Dr. Hrach MD – ExtraCare May 2019 Newsletter

May 2019
ExtraCare Newsletter

Did you see those beautiful mountains this morning? The weekend storm blew away the fog and the rains greened the earth to create a picture postcard day. I hope you are able to go out and enjoy it. Measles are all over the news this month so I thought it would be helpful to give you the facts and I also tried to dig up some science on the ubiquitous CBD.

Just a gentle reminder to those few patients who are still texting without tiger connect to please call the office to sign up now. I am trying hard to separate my patient related texts from my personal texts and the tiger connect secure texting system is the best way to do this.

Thank you for your cooperation.

The Facts About Measles

Measles is caused by the Rubeola virus, which belongs to the Paramyxovirus family. The first scientific description of measles is credited to the Persian physician Rhazes (860–932). Francis Home, a Scottish physician, demonstrated in 1757 that measles is caused by an infectious agent in the blood of patients. In the decade before 1963 when a vaccine became available, nearly all children in the United States got measles by the time they were 15 years of age. It is estimated that 3 to 4 million were infected each year. Also each year, among reported cases, an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain) from measles.

In 1963 the first measles vaccine was licensed in the U.S. and in 1968, an improved measles vaccine began to be distributed. In 1978, CDC set a goal to eliminate measles from the United States by 1982. Although this goal was not met, widespread use of measles vaccine drastically reduced the disease rates. By 1981, the number of reported measles cases was 80% less compared with the previous year. However, a 1989 measles outbreak among vaccinated school-aged children prompted recommendations for a second dose of MMR vaccine for all children. Following widespread implementation of this recommendation and improvements in first-dose MMR vaccine coverage, reported measles cases declined even more. Measles was declared eliminated (absence of continuous disease transmission for greater than 12 months) from the United States in 2000.

From January 1 to May 10, 2019, 839 individual cases of measles have been confirmed in 23 states. This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000. The last large outbreak of measles in California was associated with Disneyland and occurred from December 2014-April 2015, when at least 131 California residents were infected with measles; the outbreak also infected residents of six other states, Mexico, and Canada. In 2019, four outbreaks linked to patients with international travel have been reported in California. As of May 8, 2019, 44 confirmed measles cases, including 30 outbreak-associated cases, have been reported. There have been no reported cases in Santa Barbara County.

Many of my patients are reaching out to me with questions about their immunity so I thought I would share this information with you.

The CDC considers you immune if you were born in the U.S. before 1957 (you likely had the disease which infers lifelong immunity). You are also considered immune if you were born outside the U.S. prior to 1970 AND moved to the U.S. in 1970 or later,  or if you were born in any country in 1970 or later and attended a U.S. primary or secondary school. You are considered immune if you have written documentation with date of receipt of at least one dose of measles-containing vaccine given on or after your first birthday in 1968 or later. You are considered immune if you served in the U.S. armed forces or entered the U.S. in 1996 or later with an immigrant visa or have a green card. You can also confirm your immunity with a documented positive IgG test for measles or laboratory confirmation of previous disease.

If you have questions about your measles immunity please contact me. I can help you determine if testing or immunization is warranted.

CBD

CBD is everywhere and being used for almost everything. Patients report using some form of CBD to me daily so I thought it would be helpful to find out exactly what it is and what it’s good for.

CBD, aka Cannabidiol, is one of more than 100 unique “cannabinoid” compounds that are found in the oily resin of the cannabis plant. The resin is concentrated on the dense clusters of cannabis flowers, or buds, which are covered by tiny, mushroom-shaped “trichomes.”  Trichomes are specialized glandular structures that contain CBD, tetrahydrocannabinol (THC), and various aromatic terpenes.  The oily trichomes protect the plant from heat and ultraviolet radiation. The oil also has antifungal, antibacterial and insecticidal properties that deter predators.

Once extracted the oil is vaporized, made into capsules, mixed into foods and drinks, or added to lotions and gels to be applied topically. The options are endless and the products now available either online or in local dispensaries are vast. Orally, cannabidiol has been used for anxiety, bipolar disorder, diabetes, dystonia, epilepsy, multiple sclerosis, Parkinson disease, Crohn disease, graft-versus-host disease (GVHD), smoking cessation, and schizophrenia. Topically, cannabidiol has been used for pain, anxiety, stress, appetite stimulation, and rash.

But my question…  “Is there science to substantiate its use?”

Again, to answer this question I go back to my resource, the Therapeutic Research Center Natural Medicines Database.

It turns out that Cannabidiol has been proven beneficial as an anti-epileptic drug and is currently FDA approved for use in treating seizures in children with rare neurological diseases. It is manufactured by GW pharmaceuticals and sold as Epidiolex. There is, however, insufficient evidence to prove CBD’s usefulness for any other disorder.

Generally, at low doses, oral Cannabidiol has very few side effects. At higher doses however it can cause dry mouth, diarrhea, vomiting, decreased appetite, weight loss, somnolence, drowsiness, fatigue, and liver toxicity. CBD may also interact with the metabolism of various classes of medications including anti-epileptic medications, anti-depressant medications, antibiotics, antifungal medications and pain medications.

Many of my patients have started to use CBD oil topically to treat arthritis so I was especially interested in the research into CBD and inflammation. Unfortunately, there is really little data addressing this issue. CBD has been shown to modulate inflammatory end products in the petri dish and in a mouse model of rheumatoid arthritis CBD seemed to improved arthritis symptoms and block disease progression. I found no relevant clinical trials studying CBD oil and inflammation/arthritis in humans. Outside of a potential allergic reaction to topically applied CBD there seems to be little harm because little if any CBD is absorbed into the bloodstream.

The CBD industry is loosely regulated which results in products with varying quality and questionable efficacy. My recommendation is to save your money and use only proven therapies known to be safe for what may ail you. As always, I am available to discuss you individual circumstance.

Copyright © 2021 Barbara A. Hrach M.D. FACP, All rights reserved.
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