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GreenField Health’s Health Matters: October 2006
Announcements
Avian Flu Update
Know Your Medications and Avoid Medication Errors
Medication Side Effects: Statins
Medication Side Effects: SSRI Antidepressants
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Announcements
Welcome to Amanda Clark!
As we announced in September’s Health Matters, we are adding 3 new Health Coordinators to our team. We are pleased to welcome Amanda Clark to our team as of October 19, 2006. She will be working primarily with Dr. Cynthia Ferrier, and her patients, although she will be available to all patients. Amanda comes to us with a great deal of experience as a Medical Assistant, and we’re delighted to have her as a part of the team. Please join us in providing a warm welcome to Amanda when you have a chance to meet her. We plan to have our other two Health Coordinators in place within the month, and again, we thank you for your patience if our response times are not quite up to par as we work through this transition.
Transformation Changes
Good news for those of you who have tried to fit Transformation into your schedule – we have revamped the program to a monthly format that you can join at any time. It now consists of 12 monthly sessions to take you through an entire year of healthy changes. The program kicks off with a 5 hour initial personalized assessment (one offered each month), and continues with the monthly sessions and weekly individual check-ins with Dr. Cynthia Ferrier to track your progress and to discuss challenges. Please contact Cynthia for more details – she can be reached at 503.292.9560 or via email at cynthia.ferrier@greenfieldhealth.com
Delay in Flu Shot Availability
Flu shots are here—please give us a call if you'd like to come in for one.
Avian Flu Update
The anxiety over a possible avian influenza outbreak appears to be waning this year as compared with last year. Time tends to help bring some rationality in both the way the press covers such issues and the way people respond. Certainly the press appears to be less sensationalistic so far this year than last, but we’re just entering flu season also.
We provided our thoughts on avian influenza in both our October and November 2005 GreenField Health’s Health Matters and they remain applicable today.
Avian flu remains a potential serious risk to humans, but the virus has not developed the ability to spread from one human to another. In order for there to be a wide spread outbreak, human-to-human spread is a necessary. Vaccines against Avian Influenza are under investigation, but none are ready for clinical use.
Last year, we had a few requests for prescriptions for Tamiflu – the antiviral medication that has some efficacy against avian influenza. Health authorities including the US Centers for Disease Control and Prevention recommend strongly against giving out such prescriptions for a wide variety of reasons, and we agree with this. We do not recommend that people purchase respiratory masks either as these measures are generally impractical for a variety of reasons.
We do take the situation very seriously, and will continue to track it closely. Please recall the following issues:
- Avian flu has been around and transmitted from birds-to-humans for at least 10 years now, and has not yet learned to move from human-to-human. Unless it gains that capability via a genetic mutation, then there can be no large scale outbreak. It is quite unlikely that it will do so in 2006-2007.
- Tamiflu is the only antiviral medication that would theoretically work against avian flu, and that is only theoretical.
- If you were going to take Tamiflu, you’d have to take it for a prolonged period of time – not knowing when the virus would appear in our local area and when it would be safe to stop it. It is not practical to provide that much medication to cover someone for weeks or months on a speculative basis.
- Should a pandemic start, the best thing to do will be to stay at home and avoid contact with people so as to not be exposed, although we realize that such isolation is not practical for a prolonged period of time.
If you would like additional information, you can visit the Center for Disease Control’s web site at www.cdc.gov/flu/avian.
Know Your Medications and Avoid Medication Errors
It is important that individuals know what medications they are on – not just the name of the medications but the dosages as well. Medications obviously have possible side effects, and they can interact with each other. Anytime you go to a medical practice or emergency room, or if you are admitted to a hospital, it is critical that you have an accurate medication list. Optimally, you should know why you take each medication – what condition each medication is being used for.
Here at GreenField Health, our computer system automatically checks for medication-to-medication interactions whenever we prescribe a new drug for you. That is not the case in many practices that you may use however, and the interaction monitoring will not be effective if the practice doesn’t have a correct medication list for you. An accurate list that you keep with you helps medical providers assure that you are on the best medications and it helps to avoid medication interactions when a new medication is prescribed.
Here are a few tips:
- Carry your medication list with you at all times in your wallet or purse – it should include the name of all of your prescription medications, as well as the dosage and frequency that you take it -- for example, lisinopril 20 mg every 12 hours taken for high blood pressure.
- Have this list available at every medical visit, be it here at GreenField Health or at a specialist office – never assume that any medical practice has an updated list.
- Update your list every time a change is made.
- If you stop a medication on your own, please let us know and don’t be embarrassed to tell us. It is important for us to know the reason that you’ve stopped it. We can either remove the medication from your list in your electronic record, or we can discuss alternatives.
- Let us know if you believe you are having side effects to your medications.
- Remember that you can review your medication list via our patient portal at: www.greenfieldhealth.com If you have not yet registered for this service, you may do so by clicking on the yellow “Register” in the upper left hand corner of the home page. This will also allow you to initiate a secure email, and request an appointment or a referral in a structured fashion. You may also continue to do those via email or phone as you have in the past – this is just an additional option for you.
Your participation in your medication management is important. We encourage you to take an active role in order to avoid confusion, medication interactions, and medication errors.
Medication Site Effects: Statins
“Statins” are a class of cholesterol-lowering medications used to prevent and treat heart disease. They include Lipitor (atorvastatin), Zocor (simvastatin), Crestor (rosuvastatin), Mevacor (lovastatin), Provachol, and others. As we discussed in Health Matters previously, statins are both effective and quite safe. They are used very commonly and thus, it is prudent to be aware of their side effects.
Previous concerns about statins causing liver disease have been shown unwarranted and the routine monitoring of liver function blood tests is no longer recommended except in those individuals with pre-existing liver disease.
Muscle toxicity is the main side effect with statin treatment. Muscle injury associated with statin therapy ranges from muscle aches (myalgias) to muscle inflammation (myositis) to muscle breakdown (rhabdomyolysis). We can measure muscle injury with a blood test called creatine kinase (CK), an enzyme found in muscle cells that is released into the blood when muscles are damaged.
The incidence of benign myalgias, or muscle aches, ranges from about 2 - 10% of individuals on a statin, similar to the incidence in individuals treated with a placebo. Clinically significant myositis, or muscle inflammation, is defined as a CK elevation more than 10 times normal in association with muscle symptoms, and it occurs in less than 0.5% of individuals on a statin. Severe myositis causing muscle aches, weakness, and decreased exercise tolerance affects only about 0.1% of treated individuals.
Rhabdomyolysis, or muscle breakdown potentially associated with permanent muscle injury and acute kidney failure, caused by statins is an extremely rare complication generally only seen in individuals who have other risk factors. Death due to statin-induced rhabdomyolysis averages only about 0.15 per million prescriptions.
Statin-associated muscle symptoms usually occur within the first few months after starting treatment therapy, but may occur at any time during treatment. The incidence of muscle side effects is associated with the dosage – higher dosages more commonly cause muscle injury. The effects are generally reversible - muscle aches and weakness resolve and CK concentrations return to normal over a few days to a few weeks after discontinuation of the medication.
What are the risk factors for myopathy (progressive muscle weakness)? Enhanced susceptibility to statin-associated myopathy occurs in patients with chronic kidney failure, chronic liver disease, and untreated hypothyroidism. The risk of myopathy is also increased with the simultaneous use of certain other drugs, particularly the following:
- niacin (Slo-niacin, Niaspan) - a lipid lowering medication
- gemfibrozil (Lopid) and fenofibrate (Tricor) - lipid lowering medications
- erythromycin, azithromycin (Zithromax), and clarithromycin (Biaxin) – the class of macrolide antibiotics
- digoxin (Lanoxin) – a medication used in heart failure and cardiac arrhythmias such as atrial fibrillation
- itaconazole (Sporanox) – an antifungal medication
- warfarin (Coumadin) – a blood thinning medication
- cyclosporine - an immunosuppressive drug most frequently used in transplantation
- antiviral drugs used in HIV infection
Despite the increased risk of myopathy associated with statin therapy, routine monitoring of CK levels is not recommended. If you are on a statin, the most important thing is to be aware of the possibility of myopathy. If you develop generalized muscle aches, tenderness, or weakness, stop taking the statin and let us know right away.
If your symptoms are mild and resolve with the discontinuation of the medication, we will probably switch you to a different statin medication. Having mild myalgias with one statin does not mean that you will have the same reaction to another statin.
Medication Side Effects: SSRI Antidepressants
SSRIs - selective serotonin reuptake inhibitors - are the most commonly used class of antidepressants. These include Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Lexapro (escitalopram) and others. The most common side effects of SSRIs are nausea, insomnia, and anxiety. These effects usually present at the start of treatment and tend to resolve over one to two weeks.
The most bothersome side effect of SSRIs tends to be sexual dysfunction, most notably reduced libido (sexual interest) in both women and men. SSRIs can also tend to cause anorgasmia (inability to reach orgasm) in women, and to increase ejaculation latency (prolonged time until orgasm) in men. These effects resolve when the medication is stopped. Sexual dysfunction may also be caused by depression itself.
For those who experience bothersome sexual dysfunction while on an SSRI, decreasing the dose, switching to another SSRI, or switching to a non-SSRI antidepressant are all possibilities.
Thanks to You
As GreenField is able to continue its ground-breaking work in patient care delivery systems and practice redesign, we are thankful to our patients and colleagues who provide ongoing support to our group. We could not do it without you! We hope you enjoy the beginning of our beautiful autumn, including turning leaves, hot cider and of course, those cute Trick or Treaters! We’ll back in November with more – until then, please do not hesitate to call or contact us if there is anything we can do for you.
Thanks to our corporate partners
Kryptiq Corporation
Baker-Ellis Asset Management, LLC
Stahancyk, Kent, Johnson & Hook, PC
Go
to our website to learn more about these corporate sponsors
https://securemail.greenfieldhealth.com/Portal/General+Info/Corporate+Partners/Default.aspx
First Tuesday Reminder
First Tuesday Reminder
The
schedule for our upcoming GreenField Health First Tuesday Open House is November 7, December 5, and February 6. This is a good introduction to
our practice for relatives, friends or coworkers who might be
interested in becoming a GreenField patient. The sessions begin
promptly at 5:30 PM on the first Tuesday of each month. Learn more
about our First Tuesday Open House Online at: https://securemail.greenfieldhealth.com/Portal/General+Info/First+Tuesdays/default.aspx
Sincerely,
Your GreenField Health Team:
Beth Davis, your Benefits Coordinator and Biller- beth.davis@greenfieldhealth.com
Chuck Kilo, MD - chuck.kilo@greenfieldhealth.com
Cynthia Ferrier, MD - cynthia.ferrier@greenfieldhealth.com
David Shute, MD - david.schute@greenfieldhealth.com
Amanda Clark, MA - amanda.clark@greenfieldhealth.com
Elizabeth Hays, MD - elizabeth.hays@greenfieldhealth.com
Eric Murray, MD - eric.murray@greenfieldhealth.com
Heidi Downey, your Consultant - heidi.downey@greenfieldhealth.com
Jill Arena, your Clinic Administrator - jill.arena@greenfieldhealth.com
Joel Swartzmiller, IT Manager - joel.swartzmiller@greenfieldhealth.com
Lindy Thornbloom, your Health Coordinator - lindy.thornbloom@greenfieldhealth.com
Pam Mockenhaupt, CMA, your Health Coordinator - pam.mockenhaupt@greenfieldhealth.com
Paula Koeller, MD - paula.koeller@greenfieldhealth.com
Shelly Banta, your Clinic Manager - shelly.banta@greenfieldhealth.com
Tiana Schmitt, CMA, your Health Coordinator - tiana.schmitt@greenfieldhealth.com
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GreenField Health System
9427 SW Barnes Road, Suite 590
Portland, OR 97225
Phone: 503-292-9560
Fax: 503-292-9510
Web: http://www.greenfieldhealth.com
Questions, concerns, comments appreciated: questions@greenfieldhealth.com
copyright 2003-2006 GreenField Health
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