Vaccine preventable disease rates are at all time lows due to diligent research, effective immunization systems, and outreach. This success has come from a collaboration of private and public sectors. Nonetheless, there are still barriers to optimizing immunization protection from vaccine preventable diseases. Prior to modern day immunizations, many diseases impacted countless numbers of children with disability and, unfortunately, mortality. In recent decades, there have been advances in vaccines broadening the protection net for children and adults. As vaccine preventable illnesses diminish, such as polio, measles, pertussis and even now haemophilus, pneumococcus, rotavirus and varicella, the public loses valuable memory of the devastation of these diseases. Yet outside of the United States one million deaths occur annually from measles alone. Complacency sets in from a lack of knowledge of natural diseases and fears of adverse events, including autism, further add to the barriers to protecting our children and adults. Idaho continues to struggle to obtain higher immunization coverage rates.
The Idaho Immunization Program, funded jointly by the State of Idaho and the Centers for Disease Control, has grown in the past decade improving our rates considerably. The Idaho Immunization Program hosted an Immunization Summit in the fall of 2007 inviting public and private health sectors to formulate the problems facing our State and potential solutions. The group discussed the successes of the Canyon Area Immunization Coalition and proposed a Statewide Coalition. Idaho is the only state in the Nation without a widespread or statewide Immunization Coalition.

This brings us to May of 2008. The AAP Idaho Chapter held an Immunization Congress, funded by a grant from AAP National. The congress succeeded in bringing public and private sectors together to launch what is now the Idaho Immunization Coalition. The coalition is a 501 c3 non profit organization to enhance the existing immunization system in Idaho. The goal is to protect adults and children from vaccine preventable disease in an efficient, safe and enlightened manner and to maintain the statewide immunization registry. The Coalition will have an Executive Committee with Keith Davis, MD, President of the Idaho Academy of Family Physicians and Tom Patterson, MD, President Elect of the Idaho American Academy of Pediatrics as co-chairmen. Subcommittees consisting of Education, Legislation and Vaccine Outreach will address specific issues. The state Immunization Program, the AAP, and AAFP Idaho Chapters are all on board to see the coalition to fruition. We have succeeded in many ways, though there is much work to be done to reach our goal of maximum immunization coverage in all populations.

“Ok, you have some varicose veins, but… Do you have venous reflux?”

This question is more important that many people realize. Venous reflux is a common medical problem where the blood traveling in the leg veins “refluxes” or, slides back down the leg veins instead of going upwards, back to the heart. This condition is a result of the ever present force of gravity while we are standing and the fact that age, previous blood clots, pregnancy, and other conditions cause the small valves in the vein to malfunction and allow the blood to slip back downwards, towards the feet. This de-oxygenated blood then pools in the lower leg veins and creates several problems over time. One of the earliest manifestations is varicose veins, which sometimes may be noted as a painful throbbing sensation, because of the pressure of the “old” blood which is pooling in them. Other problems then result over time, such as discoloration of the skin, increased swelling of the surrounding tissue (edema), and ultimately, skin breakdown and chronic sores called venous stasis ulcers. The goal is to prevent these later changes from occurring and treat the reflux early, since it only worsens over time.

So, whenever a provider is examining a patient who has complained of varicose veins, the most important question is whether those veins are the result of venous reflux (bad vein valves). The reason this is so important, is that if the reflux, which is the actual cause of the problem, is not treated, then treated problem veins will recur. We encounter many patients who have previously been treated in a med spa or shopping mall facility where laser or sclerotherapy treatment was performed, but the patients find that their problem veins recur in a few years time. Many of these patients are found to have venous reflux on a comprehensive ultrasound evaluation. Here, at Saltzer vein clinic, patients who are suspected of having venous reflux are screened by a Registered Vascular Ultrasound Technician to find whether or not they have venous reflux. If they do, the underlying reflux is treated with a catheter inserted into the vein using laser or radiofrequency energy. If they do not have reflux, they are usually treated by injecting a sclerosant chemical into the veins or by use of a cutaneous laser for these veins.

As mentioned above, if the patient does have venous reflux, almost all insurers and medicare programs consider this a medical problem and it is covered as such. The patient who chooses Saltzer Vein Clinic benefits from our expertise in treating all sizes of varicose veins as well as the causes of venous reflux and late effects of reflux, such as venous ulcers. Not only do patients benefit from our high tech, comfortable, American College of Radiology approved imaging facility, they also receive care from a board certified surgeon and phycisian assistant. We have invested much more into these resources than most of our competitors. We have multiple options for treatment, all the way from ultrasound guided injection, different laser treatments, radiofrequency treatment, to actual surgery. As you can imagine, having all of these options available means we can tailor the best treatment for each individual patient, instead of “pushing” our patients to be treated with limited options. Just like home or car repair, having the right tool for the job at hand makes all the difference. Now that you know how much we have invested into these resources, you would likely conclude that we charge more than some of the smaller shops in the area. Our costs are cheaper than any of the area vein treatment facilities and I encourage patients to call around and prove this for themselves.

Please visit our website, www.saltzervein.com for more detailed information. Thank you.

Steven W. Williams, M.D., F.A.C.S.

Sometimes, a medical study challenges our presumptions. For instance, a recent report suggested that maybe fitness is more important than weight. A study published in the Archives of Internal Medicine in August 2008 looked at risk factors based on the body weights of 5,440 people age 20 and over. The results suggest that just looking at body weight alone can be misleading since almost 25% of normal weight adults had 2 or more risk factors that are often associated with being overweight and obese. Within the normal weight adults who had 2 or more risk factors, the study showed that older age, physical inactivity and a larger waist size were associated with increased risk.

Approximately 50% of overweight adults and 30% of obese adults had normal or only one risk factor. Of these adults, the study showed that younger age, higher physical activity and a smaller waist size were associated with decreased risk.

This study emphasizes the importance that everyone, of all ages and body sizes, should see their primary care provider to help determine the need for screening for cardiovascular risks. Some of the risk factors in this study included elevated blood pressure, low high density lipoprotein (the “good” cholesterol), elevated triglycerides and blood sugar levels.

RICE = Rest, Ice, Compression, Elevate

The RICE method often helps with many types of joint and muscle injuries. The method will ease pain and help speed recovery. The RICE method is very helpfully if you use it right away after an injury.

REST - For most injuries, rest the area until the pain decreases. However, For simple sore muscles gentle stretching will reduce stiffness more quickly.

ICE - Ice is the most effective treatment for reducing inflammation, pain and swelling of injured muscles, joints and connective tissue. The cold helps keep blood and fluid from building up in the injured area, reducing pain and swelling. For the first 48 hours post-injury, ice for 20 to 30 minutes every 2 hours. More than 30 minutes doesn’t help heal the injury any faster, you can cause damage to the tissue.

COMPRESSION – Between icings, wrap the injured area with an elastic bandage to help control swelling and provide support. Begin wrapping at the farthest point away from the body and wrap towards the heart. The wrap should be snug, but not cutting off circulation to the extremity. So, if the extremity becomes cold, blue, or tingle, re-wrap!

ELEVATE – Raising the injured area for the first 24hours above your heart will allow gravity to help reduce swelling and draining excess fluid. The less swelling present, the faster an injury will heal.