GreenField Health’s Health Matters

January 2009  

Wishing You a Happy and Healthy Year  

The team at GreenField Health welcomes you to what we hope will be a healthy 2009! We are here to assist you with your healthcare needs throughout the year– please contact us if we can be of service. We appreciate your reading of Health Matters as it is an important method of communication.  

We would like to take a moment to encourage you to respond to calls or emails from our staff about scheduling an appointment, most importantly your annual exam. We work hard to provide care to you without an actual office visit. However, your annual exam is an exception. We do want to see you once a year to review your medical conditions, order labs as needed, and do a thorough physical examination.  

Welcoming Jenna Baird  

Please help us in welcoming Jenna Baird to our team at our Barnes Road clinic. Jenna is our newest health coordinator and will be working with David Shute, MD and his patients. Over the past 12 years, Jenna has worked as a phlebotomist and a medical assistant. She enjoys hanging out with her friends, riding motorcycles, snowboarding, the outdoors, cooking and music. She is currently training for a triathlon this summer and loves to travel. She looks forward to meeting many of you in the near future.  

Secure Email Update  

If you are working on an email message in our secure messaging system and need to walk away for some reason, you may find that when you return to finish and send the email that it has timed out, and it may look as though you have lost the message that you were working on. We have had this feedback from some of you and can imagine that it would be rather frustrating. This is a security feature so that secure messages are not left open for a long period of time when a user is not actively working on them. We have discussed this with Kryptiq and have run several tests, and have calculated that the time out length is 20 minutes of non use.  

While you are creating a new email message or responding to an email message, automatic drafts are saved to the server. If your session times out, when you log back in, the system will take you back to where you were before - in your inbox looking at the last message. It will appear as if the email you were working on is lost. However, if you go to the drafts folder, you should easily find a copy of your email that you were working on.  

We hope that this is helpful information. Please let us know if you encounter any problems with our email system or website. We are continually trying to improve them to make them more efficient and effective communication tools.

Most Vitamins and Supplements Don’t Help  

Even though true vitamin deficiency is very rare in the US, the vitamin and dietary supplement business is huge. Individuals spend billions of dollars yearly on them hoping that they will improve their health or keep them from getting sick. Many people believe that vitamins can help boost the immune system and the medical industry has promoted various vitamins or supplements in the past for their anti-oxidant properties and their theoretical ability to reduce “free radicals” associated with cancer and heart disease.  

Unfortunately, an increasing number of well designed clinical studies have failed to document the health benefits of most vitamins and supplements. Here are just a few examples of such studies-  

So What should you do? Everyone needs vitamins, but for most people, the vitamins and nutrients obtained from good nutritious foods are adequate for good health… extra vitamins and supplements are not necessary.

Some extra vitamins are beneficial in specific circumstances such as folic acid for women of child-bearing age, calcium and vitamin D in women over 65 to protect bone health, and vitamin D for those who live in northern climates such as Oregon. Vitamin C may help reduce colds among individuals who are engaged in heavy physical exertion such as long distance running. Niacin (vitamin B6) can help improve HDL cholesterol levels but should generally be reserved for use when recommended by a physician. Likewise, fish oil that includes omega 3 fatty acids also improves cholesterol levels.  

The bottom line of these studies reiterates once again that few things are better for you and your family or more health promoting than a very healthy diet and plenty of daily mental and physical exercise.

The Dangers of Antibiotic Overuse  

Many people continue to believe that antibiotics are beneficial in the treatment of upper respiratory infections. We’ve discussed this issue many times in Health Matters, specifically addressing the fact that the vast majority of upper respiratory infections are due to viruses which do not respond to antibiotics. Yet many people continue to request antibiotics without considering their risks, and some community physicians continue to inappropriately prescribe them sending a message to many that antibiotics are useful when they are not.  

The common cold and influenza do not respond to antibiotics, most sore throats are caused by viruses, and only 10% of acute bronchitis cases are caused by bacteria and despite that, the majority still resolve without antibiotics. Likewise, most cases of acute ear infections (otitis media) resolve without antibiotics as do almost all cases of acute bacterial sinusitis. For sore throats or “pharyngitis”, antibiotics are only recommended for individuals with documented strep throat with only about 25% of sore throats in children and 10% in adults being caused by strep. Many infectious disease authorities note that even documented strep throat will usually resolve without complications in most people without antibiotics.  

While antibiotics can certainly be useful when warranted, overusing them or using them in situations where they are not helpful such as acute upper respiratory infections puts individuals at risk of side effects.  

It was recently estimated that antibiotics have only a 1 in 4000 chance of helping to improve acute upper respiratory infections, while there is a 1 in 4 risk of diarrhea, a 1 in 50 chance of developing a rash to the antibiotic, a 1 in a 1000 chance of a reaction that causes an emergency room visit and a 1 in 5000 risk of a very dangerous anaphylactic reaction. These are not great odds. In fact, the risk of an adverse reaction from antibiotics is more significant than many other medications that are frequently considered more dangerous.  

The overuse of antibiotics can also lead to an increased resistance among bacteria making them harder to treat. Thus, the risks of antibiotics are real.  

Here are some additional resources for you from the Centers for Disease Control and Prevention:  

-        For Adults: “Cold or flu. Antibiotics won't work for you.” http://www.cdc.gov/drugresistance/community/campaign_materials/Brochure-General-color.pdf

-        For Parents: “Snort. Sniffle. Sneeze. No antibiotics please.” http://www.cdc.gov/drugresistance/community/campaign_materials/Brochure-Parent-color.pdf

-        For Parents: “Runny nose Q&A.” http://www.cdc.gov/drugresistance/community/campaign_materials/FactSheet-RunnyNose-color.pdf

-        For Parents: “Fluid in the middle ear Q&A.” http://www.cdc.gov/drugresistance/community/campaign_materials/Fact-Sheet-FluidMiddleEar-color.pdf

Customer Service at GreenField Health  

Real examples are perhaps the most effective way of illustrating the value of our services. Our goal is to provide comprehensive clinical services in order to meet your needs in a high quality and cost effective manner, frequently avoiding more expensive and time consuming services that you might have received elsewhere.  

Sewing up cuts is something that we do frequently, even at a time when most primary care practices have given this up. A friend’s son recently fell at school resulting in a 1.5 cm cut to the top of his head. Such cuts, or “lacerations”, are easy to sew (called suturing). Unfortunately, when this individual called his pediatric practice where there were 10 practicing pediatricians, he was told that he would have to take his son to the emergency room – none of the pediatricians do suturing of lacerations. This is unfortunately a very common situation. A $150 office visit is turned into an $800 visit to the emergency room.  

One of our patients recently cut his hand on farming equipment. He called us and we asked him to come right in. Within 30 minutes of his arrival, he had 5 stitches and was on his way home saving him several hours and hundreds of dollars in emergency room expenses.  

Another patient was fishing recently in St. Helens and managed to hook his thumb with a rather large fishing hook. He also called us and again we asked him to come right in. Fishing hook injuries can be a challenge, but we removed the hook and had him on his way home in about 45 minutes. He was also spared considerable time and money by avoiding an emergency room visit.  

We also perform shoulder injections regularly for rotator cuff tendonitis, elbow injections for tennis and golfer’s elbows. We remove moles and do pelvic exams and pap smears. The point is that a comprehensive primary care practice should do these things for you. At GreenField Health, we work hard to deliver great service, to provide a wide range of high quality services at a more affordable cost (to you and your insurance company) than other locations. If we can’t do something, or if we believe that it is beyond our capabilities, don’t worry – we will refer you to the right physicians.

Family Matters: Cold & Cough Medications in Young Children  

During a two year period from 2004 – 2005 emergency departments treated over 1500 children under the age of two for adverse events related to over-the-counter (OTC) cough and cold medication use, including three infant deaths.  Reports of this kind led the Food and Drug Administration (FDA) in the fall of 2007 to recommend that infants and children under the age of two not be treated with OTC cough and cold medicines because of the risk of serious and potentially life-threatening side effects.   

Currently the FDA is reviewing data on children younger than age 12 and there is growing concern that these medicines may not be safe for children younger than 6 years old.  The American Academy of Pediatrics recommends avoiding use of OTC cough and cold medicines in children under 6 years old.  

One reason that these products are risky in children is that cold medicines are often made with combinations of many different “active ingredients”, including the following: