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Dr Bob's Medical Newsletter Oct. 2004



Hi <>

Medical-News-For-You

Hi It's Dr Bob with your latest and up to date newsletter.

Volume 1 # 4

------------Topics-----------

#1 FLu Shortage: Why and What You Should Do
#2 Sports Injury The ACL Blow Out
#3 Concussions: Know The Facts For Your Athletes
#4 Dieting? Here Are Some 100 Calorie Snacks

--------------------------------------------------------------------------------

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Flu Vaccine Shortage:

By now everyone has heard about the shortage of the vaccine. Chiron is the producer which has caused the short fall. Initially it was expected that the closure of the production plant only affected 6-8 million doses. But the reality is the regulators has suspended Chiron license to manufacture any vaccine. Now the effect is on 48 million doses that were destined for the U.S. And the other manufacturer cannot make up the difference.

Last month I outlined the recommendations of who should receive the vaccine but now with the shortage they need to be given only to those at high risk. These include: 1.those adults over 65 yr old
2. pregnant women
3. children with chronic diseases like asthma, diabetes, or heart failure or chronic kidney disease
4. adults and children who's immunity is diminished, such as those who are undergoing chemotherapy or on steroids
5. HIV positive individuals

Dr Bob's Take: I urge those who are at high risk to not hesitate and get your vaccine. This is serious and a real shortage.

School Sports Be watchful of these

Anterior Cruciate Ligament (ACL or Blown Knee)

One of the most frequent serious injuries to young athletes is a complete tear of the ACL. The ACL is a tough fibrous band that crosses the knee joint and holds it in place. This injury is seen in sports like soccer or basketball or other sports where there is sudden stopping and twisting to change direction.

It is seen primarily in girls and the reason for the gender difference is not known. Some experts think the difference is in the muscle development as it generally occurs when the girls are going through a growth spurt.

A recent study by a Sweedish Dr Lohmander on 103 females showed that these athletes developed osteoarthritis at a young age. The 103 athletes had ACL tears while in high school or college and were studied again about age 31.

The osteoarthritis was diagnosed by x-ray and caused the ladies pain and some difficulty with daily activities. Typically this occurs in most adults after decades of wear and tear and after the ages of 50- 70.

It is felt by some experts that 50% of these ladies will need knee replacements much earlier than a person who has normal onset of osteoarthritis. The problem with that is knee replacements last about 10- 15 years and some of these ladies will need 2 or 3 of them.

Dr. Bob's Take: Although this study is not surprising the extent of the disability is. I would recommend that your high school athletes do exercises to build up there quads.

Concussion On The Sports Field, What You Need To Know!

I am basing this report on definitions and guidelines from the American Academy of Neurology. These guidelines should be well known by the coaches, athletic directors and trainers.

There are 3 grades of concussion, if you are going to have any grade 1 is the best and grade 3 is the worst. A concussion does not mean that an athlete or anyone has to have any loss of consciousness. This is not necessary for grades 1 and 2. Confusion is the key factor to be assessed. Is the athlete forgetting plays or is mildly disoriented, does not know the name of the team they are playing, or the period


they are in.

Here are the guidelines that need to be followed. grade 1st concussion 2nd concussion
grade 1: transient confusion, no loss of consciousness or mental status abnormalities on exam. symptoms resolve in 15 minutes or less. return to play when asymptomatic for 1 minutes return to play when asymptomatic for 1 week. if 2nd during same game must not return to same activity that day.
grade 2, similar to grade 1 but the symptoms resolve in more than 15 minutes return to lay when asmptymatic for 1 week. return to play after 2 weeks of being asymptomatic.
grade 3, any loss of consciousness transport to hospital. return to play when asymptomatic for 1 week. if loss of consciousness > than a few seconds must be asymptomatic for 2 weeks. terminate for the season, discourage return to the sport.

Dr Bob's Take:As parents we need to remember that an athlete who suffers a concussion has up to 4 times the risk of getting another. Cumulative concussions may cause cognitive (learning) disabilities.

Holidays Seasons and Snacks

As much as I hate to admit it the holiday season is coming up real fast. With the holiday season it seems to me that our eating habits change as well. Yes, some of us have been or are on diets and a question that frequently comes up is "what about snacks?".

First off, we should not waste our times on "wasted calories". These are calories that are primarily made up of sugars including one called "high fructose". Look at the ingredient list if sugars are near the top of the list that means those ingredients make up the highest percentage of ingredients.

The good snacks should be balanced with fat making up less 33% and sugars are not near the top of the ingredients. Occasionally we all get urges for that "cookie". And it's ok to give in to these but do it sparingly. Eat a couple of cookies but not 4 or 5.

One hundred calorie snacks can really help you when you just need something to carry you over. This will not blow your diet. Here are some ways to estimate the size of portions when you are on the run.

The palm of your hand generally represents about 3 ounces. The last part of your thumb is about 1 tablespoon. The length of your forefinger equals to about ounce.

Here are some 100 calorie snacks for you to try:
half an apple and 2 tsp of peanut butter
an orange and a few dry roasted nuts
10 cashews
10 almonds
2 oz of lean roast beef
half a small avocado
3 oz of whole grained noodles, with 1 fresh tomato and 1/2 oz hard cheese
1 seven grain Belgian waffle
4 mini rice cakes with 2 tbsp of low fat cottage cheese
!/2 cup of frozen orange juice eaten as a sorbet
2 large graham cracker squares with 1 tsp of peanut butter
3 handfuls of unbuttered popcorn seasoned with herbs

Dr Bob's Take: with the holiday season fast approaching we need to be more careful not to over-indulge. These snacks provide a wonderful to way to satisfy our "hunger pains".

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