ZoomCare: Healthcare on Demand

Greetings,

Summer is here in full force, and we at ZoomCare are enjoying the changes that the season brings. In this issue, we are happy to provide (what we think is) useful information about your everyday health topics, from UTI's to bug repellants. To give you a better idea about some of the conditions we have been seeing recently, here's a list of our top 12 visits for June.

• Throat Infections
• Sinusitis
• Allergies
• Bladder Infections
• Bronchitis
• Skin Infections
• Diarrhea
• Ear Infections
• Eye Infections
• Sprains, Cuts, Bites
• Abscess
• Genital Infections

We hope you enjoy this issue of ZoomNews. Please let us know if there's a topic you'd like to see in future issues.

Till then, Be Well!

Sincerely,

David Sanders, MD
dsanders@zoomcare.com
&
Albert DiPiero, MD, MPH
adipiero@zoomcare.com

Bug Repellants

Keeping bites (and disease) at bay this summer season

Summer.

We wait all year, through the cold and wet for this magical season. Barbequing, swimming, camping, skydiving- it's now time for all those awesome outdoor activities we were dreaming of during the rain. This is great, except there is someone else who loves summer just as much as we do: bugs.

Lovely little creepy crawlies, who want nothing more than to snack on you and your family...

Which can put a kink into summer fun plans. So, unless you want to stay inside (or if you repel bugs naturally) here are some ways you can avoid being bitten this summer season.

First of all, you should be armed with knowledge:

• Mosquitoes bite usually during dawn and dusk, though they have been known to bite when disturbed during the day as well. Only the female mosquitoes bite, so that they can get more protein in order to lay eggs.
• Mosquitoes are naturally more attracted to some people, especially ones who smell sweet.

So, if you're looking to avoid some hungry mama mosquitoes one good precaution would be to avoid wearing perfume or cologne and don some special spray – eau de DEET.

It may sound scary, but DEET is nothing to be afraid of. The real threat is not the bug spray, but the potential diseases that bugs can carry. By now, most of us have heard of conditions such as:

• West Nile Virus (over 3,000 cases in 2006 in America)
• Encephalitis (swelling of the brain commonly caused by a bacterial infection)
• Lyme disease
• Dengue Fever
• Malaria

Just to name a few.

The CDC recommends:

DEET (N,N-diethyl-meta-toluamide)

This one is the granddaddy of repellants- developed by the US military in 1946, it has been used effectively by the civilian population since 1957. The general rule is that 30% DEET is an effective concentration that can repel insects for many hours without reapplication.

The label directions on DEET products will say you should apply it only once a day to exposed skin and outerwear — not under clothing. Under clothes, it can absorb into the skin more readily, and possibly cause irritation. DEET can also irritate the eyes.

This year, the American Academy of Pediatrics issued a statement saying that DEET is safe for children aged two months and older. Previously, the age limit was set at two years. The academy also raised the maximum DEET concentration in mosquito repellent for kids from 10% to 30%.

Permethrin has also been recommended as an effective insect repellent. In fact, this one kills ticks on contact. It is important to note that permethrin is for use on clothing, and NOT on skin.

Here's a great article courtesy of WebMD and Consumer Reports Magazine where some of the leading products are put to the test and rated against each other.

Experts agree that the chemical risks in using these products are considered much less than the threat of disease that some of these insects carry.

If better living through chemistry is not your style, there are many natural alternatives that you could try (though they don't fare as well in the comparison tests).

Some of these alternatives are:

• Citronella
• Lemon Eucalyptus Oil
• Geranium or Soybean Oil

If you are looking for a natural alternative, the best advice would be to reapply every hour or so, as these products have been proven to last a shorter time then their chemical counterparts.

If you'd like to learn more about natural alternatives and how they stack up, you can visit this article, courtesy of Altmedicine on About.com.

Now, you are armed with knowledge to keep you and your loved ones (bug) bite free this summer. If have been bitten by an insect (or anything else for that matter) and are experiencing unusual symptoms or reaction, come see us here at ZoomCare. We are here seven days a week, and our office is bug free!

As part of our commitment to growing deeper roots in the communities we serve, each month, ZoomCare gives a ZoomGrant of $250 to a local area non-profit.

Congratulations to July's winner:
The Tualatin School House Pantry!

If your organization would like to apply for a ZoomGrant, you can do so on our website. Or, click here.

In This Issue

Urinary Tract Infections:
Everything you never knew

Bug Repellants:
Because hatred alone won't keep you safe

ZoomGrant Winner:
Tualatin Food Pantry

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Ask your ZCP: UTI
(Urinary Tract Infection)

A 24 year old woman university student came in with symptoms of burning on urination, blood in the urine and having to go to the bathroom frequently. These symptoms developed suddenly over the previous 24 hours and felt like her past urine infections. She has had 3 such infections since the age of 20.

This young woman presents with a typical constellation of symptoms indicating a urine infection. Urine tract infections (UTI) are one of the most common acute conditions experienced by adult women. When we say urine infection here, we mean an infection in the urine that is limited to the urinary bladder. Up to 60% of women have at least one UTI during their lifetimes.

The classic symptoms of a UTI include pain or burning with urination, frequent need to urinate, the sensation of needing to urinate, pain in the lower abdomen and, blood in the urine. These symptoms can be bothersome to the point of limiting activity and preventing the patient from working.

Why do women get UTIs? The main cause appears to be a combination of microbiology, anatomy, and certain risk factors. First the microbiology and anatomy: a UTI can occur when bacteria from the gastrointestinal tract reach the urethra, which is the tube leading from the bladder to the outside world. Once the bacteria reach the urethra, they can climb up and establish an infection in the bladder. In women, the rectum is very close to the urethra, which makes it easier for normal fecal bacteria to get into the bladder.

No, it's not pretty. But that's nature. Finally, certain normal behaviors increase the chance that the bacteria reach the bladder. One of the most important risk factors is sexual intercourse. Especially in younger woman, the number of urine infections appears to increase with the number of sexual intercourse events per week. However, it is important to understand that UTIs are NOT a sexually transmitted disease transmitted through sexual contact. Instead UTIs are caused by the woman's normal fecal bacteria reaching her bladder. This process appears to be facilitated due to sexual intercourse.

Another situation or condition that increases the chance of getting a UTI includes the use of spermicide-containing contraceptives. These spermicides appear to alter the normal protection against infection in woman. Diabetes, immune deficiency conditions, and previous frequency of urine infections also increase the chance of further infections. Finally, some people are just more predisposed to getting urine infections, because of genetics and anatomy.

Here we are concentrating on women getting an UTI. Men too may get urine infections. But because of obvious differences in anatomy, the approach and treatment is somewhat different. We will discuss their situation in future ZoomNews editions. (Children and pregnant women also deserve separate consideration).

How do doctors diagnose UTI? UTI are diagnosed by a combination of interpreting the symptoms and performing a simple test. The main diagnostic approach is having a doctor assess the symptoms and perform an examination. Our patient above came in with the classic symptoms. But an astute doctor will remember that other conditions can cause similar symptoms.

Although UTIs are not alone dangerous they can lead to complications that can cause disability and even death. For that reason, if you experience symptoms like this, it could be that you have a urine infection, which should be evaluated and treated. The most common, serious immediate consequence of a urine infection is a kidney infection. This occurs when the infection in the urine of the bladder climbs up from the bladder and reaches the kidneys. Your doctor evaluates for this possibility even when you come in for a simple urine tract infection by asking about more serious symptoms, such as back pain, nausea, vomiting, high fever - that may indicate a kidney infection.

Simple urine tract infections are usually rapidly treated with oral antibiotics. In a woman with an uncomplicated UTI, a three-day course of an antibiotic is usually fully curative. The best options for a three-day course of antibiotic include, Trimethoprim-Sulfamethoxazole (Bactrim or Septra), or an antibiotic such as ciprofloxacin. The exact choice of an antibiotic will depend on patterns of antibiotic resistance in your area and the individual patient's condition and history.

With rapid diagnosis and effective treatment, the patient's symptoms started improving in one day and she was back to normal in three days. This is a very typical pattern. There are no complications or disabilities that occur due to a simple, acute urine infections in young woman like this. But some woman get frequent, recurring urine infections. What to do about these is a topic for future discussion.

- Dr. Albert DiPiero MD, MPH