This week I want to write about two subjects. The first affects all women, children and, of course, men. You all should get your flu shot for the 2012 – 2013 flu season. And now is the time to do it. There is no need to suffer with the debilitating fever/chills, cough, sore throat, headache, muscle aches (even your teeth seem to hurt) as well as fatigue and runny nose due to the most prevalent strains of influenza. And in some cases, especially women over 65, pregnant women, young children, individuals with chronic disease, and anyone with impaired immunity, flu can lead to pneumonia and even death! Thirty thousand Americans die yearly from the flu. In the past, we told you to make sure you were given your flu shot if you had a chronic disease, worked with children, had contact with babies, exposed adults or you were elderly or planned to get pregnant. Now the recommendation is that everyone over the age of 6 months get a flu shot.
And it is especially important for pregnant women. (Pregnancy decreases immunity to viral disease and if a pregnant women gets the flu she significantly endangers her health and that of her fetus). There are no contraindications to getting a flu shot during pregnancy, even in the first trimester. And remember, the flu shot you got last year will not protect you from the new strains of influenza that are coming to get you this year. It takes 2 weeks to build up the antibodies needed for your protection so the earlier you get your flu shot the sooner you will gain protection for the year to come.
We have the vaccine in our office… So if you would like to come, in my nurse, Judy, will be happy to give you your shot…and at the same time you can see our new office. (Which I must say looks great!) Or if you are due for an appointment in the next few weeks, we will be happy to give you your flu shot at that time. You can also get the influenza vaccine at most local pharmacies. Please just figure out the most convenient venue and take the time in the weeks to come to protect yourself and your family from the misery of influenza this year.
Now onto the second subject for this week’s newsletter: An interesting article from the American Journal of Gastoenterology caught my eye.. The Journal reported on a nationally representative survey of about 7800 people. Of these, one in 141 or 0.71% were found to have celiac disease or Sprue. This disease is a gastrointestinal disorder in which gluten, a protein found in wheat, rye and barley causes an immune response by damaging or destroying villi in the small intestine. Once those villi, which are small projections that increase the surface of the small intestine and allow for absorption of nutrients, are destroyed, malnutrition occurs. Celiac disease is thought to be genetic but can be triggered or become active after surgery, pregnancy, childbirth, viral infection or severe emotional stress.
The symptoms may be clearly gastrointestinal: bloating, abdominal pain, chronic diarrhea, vomiting and/or pale stool, but they also may be less digestive-tract-apparent: weight loss, anemia, fatigue, joint and bone pain, arthritis, osteoporosis, depression, anxiety and even gynecologic symptoms such as missed periods, infertility and miscarriage. Because of the vagueness of the many symptoms associated with celiac disease, diagnosis is often delayed by 1 to 2 decades. The authors of the article estimate that due to the vast under-appreciated disease burden, 83% of celiac disease cases in the USA remain undiagnosed. Diagnosis usually requires a blood test for specific antibodies: anti-tissue transglutaminase antibody (t TGA) and anti-endomysium antibody (EMA). If these are positive, an intestinal biopsy done via endoscopy will confirm the diagnosis by demonstrating the damaged villi.
This is not a test that is done routinely. But studies have shown that if an individual has celiac disease 4 to 12% of first-degree relatives will also have it.
So far, the only treatment for celiac disease is a strict and lifelong gluten-free diet, which involves avoiding foods containing wheat, rye and barley. The authors estimate that 1.6 million US citizens currently choose to abstain from gluten but many of them do not have celiac disease. (There was a cartoon in The New Yorker that showed 2 young people driving in a convertible. One said to the other “I don’t know what gluten is but I am staying away from it!”) And that is part of the issue; many individuals simply choose a gluten- free lifestyle for perceived health benefits. The authors of the article point out that more research is needed into the systemic effects of gluten abstinence in healthy people. It’s certainly not an easy diet to maintain.
Bottom-line: If you do have a first-degree family member who has been diagnosed with celiac disease, it might be worthwhile to request that the blood test be done. And if you have persistent symptoms included in those listed above, you might also request that your physician do appropriate antibody testing and if positive, discuss the results and your symptoms with a gastroenterologist.