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Pneumonia: Not an Illness to Take Lightly
Editorial written by Roberta Herman, MD, Senior Vice President and Chief Medical Officer, Harvard Pilgrim Health Care
(Fall 2004)

Pneumonia is an infection or inflammation of the smallest air passages in the lungs, causing these passages to fill up with mucus. When this happens the lungs are unable to function properly. Symptoms of pneumonia include fever, chills, cough, and breathing difficulties. For older adults and those persons who have a chronic illness or weakened immune system, pneumonia is a serious and sometimes life-threatening condition.

Pneumonia can be caused by a variety of bacteria or viruses. Over half the cases of pneumonia are caused by the pneumococcus bacterium and, thus, called pneumococcal pneumonia. This type of pneumonia is a common complication of the flu. People who are sick with the flu have weaker body defenses allowing bacteria such as pneumococcus to more easily reach the lungs. Flu is a very preventable illness and you can help protect yourself by getting a flu shot every fall.

In addition to flu shots, there is a pneumococcal vaccine beneficial in preventing severe disease, hospitalization and death. You can protect yourself from pneumococcal pneumonia by receiving the pneumococcal vaccine.

Who should get the pneumococcal shot?

Taking Care of Your Baby Before Birth
(fall 2004)

Keeping healthy and following your doctor's orders during pregnancy will reap health payoffs to you and your baby after birth. Routine prenatal care helps to ensure that you and your baby are on track for a healthy delivery. Even if you are not experiencing any complications, you should see your obstetrician or midwife every four weeks through your 28th week, every two to three weeks until your 36th week, and weekly after that. During these visits you will discuss your personal health history, changes you are feeling, and will have routine blood tests and screenings for certain conditions. Here's how you can help ensure a healthy pregnancy:

Stop Smoking: When you are pregnant, you have two important reasons to quit smoking - your baby's and your own health. If you continue to smoke during pregnancy, the potential substantially increases for miscarriage, stillbirth, premature birth, low birth weight leading to serious infant health problems, Sudden Infant Death Syndrome (SIDS), and increased childhood health problems, including learning disabilities.

Eat Healthy: Eating a wide variety of foods, including fruits, grains, vegetables, dairy products, fish and meat will help ensure that you meet the nutritional requirements of your fetus and help you prepare for breastfeeding. Your doctor may prescribe a daily supplement of folic acid to reduce the risk of neural tube defects, which affect the baby's brain, spinal cord and tissues that enclose them. In general, your doctor will recommend that you gain between 25 and 35 pounds during pregnancy, unless you are already very underweight or overweight.

Do Not Drink Alcohol: Any amount of alcohol during pregnancy is too much. Alcohol may cause fetal alcohol syndrome (FAS), and is the leading preventable cause of mental retardation and birth defects. Complications of FAS can include abnormally formed organs, mental retardation, small brains, vision difficulties, epilepsy, and poor socialization skills, behavioral problems and learning disabilities.

Do Not Use Illegal Drugs and Check with Your Doctor Before Taking Other Drugs: Substance abuse can lead to miscarriage, premature birth, low birth weight and other health problems. Many over-the-counter drugs can be taken safely during pregnancy, but check with your doctor before taking them. Additionally, always let your obstetrical care provider know about any prescription drugs, herbal or nutritional supplements you are taking.

Rest: Feeling tired much of the time is common, especially during the first and third trimester of your pregnancy. Take naps when you can, or rest for a few minutes with your feet up periodically throughout the day. Minimize fluids before bedtime and keep caffeine to a minimum to help reduce frequent urination during the night. Keep your evenings free for quiet activities, and go to bed when you are tired, even if it seems early.

Exercise: Even if you have not exercised before pregnancy, exercising during pregnancy can help you maintain muscle strength, aerobic capacity, and build strength and stamina for delivery. Regular exercise will also help you sleep better, boost your mood and energy level, stay within recommended weight gain parameters, and help with common discomforts, such as lower back pain. The American College of Obstetricians and Gynecologists advocates moderate exercise, such as walking, for at least 30 minutes every day. However, if you have certain medical conditions, such as anemia, diabetes, a history of preterm labor, or an irregular heartbeat, your obstetrical care provider will need to help you plan your physical activity.

If you have not exercised before, start slowly. Walking, swimming, beginner's yoga, and cycling on a stationary bike are good choices. Always stretch before and after exercise, and avoid overheating. Keep yourself well hydrated by drinking fluids during exercise. Even if you have been exercising, your obstetrical care provider will probably suggest discontinuing sports that pose a high risk of injury, such as downhill and water skiing, scuba diving, gymnastics, horseback riding and vigorous racquet sports. If you feel signs of heat stroke -- dizziness, nausea, fatigue or shortness of breath -- stop exercising immediately, drinks fluids and rest. If you experience danger signs, such as chest pain, abdominal pain, vaginal bleeding and leaking amniotic fluid, stop what you are doing and contact your doctor immediately.

Take Care of Your Mental Health: The physical and emotional changes of pregnancy can lead to depression, with up to 20% of pregnant women experiencing mild to severe symptoms. If you experience two or more of any of the following for two weeks or more, seek assistance: extreme sadness, feelings of emptiness, guilt or worthlessness, difficulty concentrating, thoughts of suicide or death, lack of interest in formerly pleasurable activities, or dramatic changes in eating habits. You owe it to yourself and your baby to take care of your mental health so that you are prepared mentally for the demands of motherhood. Contact your health plan or United Behavioral Health (Indemnity and Navigator members only) for assistance.

Prepare for Breastfeeding Before Birth: Breastfeeding requires some advanced preparation for new mothers. Breastfeeding provides many benefits to your baby with improved immune function, decreased risk of Sudden Infant Death Syndrome (SIDS), and decreased risk of other health problems. Mothers also benefit with faster weight loss, and decreased risk for breast, ovarian, and cervical cancers as well as chance of developing osteoporosis later in life. However, learning how to breastfeed in the midst of adjusting to life with your new baby can be difficult. Check with your hospital, health plan and your local health department to see what breastfeeding resources are available and take advantage of breastfeeding classes before your baby is born.

Health Plan Pregnancy Resources:
Harvard Pilgrim Health Care: Pregnant members, or those planning to become pregnant, can speak confidentially to a Harvard Pilgrim maternal and child health nurse to ask questions by calling 1-800-742-2423. Members identified as having a high-risk pregnancy have access to maternal and child health nurses to help them sustain a successful pregnancy.
Health New England: Health New England's Brighter Infant Beginnings Program provides members with educational information for the mom-to-be as well as for the newborn. The program includes a number of helpful resources about health during pregnancy, health during the first six years of life, and early childhood development. Contact 413-787-4000 for more information.
Navigator by Tufts Health Plan: Members have access to the Healthy Birthday Program, for pregnant women at risk for premature delivery. This program helps high-risk members manage prenatal care during their pregnancy. All pregnant members receive the Tufts Health Plan Prenatal Guidebook, which includes pregnancy resources, self-referral to maternity management programs, depression information and a self-screener. The Mom and Me Smoke Free Program helps pregnant moms kick the habit. Tufts Health Plan will work with you to develop a customized plan to help you quit smoking. For additional information call 1-888-766-9818 ext. 3218.
Neighborhood Health Plan: NHP's For You Two program is available to all pregnant members. It includes home visits from a nurse after delivery, breast pumps, education about caring for a newborn, a quit smoking program, and mental health services. Contact 1-800-462-5449 for more information.

Relief from Heartburn Update

Our summer newsletter included an article on Relief from Heartburn and Reflux. After it was published, Prilosec®, which was a prescription drug, became available over the counter in its most popular strength. This means that enrollees who suffer frequent heartburn have access to short term relief without the need to see their doctor for a prescription. Prilosec OTC is only for short-term heartburn relief; it should only be taken for a single 14-day course of treatment every four months. For those who suffer from frequent heartburn, patients are advised to see their doctor. Your doctor may recommend lifestyle changes such as weight loss and portion reduction, as well as a prescription medication.

Talk with your doctor if you have frequent heartburn (defined as symptoms two or more days per week) before you take any over-the-counter drug for relief. For additional information on your prescription drug benefits, contact your Plan (HMOs) or Express Scripts (Indemnity, PPO, PLUS and OME).

Getting Relief from Reflux and Heartburn
(spring 2003)

More than 60 million people over the age of 50 (and some pregnant women) experience Gastroesophageal Reflux Disease (GERD) at least once a month. The most common symptom is heartburn, a burning feeling behind the breastbone. Unlike pain associated with heart disease, heartburn pain is not usually associated with exercise, and becomes more acute when you lie down and after eating. It is caused when the muscle connecting the esophagus with the stomach (lower esophageal sphincter - LES) is weak or relaxes inappropriately, allowing the stomach's contents to flow up into the esophagus. The stomach contents can cause the burning sensation called heartburn because stomach contents are acidic, and the lining of the esophagus is not protected from acid.

If you have been diagnosed with GERD, your doctor will suggest that you avoid the following, which weaken the LES: Chocolate, peppermint, fatty foods, coffee, alcoholic beverages, citrus fruits and juices, tomato products, pepper and smoking

Your doctor may also recommend losing weight, eating meals at least 2 to 3 hours before bedtime, reducing the size of portions at mealtime, and elevating the head of your bed on 6-inch blocks, or sleeping on a specially-designed wedge. Nonprescription antacids can provide temporary or partial relief.

For chronic reflux and heartburn, your doctor may prescribe medications. H2 blockers, which inhibit acid secretion in the stomach, relieve symptoms in up to 70% of patients with GERD. If H2 blockers are not effective, your doctor may prescribe proton-pump inhibitors, which decrease the acid in the stomach. As with all conditions, follow your doctor's advice and make the lifestyle changes he or she has recommended. Take your medication as directed. If you have followed these measures, but your heartburn returns, consult with your doctor.

Just the Facts on Buckling Up (summer 2001)

If you are one of the estimated 50% of Massachusetts drivers who does not wear a seat belt, these facts are for you. Over 41,000 people were killed last year in a car accident. Motor vehicle crashes are the leading cause of injury death in the United States. According to the National Highway Traffic Safety Administration (NHTSA), car crashes create $3.6 billion annually in health care and other related costs in Massachusetts.

Seat belts, combined with airbags, are the most effective safety devices in vehicles today, estimated to save 9,500 lives each year. Safety belts reduce the risk of fatal injury by 45% and the risk of serious injury by 50 percent, according to the NHTSA. Child safety seats, used correctly, reduce fatal injury by 71 percent for infants and 54 percent for toddlers.

Important Safety Tips:
· Adults should wear a seat belt at all times.
· Children model your behavior; adults who don't buckle up send children the message that it is all right not to wear a seat belt. Almost ninety percent of children are buckled when the car's adults wear seat belts. The percentage drops to 76% when adults are not wearing a seat belt.
· Infants age one and younger, or weighing less than 20 pounds, should ride in rear facing child safety seats in the back seat.
· Children weighing 20 to 40 pounds should ride in a booster seat, facing forward in the back seat.
· All children from 40 to 80 pounds and less than 4'9" tall should be properly restrained in a booster seat in the back seat. Children these sizes are usually age four to eight.

Many of GIC health plans offer additional information on car seat safety on their web site. Fallon Community Health Plan offers a one-hour Child Passenger Safety Class for expectant parents at various locations throughout their service area. Participants learn about the Massachusetts seatbelt and safety seat law and how to correctly install and use a child safety seat. At the completion of the class, participants receive a Century infant/toddler seat. Class costs are: FCHP members - $45 and Non-Fallon members - $60. Contact Fallon for additional details: 1-800-891-2300 or e-mail.

Enrollees Age 50 and Over at Greatest Risk For Shingles
(fall 2001)

Every year 600,000 to one million Americans are diagnosed with shingles, also known as herpes zoster. If you had chicken pox as a child, you are at risk of developing shingles later in life. After chicken pox runs its course, the varicella-zoster virus remains dormant. As you grow older, or if you have lymphoma or AIDS, the virus can become reactivated and shingles results. Approximately one in five adults experiences shingles, usually after age fifty.

The first sign of shingles is usually a tingling feeling, itchiness, or stabbing pain on the skin. A few days later a rash appears on the trunk or face. The rash develops into fluid-filled blisters, which dry out and crust over within several days. Symptoms can range from mild itching to extreme and intense pain. Some seniors also get flu-like symptoms.

Although shingles usually heals entirely within a month, complications can occur. One potential complication is an infection of your cornea, which can cause temporary or permanent blindness. If a rash develops anywhere near your eye, see a doctor immediately. Postherpetic neuralgia, skin sensitive to the slightest touch after blisters have cleared, is a common complication affecting half of older people.

If you feel symptoms of shingles, such as skin pain, burning, tingling or itching in a localized area, contact your doctor immediately. Prompt treatment can shorten your infection and decrease your chances of complications. Antiviral drugs are widely used for to treat herpes zoster. Your doctor may also recommend cool wet compresses and over-the-counter pain relievers.

Packing Healthy Snacks Your Child Will Eat
(fall 2004)

Obesity is quickly approaching tobacco as the number one cause of chronic disease. Massachusetts Department of Public Health statistics reveal that 10% of Massachusetts children aged 6-19 are overweight and another 17% are at risk of becoming overweight. Nationally the percentage of school-age overweight children has tripled since 1980. Overweight children are more likely to become overweight or obese adults, leading to costly and debilitating health conditions including diabetes, cardiovascular disease and high blood pressure.

Almost one quarter of children's daily energy intake comes from snacking between meals. Therefore, healthy snack choices can play an important part in helping your child maintain an ideal weight. Finding nutritious snacks that you and your child can agree on can be a challenge. The Mayo Foundation for Medical Education and Research offers the following tips for getting your child to eat healthy snacks:
Offer similar choices to your child, getting their input: for example, let them choose between celery and carrots, or pretzels and assorted nuts.
Offer variety: Choose a variety of snacks so your child doesn't get bored and reach for a fatty snack.
Be creative: Cut vegetables into shapes to make them more appealing. Health New England suggests "ants on a log" made of celery sticks with peanut butter or light cream cheese topped with raisins.
Expose your picky eater repeatedly to new foods: Try offering small portions of new foods with other familiar choices.

Look for snacks that are low in fat, sugar and sodium. Be aware that some seemingly nutritious snacks are not. Many granola bars are high in calories. Fruit roll-ups and fruit snacks are high in sugar and can lead to cavities. Good choices of snacks include:
§ Any kind of fruit
§ Vegetable sticks with low-fat dip or chunks of cheese
§ Pretzels and nuts
§ Yogurt/Gogurt
§ Cut up pieces of low-fat cheese
§ Baked chips
§ Whole-grain bagels
§ Frozen juice bars
§ Unbuttered Popcorn (for older children)
§ Peanut butter and crackers
§ Dry whole-grain cereal

Juice should be drunk in moderation. Although juice contains some healthy nutrients, it's high in calories. The American Academy of Pediatrics recommends that children drink no more than two 6-ounce servings of fruit juice a day.

Health Plan Resources:
Health New England: HNE's Whiz Kid Series includes Seymour's Weight Loss Challenge, which teaches children how to manage their weight through an interactive 5-step physical activity and healthy eating program. Members can learn more about this program by logging onto Health New England's store website or calling 413-233-3079.