You know what they say about an ounce of prevention. That’s why ‘wellness’ dominates health conversations these days. It’s all about keeping us healthy before something goes wrong. To that end, we, the patient, must be ever-vigilant. If we want to be dealing with wellness instead of illness, we have to keep up with recommended vaccinations, check-ups and screenings.
Whether you’re trying to ward off serious health problems like the flu and pneumonia, hoping to avoid the misery of allergies, or making sure you continue to use your own teeth for a lifetime, an ounce of prevention is worth a pound of cure. One important tool: vaccinations, which can prevent shingles, influenza, pneumonia and more.
with shingles, age matters
The importance of different vaccines varies by age. One example, says Dr. Kirsten Brandt, a Washington University internal medicine specialist, is the recommendation to get vaccinated for shingles, a reactivation of the same virus that causes chicken pox and results in a painful rash around the torso. It is recommended that patients get this vaccine starting at age 60, when individuals become increasingly at risk of developing the disease. “Shingles are not fatal but can be debilitating; the pain can continue for months,” says Dr. Mary Fox, chief medical officer of the Visiting Nurse Association of Greater St. Louis.
The vaccine for shingles is recommended for everyone except those who are immunocompromised, who should check with a doctor first. Because the vaccine is expensive, Brandt urges individuals to check with their insurance companies to find the best price.
The flu shot is recommended for everyone, Fox says. “The flu can be very serious; in patients with chronic disease, it can even cause death,” she says. It takes two to four weeks to develop the immune reaction that protects people from influenza, so the ideal time to get vaccinated is before the start of flu season, usually from September through November.
People are vaccinated for two reasons. “One is to help decrease the chance of that person getting the flu, or to lessen the severity of it,” Brandt says. “The second reason is to try to prevent epidemics in the community.” Those likely to get very sick from the flu include the elderly and individuals with compromised immune systems.
One reason to avoid the flu shot, Brandt adds, is if you have an egg allergy, as typical vaccines are grown in eggs. Otherwise, you don’t need to worry about getting sick from the vaccination. “The shot is a dead virus,” she notes. “The point is to activate the immune system to develop immunity to those strains. Some people do feel a little unwell afterward, but that’s most likely a sign the shot is doing what it’s supposed to.”
There are several methods of obtaining the flu vaccine. People who dislike needles can get a nasal vaccine, but this is only available for those who are healthy, not pregnant and under age 50. The injectable vaccine comes in three intensities—trivalent (covers three strains), quadrivalent (covers four strains) and high potency (recommended for seniors).
Pneumonia is another illness that can be avoided through vaccination. One million adults in the U.S. get the disease in a typical year, and up to 7 percent of that number dies, Fox says. That’s what happened to 53-year-old Muppets creator Jim Henson. “He didn’t have any major health problems, but he ignored the symptoms, and it cost him his life,” Fox says. “We have good antibiotics to treat this, but it makes sense that you would want to stop it before it gets started.”
There are two pneumonia vaccines—PCV pneumococcal 13 and 23, named for the number of strains they cover. These are recommended for people age 65 and older. “They protect against the most common type of community-acquired pneumonia,” Fox says. Protocol for those who have never been vaccinated before is to get the 13 first, then follow it with the 23 a year later. People with conditions like COPD, diabetes or severe asthma may be urged to get the 23 earlier than age 65, Brandt notes. For a list of immunization schedules, visit cdc.gov/vaccines.
Whether the issue is ragweed, pollen, animal dander or a host of other bothersome allergies, treatment can provide relief. No one wants to walk around sneezing, itchy eyed and coughing, the way allergy sufferers do without their medication.
shots or pills?
The two ways to administer treatment for allergies are via injection or orally. “Allergy injections have been around a long time, and they absolutely work,” says Dr. Hamsa Subramanian, an allergist with Signature Medical Group Allergy and Asthma Docs. “The extracts are standardized and very safe.”
Shots have been available since the 1920s and work for a variety of allergens, including tree, grass and weed pollens, cat and dog dander, dust, ragweed and mold. Oral treatment, also called sublingual, is relatively recent and works against ragweed and grass. Shots can be administered to any age population, while ragweed pills are limited to those in the 18 to 65 range. Grass pills are made by two companies, each with separate age approvals.
“With all the options we have available, most people, with time, can be extremely well-controlled and don’t have to suffer,” says Dr. Mark Dykewicz, director of the Allergy and Immunology Fellowship Program at Saint Louis University School of Medicine. Shots are given in the office and must be continued throughout the year, with a buildup phase of weekly shots for six to eight months, then monthly maintenance for three to five years, Dykewicz says. For patients with multiple allergies, shots are the best bet.
“If you have a patient who has problems over several different allergy seasons, or say they’ve got year-round problems with dust mites or pets, injections certainly would have an advantage,” Dykewicz says. “Although there is more of a time investment with injections, patients get more comprehensive coverage of all the things they’re allergic to.”
Oral treatments begin eight to 12 weeks before the allergy season, continue through the season and don’t require a lot of medical supervision other than a monthly checkup. “You don’t have to come to the office or wait 30 minutes to make sure you don’t have a reaction, and there are no needles,” Subramanian says. “The big disadvantage is it’s very rare that we find patients who are mono-allergic—just grass or ragweed allergy.”
Contraindications can occur with both shots and pills. For instance, people taking beta-blockers or those with severe uncontrolled asthma will not be given shots or pills. Oral treatment is also problematic for patients with GI issues. “Each patient is different,” Subramanian says.
Because mono-allergy is rare, it’s more common to see patients who need year-round shots. But people who travel frequently, or those who work in landscaping, can benefit from the convenience and effectiveness of pills even if these cover only grass and ragweed issues. “Of course, it’s done with the disclaimer that they cannot expect 100 percent (coverage),” Subramanian says.
A recent study by a drug company that makes both ragweed and grass allergy pills found that people could take both in the same day without adverse reaction, Dykewicz says. There also are other medications that can help, including nasal steroids, nasal antihistamines, oral antihistamines and decongestants. “During the acute season, there are all sorts of medication options available, both over the counter and by prescription, that give good relief for the majority of patients,” he says.
No wellness program is complete without talking about teeth. You don’t realize how important they are until something goes wrong, and then … well, it seems like nothing is right!
brush up on the latest
“It’s so much easier to prevent things,” says Dr. Tim Grayem of Grayem, Brace and Associates in Kirkwood. “Once you have dental work, you’re always going to have to replace it. I always say, if you just get into good habits now, before you have problems, you could pay for part of your college. Otherwise, you’ll help put my kids through college.”
Prevention starts early with fluoride treatments. “In dentistry, fluoride is used not only to reduce decay, but also to re-mineralize weakened enamel and reduce tooth sensitivity,” explains Dr. Robert Boyle of Clarkson Dental Group. That’s why fluoride has been added to water for the past 70 years. “The incorporation of fluoride in developing permanent teeth—while under the gum—makes the enamel much more decay-resistant,” Boyle says.
Adults need fluoride too, which is why Boyle recommends brushing twice a day with fluoride toothpaste. “As we age, gum recession can expose the roots of teeth, which are not protected by enamel. These surfaces are more thermally sensitive and decay-prone,” he notes.
Many children don’t spend enough time brushing, which can lead to plaque buildup and cavities. Everyone needs to spend two minutes brushing, plus time to floss, the doctors agree. “That 3 minutes to floss and brush correctly makes all the difference for a mouth to be healthy and inflammation-free and prevent expensive dental work,” Grayem says.
Regular oral hygiene at home, preferably with a soft brush with a smaller head and fluoride toothpaste, is essential in making office visits better. “It’s all about physically using the brush to get plaque off, just physically getting the bristles into the areas to rub it off,” Grayem says. Brushes should be replaced about once a month. “If it’s getting frayed, it’s time for a new one,” he says. And, as dentists love to stress, only floss the teeth you want to keep, more often if areas in your mouth trap food. “Flossing after each meal is desirable,” Boyle says.
Grayem recommends a Waterpik, particularly for patients who have bone loss. “It’s like a power washer for your mouth—it gets all that plaque out of all those nooks and crannies,” he says. “Because when you have bone loss, you have a lot more areas for plaque to hide, and they’re harder to get to.”
clean & cared for
Grayem tells patients tooth care takes 2 or 3 minutes, but it saves tens of thousands in future dental work. “It’s not usually until adulthood that people who have had poor or moderate hygiene suddenly get it and realize how expensive it is. But usually at that point, they already have a lot of problems.”
And never underestimate the importance of regular office visits and professional teeth cleaning. “For those who have periodontal gum disease and/or a high decay rate, more frequent cleanings are beneficial,” Boyle notes. “The trend is that the older we get, the more likely a shorter interval between cleanings may be recommended.”