pain relievers

Acetaminophen or aspirin are safer alternatives to manage pain than relying on ones like ibuprofen and naproxen, which can increase the risk of heart attack or stroke. [© Monkey Business Images |]

The U.S. Food and Drug Administration (FDA) recently announced it is “strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs)­—including ibuprofen, naproxen, diclofenac, and celecoxib as well as others—increase the chance of heart attack or stroke. The risk of heart attack and stroke with NSAIDs, both of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of prescription drug labels.”

We knew that long-term use of NSAIDs increased the risk of heart disease and stroke, but this new study discovered that short-term use could also pose a significant threat. This warning is especially important for high-risk groups that include males over age 50, females over age 60 and those who have high-risk factors of developing coronary artery disease such as diabetes, high blood pressure, high cholesterol, smoking or obesity.

For my patients with diagnosed coronary artery disease, a stent, history of a heart attack or bypass surgery who are suffering from a headache, arthritis or backache, I recommend that they take NSAIDs for no more than a few days. If you are a high-risk cardiac patient, but have not had a cardiac event, you can take NSAIDs for a few weeks but no longer.

If you want to avoid the risks associated with NSAIDs, Tylenol (acetaminophen) or aspirin are safer alternatives to manage pain. If you have concerns, you should call your doctor to discuss your risk of taking NSAIDs versus the benefit they may have in treating your pain.

If you are taking NSAIDs and experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of your body or slurred speech, call 911.


According to the FDA, new prescription NSAID labels will be revised to reflect the following information:

  • The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID.
  • The risk may increase with longer use of the NSAID. The risk appears greater at higher doses.
  • It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
  • NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
  • In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
  • Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
  • There is an increased risk of heart failure with NSAID use.
Keith Freidman, M.D., is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.

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childhood diseases, measles, mumps

© smartview27 |

How you can avoid the outbreak of childhood diseases, and what to do if you develop one

As if the flu and Ebola weren’t enough to worry about, now we’re hearing increasing stories of outbreaks of childhood diseases among adults. Angelina Jolie misses the premier of her new film due to a case of chickenpox. NHL hockey players sit out games because they’re coming down with the mumps, along with approximately 1,100 other Americans in 2014. In California, there’s an outbreak of whooping cough, among kids and adults. There’s also a multi-state outbreak of measles, 102 cases in January alone, most linked to Disneyland. Most of the measles cases were among people who were not vaccinated. (Measles cases in 2014 were triple the number from the previous year.)

Even adults who were vaccinated against these diseases as kids are contracting them at record rates. So, what’s happening and why are adults becoming victim to diseases we thought only children could catch?

Waning immunity
People old enough to remember the days before vaccines for mumps, measles and chickenpox probably contracted these diseases when they were young, so they have natural immunity and will be unlikely to succumb to the maladies. But adults who were vaccinated as young children, and therefore didn’t contract the diseases, may become vulnerable again because immunity can fade over time.

If you are concerned that your immunity may be wearing off, ask your doctor about a blood test that checks for antibodies to see if you are still immune. This is especially important for people with chronic medical conditions or who do a lot of foreign travel. And be sure you are up to date on vaccinations the CDC recommends for adults: a booster shot every 10 years for tetanus, diphtheria and whooping cough, and an annual flu shot.

Lower vaccination rates for children
The best defense against childhood diseases is to have your children vaccinated. In some parts of the country, skepticism regarding the safety of vaccines has resulted in fewer children being vaccinated for chickenpox, measles, mumps and whooping cough. Among parents of kindergarten children in California, “personal belief exemptions” rose from 1.56 percent in 2007-08 up to 2.79 percent in 2012-13. With fewer children being vaccinated against these diseases, they are much more likely to spread from one person to another.

Childhood diseases that are affecting adults
Causes fatigue, irritability, itchy rash that progresses to raised red bumps and then blisters. Adults who get chicken pox are more likely to contract pneumonia, hepatitis or encephalitis. This virus can also resurface years later as shingles.

Treatment: Bed rest, lots of fluids, a fever-reducer and an antihistamine to relieve itching. Calamine lotion or an oatmeal bath may also relieve symptoms.

Whooping Cough
Causes violent coughing accompanied by a “whooping” sound, nasal discharge, fever, sore and watery eyes. Lips, tongue and nail beds may turn blue during coughing spells. It can last up to 10 weeks and can lead to pneumonia and other complications.

Treatment: Antibiotics, keeping warm, plenty of fluids and reducing stimuli that provoke coughing.

Causes a rash, fever, runny nose, conjunctivitis, cough, swollen lymph nodes and headache. It can have serious complications in adults and can be fatal for children and adults with compromised immune systems. Complications include ear infection, pneumonia, vomiting, diarrhea and encephalitis.

Treatment: Plenty of fluids, fever reducer and antibiotics if a secondary infection develops.

Causes discomfort and swelling of salivary glands in front of neck, difficulty chewing, fever, headache, muscle aches, tiredness and loss of appetite. In males it can cause pain and tenderness of testicles, and, on rare occasions, sterility.

Treatment: Bed rest and analgesics (acetaminophen, ibuprofen) for fever and pain and applying cold packs to the swollen and inflamed salivary gland region may reduce symptoms and pain.

Fifth Disease
Causes cold-like symptoms and bright red rash that spreads from the cheeks to trunk, arms and legs. There may also be fever, headache, sore throat, nausea or vomiting and diarrhea. It can be associated with persistent fevers and arthritis in adults.

Treatment: Plenty of fluids,­­­ fever reducer and antihistamine for itching.

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sneezing father and daughter

© Jedimaster |

The flu season started earlier than usual this year, and most states are reporting continued and widespread outbreaks. Here are some commonly asked questions answered by a Johns Hopkins infectious disease specialist.

Q. Is it true that the flu season is turning out to be more severe than expected this year?
A. The flu season started off earlier and stronger than in several previous years, and the Centers for Disease Control and Prevention (CDC) says state-by-state reports of flu cases, hospitalizations and deaths are elevated. But it is still too early to tell if there will be more flu cases than is typical in the United States this flu season, which runs from October until May. That said, influenza is widespread in most states, so everyone should take precautions to avoid getting the flu.

Q. If people become sick with flu symptoms, should they go to an emergency room?
A. The flu can make you feel pretty lousy, but the best thing to do is first consult your personal doctor or health care provider. If you don’t have one, visit a community health clinic. Your personal health care provider is best able to determine, based on your symptoms, age and medical history, whether you need specialized care in an emergency department or hospital setting. Emergency departments are primarily set up to address urgent and critical medical issues.

Q. The flu vaccine available this year isn’t very effective. Why?
Flu vaccines are developed in advance to protect against several strains of flu virus that epidemiologists who track worldwide flu virus outbreaks do their best to predict. Unfortunately, the strain infecting most people this season — known as H3N2 — mutated, something viruses often do. As a result, the vaccine available this season isn’t as effective as hoped in protecting against the H3N2 strain.

Q. Does that mean the vaccine is useless? Should people still get it?
A. The vaccine still has significant value. Definitely ask your doctor or health care provider for a flu shot, because even this late in the season, it may still offer some protection or moderate the flu if you get it. The CDC recommends that everyone 6 months or older get a flu shot every year because it is an effective way of boosting the immune system to fight circulating strains of flu virus. In addition, by protecting yourself, you may also help protect others who could be exposed if you don’t get a flu shot and come down with the flu.

Q. Other than a flu shot, what other steps can we take to keep from getting the flu?
A.Yes. Wash hands often or use alcohol-based hand gel, especially after shaking others’ hands or being around someone who has cold or flulike symptoms, such as high fever, cough and fatigue.

Q. Should people who have the flu take Tamiflu?
Antiviral drugs like Tamiflu are best and typically prescribed for those most at risk for serious flu complications, including the young, elderly, or those with other serious health conditions or compromised immune systems. Antivirals are only available by prescription and can’t be purchased over the counter. No one should take an antiviral unless a doctor specifically prescribes it. Most otherwise-healthy people can beat the flu by staying home and resting in bed, taking medicines to reduce fever and drinking plenty of water or other clear liquids to stay hydrated.

Q. What can health care workers do to keep themselves and patients healthy in flu season?
A. First and foremost, health care workers who have direct patient contact should get the flu vaccination. They also should practice good hand hygiene with frequent hand-washing or the application of sanitizing hand gel. Health care workers who feel sick with cold and flu symptoms should stay home and rest to avoid exposing patients to a flu or cold virus.

Lisa Maragakis, M.D., is an infectious disease expert and director of the Department of Hospital Epidemiology and Infection Control at The Johns Hopkins Hospital.

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end-of-year-donations nurse holding heart


‘Tis the season for giving

As vice president of development for the Howard Hospital Foundation (HHF), I am fortunate to get to witness firsthand the benefits of our community’s charitable donations to Howard County General Hospital.

From patients who have honored their caregiver with a donation; to the baker who hosted a cupcake event with Santa with proceeds benefiting the hospital; to a local neighbor who for the past two years has mailed a check for $25 every month to support his local hospital; to the child who donated new toys to the pediatric department; to the widow who memorialized the life of her husband with a gift; to the man who provided a $5 million donation to recognize the care his wife had received; and to the many this year who have included the hospital in their estate plans – we thank you all!.

It does not matter how big or small your donation may be, each gift is important to providing quality care and comfort to those served by HCGH. Whether you are donating as an individual, business or organization – you are helping us develop vital new programs and purchase state-of-the-art equipment that we need to continually improve patient care.

As you make your plans for your end-of-year donations, I ask that you please keep the hospital in mind. Howard County General Hospital relies on the philanthropic support of its community. Additionally, your end of the year generosity also may provide you with tax benefits.

On behalf of the Howard Hospital Foundation and Howard County General Hospital, I thank each of you for all of your generosity year round. Warm wishes to you and your family during this holiday season.

Sandy Harriman is the vice president of development of the Howard Hospital Foundation, the fundraising arm of Howard County General Hospital.

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Diagnosis and treatment for Seasonal Affective Disorder (SAD)

As Daylight Saving Time ended this past weekend, we experienced the “fall back,” shortening our hours of sunlight during the day. During this time of diminished daylight, some people suffer from what is called seasonal affective disorder (SAD). Learn more about SAD in the slideshow below. If you think you may be experiencing SAD symptoms, contact your primary care physician.


  • snowy landscape
    According to a Johns Hopkins study, SAD is a “mood disorder characterized by depression related to a certain season of the year – especially winter.” SAD is known to be caused by seasonal variations of light or decreased sunlight. [© Michal Bednarek |]
  • sun through window
    SAD peaks in December, January and February. During this time, many are seeing very limited, if any, daylight. Victims of SAD are typically adults between 18 and 30 years old and are more often women than men. [© Arman Zhenikeyev |]
  • According to the National Mental Health Disorders Association, approximately 10 to 20 percent of the U.S. suffers from mild SAD, and nearly five percent suffer from a more severe form. Geographically, SAD appears to be more common in people living far north or south of the equator. A person’s vulnerability is increased if they have a family history of SAD or other form of depression, or if they have clinical depression or bipolar disorder. [© Jperagine |]
  • sleepy employee
    Symptoms of SAD may include: Fatigue/low energy level/lethargy, increased daytime drowsines, increased appetite (often more for carbohydrates and sweets, resulting in weight gain), irritability/social problems, decreased sex drive, difficulty thinking clearly and/or diminished concentration. [© Ximagination |]
  • woman with doctor
    A diagnosis of SAD can be made after three consecutive winters of symptoms and complete remission of symptoms in the spring and summer months. [© Mauricio Jordan De Souza Coelho |]
  • bright sunlight
    The first line of treatment for SAD is light therapy, which is exposure to artificial light by sitting or working near a device called a light therapy box. This box mimics natural outdoor light by giving off a bright light that is thought to affect the brain chemicals linked to mood. Antidepressant medication and psychotherapy can reduce SAD symptoms either alone or in combination with light therapy. [© Halil I. Inci |]

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© Madartists |

© Madartists |

With all the news about infectious diseases, people may get the idea that the flu isn’t all that serious; but we need to remember that it can be a very dangerous—even fatal—illness, especially to the very young, the very old and the immune-compromised. It descends upon our local communities every year, causing a great deal of sickness and sometimes death. The Centers for Disease Control and Prevention (CDC) notes, “Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. During a regular flu season, about 90 percent of deaths occur in people 65 years and older.” But even healthy people can get very sick from the flu and spread it to others.

How should I prepare for the flu?
As with most illness, prevention is the best defense and the best form of prevention is the annual flu vaccine. The CDC recommends a yearly flu vaccine for everyone 6 months of age and older.

Influenza can be spread even before you have symptoms. Therefore, practicing good flu etiquette is always encouraged:

  • wash your hands often
  • try to stay away from people who are sick
  • stay home if you are sick
  • cover your cough with tissue or the inside of your elbow.

Is there any treatment for the flu?
If you get the flu, there are antiviral drugs that can make your symptoms milder and make you feel better sooner. They can also prevent serious flu-related complications, like pneumonia. However, sometimes a flu virus has changed in a way that makes antiviral drugs less effective, and the CDC conducts studies to determine which strains are becoming resistant. (Click for more information about antiviral drugs.)

What should I do if I get the flu?
If your illness is mild, stay home and avoid contact with other people. You should stay home for at least 24 hours after your fever is gone. However, if you have symptoms and are in a high-risk group, contact your doctor. See People at High Risk of Developing Flu–Related Complications. Your doctor may prescribe an antiviral drug.

What is the difference between the common cold and the flu?
In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness and dry cough are more common and intense. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections or hospitalizations. Special tests done within the first few days of illness can tell if a person has the flu.

When should I get the flu vaccine?
The flu season peak activity most commonly hits in the U.S. between December and February, however it can begin as early as October and continue until May. Since it takes about two weeks to develop antibodies after vaccination, it is a good idea to get vaccinated soon after the vaccine becomes available, usually in October, to ensure you are protected before the flu season starts.

Where can I get the flu vaccine?
Flu vaccines are offered at locations throughout the community: doctors’ offices, clinics, health departments, pharmacies, college health centers, employers and even some schools. Even if you don’t have a regular doctor or nurse, you can find a vaccination location by visiting the HealthMap Vaccine Finder.

How long does the flu vaccine protect from the flu?
Studies over several years show that the body’s immunity to influenza viruses (acquired through natural infection or by vaccination) declines over time. Older people and those with weakened immune systems might not generate the same amount of antibodies after vaccination, so it’s important to get a vaccine every season.

Can the vaccine provide protection even if the vaccine is not a “good” match?
Even if the virus and vaccine are not a “good match,” getting the vaccine can lessen the severity of your illness. Antibodies made in response to vaccination with one flu virus can sometimes provide protection against different but related viruses, although sometimes with reduced effectiveness.

Myths about the flu and flu vaccine:

  • You can get the flu from the flu vaccine.
    No, you cannot contract the flu from either the flu shot or the nasal spray, although you might have a mild fever, runny nose or sore arm that lasts only for a day or two.
  • The flu vaccine is more dangerous than the flu.
    No. Any flu infection can carry a risk of serious complications, hospitalization or death, even among otherwise healthy children and adults. Getting vaccinated is a much safer choice than risking illness.
  • Getting vaccinated twice provides more immunity.
    No. Studies have not shown any benefits for adults receiving more than one dose during an influenza season. Except for some children, only one dose is recommended.

Are there special concerns for vaccinating children?
Children between 6 months and 8 years may need two doses of flu vaccine to be fully protected. Your child’s health care professional can tell you whether your child needs two doses. Visit Children, the Flu, and the Flu Vaccine for more information.

Starting with this season, the CDC recommends use of the nasal spray vaccine (LAIV) for healthy children 2 through 8 years, because recent studies suggest that nasal spray is more effective than the flu shot for younger children. However, if the nasal spray vaccine is not immediately available and the flu shot is, your child should get the flu shot. Don’t delay vaccination to find the nasal spray flu vaccine. Visit Nasal Spray Flu Vaccine in Children 2 through 8 Years Old or the 2014-2015 MMWR Influenza Vaccine Recommendations. Children younger than 6 months are at higher risk of serious flu complications, but are too young to get a flu vaccine. If you live with or care for an infant younger than 6 months of age, you should get a flu vaccine to help protect them from flu. See Advice for Caregivers of Young Children for more information.

Emergency Warning Signs
Go to the Emergency Department if a child experiences the following symptoms:

  • Fast or difficult breathing
  • Bluish skin color
  • Not taking fluids
  • Not waking up
  • Fever with rash
  • Symptoms that improve but return with fever and worse cough.

For adults emergency signs include:

  • Difficult breathing and shortness of breath
  • Pain or pressure in chest or abdomen
  • Sudden dizziness or confusion
  • Persistent vomiting
  • Symptoms that lessen but return with fever and worse cough.

The bottom line is the flu vaccine is your best defense. More information about influenza vaccines is available at Preventing Seasonal Flu with Vaccination.

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