The Pocono area ducked the flu this winter, but we didn’t get off scot-free.

The region is seeing a rash of nasty stomach viruses — the kind that keep you close to home.

Cases of the stomach bug have more than tripled locally, said Dr. Susheer Gandotra, medical director of infectious diseases at Pocono Medical Center, East Stroudsburg.

Also known as gastroenteritis, it’s an inflammation of the intestines. the culprit is typically a norovirus, the most common food-borne illness in the United States, according to Stroudsburg gastroenterologist Dr. Charles Cohan.

Symptoms usually include nausea and vomiting, abdominal pain and diarrhea. Low-grade fevers sometime occur.

“Nausea and vomiting is first to go away, followed by abdominal pain, which resolves second. Diarrhea is third — it usually goes away in five days,” Cohan said.

For most healthy people with properly functioning immune systems, the virus is hardly ever dangerous.

“The overwhelming majority of cases resolve without treatment whatsoever,” Cohan said. “Keep yourself hydrated. the best formula is water with sugar and electrolytes or sports drinks like Gatorade.”

Noroviruses are highly contagious, according to the U.S. Centers for Disease Control and Prevention. the illness usually is over in 24 to 48 hours, but people can still feel run down for a few days after.

“The danger is major dehydration,” said Dr. Jeff Jahre, section chief of infectious diseases at St. Luke’s University Health Network.

Between 80 and 90 percent of stomach bugs are viral in origin, not bacterial, according to Cohan.

“Assuming the person’s immune system is intact, your immune system will overcome the virus and you typically will get better,” he said.

At greatest risk are young children, the elderly and people who are already sick. “They are more prone to get dehydrated,” Gandotra said.

In a separate report released last week, the CDC said noroviruses are more deadly than previously realized. the report says that, on average, they were linked to 800 deaths a year in the U.S., but deaths also doubled in years where new strains emerged. the study looked at gastroenteritis-related deaths from 1999 to 2007 and showed that noroviruses ranked second among the causes.

“Our findings highlight the need for effective measures to prevent, diagnose and manage gastroenteritis,” said lead researcher Aron Hall.

Noroviruses can spread through contaminated food or water and by touching contaminated surfaces, the CDC says.

Contamination occurs, Jahre said, through what health officials politely call the “fecal-oral route,” meaning it’s likely spread first by someone who did not wash his hands after using the bathroom or after vomiting.

In addition, people who have been sick remain contagious for three days to two weeks, the CDC said, so being vigilant is important to stop the spread of the illness.

Gandotra said the outbreak will probably last another few weeks, but it’s impossible to say for sure.

If there is a bright spot, he added, it’s what the illness is not — the flu. Influenza, a much more serious and often deadly virus, has been “virtually non-existent” this year, Jahre said.

Laboratory-confirmed cases of influenza in Pennsylvania fell 96 percent this winter, from 9,851 last year to 367 this year.

Monroe County had four cases positively identified as influenza this year compared with 130 last year — a 97 percent drop. Pike reported an 81 percent drop, from 16 a year ago to three this year.

MCT Information Services contributed to this story.

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Sun Special WriterSt. Louis Public School District released a letter from the Mid-Michigan District Health Department Friday, reporting a case of Hepatitis A found in a school employee.Dr. Robert Graham, medical director for MMDHD, said there is no current cause for alarm, but the district sent home copies of Graham’s letter to parents as a precautionary measure.as a food handler for Chartwell, a contracted, independent food service for the district, the person reported to carry the disease last worked in the T.S. Nurnberger School.“We were notified by the health department prior to them coming to the district to actually touch base as part of that investigation piece,” Superintendent Joann Spry said. “We were notified right around noon today.”Spry, who received the information at 11:25 a.m., was not sure how much contact the person had with items potentially distributed to students, nor the time when the person was diagnosed.“No parental action is needed at this time,” Spry said. “in a conversation with Dr. Graham, he was just sharing that what we were doing was sending this information home so the parents would have the information about Hepatitis A.”Spry said, following Graham’s recommendations, letters were sent out to district parents, providing information about hepatitis symptoms so if parents were to see anything disconcerting, they could contact the health department.“He didn’t feel there was any major concern in terms of the students, but we wanted to get the information out there in case parents wanted to find out more,” she said.The name of the person has not been released, but is expected to make a full recovery. Spry said the only information she received of the worker was the person was a substitute, who occasionally filled in for other workers.if further cases of the disease are reported, Spry said the district would immediately follow up with the health department.“We sent out an instant alert, sent home letters to all parents today, and we would continue to do what is directed by professionals to maintain health and safety for all the staff and students,” she said. “in a very few short hours here, we have gotten a lot of information to a lot of people.”

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Pulmonologist Bruce Beck enjoys playing an occasional blues lick on his harmonica, but seeing his patients not only learn to play harmonica — but improve their lung and cardiac function in the process — is even more satisfying for him.

Bruce Beck, M.D., is medical director of the Pulmonary Rehabilitation Program at El Camino Hospital in Mountain View. The Harmonica Therapy Program was started in 2004 as part of the El Camino Better Breathers Support Group to help improve respiratory function for pulmonary patients. more than 30 people have gone through the program (elcaminohospital.org).

Q: how did the Harmonica Therapy Program get started?

A: one of our patients had heard about musician David Barrett, who is internationally known in the music world, lives locally, and who has been involved with harmonica for health for many years. Our patient went to one of Barrett’s harmonica-for-fun-and-health classes and returned, saying, “This is better than sliced bread. I can breathe so much better!” So we looked into it, and found that the University of Michigan was using harmonica therapy with their pulmonary patients, and had published information on its benefits. we asked David Barrett to give a lecture and harmonica instruction at our Better Breathers Club monthly meeting, and we then started a program to offer harmonica therapy to our pulmonary patients. two of Barrett’s students, Dennis Carelli and Jeff Ballard, teach harmonica to our pulmonary patients on the second and fourth Fridays of the month, and Mr. Barrett himself comes once a year in April to our Better Breathers Club to give an introductory lesson.

Q: what are the pulmonary benefits of using a harmonica?

A: it does three main things: the first benefit has to do with positive pressure when you are breathing out, or what we call pursed-lip breathing. The harmonica is a small instrument that forces you to do pursed-lip breathing. you have to blow air through a small cavity, and this produces positive pressure in the back of your lungs. it can keep the lungs open, and make them more efficient. we teach this breathing method in our rehab classes for people with emphysema and asthma, which are conditions where the lungs want to collapse. And, of course, with a harmonica you also make sounds on inhalation and exhalation.

The second thing that playing harmonica provides is control of your breathing. A lot of our patients are chronically short of breath, and they may have shallow breathing, and get panicked easily. It’s very uncomfortable to be short of breath. When you’re breathing into a harmonica, not only are you doing pursed-lip breathing and creating positive expiratory pressures, but you are actually slowing your breathing down. It’s the same thing as relaxing, and another way people achieve this is through meditation or other exercises that we give them. But playing harmonica is the same type of exercise, plus it produces sound. So not only does it slow down their breathing in order to play music, but they learn the message that if they slow down their breathing, they feel better. And it’s fun to carry around something that they can play.

Thirdly, a lot of these people are on oxygen (which can be difficult), and this helps them feel better about themselves. I think music, in general, helps people relax, and it’s a positive thing when they are able to listen to, as well as make, music. And, they also get to perform in front of people. So there are physiological and emotional reasons why people should be better, and I think anything that controls your breathing is going to help your endurance as well as your strength. In our Better Breathers’ eight-week rehab program, we talk about controlling breathing, using pursed-lip breathing, and (building) exercise tolerance.

I enjoy playing the harmonica myself, and I have experienced what people tell me they have experienced (physiologically). When you exhale through the harmonica, resistance makes the pressure go up inside when you breathe out. And when you’re breathing in, it’s like lifting weights because of the resistance.

Q: what type of patient benefits from harmonica therapy?

A: Our patients have intrinsic lung disease like emphysema, asthma and bronchiectasis. But I would also include people who have heart disease, because a lot of the symptoms are the same — such as shortness of breath. The person who benefits the most from harmonica therapy is someone with bad COPD (chronic obstructive pulmonary disease), emphysema, or pulmonary fibrosis — which makes your lungs stiff and makes you breathe shallowly. In COPD and emphysema, your lungs tend to collapse when you breathe out, and that’s why the pursed-lip breathing is so important. using the harmonica makes you “stretch your lungs,” as it were. I think it’s good for anybody with a lung or heart condition, but you don’t have to have either condition to feel better.

Using the harmonica becomes less of an exercise and more of something that you do for enjoyment. we have other things that we do with people to help exercise their lungs, and some of them are somewhat boring. But harmonica is not boring — it’s stimulating, particularly the blues. you can also be pretty flexible about what you do with the harmonica, and playing with groups of people makes it even better. we want to help people get more out of their day-to-day life, and that’s been our focus.

LJ Anderson writes on health matters every other Wednesday. she can be reached at or ljanderson.com.

Eating disorders have one of the highest mortality rates of any illness —about 10 to 20 percent. furthermore, there is a .5 percent prevalence nationwide, a statistic that is much greater in the case of both college students and athletes. These circumstances added to the meaning and significance of “Before and After Image,” a discussion panel on eating disorders sponsored by the Student Health Center and Personal Counseling Center.

the panel provided students with information about eating disorders from a variety of professionals in the medical, psychological, and nutrition fields. They gave significant details of symptoms and trends to audience members to look for if they suspect that one of their friends have a eating problem.

Suzanne Bornschein, M.D., medical director at the Student Health Center, spoke about how disorder eating is like any other illness — there is a spectrum of mild and severe circumstances.

in addition, there are different kinds of disorder eating that involve restricting diet as well as binging and purging. it is not only females who suffer from this illness. About 10 percent of those who have an eating disorder are male. it is common in wrestlers who have to make their routine weight requirement.

“Just because you do not fit into a certain criteria does not mean you do not have an eating disorder,” said Bornschein. “You do not have to fit a category in order to be suffering and to be hurt.”

the panel went further than to merely explain the physical symptoms of disorder eating, many of which are common knowledge to the general public. They discussed how people with anorexia nervosa are usually in denial of the seriousness of their actions.

“They have ignored hunger long enough that they lose all understanding of their body,” said Bornschein.

“It becomes a personal competition with themselves, an obsessive-compulsive behavior.”

she also pointed out that people with eating disorders are often motivated, driven individuals who do well in school. They are often the people who would never be suspected of crying out inside.

“It is extremely hard work to do all of these things and to live a normal lifestyle,” said Bornschein. “It takes a lot of drive, which causes a lot of individuals to have anxiety as well.”

Michelle Smith, a dietician in Providence, also reflected on her experience working with people who practice disordered eating.

“It is hard to identify individuals suffering from bulemia because they actually eat,” said Smith. “You can look for signs of them going to the bathroom regularly within 30 minutes or one hour after eating. often they will be strict all day, and binge at night.”

Symptoms also include pushing food around on their plate, cooking for other people, or talking about food and never actually consuming.

the speakers urged students to talk to professionals at the Student Health Center or Personal Counseling Center if they are concerned about their own eating habits or those of a friend.

York, PA – the number of lead poisoning cases in York might increase because of cuts to an eradication program’s budget, said Dr. David Hawk, medical director for the York City Bureau of Health.

Funding for York City’s childhood lead poisoning prevention program fell from $172,905 in 2009-10 to $146,635 in 2010-11, coordinator Marilou Yingling said. the program receives its allocation from the state, Yingling said.

In July, budget cuts required the city to eliminate one of its screeners, she said.

The loss of personnel required the health bureau to abandon door-to-door screening. in the summer months, two screeners hit selected neighborhoods and checked residents’ lead levels. It’s a blood test — more than 10 micrograms of lead in the blood is considered dangerous.

The two remaining screeners still check about 2,000 kids a year at places like head-start programs and by appointment, Yingling said.

The funding cuts are already having an effect. There were 37 reported cases of lead poisoning in York in 2010, down from 69 the previous year, according to the bureau’s annual reportable conditions summary for 2010. That doesn’t mean York’s lead poisoning problem is going away — it means more cases of lead poisoning aren’t detected, Hawk said.

Lead-based paint was banned in 1978, but it’s still in many homes IN York. in places where the lead-based paint is still on the surface, there’s a danger that children will eat paint chips, attracted by lead’s sweet taste.

“The days of mortality from lead poisoning are pretty much gone,” he said.

The lower-level cases health care workers confront today can affect bone and muscle growth, speech and language problems and delays in child development.

The disease can affect a person’s aptitude, ultimately lowering expectations, Hawk said.

That’s why funding cuts to York City’s Childhood Lead Poisoning Prevention Program worry Hawk — the toll poisoning takes on a patient’s quality of life.

Lead poisoning “doesn’t just create a medical problem,” Hawk said, “it creates a social problem.”

2010 whooping cough outbreak on decline

The outbreak of pertussis, or whooping cough, saw 12 confirmed cases of the disease in 2010, according to the York City Bureau of Health. in 2009, there were none.

“Twelve pertussis cases were the tip of the iceberg in terms of what was happening here in the city,” Medical Director Dr. David Hawk said. “We had a lot more unconfirmed pertussis cases going on.”

To qualify as a reported case, symptoms have to meet strict guidelines set by the federal Centers for Disease Control. so far, there has been one confirmed case of the illness in 2011, Hawk said.

The outbreak resulted in no pediatric deaths to date, Hawk said. the disease can be fatal.

Swine flu, which saw 62 confirmed cases in 2009, is still lingering, Hawk said. however, no confirmed cases were reported in 2010.

STDs

York saw decreases in gonorrhea and syphilis in 2010, according the York City Bureau of Health.

The decrease is part of a recent national trend for sexually transmitted diseases, Medical Director Dr. David Hawk said. Recent advancements in single-dose therapies — where patients can opt for a single shot instead of a regimen of pills — deserves at least some of the credit for the decrease.

Also in 2010, there were 22 reported cases of HIV in York, Hawk said. It was the first year medical employees compiled statistics for HIV patients by where they live. in the past, HIV patients were listed only where they were diagnosed or received treatment, which led to inaccurate readings, Hawk said.

Lead paint safety

For more on lead paint, including safety tips, visit cpsc.gov/cpscpub/pubs/5054.html.

How to reduce stress and suspicion when seeking chronic pain medications.

You’re a chronic pain patient who takes several prescription narcotics to control your symptoms. Then one weekend, excruciating pain lands you in the emergency room. there, a doctor grills you about your medications, in part to make sure that you’re a legitimate pain patient, not someone seeking drugs. What can you do to help the ER doctor to believe you?

It’s not always easy to tell chronic pain patients from drug-seeking patients, says Howard Blumstein, MD, FAAEM, president of the American Academy of Emergency Medicine and medical director of the North Carolina Baptist Hospital emergency room.

Patients with chronic pain visit the ER for various complaints, he says. “Some of these patients have demonstrable disease, like sickle cell disease or chronic pancreatitis. I think that physicians are more likely to give them the benefit of the doubt when they come in and say they have pain.”

“Other patients are prone to have problems that you can never objectively demonstrate, like chronic back pain and chronic headaches,” he says. “We just have to take their word for it. You can’t look into anything and tell whether or not they’re actually having pain.”

Regardless of which group patients fall into, Blumstein says, “there are some patients who, because of their behavior or their frequent visits, still get labeled as being addicted to drugs or abusing drugs.”

What type of behavior raises suspicions? “Patients will come in and be very demanding, get into fights with doctors and nurses because they don’t think they’re getting enough pain medicine, and that causes the health-care providers to become suspicious of the patient’s motives,” he says. or the patient may ask for a specific narcotic like Demerol, or say they’re allergic to non-narcotic pain relievers.

Understanding Suspicion in the Emergency Room

“In most cases, it’s probably unfair to the patient,” Blumstein says. but emergency room doctors have strong motivations to carefully screen out drug seekers. they want to thwart drug abuse and any chance that narcotics will be diverted, for example, sold to strangers, or exchanged for illegal substances. “They have a high street value,” Blumstein says.

ER doctors have one useful tool, though. Currently, 34 states have prescription drug monitoring programs that allow doctors to check a patient’s prescription history online. “I can look up a patient and see all the prescriptions that have been filled for controlled substances,” says Blumstein, who practices in North Carolina. Doctors can use the database to corroborate a patient’s story. or they might see patterns that warn them to probe further for drug abuse, for example, prescriptions from numerous physicians that have been filled at multiple pharmacies.

“It is an unbelievably great tool for physicians,” says Eduardo Fraifeld, MD, president of the American Academy of Pain Medicine.