16 Important Health Tips for Olympics Travelers to China

By Jeffrey Band, MD, FACP, FIDSA

Less than two months remain before the 2008 Beijing Olympic and Paralympic Games. It is estimated that up to 2.5 million visitors are expected to attend the August 8 – 24 games. The following health and safety tips to ensure safe travels are offered by Dr. Jeffrey Band, medical director of the InterHealth Travel Medicine Program at Beaumont Hospital in Royal Oak, Michigan.

1. Travelers should make certain they have had a recent medical and dental exam, especially if pre-existing conditions exist. A copy of one’s medical profile listing medical conditions, allergies, medications and special needs should be carried at all times.

2. Bring an adequate supply of all prescriptions (carefully labeled) and other medications. Pack medications in carryon bags only.

3. Take an extra pair of prescription eye glasses or lens prescription, hearing-aid batteries and other important personal items.

4. Make certain vaccinations are up-to-date.

• A tetanus-diphtheria booster is recommended for everyone every 10 yrs.

• A polio booster may be needed unless previously vaccinated.

• Measles is quite active in China. All travelers should be immune to measles, mumps and rubella. If not, a vaccine called MMR will be needed.

• If you have not had chickenpox, vaccination should be provided.

5. Travelers to China should best receive protection against both hepatitis A and typhoid (infections that besides being passed person-to-person, can be foodborne).

6. Travelers should not drink the tap water or use ice. All water for drinking, brushing teeth, and making ice cubes should be bottled water or purified by boiling first. Milk and dairy products should not be considered safe. All meat, poultry, seafood, and vegetables must be cooked well and served hot. Fruits with intact skin should be peeled by you. Salads and cold buffets should best be avoided.

7. Intestinal upsets: travelers to China may experience diarrhea. Take antidiarrheal medications with you on the trip. If one develops mild diarrhea, take Pepto-Bismol tablets as directed. If diarrhea continues but is not associated with vomiting, severe cramps or high fevers (> 101º F), add the antidiarrheal medication Imodium to the Pepto-Bismol. If diarrhea persists for more than 8 to 12 hours, a prescription antibiotic may be warranted. This should be discussed with the travel medicine specialist and filled before traveling. If illness persists or if high fevers are present, seek medical advice (the United States Embassy can be contacted for assistance).

8. Precautions against insects: mosquitoes and other insects can transmit a number of diseases. To protect against insect bites, especially when in the desert or in rural areas, use a repellent containing 28 – 35% diethyltoluamide (DEET). Also, consider wearing long-sleeved shirts and pants at dusk or at other times insects are more likely to be prevalent.

9. Sunburn protection: use a sun block to provide maximum protection. Wear a hat in hot, sunny areas.

10. Footwear: wear appropriate footwear at all times to prevent both injuries and infection.

11. Jet lag can be largely prevented by resting before travel, avoiding heavy meals en route, limiting alcohol while flying and by selective use of sleep medications.

12. Don’t forget to take antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol with you.

13. If you are extending your travels to rural areas, medication to prevent malaria may be needed. Discuss this with your travel medicine physician.

14. Bird flu (avian influenza) is a viral infection that usually affects birds but rarely people. People catch bird flu from touching sick or dead birds, and rarely by visiting “wet” markets where recently killed birds are on display. Only three cases have occurred in China in 2008. If visiting a “wet” market stay approximately 6 – 12 feet from the birds themselves. Wash your hands after the visit and do not consume undercooked poultry.

15. Air pollution can worsen breathing problems. If you have asthma, allergies or lung problems, discuss this with your primary care provider and travel medicine physician.

16. Be careful. Don’t drink and drive, wear seatbelts at all times and stay alert in crowds. Avoid political protests and rallies. These recommendations are only intended as general guidelines. They should not be regarded as a substitute for consultation with a travel medicine specialist.

China is a vibrant and beautiful country with wonderful sites to visit and friendly people. The 2008 Olympics will be exciting… let the games begin!

Dr. Jeffrey Band is the director of the Division of Infectious Disease and International Medicine, and Corporate Epidemiologists at Beaumont Hospital in Royal Oak, MI. He is a Clinical Professor of Medicine, Wayne State University School of Medicine.

Beaumont’s WISH: Cutting Edge Care for Women

Women’s health is no longer just about periods, pregnancy and menopause. A greater awareness and understanding of additional nebulous or unspoken conditions are garnering more attention and research dollars from those dedicated to understanding and improving women’s health. One such subspecialty of women’s medicine involves investigating the causes, effects and care of diseases that affect the pelvis.

At Beaumont Hospital in Royal Oak, a new and highly unique program called the WISH program, is dedicated to seeing and treating women of all ages who suffer from chronic pelvic pain, discomfort during intercourse and a host of other symptoms that are attributed to this class of disorders.

Donna Carrico, a licensed nurse practitioner, presides over the WISH program. It is by no coincidence that the acronym of the program, which represents Women’s Initiative for pelvic pain, and Sexual Health also holds additional meaning for the women that come to seek treatment from the program itself.

“Most women by the time they see me have met with four or five other health specialists so they truly have a ‘wish’ to feel better,” says Carrico.

The Conditions

The majority of women who come to the WISH program are between the ages of 18 and 65 but, there also women who fall above or below these ranges who receive care and treatment under the guidance of Carrico. Once doctors have ruled out diseases like endometriosis or ovarian cysts, they are often referred to the WISH program.

The most common conditions that Carrico treats are painful bladder syndrome (PBS), chronic pelvic pain and vulvodynia. Painful bladder syndrome is also referred to as interstitial cystitis, a name for which it was previously called. There is no cure yet for these conditions but there are treatments that can help to alleviate some of the condition’s pain and symptoms.

Chronic pelvic pain is pain that primarily affects adult white women and includes pain that lingers for more than six months. It’s symptoms include involuntary contractions of pelvic muscles, burning, itching, irregular and painful periods and possible low back or abdominal pain. The emotional symptoms like anxiety and depression must be included too in the understanding and treatment of this disorder. It is estimated to affect approximately 1 in 7 women in the U.S.

According to The International Society for the Study of Vulvar Disease, vulvodynia is chronic vulvar discomfort characterized by perineal burning, stinging, irritation, or rawness. Pain during intercourse and a heightened sensitivity to clothing or touch are also hallmark symptoms. Since its diagnosis is relatively new, data on its prevalence and incidence cannot be accurately estimated.

Painful bladder syndrome involves discomfort in the bladder and surrounding pelvic region. Symptoms include the urgent and frequent need to urinate, painful periods and discomfort during intercourse. Researchers are beginning to investigate the possibility of a hereditary component to PBS and the presence of a particular substance in the urine that blocks the normal growth of cells that line the inside wall of the bladder. It is estimated that 90 percent of the 700,000 Americans living with painful bladder syndrome are women.

Care

Currently, Beaumont’s WISH program is the only one of its kind in Michigan and one of just a few throughout the entire country. Given its specialized focus, Carrico sees women who travel from other states in addition to those local to the Detroit area. In order to accommodate their travels, Carrico does as much as she can with them during their appointments.

“I’ll create a plan-of-care that includes an arsenal of tools including educational resources so that they don’t have to continue coming back for follow-up visits,” says Carrico.

Most women who make an appointment will first receive a comprehensive questionnaire that chronicles their complete medical history starting from birth. Carrico requests that the woman complete the questionnaire in the privacy of her own home since it is so involved and thorough. Once the questionnaire is complete, Carrico’s initial exam and consultation takes between 90 minutes to two hours.

This generous amount of time that can be spent with each patient is in part due to its funding source. The WISH program receives its funding from the Ministrelli Program for Urology and Education. The need for the WISH program was recognized when the urology department at Beaumont began to see large numbers of female patients with pelvic disorders. It soon became apparent that a more advanced and specialized team of practitioners was needed to provide care and treatment to women affected by these conditions.

The Cause

The causes for these conditions continue to baffle medical professionals. But during Carrico’s thorough questionnaire, she noticed that half of her patients had experienced some sort of sexual abuse in their lives. Now she encourages all medical professionals who see pelvic disorder cases to routinely screen for a history of sexual abuse. She also has a team of psychologists that the individual can work with if they would like additional support in processing the trauma of the abuse.

Since it is such a unique and specialized program, clinical research trials are routinely conducted under the directorship of Carrico. Her findings, including those on sexual abuse, have been presented at conferences around the country and published in many prominent medical urology journals.

Treatment

During the consultation, Carrico works with each patient to create a treatment plan that is individualized to not just the woman’s condition but also her lifestyle and treatment choices. For instance, some women prefer to start out by taking medication while others prefer to adopt alternative treatment modalities like acupuncture, which has shown to reduce pain and discomfort and many of the pelvis conditions. Other treatments include physical therapy, which is conducted by a pelvic floor physical therapist that works exclusively with women who experience pelvic pain.

The WISH program also relies on guided imagery techniques to help the woman relieve pain. Studies suggest that guided imagery or visualization techniques can help individuals respond to chronic pain with less reaction and improved coping skills. The program has created a guided imagery CD that is available to anyone who has vulvodynia or painful bladder syndrome.

Diet and lifestyle modifications and other at-home treatments can also comprise the components of the plan that Carrico outlines for each patient.

Looking Ahead

In the future, Carrico would love to see the WISH program expand so that all areas of care are available to the patient in one setting.

“Our goal is to create a center where clinicians, physical therapists, psychologists, and acupuncturists are on hand to provide care to each patient,” says Carrico.

If you, or someone you know, is living with pelvic disorders encourage them to seek help at a programs such as WISH.

A Better Way to Beat Breast Cancer

With Dr. Frank Vicini, MD

A diagnosis of breast cancer can be devastating to any woman; unfortunately the treatment and its aftermath can be just as devastating. That story could all be changing with research that is being done around the country and being led by a team right here in the Detroit area. Dr. Frank Vicini and the oncologists and surgeons at Beaumont Hospital have been leading a study into Accelerated Partial Breast Irradiation (APBI) therapy. While this procedure has been utilized around the world since 1992, it was only in 2005, that a randomized, multi-center study was launched under the auspices of the National Cancer Institute and National Surgical Adjuvant Breast and Bowel Project. The study is looking at women with early-stage breast cancer who have a lumpectomy followed by radiation therapy. Originally envisioned to be a study involving 3000 women, it has recently been expanded to 4300. The women are randomized to have either the standard regimen of six and a half weeks of full breast irradiation therapy or partial-breast irradiation therapy twice a day for five days. The study is expected to be completed by 2009.

What does this mean for women with early-stage breast cancer? In the past, women often had to struggle to fit their radiation therapy into their lives since it is every day, Monday through Friday for almost two months. Women who live far away from their treatment centers or who are older and have trouble transporting themselves to their treatment center have often had to choose to have mastectomy rather than the breast-saving lumpectomy procedure. They may also choose to have a lumpectomy without the following radiation therapy which could allow the cancer to return. By being able to shorten the course of radiation therapy to five days, more women may be able to have the lumpectomy with radiation therapy and therefore have the best chance of staying cancer-free. Hopefully the study will also show that the shorter duration therapy is associated with fewer side effects. Preliminary research has shown that partial breast radiation over five days works as well as whole breast radiation for cancer control but these studies involved a smaller number of women. This new study will help to make the five day regimen the standard of care for early-stage breast cancer.

“The medical community has known for some time that radiation administered to the entire breast has its primary effect at or near where the tumor was,” says Dr. Vicini, a radiation oncologist at William Beaumont Hospital in Royal Oak and the principal investigator for the study. “That is what leads us to believe that it may not be necessary to treat the whole breast in certain patients.” Radiation damages the cancer cells and since they are unable to repair the damage, they die and are removed by the body. Healthy tissue that is irradiated is able to repair itself.

Current standard of care for early-stage breast cancer involves either a mastectomy to remove the entire breast which has the cancer, or a lumpectomy with whole breast irradiation plus possible chemotherapy. Whole breast irradiation can have some serious side effects for the healthy breast tissue as well as adjacent organs and tissues. Under this new regimen, patients would undergo a lumpectomy followed by partial breast irradiation plus possible chemotherapy. The partial irradiation is administered one of two ways. The most common form of partial breast irradiation is called breast brachytherapy and involves using a catheter to insert a small balloon into the cavity where the cancer was located. For each session, the balloon is connected to a brachytherapy machine which directs a small radioactive seed into the balloon and is left in place for ten minutes. This irradiates only the tissue surrounding where the cancer was removed and has the greatest likelihood of still containing any remaining cancer cells. Another form of partial breast irradiation is called 3-Dimensional Conformal Partial Breast Radiotherapy and delivers very precise doses of radiation to specific areas of the breast, sparing surrounding normal tissue. The shorter course of treatment is made possible not only by specifically targeting the lumpectomy site, but by also increasing the radiation levels for each treatment. While each treatment involves more radiation, the partial breast procedures involve less overall radiation exposure.

While there still is no cure for breast cancer, advances are being made in its treatment right here in your backyard. With early detection and treatment over 80 percent of breast cancer patients are cancer free ten years after their diagnosis. If you are interested in participating in this study, contact Beaumont Hospital at 248-551-7695.

Dr. Frank Vicini is the Corporate Chief, Oncology, at Beaumont Hospitals and is board certified by the American Board of Radiation –Radiation Oncology. He is a graduate of Wayne State University and completed his residency in Radiation Oncology at Beaumont hospital followed by a fellowship at Harvard University Medical School. He has been in practice 22 years.