Hepatitis B Virus (HBV)

The hepatitis B virus causes serious and sometimes fatal liver disease. Vaccination against HBV prevents infection and its complications. Efforts to immunize only people in high-risk groups (people with many sexual partners, intravenous drug users, infants born to women who have HBV, and health care workers) have not been effective in eliminating the disease.
It is now recommended that all infants be vaccinated against HEV. This will help eliminate hepatitis B as a public health problem in the future. Three shots provide long-term immunity. Immunization is also recommended for:
•    Adolescents who were not previously vaccinated, especially if they are at high risk.

Health care workers.
•    People planning extended travel
to China, Southeast Asia, and other areas where HBV infection rates are high.

HaemophiJus infJuenzae Type b (Hib)

Haemophilus influenzae type b does not cause the flu. It is a serious bacterial illness that causes meningitis and may lead to brain damage and death. Most serious Rib disease affects children between six months and one year of age. Every child between two months and five years should be immunized against Rib. Children over five and adults need immunizations only if they have sickle cell anemia or spleen problems.

Polio

Polio is a viral illness that leads to loss of mobility or even paralysis. It is rare today because of the effectiveness of polio vaccines. The first vaccine is given at age two months, and the series of immunizations gives lifelong immunity. An inactivated polio virus vaccine (injectable, IPV or Salk) is recommended for anyone whose immune system may be impaired due to illness or medications. Nonimmunized adults need immunization only if they have a high risk of polio exposure. The IPV vaccine is recommended for adults.

Measles, Mumps, and Rubella (MMR)
MMR is an immunization for measles, mumps, and rubella (German measles) (see page 167). Two shots (given at 15 months and 11 to 12 years of age) are recommended. If both doses are given, no further MMR immunization is needed.
If you have a 6- to 14-month-old child in an area with a measles outbreak, call your doctor or health department to discuss having an early MMR shot. If given early, the dose should be repeated at age 15 months for full protection. If you don’t have records showing that you received two doses of MMR vaccine, and you did not have these illnesses as a child, discuss your need for immunization with your doctor

Immunizations work by helping your immune system recognize and quickly attack diseases before they can cause problems. Some immunizations are given in a single shot while others require several shots over a period of time. Childhood immunizations protect against pertussis (whooping cough), polio, measles, mumps, rubella, haemophilus influenza, and hepatitis B. Immunizations also protect against tetanus and diphtheria, although booster shots are needed every 10 years to maintain lifelong protection.If your children are immunized, these serious illnesses will not be a problem. Schedule your child’s immunizations according to the chart There is no need to delay immunizations because of colds or other minor illnesses. Be sure to keep good records. Children often need to show immunization records at school.

Diphtheria, Pertussis, and Tetanus (OPT)

Infectious diseases like diphtheria and pertussis were major killers before the DPT vaccine was developed. This vaccine also protects against tetanus (”lockjaw”), a bacterial infection that can result when a wound is contaminated. The bacteria enter the body through cuts and thrive only in the absence of oxygen. So, the deeper and narrower the wound, the greater the possibility of tetanus. With proper immunization, these diseases are rare. Childhood immunizations for these diseases are given together with a series of shots starting at age two months. Follow the DPT guidelines. The first booster is given around age 15. After that, get a Td (tetanus and diphtheria) booster every 10 years. Keeping up to date with Td boosters is important because tetanus can be fatal. If it has been at least five years since your last shot, and you have a wound (especially a puncture wound) that is very dirty or that you suspect may be contaminated, get a Td booster. Otherwise there is no need for more frequent vaccinations because this increases the risk of an uncomfortable local reaction.

Prevention works! You and your family can save a lot of pain, worry, and money by avoiding health problems in the first place. If you can’t prevent a problem altogether, the next best thing is to discover it early, when it is easy to treat. This chapter helps you do both.

Ten Ways to Stay Healthy

1. Immunize. Immunizations are the best bargain in health care. When you immunize, you prevent illness for your family and help prevent epidemics in your community.

2. Keep moving. Any way you define it, fitness is essential to good health. Even moderate exercise makes a huge difference both in how you feel and what illnesses you get. For a threepart fitness plan

3. Eat right. Eating a well-balanced, low-fat diet of wholesome foods will keep you energetic and free of many illnesses. See Chapter 17. Consider breast-feeding your baby to help keep him or her in the best health.

4. Control stress. Even with a hectic and hurried lifestyle, you can prevent stress from undermining your health. See page 250 for relaxation skills.

5. Be smoke-free. Smokers who quit gain tremendous health benefits. So do people who avoid second-hand smoke.

6. Avoid drugs and excess alcohol. When you say “no” to drugs and limit what you drink, you prevent accidents and illnesses and avoid a lot of problems for yourself and your family. For more on drug and alcohol problems.

7. Put safety first. Safety at home, at work, and at play, safe driving, firearm safety, and safe sex will all help keep you healthy:

8. Pursue healthy pleasures. Take naps, relax during meals, play with kids, care for a pet-they all can add to your health.

9. Think well of yourself. A good self-image is the foundation of good health. For more on self-esteem and wellness, see page 283.

10. Promote peace. Peace on earth begins at home. Seek nonviolent ways of resolving conflicts at home, at school, at work, and in your community.

Use specialists for special problems. Specialists are doctors with in-depth training and experience in a particular area of medicine. For example, a cardiologist has years of special training to deal with heart problems. A visit to a specialist often costs more than a visit to your family doctor, and the tests and treatment you receive may be more expensive. Of course, specialists often provide the information you need to decide what to do about a major health

When your primary doctor refers you to a specialist, a little preparation and good communication can help you get your money’s worth. Before you go see a specialist:

• Know the diagnosis or suspected diagnosis.

• Learn about your basic treatment options.

• Know what your family doctor would like the specialist to do (take over the case, confirm the diagnosis, conduct tests, etc.).

• Make sure that any test results or records on your case are sent to the specialist.

s Ask your regular doctor to remain involved in your case. Ask the specialist to send new test results or recommendations to both you and your regular doctor.
7. Use emergency services wisely.

In life-threatening situations, modern emergency services are worth their weight in gold. However, emergency rooms charge two to three times more for routine services than a doctor’s office. Also, your records are not available, so emergency room doctors have no information on your medical
history.

Hospital emergency rooms are set up to handle trauma and life-threatening cases. They are not set up to care for routine illnesses, and they do not work on a first-come, first-served basis. During busy times, people with minor illnesses may wait for hours. Use good judgment in deciding when to use emergency medical services. Whenever you feel you can apply home treatment safely and wait to see your regular doctor, do so. However, if you feel that it is an emergency situation, by all means go to the emergency department.

Prepare for the emergency room:

•  Call ahead, if possible, to let them know you are coming.
•  Call your doctor, if possible. He or she may meet you at the ER or call in important information.
•  If there is time, take this book and your medical records with you:
•  Use page 1, the Healthwise Approach, to help you think through the problem and report symptoms to the doctor.
•  Use page 2, the Ask-the-DoctorChecklist, to organize questions for the doctor.
•  See page 8 to review the medical test checklist.
•  Use your home medical records to discuss your medications, past test results, or treatments. Information about your allergies, medications, and conditions may be critical.

•  As soon as you arrive, tell the emergency room staff why you think it is an emergency.

8 Use hospitals only when you need them. Over half of all health care costs are for hospitalizations. A stay in a modern hospital costs far more than a vacation at most luxury resorts. (And hospitals are a lot less fun.)

If you do need in-patient care, get in and out of the hospital as quickly as possible. This will reduce costs and your risk of hospital-acquired infections.

Don’t check in just for tests. Hospitalization is no longer needed for most medical tests. Ask if the tests can be done on an out-patient basis. If you agree to control your diet and activities, the doctor will usually support your request.

Try to avoid additional days in the hospital by bringing in extra help at home. Ask about home nursing services to help while you recover. With help available, many patients can shorten a hospital stay.

Hospitals are not the only choice for people with a terminal illness. Many people choose to spend their remaining time at home with people they know and love. Special arrangements for the needed care can be made through hospice care programs in most communities. Try “Hospice” in the Yellow Pages or ask your doctor.

If you have ever thought that the cost of your medical care doesn’t matter because your company or health plan pays the bills, think again. You do pay. Most people have to pay co-payments and deductibles. Employers pay for health care coverage by restricting wage increases. Governments pay for health care by increasing taxes or
reducing other benefits. As medical costs go up, there is less money available for housing, education, wage increases, etc. These costs do affect you. If you can help reduce health care costs, you help yourself
and everyone else. Once you become a partner with your doctor, you can do a lot to reduce your health care costs. The goal is to get just the care you need, nothing more, and certainly, nothing less.
Nine Ways to Cut Costs
(but not quality)

1. Stay healthy. Healthy lifestyles and regular preventive services are the best ways to keep costs down. See Chapter 2. Also see Chapters 16, 17, and 18 of this book for ideas on how to stay healthy your whole life.

2. Use self-care when you can. Every time you successfully manage a health problem at home, you reduce the cost of health care for you and for others.

. Get your professional care from a primary care provider. Family physicians, internists, pediatricians, nurse practitioners, and other primary care providers are the best place to start for most health problems. See page 5 for more information.

4. Reduce your medical test costs. Don’t agree to expensive medical

tests until you understand how they will help you. Unneeded tests are often done because “it is standard practice” or to protect doctors from possible malpractice suits. The only good reason to do a test is because the benefits to you outweigh the risks and the costs. No test can be done without your consent. See page 8 for more
information.

5. Reduce your drug costs. Ask your doctor about every prescribed medication. Ask what would happen if you chose not to take a medication. Don’t expect to get a prescription for every illness; sometimes self-care or nondrug remedies are all you need. See page 9 for more information.

Medical tests are important tools, but they have limits. Some people think that the more tests they have, the better off they’ll be. Wise consumers know medical tests have costs and risks as well as benefits. To help your doctor make good choices about tests for you, you need to:

Learn the basics.
•    What is the name of the test and why do I need it?
•    If the test is positive, what will the doctor do differently?
•    What could happen if I don’t have the test?
Consider the risks and benefits.
•    How accurate is the test? How often does it indicate a problem exists when there is none (false positive)? How often does it say there is no problem when there is one (false negative)?
•    Is the test painful? What can go wrong?
•    How will I feel afterward?
•    Are there less risky alternatives?

Ask about costs.
•    How much does the test cost?
•    Is there a less expensive test that
might give the same information?

Let your doctor know

•    Your concerns about the test.
•    What you expect the test will do for you. Ask if that is realistic.
•    Any medications you are taking.
•    Whether you are pregnant or have other medical conditions.

•Your decision to accept the test.

Medical Ping- Pong Shared decision-making requires two-way communication, like playing a game of ping-pong.
Ping: You describe your symptoms, main concern, and hunches.
Pong: Your doctor makes a diagnosis and describes treatment options.
Ping: You tell your doctor your personal preferences or ask about other options.
Pong: Your doctor restates the options and how they relate to your preferences.
Ping: You accept one of the recommended options or learn more about what you should do.
With good two-way discussion, the chances are better that you will end up with the treatment plan that is best for you.

If a test seems costly, risky, and not likely to change the recommended treatment, ask your doctor if you can avoid it. Try to agree on the best approach. No test can be done without your permission.
Once you agree to a test, ask what you can do to reduce the chance of errors. Ask about food, exercise, alcohol, or medications to avoid before the test. After the test, ask to review the results. Take notes for your home records. If the results are unexpected and the error rate of the test is high, consider redoing the test before basing further treatment on the results.

1. Let your doctor know what you want. Tell your doctor that you want to help make decisions about what to do for your health problems.

2. Do your own research. Sometimes you need to learn things on your own before you can fully understand what your doctor is saying. See “Do Your Own Research” on page 15 for some ways to get the information you need.

3. Ask “why?” Always ask “why?” before agreeing to any medical test, medication, or treatment. Asking why may help you discover another option that better meets your needs.

4. Ask about alternatives. Learn enough to understand the options your doctor thinks are feasible.

5. Consider watchful waiting. Ask your doctor if it would be risky or costly to wait a while (day, week, month) before treatment.

6. State your preferences. Tell your doctor if you prefer one option over another based on your personal desires and values.
7. Compare expectations. Tell your doctor what you are expecting from the treatment and ask if that is realistic. If appropriate, discuss side effects, pain, recovery time, long-term limitations, etc.

8. Accept responsibility. When you make shared decisions with your doctor, both of you must accept the responsibility for the outcomes.

Except in an emergency, you cannot be given a treatment or test without your “informed consent.” You must be informed of the risks and agree to the treatment. In a partnership, however, informed consent may not be enough. The real goal is shared decision-making, where you actively participate in every medical decision. Why should you help make decisions with your doctor? Aren’t you paying him to know what to do? Well, the choices aren’t always black and white. With many health problems, there is more than one option.

Consider these examples:

You have moderately high blood pressure (160/95). Your doctor says that exercise and diet might bring it down, but most people don’t succeed that way. He recommends that you start on medication to control it. You would rather try exercise and lose weight than take pills for the rest of your life. The best decision depends on your values. Your three-year-old has a headache and a fever. The doctor says it’s probably nothing to worry about. Then you tell her your hunch that it might be meningitis. Some testing may be appropriate. You have been suffering from carpal tunnel syndrome for several months. Your doctor is now recommending a wrist splint and a steroid injection. You would prefer trying just the splint with aspirin first. If that doesn’t work, you will consider other medications. Your doctor agrees that is a good plan. In each case, the treatment you choose will have an effect on your life. Therefore, the best medicine for you combines your doctor’s medical expertise with your personal values.

The Advice Nurse
Many health plans and health maintenance organizations (HMOs) offer an advice nurse telephone service. Advice nurses are registered nurses who have special training to help you decide what to do about symptoms, how to manage minor illnesses, and answer your questions about health problems. A call to the advice nurse can often save you a doctor visit, or help you decide if you need an urgent or routine appointment.
Advise nurses can also help when your doctor diagnoses a health problem or recommends a test or treatment that you don’t fully understand. Sometimes the advice nurse can answer your questions. Other times, he or she may help you come up with questions you can ask your doctor at your next visit.