disease such as asthma, COPD, diabetes, heart, kidney or liver disease, and any kind of cancer.  Also, those who are overweight or 50 and older are at a significant risk as well.

The influenza immunization recommendation from the CDC for the 2020-2021 season again includes trivalent and quadrivalent injectable vaccines.  This year vaccines have been updated to match the expected circulating viruses and are provided as the inactivated influenza vaccine (IIV), the live attenuated nasal spray (LAIV4) and the recombinant influenza vaccine (RIV).

For those interested, the updated protections for this year’s likely infections include:

Egg-based H1N1: A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus.

Cell/recombinant H1N1: A/Hawaii/70/2019 (H1N1)pdm09-like virus.

Egg-based H3N2:  A/Hong Kong/2671/2019 (H3N2)-like virus.

Cell/recombinant H3N2:  A/Hong Kong/2671/2019 (H3N2)-like virus.

B-Victoria lineage: B/Washington/02/2019 (B/Victoria lineage)-like virus.

Annual flu vaccines are commonly covered by most health insurance programs at no cost to patients.  These immunizations are usually readily available at county health clinics, most retail pharmacies, and many family doctor offices.  Nobody knows when the flu will show up in any community, but is often seen as early as October.  Of course, the sooner the administration, the more effective the immunization for the entire influenza season which may go well into the spring.  It can take up to two full weeks to acquire immunity from the shot.  Now is the time to prevent the flu!  Immunize, and do not let the flu get YOU!

Bradford Croft, DO

East Flagstaff Family Medicine