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David Katzman, MD & Jennifer DeLaney, MD
Internal Medicine Specialists


Dear Friends,
I hope everyone has enjoyed their summer! For many, it is a time to relax and spend extra time with loved ones. Studies have shown there are many positive health benefits that come along with supportive social connections.  As we shift gears into the fall season, take a moment to be mindful, the practice of purposely focusing your attention on the present moment and shift away from your usual preoccupations. This can help alleviate stress and strengthen lots of good qualities such as gratitude, and hope which is linked to happiness... and happiness is contagious! 
Am I Losing My Mind?
Dr. David Katzman
People of all ages have concerns about their memory. We all have little lapses and wonder “Should I be worried” The medical corollary is “Do I have Dementia”?
Memory, like hearing or vision, typically worsens as we age. Peak memory is at age 14, and a decline in the rate at which we acquire new information and learn new tasks is considered normal—up to a point. However, when memory loss interferes with independence in day to day activities it is considered Dementia. Memory impairment which is more significant than normal aging but does not affect daily living is called Mild Cognitive Impairment. About 10% of persons with Mild Cognitive Impairment will progress to Alzheimer’s dementia each year.
There are many medical causes of dementia and mild cognitive impairment: multiple small strokes, medications (particularly sleeping, pain and anxiety pills), excessive alcohol use, vitamin deficiencies, and depression are some of the more common causes. Alzheimer’s dementia is a subtype of dementia where there is no clear cause on routine testing.
When there are memory concerns from patients or their family members, we need to understand what their memory issues are, how they are affecting daily life, and the time course and trend. Part of the physical exam will include standardized memory tests to quantify the problem.
If significant memory loss is discovered, it is especially important to identify the causes—especially the reversible ones. Medications and alcohol use are very common and easily reversible causes of memory loss or accelerated decline. Common medications that impair memory include sleeping pills (Ambien, Tylenol PM, Lunesta), Pain medications (hydrocodone, oxycodone), and anxiety medications (Xanax, Valium, Ativan). Depression, particularly in the elderly, will often mimic dementia and is easily treated. Other reversible causes include vitamin B12 deficiency, thyroid problems, or hydrocephalus (enlarged ventricles in the brain due to inadequate drainage of spinal fluid). Generally, a thorough physical examination, blood work and a brain scan will identify most causes of dementia.
Many studies have looked into medications to prevent memory loss and dementia, including Vitamin E, anti-inflammatories, estrogens, cholesterol medications and multivitamins. None have been shown to be of any clear benefit, and some can possibly worsen memory issues or cause harm in other ways. It is generally agreed that the best way to prevent memory loss or to slow it down is be physically active and follow a plant-based Mediterranean-style diet that is low in sugar. Moreover, eliminating or reducing alcohol consumption along with any non-essential medications for pain, sleep or anxiety is critical. Finally, pursuing activities that stimulate learning, verbal skills and reaction time and maintaining enjoyable social interactions with others will not only help with memory loss but lead to more fulfilling life.
Are Your Cleaners in the Clear? 
Dr. Jennifer DeLaney
Sometimes less is more! There are numerous harsh chemicals in everyday household items like personal care products, household cleansers, and laundry products. The FDA has been much slower to regulate these, despite clear evidence that they can be harmful to people. The FDA has just banned triclosan in liquid hand soaps. Triclosan is an anti-bacterial chemical that has been linked to toxic effects on the thyroid gland and to an increase in antibiotic resistant bacteria. So what should you do to clean your hands? Plain soap and water is always best. Soap is antibacterial naturally. Bar soaps contain fewer chemicals, and are hygenic to use. Hand sanitizers kill bacteria, but don’t remove chemicals from your hands. It is best to wash your hands before eating. Use of air fresheners and spray cleaners has been linked to asthma, eczema and allergies. Check the environmental working group website for safe alternatives to use in your home.
Influenza
Lauri Slyman, RN
The best defense against influenza, or the flu, is yearly vaccination. 10 percent of Americans are infected with the flu every year. The flu causes pneumonia, which usually resolves without treatment in 2-3 weeks. However, older adults and individuals with underlying health problems are at increased risk for complications requiring hospitalization. 36,000 Americans die of influenza every year. Flu vaccination not only reduces the risk of influenza infection but also reduces the severity of illness in those who are infected.
The Influenza virus is remarkable for its high rate of mutation, compromising the ability of the immune system to protect against new strains. As a consequence, new vaccines are produced each year to match circulating viruses. Current influenza vaccines available are the inactivated trivalent, quadrivalent, or high dose.
Who should get the vaccine?
• Everyone over 6 months of age should be vaccinated every year unless they have had a life threatening allergic reaction to the flu vaccine.
• For individuals 65 years of age and older, we recommend the high-dose trivalent inactivated flu vaccine (Fluzone high-dose). This vaccine contains four times the dose of the standard vaccine, which is important to maintain immunity throughout the long flu season in older adults. Studies suggest that the high-dose vaccine is more effective than the standard-dose vaccine in older adults. Mild to moderate local reactions, such as a red, hot arm, are more common with the high-dose vaccine.
• For individuals with a known severe egg allergy we recommend Flublok. This flu vaccine contains contains no egg proteins. We do not have this available in the office, but can be administered at your local pharmacy.
• Pregnancy- Pregnant women are at much higher risk from serious complications form the flu. Pregnant women should get vaccinated, regardless of what trimester they are in in their pregnancy.
• A single dose of the flu vaccine should be offered soon after the vaccine becomes available, ideally by October.
Treatment- Most healthy adults don’t need medical treatment for the flu. However, you should drink plenty of fluids, avoid contact with others, wash your hands frequently and get plenty of sleep. You should stay home for 24 hours after your fever is gone.
If your symptoms are severe, or you are in the high risk group for flu complications, ( adults 65 and older, with significant heart or lung disease, diabetic, pregnant, or immune compromised), your doctor may want to treat you with an antiviral medication.

SYMPTOMS of FLU vs. COLD


Flu: Onset of symptoms usually abrupt
        Usually multiple symptoms
        Fever usual for 3-4 days (100-102 degrees)
        Aches usual, often severe
        Chills common
        Fatigue/weakness usual, can last up to 3 weeks
        Sneezing, stuffy nose, sore throat sometimes
        Chest discomfort/cough common, can be severe
        Headache common
        Vomiting/diarrhea sometimes, more common in kids

Cold:
Onset of symptoms usually gradual
          Often starts with one symptom
          Fever rare, usually lower grade temp
          Aches sometimes, milder
          Chills uncommon
          Fatigue sometimes, a couple of days
          Sneezing, stuffy nose, sore throat common
          Mild/moderate hacking cough sometimes
          Headache sometimes
          No vomiting or diarrhea

Office News
*Please welcome the newest member of our team, Megi Krapja.
Megi is a Medical Assistant who will be working with both Dr. Katzman and Dr. DeLaney in the office.
*Flu vaccine
Appointments for flu shots will be scheduled as soon as our High Dose Vaccine is shipped! Please look for email blast with upcoming available dates! If you already have a scheduled appointment with your doctor we will administer the vaccine at that time. 
*Please E-mail Instead of Texting For Medical Q
uestions
Dr. Katzman and Dr. DeLaney would prefer to be emailed instead of using text messages over the phone for relaying any medical questions. This is for your privacy and personal information protection. 
*Payment Request 
Please reference the invoice number that you are paying on every check. More than one invoice can be on the same check as long as they are from same doctor. 
*Billing Concerns and Questions
Please Contact Tonya for any questions concerning your account. She will be available to return your calls on Wednesdays and can also be reached via e-mail
*Office Website
Please visit our website if you missed past newsletters. The newsletter archives can be found by hovering your mouse over the "Medical Links" tab. You will also find here links to several reputable websites with the latest medical news and health information. 

Pear Bruschetta
seasonal fruit and toasted nuts add to the rich flavor of this appetizer
1 pkg. (5.3 ounces) Chavrie goat cheese
2 Tablespoons light, soft cream cheese
1 shallot, finely chopped
1 pear, cored and diced (unpeeled)
1 loaf (8 ounces) french baguette
3 Tablespoons pecans, toasted
In medium bowl, stir together goat cheese, cream cheese, and shallot. Stir in diced pear. Split baguette in half lengthwise, or cut into slices. Spread cheese mixture onto cut surface of bread.  Top with pecans.  Place bread, cheese-side up, on foil-lined baking sheet.  Broil until cheese is melted and warmed, about 3-5 minutes. 
Makes 8-12 servings. 
Per serving: Calories 100; cholesterol 9 mg, fat 3.7 g, sodium 171 mg, carbohydrate 14 g. 

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