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

Flu and Pneumonia Shots Offer Best Protection

As predictably as leaves fall from the trees this time of year, so comes flu season. One big difference from last year, though, is that no shortages of vaccines are expected.

According to CPC Clinical Supervisor Rhonda Brown, almost everyone should consider getting an annual flu shot, which can prevent or reduce the symptoms of influenza. It is especially important for people who are most vulnerable, including the elderly, people with chronic illnesses (especially respiratory disease), those with weak immune systems, and those exposed to the public, such as teachers and hospital care workers.

At CPC, you do not even have to make an appointment to get a flu shot. At a minimal cost ($13), it is the most effective step you can take to protect yourself from the miserable and sometimes dangerous symptoms associated with flu.

If you do get the flu, there are now antiviral medications that can reduce the severity of the illness if taken soon enough after the first symptoms occur. These agents include amantadine (Symmetrel) and rimantadine (Flumadine), which are effective against flu virus A, and oseltamivir (Tamiflu), which is active against viral types A and B. The FDA recently approved Tamiflu for use as a preventive agent against the flu, but it is significantly more expensive and less effective than a flu shot in preventing the illness.

Aside from antiviral medications, there is very little you can do once you get the flu other than treat the symptoms: acetaminophen for aching, fever and chills, along with bed rest and fluids for the duration of the illness, which can be 4 to 5 days or more.

According to the American Academy of Family Physicians, the same individuals who are most vulnerable to the symptoms of influenza are also at risk for pneumonia. People in this at-risk group could benefit from a pneumonia shot (PPV), a vaccine that protects against pneumococcal pneumonia, one of the worst strains. If you are over 65 or suffer some form of respiratory disease, consult your family physician for advice about the pneumonia vaccine.

Source: Updated Treatment for Influenza A and B, American Family Physician (updated manuscript posted on AAFP website, 2000); Family Physicians Advise Patients to Get Pneumonia Shot, AAFP news release, 2000.

Physician Profile: Dr. Keith L. Harden of CPC South

As he was growing up, Keith L. Harden, M.D., remembers having had three especially strong influences in his life: his mother, Mary; his father, Kenneth; and Dr. Martin Luther King, Jr. Together, these three helped Keith gain focus and initiative in his early years and guided him along a straight and narrow path toward what he now considers his greatest blessings a career in medicine, a strong and loving family, and a love of diversity in all things.

My parents were both strong influences on me, he says. Keiths mother kept God and education in her sons sights, and his father ushered him into a lifelong love of expression and self-discipline through music. Together, they built a stable home and strong family that would become a model for his own. Although Dr. Kings influence was more remote than that of Keiths parents, his example of peaceful change and benevolent leadership and his lessons in diversity and acceptance would also have a great impact on Keiths view of the world.

Born in Columbus, Georgia, where his father was a soldier stationed at Fort Benning, Keith is the middle child of seven. With a span of 16 years between oldest and youngest, Keith was preceded by Kimberly, Kenneth Jr., and Kevin and followed by younger sisters Kendra, Karen, and Kerri. When Keith was very young, his father retired with disability from the military after serving in the Vietnam War and the family returned to their hometown of Newnan, near Atlanta.

During his school years, music was Keiths primary extracurricular interest. He was the drum major for his high school band, loved jazz, and also played saxophone, keyboard and drums. He and a friend later formed a two-man rhythm and blues band, put together a mini-recording studio, and eventually cut several records. For a while, Keith had even considered a career in music, but he heard another calling.

Keith started thinking of medicine as a career in 10th grade when he realized how much he enjoyed math and science. When an aptitude test confirmed his potential in the medical field, he asked for his mothers perspective. I told her, It looks like I could be a doctor, he recalls. In her typically supportive and positive tone, she replied, OK . . . go for it.

Although Keith was a focused, involved student at his school in Coweta County, he couldnt help being distracted by a younger student named Sheila who commuted by bus from a neighboring county 1 hours each way. They soon became sweethearts who would not be deterred by the inconvenience and expense of long-distance phone calls and long treks back and forth. In fact, the distance factor turned out to be good training for what was to come. Keith graduated from high school in 1987, Sheila in 1988, and the couple married in 1989, but it would be another 6 years before they would physically make a home together.

Keith received a full scholarship to attend West Georgia College in Carrollton, where he earned a bachelors degree in biology and chemistry. After graduation, he began his medical education at Morehouse School of Medicine in Atlanta. In the meantime, Sheila joined the U.S. Air Force, which took her elsewhere – England, Texas and then Alabama while Keith was pursuing his undergraduate and medical education. After completing her commitment to the Air Force, Sheila began her own postsecondary education at Georgia State University in Atlanta.

Some people might view their separation during the early years of their marriage as a negative, but Keith has a different take. Being married during that time even though we werent together much gave me stability and focus in my education, he says. He graduated from Morehouse School of Medicine magna cum laude in 1995.

The newly graduated Dr. Harden was doing his residency at Halifax Memorial Hospital in Daytona Beach, Florida, and for the first time since their wedding, he and Sheila were together on a day-to-day basis. Sheila was teaching at an elementary school in town and, following his residency, Dr. Harden joined a physician group serving the same hospital. Having brought one son into the world and soon expecting another, they were now a family and ready to settle in the famous coastal community. During their time in Daytona, Sheila and Keith developed a love for the beach and deep-sea and freshwater fishing. Keith had also become an avid

stock car racing fan and an official NASCAR physician for the Daytona 500 and Pepsi 400 races. Changes were in the wind, though, and soon, hospital restructuring would require Dr. Harden to move his lifes work elsewhere.

One of the biggest factors in Dr. Hardens decision about where and with whom to practice was family priorities. When I realized I had to establish my own practice, I started looking closer to home, especially because of my sons, Kacey and Kelsey he says. We wanted them to be close to their grandparents. He also wanted to find a balance between the professional and personal aspects of his life.

With 11 physicians already on staff at the time and a growing patient population, the Center for Primary Care and Dr. Harden were a perfect match. A diverse and cohesive group, CPC offered just the chemistry he was looking for. I came to this group largely because of the diversity, he says. Augusta also was close enough to Newnan that his family could maintain close ties with the grandparents (and the Atlanta Braves) and still steal away for weekends at the coast or one-day trips to nearby attractions, such as bass-fishing excursions to Clarks Hill. Im glad to be back in Georgia, he says. Especially Augusta, since its so close to everything.

At CPC, Dr. Harden delivers a level of patient care that extends beyond the physical aspect. He loves treating patients and helping them stay healthy not only physically but spiritually, mentally, and emotionally as well. I like being able to talk with patients about their feelings of stress, anxiety, or depression and refer them for counseling when needed, he says, explaining that these factors can have such a huge impact on physical health.

As a physician with CPC, he has also maintained the balance he sought in his life. When not at work, Dr. Harden devotes his time and attention to Sheila and their children, now 3 years and 18 months old, and the activities they enjoy together, but he still manages to find space for his personal interests music, sports, writing, sketching, and art collecting.

Keith Harden is the sort of person who always sees the glass half full instead of half empty. He has the kind of attitude that turns difficult situations into opportunities and good times into better ones. Hes the kind of person people like to be around and wouldnt mind being like. But thats not how he sees it. Im just a blessed man, he says, with a smile and a shrug. And CPC is likewise blessed to have him

Premenstrual Dysphoric Dysfunction a Serious Condition

premenstrual syndrome, or PMS, is a widely recognized condition experienced by many women around the time of menstruation. The symptoms can include mood swings, irritability, bloating, headache, and/or sadness. For most women, these symptoms are manageable and considered normal.

One in 20 American women who have menstrual periods, however, suffer an extreme form of PMS known as premenstrual dysphoric disorder (PMDD). Like PMS, it occurs in the timeframe just before and after menstruation but is characterized by severe mood swings and other emotional symptoms that interfere with a womans ability to function normally, especially interpersonal relationships. The symptoms of PMDD, although similar to those of PMS, are much more serious, and can include extreme irritability, depression, inability to concentrate, angry outbursts, hopelessness, and in extreme cases, thoughts of suicide or homicide.

Although the cause of PMDD has not been pinpointed, it is believed to be a response to hormonal changes associated with the menstrual cycle. Research has also linked the disorder to low levels of serotonin, a neurotransmitter in the brain that affects mood.

According to a recent survey, a majority of the 500 women who responded were not aware that severe premenstrual syndrome had been officially classified as PMDD or that the problem can be treated. Increased exercise changes in diet, such as increased carbohydrates and reduced salt and caffeine, are often first line-treatments, along with calcium supplementation to relieve physical symptoms. These approaches, however, do little to relieve the emotional component of PMDD. The American College of Obstetricians and Gynecologists, which recently issued symptom and treatment guidelines for PMDD, advocate the use of SSRI (selective serotonin reuptake inhibitors) antidepressants to alleviate the emotional symptoms.

If you have been experiencing severe PMS and suspect you may have PMDD, make an appointment with your CPC physician to discuss your symptoms and find out what treatment options are available to you.

Source: Public Education: Premenstrual Dysphoric Disorder, Society for Womens Health Research (website); PMDD, DrDonnica.com The First Name in Womens Health (website).

Diabetes Type 1 Affects 800,000 in U.S., More Who Are Unaware

It is estimated that 16 million Americans have diabetes, but according to the American Diabetes Association (ADA), one third of them do not even realize they have the disease and, thus, are at risk for the significant health complications of untreated diabetes.

Diabetes takes one of two forms Type 1 or Type 2 both of which result in elevated blood sugar, but for different reasons. This article focuses on Type 1, a much less common form of the disease than Type 2, but one that still affects 800,000 people in the United States who realize they have diabetes and potentially many more who are unaware.

Type 1 diabetes occurs when the pancreas quits producing insulin, a hormone that helps glucose (blood sugar) enter the cells to be used by the body for energy. When this occurs, the level of sugar in the bloodstream becomes extremely high, a condition known as hyperglycemia. Symptoms that can occur quickly include weakness and fatigue, weight loss with increased appetite, frequent urination, blurred vision, and greater susceptibility to bacterial and fungal infections. Other more dangerous consequences, such as heart and kidney disease, can take years to develop.

Often, Type 1 diabetes begins in the relatively young. This form of diabetes is likely to run in families and, for reasons that are not well understood, it is more common among white people than among those of other races.

A suspicion of diabetes Type 1 based on symptoms is usually easy to confirm with blood glucose tests. Once diagnosed, Type 1 diabetes is treated with insulin injections, weight control through diet and exercise, and regular blood sugar testing with a glucose monitor with a goal of keeping the blood sugar at a stable level throughout the day. Regular medical checkups is another important aspect of good diabetes care.

There are several types of insulin available to treat Type 1 diabetes. What kind and how much a person needs depends on age, blood sugar level, and lifestyle factors, such as diet and exercise habits. Through regular checkups and monitoring, physicians work with diabetic patients to develop a treatment plan that is best suited to their individual needs.

Most diabetics manage their blood sugar levels with injections several times a day. One alternative to this is the external pump, a lightweight pager-sized device that can be programmed to deliver insulin through a catheter in the abdomen. Although it has to be changed every three days and does not always totally eliminate the need for self-injections, many diabetics who use the pump instead of relying solely on insulin shots report the device has improved their quality of life.

One of the potential problems with all insulin treatments is hypoglycemia, or low blood sugar. This can occur when the body gets too much insulin or as a result of too little food or missed meals, excessive exercise, or too much alcohol. Low blood sugar can cause confusion and dizziness, heart pounding, weakness, and hunger. Other symptoms might include sweating, headache, blurred vision, slurred speech and trembling. Low blood sugar is best treated with a sweet snack, such as fruit juice, milk, or hard candy to quickly raise the blood sugar level. Since hypoglycemia can cause fainting, it is important that loved ones and friends know the symptoms of hypoglycemia and know what to do when the diabetic is unable to help himself.

Beta-cell transplantation to restore the ability of the pancreas to produce insulin is being studied as a possible treatment for diabetes Type 1. It is expected that this approach would require the use of medications to prevent the recipients immune system from attacking the transplanted cells. Clinical trials on humans to determine whether this is a viable treatment have not yet been done.

Diabetes Type 1 is a lifelong disease but it can be managed well with insulin, diet and exercise and need not compromise the diabetics quality of life. If you have experienced symptoms of diabetes or know you have the disease and would like to have better control of your symptoms, make an appointment to see your CPC physician today. You can also find more information about diabetes from the ADA at www.diabetes.org.

Source: Diabetes Type I, Health.com (website); Diabetes: Type I, WebMDHealth (website); American Diabetes Association Cure, Care, Commitment (website); Scientists strive to spare diabetics from the needle, Health and Science, American Medical News, Sept. 17, p. 28.

Dr. Livingston Joins Physician Staff of CPC Evans

The Center for Primary Care is pleased to welcome Richard W. Livingston, Jr., M.D., to the physician staff of CPC Evans.

Dr. Livingston is a graduate of Augusta State University and the Medical College of Georgia. He completed his family practice residency at Martin Army Community Hospital in Fort Benning, Georgia, in 1997, and is Board-Certified in Family Medicine. Prior to joining the physician staff of CPC Evans in August, Dr. Livingston served in the U.S. Army at Fort Polk, Louisiana, where he was the Chief of the Department of Family Practice.

Dr. Livingstons areas of special interest include diabetes, hypertension, and mens health. His hobbies include classic American car restoration, boating, and aviation. Dr. Livingston is available to see patients Monday through Friday, including Thursday and Friday evenings. To make an appointment, call CPC Evans at 650-7563.