Is It Pertussis, Or Just A Cough?

My husband and I got a notification from the county health department this week. A student at my son’s high school was diagnosed with pertussis.

My first thought was that s/he must have not been vaccinated. But then I looked into the data and found that isn’t necessarily so.

What is Pertussis?

Pertussis, or whooping cough, is a childhood illness that starts with typical cold symptoms and progresses to a horrible spastic cough. It is very dangerous for small children and can be fatal. 13 children in the US died from pertussis in 2017.

As a bacterial infection, pertussis does respond to antibiotics but only if they are started BEFORE the typical whooping cough begins. Unfortunately, before the typical cough starts it looks just like a cold. This is one of the reasons we vaccinate against it – there is no other way to prevent the awful, potentially fatal cough.

In case you are thinking “Oh, it’s just a cough,” here’s a video of a baby girl in the ICU with pertussis. And here’s a video of a 64-year-old man hospitalized with pertussis.

What about the vaccine?

I know you’re going to say “But Dr. Jen, if there’s a good vaccine available how does this happen?” The problem with the vaccine is that the immunity decreases over time. (The immunity you get from having whooping cough itself also appears to decrease over time, which is a scary thought.)

No vaccine is 100% effective, but the current vaccine is pretty good. Immunity is estimated at 80-90% over the first year and starting to wane about 4 years after vaccination. The pertussis vaccine was changed from whole-cell to acellular (no cells) in the 1990s because the whole cell vaccine had a lot of side effects. However, the new acellular vaccine is not as effective.

It is recommended that TDaP (tetanus, diphtheria and acellular pertussis) vaccine booster doses be given every 5-10 years. Unfortunately it is not indicated for adults over 65. Pregnant women and those who spend time with babies and small children should be particularly careful to get booster doses regularly.

Bottom Line

Even though the pertussis vaccine isn’t perfect it still does a nice job of reducing the risk of whooping cough in the US. According to the CDC, in 2015 there were about 20,000 cases of pertussis in the US and 6 deaths between 2014 and 2015. Worldwide it is estimated that there were 24 million cases of whooping cough and over 160,000 deaths in 2015. Most of these cases occurred in developing countries where vaccination coverage is low.

Community vaccination decreases the risk that someone will be exposed to pertussis. Personal vaccination decreases the risk that, if exposed, an individual will get sick. Because the most vulnerable individuals are babies under the age of 1 year (too young to be fully vaccinated) it is important that all of us get regular boosters.

We live in a country that vaccinates, and we all benefit from that. We all should roll up our sleeves and get vaccinated to protect our precious, vulnerable babies from pertussis.

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Merry Christmas!

My family and I are traveling this Christmas, but I wanted to take a moment to write to you. I’m hoping you have a wonderful, peaceful holiday with your loved ones!

I’ve been reminded of a few things today:

  • Traveling makes you crabby sometimes
  • People do crazy things when driving in construction traffic
  • North Carolina has even more orange barrels than Ohio
  • When you’re 6’4″ you don’t fit on a pull-out couch anymore
  • Eating sushi while driving is not recommended

However, I also was reminded that traveling with my favorite people in the world to see my OTHER favorite people in the world is really a lot of fun 🙂

God bless you and bring you a bring you plenty of joy this holiday season <3

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Menopause Symptoms And Quality of Life

Women who have reached menopause often feel as though they’ve traded one problem for another.  Sure, you don’t have to deal with the hassle of menstrual periods and worry about pregnancy anymore.  The hot flushes, night sweats, sleep problems, mood swings and vaginal dryness are not much improvement though.

Ask women who have menopause symptoms what their least favorite part is.  They will say the hot flushes and sweats at random times of the day and night.  They will tell you about the poor sleep and emotional roller-coaster.  They often WON’T tell you they have vaginal dryness and intolerable itching and loss of urinary control.  They usually won’t tell you they can’t tolerate intercourse with their partner anymore.

A lot of times they don’t tell ME that either.  I ask every woman at her physical about these symptoms if she is heading into menopause.  Women are embarrassed to discuss those parts of their bodies, even with their doctor.

There was a research study published recently in Menopause that asked women with menopause symptoms specifically about vaginal, vulvar and urinary symptoms.  Women who had had no menstrual period for at least a year were asked to fill out a questionnaire, and then had a gynecological exam.

Over 90% of the women were found to have vulvovaginal atrophy.  After the ovaries stop making estrogen at menopause, the skin and other tissues around the vagina and urethra become thinner, dryer and more fragile.  This is called atrophy and is often responsible for the itching, irritation and pain with sex that many women experience.

Many women know about hormone replacement therapy for menopausal symptoms and often refuse to take it.  Not as many women know that there are safer alternatives for vulvovaginal atrophy.  I usually recommend women try over-the-counter DHEA cream which they can get at the health food store or online.  One of my patients told me she tried Julva cream which she bought online and it helped a lot.  (Not an affiliate and I have no personal experience with it, just passing along a report from a happy patient.)

Topical estrogen cream is also very effective and is safe to use even in women who have had estrogen-sensitive breast cancer.  This is a prescription and usually requires an exam to make sure the diagnosis is right.  Many things other than vulvovaginal atrophy cause itching in pain (including infections and some skin conditions).

If you or a woman you love is suffering with itching, pain and/or urinary symptoms after menopause please don’t suffer in silence.  See the doctor and discuss your symptoms so you can get treatment.  Treatment works!

QUESTION:  Have you had problems with menopausal vaginal symptoms?  How has it affected your life?

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DON’T Exercise For Weight Loss!

Everybody promotes the benefits of exercise for weight loss.  And yes, becoming more active is one of the best ways to increase your day’s calorie expenditure if your goal is weight loss.  However, is weight loss a good motivator for getting someone moving?

Turns out, it’s not.  In fact, it’s one of the WORST motivators.  People who said their reason for getting active was to lose weight were LEAST likely to exercise consistently.

What motivates someone to lose weight?  The most common reason is to obtain someone ELSE’s approval.  You might want to look better in a swimsuit or put a spark back in your marriage, or bring your cholesterol test results or blood sugars under better control.  The sad truth is that weight loss is usually motivated by outside factors rather than by a true and pure desire to slim down.

So if weight loss isn’t a good motivator for exercise, what is?  Here are some suggestions:

1.  Pure enjoyment.  I take care of quite a few runners.  I am a runner myself.  I don’t run to lose or maintain weight (although it is a nice side benefit) but just because I love running.  Runners will run until their toenails fall off altogether.  (Unfortunately I have a case of plantar fasciitis right now that is keeping me from running.)

Those who love tennis will play through excruciating elbow pain.  Those who love martial arts or boxing will suffer all kinds of trauma.  Family doctors are well accustomed to having to put the kibosh on our crazy sports-injured patients’ plans to do further harm to themselves in their love of their sport.  We just do it because we love it!

2.  “Me” time.  So maybe there isn’t an exercise that you love like the fitness fanatics in #1 above.  There are ways to make your exercise a getaway as well.  For instance, I have taken to watching movies and TV shows on Netflix while I’m on the treadmill.  With my busy life, this is the ONLY time I get to watch any TV or movies.  So on those crazy days when you’re just too tired to climb on the stationary bike or treadmill, you can bribe yourself also with a good movie or TV show.

3. “Us” time.  If you have a workout buddy it’s hard to back out of a workout date.  Call a good friend and ask him or her if they would like to set up a regular time for a brisk walk or a fitness class.  Tell your buddy you could use a spotter for some extra-heavy sets.  Try a new form of exercise with your spouse.  My husband and I have practiced martial arts for years and now our boys do too.  Making it a family affair keeps us engaged and showing up even on days when ONE of us really doesn’t feel like going.

4. Health benefits.  Your body works better when you’re active.  Your digestion moves along better and you’ll have less problem with constipation.  Natural endorphins are released which relieve stress, anxiety and depression.  Sleep quality improves with exercise.  Lung function improves which means you’ll huff and puff less when chasing the kids and grandkids.

There are so many good reasons to get active and fit, you’re not limited to the promise of weight loss!  What will get you to the gym or motivate you to lace up your sneakers after a long day at work, when all you want to do is park yourself on the couch in front of the TV?  Be creative and find something you truly love!  If all else fails, create an irresistible incentive that will get you moving.

Guess what!  You’ll probably lose weight too 🙂

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What Is Acute Flaccid Myelitis?

It’s a parent’s nightmare.  Your perfectly healthy child comes down with a bad cold.  While they’re miserable for a few days they get better as expected.  Then shortly after the cough and snot are gone, your child gets sick again.  Suddenly your child loses the ability to walk because their legs become very weak.

Since 2014 there has been a new, rare and severe neurological condition reported mostly in children called acute flaccid myelitis (AFM).  This illness can result in permanent paralysis and the cause is not known.

Acute flaccid myelitis behaves almost exactly like polio but it is NOT caused by the poliovirus.  Doctors have checked and none of the patients have had poliovirus in their bodies.  However, almost all of the patients have had a fever or mild respiratory illness before the weakness started.  Most of the cases occur in the late summer and early fall, when the class of viruses that includes polio, enteroviruses, are most common.

AFM causes the sudden onset of weakness in one or more limbs.  Usually one side of the body is more seriously affected than the other.  There is usually no numbness or loss of sensation in the limb(s) although there may be associated pain.

Patients may also have trouble swallowing, weakness or drooping on one side of the face, double vision, problems speaking, and in severe cases trouble breathing.  If you or your child develops these sort of symptoms it is important to get care right away because treatment can be lifesaving.  Even though the cause isn’t known, prompt diagnosis and treatment are critical.

Other illnesses can behave like acute flaccid myelitis.  A stroke, West Nile Virus, Guillain-Barre syndrome and some other infections are on the list.

It’s estimated that one to two in a million children in the US will get AFM per year.  That’s REALLY rare, but very serious.  Parents need to know that if their child seems lethargic or has any weakness at all, they should seek care immediately.

QUESTION: Have you heard of acute flaccid myelitis?

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