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Measles at Disneyland…what’s the big deal??

measles outbreak

Measles, or Rubeola, is a BIG deal! Although “endemic measles” was declared eliminated in the US in 2000, we continue to see “mini-outbreaks” here in the US. And, measles is still one of the leading causes of death among young children (145,700 deaths globally in 2013) in underdeveloped nations. Here in the US, between 1953-63, an average of 549,000 measles cases and 400 measles related deaths were reported each year. However, it was estimate that 3-4 million cases of measles occurred each year! The measles vaccine was licensed in 1963 (and the MMR in 1971) and since then we have seen a dramatic decrease in the illness-and its complications, including death! The last death related to measles illness in the US was in 2003.


  • Measles is highly contagious—even 4 days before you are sick you can spread the disease!
  • Measles causes a high fever, fatigue, cough, runny nose and red watery eyes and a rash. The rash typically comes 3-5 days into the illness and spreads from the head on down. Measles infection is more serious in children under 5yr old and adults over 20 yr old.
  • Complications such as ear infections leading to deafness, pneumonia, severe diarrhea and possible dehydration, or a brain swelling illness called encephalitis can occur in 2-3 out of 1,000 with measles and 1-3 out of 1000 infected with measles may die. A rare complication from measles leading to a fatal disease of the central nervous system developing 7-10 yr AFTER the infection can also occur, especially in children under 2 yr of age who get measles.


  • The measles vaccine (only available as the MMR—measles, mumps, and rubella) is a safe and highly effective vaccine. Given at 12mo and a booster at 4-6yr of age (although can be given earlier as long as 4 weeks apart) provides close to 99% protection! One dose is felt to be 95% effective but a second dose is given as up to 5% will “lose” protection. And some people cannot get the vaccine—children under 12mo (doesn’t work as well), immunocompromised children (cancers, transplant patients, immune deficiencies), and pregnant women.
  • HERD IMMUNITY – This is an important aspect of public health—for ALL of us! The more of us who have the vaccine means the less likely the disease will occur and thus protect those who may not be able to GET the vaccine (not chose not to get it!) or didn’t develop immunity to the disease. It also means the more of us who opt NOT TO GET the vaccine the less effective the vaccine may become in our community.


  • There is NO LINK between the MMR and autism. The vaccine is safe and adverse effects are mild and include the following, typically 6-14 days after the shot and less likely after the second shot: -fever (1 in 6) -mild rash (1 in 20) -swelling of the glands in the neck or cheek (1 in 75) -seizure caused by a high fever (1 in 3,000)

Rare adverse effects include temporary decrease in platelet count which can lead to a problem with bleeding (1 out of 30,000 doses) or an allergic reaction (1 in 1 million doses).
Vaccines are one of the most important aspects of being healthy and one of the most important things we can do for our children. So before you say NO think about it…you may not only be helping your own child, but all our children, grow up to be healthy!

Cervical Health Awareness

cervical health awareness month

Here are just a few facts about cervical health that you might not be aware of:

  • Every year, more than 12,000 women are diagnosed with cervical cancer in the United States.
  • 91 percent of women who catch cervical cancer in its early stages survive.
  • Cervical cancer is most common in women 35-44 years of age.
  • Six out of ten women who are diagnosed with cervical cancer have never had a pap smear.

Can I Reduce my Risk of Cervical Cancer?

The answer is yes. There are many things women can do to reduce the risk of getting cervical cancer, including:

  • Get pap smears regularly – Pap smears detect cervical changes prior to cancer forming. Check with your physician about how often you should get a pap smear.
  • Follow up after having an abnormal pap smear – Follow up tests or colposcopies are necessary if you have an abnormal pap smear.
  • Practice safe sex – Women with fewer sexual partners and women who practice safe sex decrease their risk of developing HPV, which is one of the causes of cervical cancer.
  • Get vaccinated – The HPV vaccine prevents the formation of high-risk strains of HPV. The vaccine is most effect for young women who are not sexually active. If you are older than 27, you might not be eligible for the vaccine.


Contact a physician to get more information on cervical cancer.

Diabetes Awareness

information on diabetes

by Kelly Sinclair, MS, RD, CDE

Type 2 diabetes is a condition characterized by high blood glucose levels caused by either a lack of insulin or the body’s inability to use insulin efficiently. Type 2 diabetes develops most often in middle-aged and older adults but can appear in young people.

Here are just a few of the recent statistics on diabetes:

  • Nearly 30 million children and adults in the United States have diabetes, about 9% of the population.
  • Of the 30 million with diabetes, 8 million people do not yet know they have the disease.
  • Another 86 million Americans have prediabetes a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes.

People with prediabetes are at increased risk for developing type 2 diabetes, heart disease and stroke.

The American Diabetes Association has developed a 5 minute test you can take to check your own risk for Type 2 diabetes. Follow the link below:

There are things you can do to significantly lower your risk of developing diabetes:

  • Lose 5-10% of your weight. For a 200 pound person that would be 10 to 20 pounds. Weight loss is the number one way to prevent type 2 diabetes.
  • Move your body almost every day. Choose activities that you enjoy and get your heart rate up like brisk walking, jogging, dancing, and swimming. If you haven’t exercises in a while start with 5 or 10 minutes every other day. The goal is 30 minutes 5 days per week. Exercise burns up calories and will help you reach your weight loss goal.
  • Eat 3 non starchy vegetables and 2 fruit servings each day. A serving is about ½ cup. Eating lower calorie vegetables and fruits can help you to lower your weight. Non starchy vegetables (everything except corn, peas, and potatoes) are so low in calories you can eat multiple servings! Add them to every meal to help you feel full.
  • Meet with a certified diabetes educator to help you get started. We are here to help you reach your goals and answer your questions.

Preventing and Controlling Diabetic Foot Problems

Preventing and Controlling Diabetic Foot Problems

by Joan Hultgren, RD, LDN, CDE

What types of foot problems are more likely seen with diabetes?

  1. Neuropathy (Nerve damage)

Neuropathy is one of the most common foot problems associated with diabetes.

Symptoms can include tingling, pain, burning, stinging and foot weakness. Over time, the nerve damage can lower the ability to feel temperature changes and pain. Without knowing it, burns, cuts or broken skin can occur. Items on the ground can get lodged in the foot and lead to complications.

Additionally the nerve damage can change the shape of the foot. Special shoes designed with wider and higher toe boxes can allow deformed feet from being further damaged.

  1. Callouses

Foot callouses can occur more often and build up faster with diabetes. Callouses, if not trimmed, thicken and turn into open sores (foot ulcers). To avoid burns and infections from doing home foot “surgery” and using over the counter remedies, it is best to have callouses safely removed by a podiatrist.

  1. Skin changes:

    Dry, peeling and cracked skin may occur because the nerves that control the oil and moisture in the foot are no longer working. Healthy skin is one of the ways the body is able to fight infection. Keep feet clean and use lotion.

  2. Poor Circulation:

    Diabetes causes the blood vessels of the feet and legs to narrow and harden making it difficult to fight infection and heal adequately. Feeling may be compromised, leading to difficulty in determining hot and cold sensations.

  3. Foot ulcers:

    Ulcers can form from poorly fitting shoes. They most often occur on the ball of the foot or on the bottom of the big toe. They may or may not hurt. It is extremely important that the ulcer is examined by a health care provider. X-rays may be needed to determine if the infection has reached the bone. Keeping pressure off the foot is key to healing. The foot needs to be cared for long after the ulcer heals.

  4. Amputation:

    Rates are higher with diabetes due to nerve damage and peripheral artery disease, both of which reduce blood flow. Complications requiring amputation can be greatly reduced by controlling blood glucose and blood pressure, and by not smoking.

What can be done to prevent any problems?

  • Work with your doctors and certified diabetes educators to keep blood glucose levels and blood pressure under control.
    • Additional medications, weight loss and exercise will all help.
  • Check feet daily for blisters, redness and cracked skin. Call your healthcare provider immediately if the area looks red, is swollen or worse than the day before.
  • Moisturize the feet with lotion, but limit the amount of lotion in between toes to avoid infection.
  • Wash feet daily, but avoid soaking as this can further dry the feet.
  • Avoid walking barefoot!
  • Walk to improve circulation.
  • Find ways to stop smoking! This will greatly improve circulation.
  • Make an appointment with a podiatrist for foot inspections, nail care, foot appliances and shoes to help limit complications.


Written by : Joan Hultgren RD LDN CDE (Certified Diabetes Educator)

Program Coordinator Pentucket Medical Associates
November 2014

The Facts About Teen Smoking

The number of smokers is decreasing among the general population, but 3,000 teenagers each day in the United States still light up. Here are a few important facts about the teen smoking epidemic in the United States:

1. 4,000 kids under the age of eighteen try smoking each year, and 1,000 of those kids start smoking regularly.

2. Teenagers under the age of 18 purchase 1.5 million packs of cigarettes each year.

3. People who start smoking as teenagers die, on average, 13 to 14 years earlier than those who do not smoke.

4. According to recent studies, teenagers who smoke are three times more likely to use alcohol.

5. Because smokers typically start the habit during their teenage years, advertisers gear their advertisements towards teenagers and young adults by making smoking look like a pleasure of adulthood. They also emphasize feelings of freedom and rebellion for teens.

6. Teens who are involved in sports and after school activities have lower rates of tobacco and alcohol use.

What Can Parents Do to Stop Teen Smoking?

  • Keep a close eye on your child and look for signs, such as the smell of cigarette smoke.
  • A lot of teenage smokers start due to peer pressure. Get to know your child’s friends so you can ensure they will be a positive influence.
  • Talk to your teen and keep an open dialogue so they feel comfortable discussing it with you.


Sources: American Lung Association, Centers for Disease Control and Foundation for a Smoke Free America

You Should Stop Smoking

“You should stop smoking.”

A study a few years ago showed that surprisingly few smokers actually hear those words from their doctor. We can speculate that their doctors assume “everybody knows that,” or expect a low success rate for the time spent, or wishfully think all smokers are already trying to quit. Well, it’s pretty darned hard to quit even knowing the dangers. Nicotine is an extremely addictive drug that triggers withdrawal discomforts even after a night’s abstinence. A cigarette delivers nicotine powerfully and directly to the lung circulation and to the brain relieving withdrawal and creating lots of powerful positive associations.

So what can a smoker do to help themselves?

Set a quit date. Most people who smoke may intend to quit “sometime” but never get around to it. Committing to a date can remove some of the emotion and anxiety surrounding stopping. Nicotine replacement can be started on the quit day. Don’t worry about continuing addiction; nicotine replacement methods enter the circulation much more slowly than cigarette smoke and are not as addictive.

Keep a positive attitude.

It is important to create a self image as a healthy nonsmoker. Starting an exercise program may help by making cessation efforts part of training (and may help prevent unwanted weight gain.) Remember that many folks smoke when anxious so the guilt about smoking may trigger the urge to light up.

Change your routine.

Figure out circumstances where you habitually smoke and do something different:

  • Drink tea instead of coffee.
  • Avoid alcoholic drinks.
  • Go for a walk instead of coffee break.
  • Get a new car!

Beware of “incremental” misperception of risk.

One cigarette may not seem harmful but sustains the habit. Once you are quit, even one cigarette triggers the return of addiction. Don’t be fooled by the inner voice of habit into making exceptions “just this once”.

With a little determination and strategy you may not need to hear those four little words ever again!

Domestic Violence: Know the Facts

October is Domestic Violence Awareness Month. Even though domestic violence is one of the most common forms of violence in America, the awareness month doesn’t get as much attention as other topics.

Every nine seconds, a woman is assaulted or beaten by a partner. However, very few leave or file a report against their partner. It’s important to be aware of the signs of domestic violence to ensure that both you and your loved ones aren’t in an abusive relationship.

If you or someone you know experiences the following signs of domestic violence, contact authorities immediately.

1. Frequent injuries, such as unexplained bruises, cuts, cigarette burns, etc. The injuries are often explained as an accident.

2. Loss of self worth and lowered self esteem

3. Depression

4. Increased anxiety

5. Anxiousness when communicating with a significant other

What to do about Domestic Violence

If you suspect a loved one is in an abusive relationship, first bring the issue up to them. Ask direct, closed-ended questions to avoid them making excuses. If you’re in an abusive relationship and feel that you are in immediate danger, contact law enforcement. There are also many support networks, including:

Breast Cancer Awareness Month

October is Breast Cancer Awareness Month.

Breast cancer is the most common cancer among American women.

In 2013, an estimated 232,340 women will be diagnosed with invasive breast cancer, while 64,640 will be diagnosed with non-invasive breast cancer. With early detection and treatment, women can fight back against breast cancer.

Diagnosed with Breast Cancer?

Here Are Your Treatment Options:

  • Breast-conserving surgery and radiation therapy. An operation to remove the breast cancer, but not the breast itself.
  • Total mastectomy. The entire breast is removed. Many celebrities, including Angelina Jolie, Christina Applegate, Kathy Bates and Sharon Osbourne, have spoken out about their choice to receive a double mastectomy.

You Are Not Alone in Your Fight Against Breast Cancer!

Receiving a diagnosis of breast cancer can be overwhelming. Hearing the perspective of others who have survived cancer can give you a better perspective on treatment and survival.
Here are a few quotes from famous faces who won the battle against breast cancer:

  • “Having had cancer, one important thing to know is you’re still the same person at the end…most people come out the other end feeling more like themselves than ever before.” -Kylie Minogue
  • “I look at my cancer journey as a gift: It made me slow down and realize the important things in life and taught me to not sweat the small stuff.” – Olivia Newton-John
  • “Cancer gave me the gift of being fearless.”- Today show co-host Hoda Kotb
  • “I was diagnosed with breast cancer two months ago and am recovering from a double mastectomy. I don’t miss my breasts as much as I miss Harry’s Law.” – Kathy Bates

What Can I Do To Show My Support in the Fight Against Breast Cancer?

“With over 3 million women battling breast cancer today, everywhere you turn there is a mother, daughter, sister, or friend who has been affected by breast cancer.” -Betsey Johnson

Even if you don’t suffer from breast cancer, you most likely know someone who is. Show your support by:

  • Donating to charities
  • Participating in walks and races that give proceeds to breast cancer foundations. Some of the most popular races include the Race for the Cure, Three-Day Walk for Breast Cancer and “Tour De Pink.”

Do your part in the fight against breast cancer!


Intimate Partner Violence Month – October, 2014

October is Domestic Violence Awareness month.

What is Domestic Violence?

Domestic Violence is also called Intimate Partner Violence (IPV) because it occurs between two people in an intimate relationship, like a girlfriend, boyfriend, husband or wife. IPV includes physical violence and sexual violence, or the threat of either of these. IPV also can be emotional abuse involving control or power of one person over another. It can result in physical and emotional pain and injuries and sometimes, even death.

Victims of IPV

In this country, nearly 20 people every minute are victims of physical violence from an intimate partner. Women are most often the victims, and young women ages 18-24 are most likely to be victims. IPV affects men also: One in four men have experienced physical violence by a partner in their lifetime. The fact is, most of these crimes go unreported.

Effects of Domestic Violence/IPV

Domestic violence has far reaching effects. Direct victims of domestic violence are more likely to suffer physically and emotionally and often have depression and/or social isolation. Children who witness domestic violence in their homes may have more physical health problems and emotional distress. Boys who grow up witnessing domestic violence in their homes are more likely to become abusers themselves and girls who are exposed to IPV are more likely to be victims themselves as teens and adults.

How to get help

If you or someone you know is suffering from intimate partner abuse, you are not alone!

Call the National Domestic Violence Hotline for help: 800-799-7233 or visit

5 Tips for Healthy Aging

healthy aging tips

People are living longer than ever thanks to medical improvements. Even though we now have access to the best medical care and medical treatments for a range of diseases, it’s still important to focus on living healthy as you age.

1. Focus on a healthy, well-balanced diet.

Focus on eating a diet that includes fruits, vegetables, whole grains and fiber is most important. It’s also important to avoid foods high in cholesterol and saturated fats.

2. Visit your doctor regularly.

Routine checkups with your doctor can help catch problems early on. A physician will also be able to tell you what exams and check ups you’ll need to be getting, such as blood work to test cholesterol, mammograms and colonoscopies.

3. Be physically active.

Incorporating at least 30 minutes of activity into your day will help reduce your chance of stroke, heart attack and other diseases. Make sure you choose activities that don’t strain your joints too much, such as walking, yoga classes or light bike rides.

4. Avoid overdoing alcoholic drinks.

It’s especially important to focus on drinking in moderation as you age. For men and women over the age of 65, one drink is considered healthy.

5. Focus on proper skin care.

Because your skin becomes even more sensitive with age, it’s important to use at least SPF 15 any time you will be exposed to the outdoors.

Consult your physician for more information on health aging.