Cyclospora Outbreak

During the summer, many people tend to eat lighter and consume more salads.  To that end, we wanted to alert you to a recent outbreak of an intestinal illness that may be attributable to eating prepackaged salad.  The Center for Disease Control (CDC) is working diligently with local health departments in several states to determine the possible link between a Cyclospora outbreak and bagged salad mix sold across the country.  Hundreds of people have become ill  and 22 people in five states have been hospitalized over the past several weeks. 

Cyclospora is an intestinal illness caused by a microscopic parasite Cyclospora cayetanensis.  The disease is transmitted by fecal matter ingested in foods or water supply.  Symptoms can include loose, water diarrhea, fatigue, bloating, stomach cramps, nausea and low grade fever.  Public health workers in several states have noticed that a large number of the afflicted had eaten the same brand of prepackaged salad mix.  CDC and public health officials are also investigating salad mix sold to patrons of a large national restaurant chain where they have identified clusters of Cyclospora outbreaks. The national restaurant chain purchased its salad ingredients for a single source. 

We recommend that you thoroughly wash all lettuce and vegetables before consuming them, even if your prepackage salad mixes are labeled as pre-washed. 

We would also like to remind you to use precaution when swimming in local lakes and ponds this summer.  Outbreaks of intestinal illness due to waterborne parasites such as Giardia occur in water supplies that are home to water fowl like ducks and geese.  Check with local officials to make sure that your lakes and ponds have been properly treated and inspected before jumping in.  

Colonoscopies Save Lives and Reduce Healthcare Expenditures

Dr. Elliot A. Heller responds to the New York Times Article – “The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures”

Dear DDAR Patient

My colleagues and I were extremely disappointed to see the New York Times article unfairly blaming colonoscopies for our nation’s growing healthcare costs. We’re very concerned about the negative impact this article could have on patients getting screened for colon cancer. Studies have shown that death due to colorectal cancer has been reduced by 53% in the United States as a result of screening colonoscopies. The New York Times article failed to note that early detection by colonoscopy results in millions of dollars of cost savings to the nation’s healthcare bottom-line, money that would otherwise be spent on the care and treatment of patients with terminal colon cancer.

We at DDAR go to great lengths to provide cost-effective delivery of high-quality care to our patients. Having your colonoscopy procedure at an office-based surgical (OBS) facility is a real quality value. Nothing is compromised, as all Office Based Surgical (OBS) facilities, like our DDAR endoscopy suite, are accredited and must adhere to the same standards for quality, infection control and patient safety as any Ambulatory Surgical Center (ASC) or Outpatient Hospital Facility.

Lastly, we’d like to note that the federal government, under the Patient Protection and Affordable Care Act, has placed a priority on eliminating all barriers to getting Americans over 50 years of age to have a colorectal cancer screening procedure. Colonoscopies are on the short list of procedures for which insurance carriers cannot impose cost-sharing requirements, such as co-pays, co-insurance and deductibles. This means your carrier should provide you with first dollar coverage for your screening colonoscopy.

The New York Times article was biased in holding colonoscopies responsible for the rising healthcare costs. The only cost we see regarding colonoscopies is that it could cost you your life by NOT being regularly screened.

Read original NYT Article

CDC Recommends One-time HCV Testing for Baby Boomers

In August 2012, the Center for Disease Control and Prevention issued final guidance recommending that all people born from 1945 to 1965 be tested once for Hepatitis C virus (HCV). This recommendation was based upon an analysis of the 1999-2008 National Health and Nutrition Examination Survey (NHANES), which found that one in 30 baby boomers is infected with Hepatitis C. Baby boomers account for 75% of HCV prevalence in the United States. Many were infected prior to any awareness of HCV, and consequently, any understanding of how HCV is transmitted. Most HCV infected individuals are asymptomatic and unaware of their infection until significant complications from chronic HCV occur.

HCV is the most common bloodborne illness in the US with an estimated 2.7 million to 3.9 million people living with the disease. The virus is spread through exposure to contaminated blood. HCV can also be transferred through sharing of personal items such as a razor or toothbrush. Approximately 80% of patients with HCV have no symptoms. Despite delayed onset of symptoms in many patients, HCV- infected patients are at an increased risk of developing many serious complications.

Our goal at DDAR is to diagnose early and initiate treatment to prevent future complications. Our physicians, in collaboration with Deborha Caputo CNP, understand that treatment and management of HCV patients must be customized for each patient. As such, we stay abreast of all updates and progress in HCV treatment and therapy. We are optimistic that the 20+ new HCV treatments in clinical research trials in the U.S. will pave the way for further improvements in DDAR’s HCV patient management.

Please check with your physician about Hepatitis C Virus screening during your next office visit.

Dr Yaron Langman performs the first fecal transplant in Rockland County.

FDA recently relaxed rules allowing an innovative form of therapy for a type of colon infection known as Clostridium difficile (C. difficile).

The colon contains hundreds of distinct strains of bacteria which help maintain healthy digestion (at least 500 have been identified and there are likely hundreds more). One of those, C. difficile, can grow out of control when the others are killed. This most often occurs after the use of antibiotics and can become life threatening. Ironically, C difficile infection has been treated with a range of antibiotics, but the infection often recurs and/or does not respond. New research based on experiments in the 1950's has suggested that returning the colon to its normal balance of microbiome (hundreds of different types of bacteria) can suppress the C. difficile and allow the colon to quickly heal. This has been attempted using probiotic supplements. Unfortunately, that treatment has only a limited effect because not enough new types of bacteria are being reintroduced through supplementation.

A more promising approach is fecal biotherapy. Simply stated, with this treatment, a healthy donor provides a stool sample that is administered to the patient. Data suggest that up to 90% of people respond and can be cured of their C. difficile infection. There are various ways to administer the stool, but the most common is during a colonoscopy. Although mainly performed at large medical research centers, the method has slowly become more widely accepted in other health facilities. Dr. Langman has performed several "stool transplants" with great success. He was the first provider to perform such transplant at Nyack Hospital and has pioneered the current standardized protocol in Rockland County.

Although still in its experimental stage, fecal therapy is available to those patients for whom traditional treatment has failed. It is important to note that fecal biotherapy also shows promise in other diseases such as ulcerative colitis.




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