This Newsletter Brought to You by the Physicians and Staff of the Center for Primary Care

IBS Diminishes Quality of Life for Millions

Although it is not well understood by most people, irritable bowel syndrome (IBS) is a common gastrointestinal disorder. Approximately 40 million Americans have IBS. Thats more than twice as many as suffer from depression (19 million), asthma, (17 million), diabetes (17 million) and coronary heart disease (12.6 million). Of these conditions, most people know the least about IBS. For instance, few people realize that IBS ranks second only to the common cold as a cause of absenteeism from school and work, or that it costs the U.S. healthcare system approximately $30 billion annually and accounts for about 3 million physician visits each year.

IBS is caused by a disturbance in how the intestines, brain, and the autonomic nervous system work together to regulate bowel function. It is characterized by abdominal cramping and pain, bloating, gassiness, mucus in the stool, and changes in bowel function, such as constipation, diarrhea, and in some cases, both. However, IBS is not associated with colorectal bleeding, fever, weight loss, and chronic pain, which may suggest other problems that should be evaluated by a physician. IBS also does not cause inflammation or changes in bowel tissue and does not increase the risk of colorectal cancer.

Although no organic cause of IBS has been identified and there is no known cure, being young and female are risk factors for the disease. Overall, two to three times as many women as men have IBS.

For some people, IBS is only a mild annoyance, while for others, it can be completely disabling. Those with severe IBS symptoms may be unable to enjoy a normal social life, travel even short distances, or go to work. Most people with IBS, however, are able to control their symptoms adequately with dietary changes, stress management, and in some instances, prescribed medications.

People with IBS are thought to have unusually sensitive and reactive colon muscles that are prone to respond to mild stimuli that would not bother most people. Emotional stress or conflict, eating, distention from abdominal gas, and some medications can trigger an IBS episode. Some foods can make it worse. For instance, high-fat foods and caffeinated beverages cause the colon muscles to contract, resulting in cramping, while other foods, such as cabbage and beans, produce excess gas, causing abdominal distention and pain. Other common offenders include chocolate, milk and milk products (especially for people who are lactose intolerant), large amounts of alcohol, and high-fat foods, such as meats, poultry, vegetable oils, margarine, and shortening.

Because bowel function varies from person to person, it may be difficult for someone to know what is normal and when medical evaluation is warranted. Generally, a normal movement is one that is firm but not hard and does not result in pain or cramping. Bowel movements that chronically cause painful cramping, diarrhea, and/or constipation should be evaluated by a physician.

In diagnosing IBS, your doctor will first rule out the presence of other diseases by means of a medical history and description of symptoms. Other diagnostic procedures will include physical examination, laboratory tests, a stool test to check for bleeding, and possibly x-rays and endoscopy.

Most people with IBS can relieve their symptoms without medications simply by making a few behavioral changes, including modifications in diet and eating patterns, stress management, and relaxation techniques. Increasing fiber intake is one way to improve IBS symptoms. There are two types of dietary fibers that can improve how the intestines function: insoluble fiber, which is found in fruits, vegetables, and whole grains, may relieve constipation, while soluble fiber, such as psyllium (a vegetable fiber found in over-the-counter fiber supplements, such as Metamucil) and oat bran, can be helpful for both diarrhea and constipation. It is important to increase dietary fiber gradually to avoid gas and bloating until your body adjusts to this change in diet.

Other approaches to alleviating IBS symptoms include identifying and avoiding foods that typically result in digestive problems, eating smaller amounts at regular intervals, drinking plenty of fluids (especially water), exercising regularly, and using antidiarrheal medications and laxatives sparingly to avoid dependence on them to control bowel function. People whose IBS symptoms are aggravated by stress may find additional relief from relaxation techniques, such as yoga, meditation, massage, biofeedback, deep breathing, or simply making time for activities that are enjoyable and relaxing, such as reading or listening to music.

If you believe you have IBS or are experiencing other types of bowel problems, make an appointment to see your CPC physician for an evaluation.

Source: Irritable Bowel Syndrome: Tips on Controlling Your Symptoms, AAFP Family Health Facts; Irritable Bowel Syndrome, Mayo Foundation for Medical Education and Research, MayoClinic.com Reliable information for a healthier life, June 12, 2002; Press release on IBS awareness, Novartis Pharmaceutical Corporation, San Francisco, CA, May 2002; Irritable Bowel Syndrome, NIDDK, November 2000; About IBS, IFFGD, January 2003 (all webpages).

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Decision Time: Reasons Why You Should Get a Flu Shot

Note: At this time the Flu Shot is not available; the article may still be of interest for next year

Once again, its flu season, and you have a choice to make.

On the one hand, you can get a flu shot, which costs approximately $18, takes about a minute, and is the most effective protection against flu available. Your other choice is to risk suffering the high fever, chills, and body aches that accompany flu, missing a week of work or school because of illness, and exposing your family, friends, neighbors, and coworkers to this dangerous viral infection.

What will you decide? Here are some facts about the flu that might help you make the choice that will protect you and those around you during the upcoming flu season:

Influenza (flu) is highly contagious. Flu is a respiratory virus that is easily spread when an infected person breathes, talks, coughs, or sneezes. Flu symptoms typically appear within four days of inhaling the virus.

A person can transmit the flu virus to others before he even realizes he is infected. Adults can spread the virus one day before symptoms appear to as much as a week after. Children can spread the virus up to a week before their symptoms appear.

Flu can be very dangerous. Flu is typically associated with sudden fever, cough, muscle aches, headache, weakness, runny nose and sore throat, but it can progress to pneumonia. Each year in the United States, flu is responsible for thousands of hospitalizations and deaths, particularly among those at high risk, including the elderly, people with weakened immune systems, and those with chronic medical problems.

The flu shot is safe and effective for most people. Some people experience mild symptoms after a flu shot, but for most, there is no reaction other than mild soreness at the injection site. The flu shot is not recommended for infants less than age 6 months, people who are allergic to eggs or have previously experienced an allergic

reaction to the flu vaccine, and those with a history of a rare nerve disorder known as Guillain-Barr Syndrome (GBS).

The flu shot is the most economical and widely applicable vaccine available. The only alternatives to the flu shot are a few antiviral drugs and a newly approved nasal spray vaccine. However, they are much more expensive than the flu shot, may not be covered by insurance, and are not as widely appropriate as the flu shot. For instance, the nasal spray vaccine is not recommended for children less than age 5, people older than age 49, people with weakened immune systems, pregnant women, people with asthma or other chronic respiratory diseases, and people at risk for flu complications.

Once you get the flu, there are limited treatment options available. There are several antiviral medications available to lessen the symptoms and duration of the flu, but they are expensive, are effective only if taken within 48 hours of the first symptoms, and are not appropriate for everyone. Aside from these prescription drugs, the best treatment is bed rest, non-aspirin pain relievers for fever and body aches, and plenty of fluids.

Flu shots should be taken annually. Flu viruses change from year to year, so the flu shot you got last year, will not protect you this year.

Flu shots: better late than never. The ideal time to get a flu shot is in October or November before the flu season begins, but if youve missed that deadline, it isnt too late. The flu season lasts until March, so if you havent had your flu shot by December, its still not too late to protect yourself.

Getting a flu shot is by far the best way to protect you and your loved ones from the flu. If you have concerns about whether a flu shot is right for you, talk with your CPC physician, and if it is, get yours today.

Source: Influenza, National Center for Infectious Disease, Centers for Disease Control and Prevention; Public Health Fact Sheet Flu, Department of Public Health, Commonwealth of Massachusetts (both websites).

Pneumovax and Flu Vaccine Both Protect Against Pneumonia

Pneumonia is a dangerous infection of the lungs. Although it can have over 30 different causes, including bacterial and viral infections, the most common cause of pneumonia is the bacterium streptococcus pneumoniae.

This type of pneumonia is a common complication of influenza (flu). For that reason, one of the best ways to protect yourself against pneumonia is to get a flu shot each fall. An additional precautionary measure directed specifically at the prevention of pneumonia the Pneumovax pneumonia vaccine – is also available and is especially appropriate for people at high risk for the disease.

Pneumonia can strike anyone from infants to the elderly and even healthy young people and adults. Those most vulnerable are anyone age 65 or older, very young children, and people with chronic diseases such as diabetes, heart disease, kidney disorders, emphysema, bronchitis, asthma, sickle cell anemia, and cystic fibrosis. Others at high risk for the disease have previously had pneumonia, have weakened immune systems caused by chemotherapy and conditions such as HIV and AIDS, and do not have a spleen as a result of injury, illness, or surgery.

In adults, pneumonia usually begins with sudden onset of chills, fever, shortness of breath or rapid breathing, chest pain worsened by deep inhalations, and a productive cough (producing phlegm).

Pneumonia can have serious health consequences requiring hospitalization. Because some strains are now resistant to antibiotics, preventive measures are always recommended. The Pneumovax vaccine, which costs approximately $30, can prevent pneumonia and protects against it by preventing bacteremia (spread of bacteria to the bloodstream). Unlike the flu vaccine, which people take annually to fight the various strains of influenza that occur each year, the pneumonia vaccine is usually given only once. However, some people at high risk for the disease may require revaccination. Your CPC physician can advise you further about the Pneumovax vaccine.

If you are experiencing a lingering or progressively worsening respiratory illness and symptoms of pneumonia, it is important to see your CPC physician immediately. Pneumonia is an extremely serious illness for which early evaluation and treatment are essential.

Source: Pneumonia, American Lung Association; Pneumococcal Disease, CDC (both websites); The Pneumonia Vaccine, Washington Post, Oct. 14, 2003, p HE03 (posted on www.washingtonpost.com).

Reducing Holiday Stress

Recognizing Personal Triggers Is a Good First Step

Do you look forward to the holidays or do you find yourself dreading the extra demands that leave you feeling overburdened and stressed? People experience stress this time of year for very personal reasons. Identifying your unique holiday stress triggers is the first step toward positive change.

Here are some common sources of stress during the holiday season and simple steps you can take to avoid them.

 Time: For most people, the work of preparing for the holidays is heaped on their already overbooked work and family schedules.

Prioritize. Put whats most important at the top of your to-do list and let the small stuff wait until later.

Savor the moment. Welcome opportunities for joy right now instead of always worrying about what comes next.

Learn to say no. Since you cant possibly do everything, make wise choices about how you want to spend your time.

Stop! When you feel pressure building, take a few moments for quiet reflection, alone time, or a few deep breaths until you feel calm and relaxed.

 

2. Money: Spending more than you can afford is a huge stressor that can carry well into the new year, long after expensive gifts are set aside and forgotten.

Create a budget. Before you head to the mall, know how much you can afford to spend on each gift and stick to your plan.

Choose wisely. An expensive present isnt always the best choice. A thoughtfully chosen, personal gift can be a real treasure.

Shop smart. Look for sales and bargains, use coupons, and shop early so you have time to compare prices and make wise choices.

Be creative. Use your time and talents to create a one-of-a-kind gift for your loved one.

Use cash, not credit. Deferred payment makes it easy to overspend. Paying now instead of charging and paying later will keep you more mindful of your budget.

 

People: Interpersonal relationships are often put to the test during holiday gatherings. Whether its too much togetherness or too much separation, people often feel anxious and overly emotional.

Acknowledge how you feel. Suppressing emotions can create tension. Discuss your feelings with close friends or understanding family members. Simply sharing your thoughts and feelings might relieve tension and avoid potential misunderstandings.

Avoid unpleasant people. Just say no to gatherings involving people who are negative, vexing, or emotionally draining.

Ask for help. Are the people in your life adding to your stress or reducing it? Dont wait for them to notice youre overburdened. Give them something to do that will lighten your load and engage them in the festivities. This is an especially good approach to take with people who fill their idle time criticizing and complaining.

Do for others. If you find yourself dwelling on your own problems, reach out to others who would appreciate your help and company. Volunteer with local organizations, visit neighbors who live alone, offer to help an elderly person address cards or wrap packages.

 Health: Overindulgence and over-commitment during the holidays can take its toll on your health and emotional well-being.

Get enough rest. Pencil in a good nights sleep on your daily schedule along with other important activities.

Eat and drink wisely. Keep your intake of high-fat foods and alcohol to a minimum. Rich foods can add unwanted weight and make you feel sluggish. Alcohol is high in calories and is a known mood depressant.

Exercise. Regular exercise refreshes your mind, body and spirit. A routine involving an enjoyable physical activity will help keep your weight in check as well as alleviate stress and depression.

 

Expectations: Do you find yourself constantly disappointed by how your holidays turn out? You may be a victim of unrealistic expectations yours and everyone elses!

Avoid the pursuit of perfection. Setting unrealistic expectations for the holiday season is setting yourself up for disappointment. Plan for a wonderful holiday, but keep your expectations for the people and events in your life reasonable.

Be courageous. Who says this holiday has to be just like weve always done it? Instead of being a slave to other peoples expectations, be guided by your own values and preferences. If youre doing what you enjoy the way you want to do it, preparing for the holidays will be less work and a lot more enjoyable. And if youre feeling relaxed and having fun, those around you probably will, too!

Source: Tips on Avoiding Holiday Stress, Barbara Braham, 2002; Holiday Stress Tips, PageWise, Inc., 2002 (websites).