July 5, 2018
On July 19, North Carolina Attorney General Josh Stein will present the keynote address at a daylong conference in Asheville on the ethical issues healthcare professionals face when treating patients who are struggling with opioid use disorders (OUDs) and substance misuse. The Attorney General will provide an update and discuss the ethics of North Carolina’s formal response to the opioid crisis.
June 6, 2018
The Mountain Area Health Education Center’s Human Resources Office is requesting proposals for Employee Assistance Program (EAP) services to assist MAHEC employees and their immediate family and household members.
May 23, 2018
This month, and especially in the past week, we have seen an increase in confirmed cases of pertussis throughout Buncombe County, mainly in school-aged children. Our Communicable Disease Control staff are working with school nurses and school administration to inform parents of exposed students, identify additional symptomatic individuals, and provide prophylaxis for high-risk contacts. Letters have been sent to parents of students who may have been exposed to pertussis. The letter asks them to contact their child’s doctor to prescribe prophylactic antibiotics against pertussis to their child if the child:
- has a weakened immune system or a pre-existing health condition that may be worsened by a pertussis infection; or
- lives with or has close contact with any of the following people:
- A woman who is in her third trimester of pregnancy,
- An infant younger than 12 months old, or
- Anyone with a weakened immune system or other pre-existing health condition that may be worsened by a pertussis infection.
The letter also instructs parents that if their child has recently started coughing, they should keep them out of school & group activities and inform their child’s health care provider of their symptoms and that they might have been exposed to pertussis. They have also been given a “Dear Colleague” letter (attached) to share with their provider that outlines clinical recommendations for testing, treatment and exclusion.
Please consider pertussis in your differential when seeing anyone who has the symptoms listed below. Test, treat, exclude & report whenever you suspect a case of pertussis. (More details below.) It is critical that you notify our Communicable Disease Control nurses immediately whenever you suspect a patient of having pertussis – this enables us to stop the spread of infection in our schools and community. For Buncombe County Communicable Disease staff, call 250-5109 (available 24/7/365).
Please promote pertussis immunization for everyone, but especially for those who are in their 3rd trimester of pregnancy or in contact with infants.
- BCHHS Immunization Clinic (53 S. French Broad Ave., ground floor) is open Monday-Friday, 8am-5pm, no appointment necessary. We will be closed Memorial Day. We are able to provide low- or no-cost Tdap to clients who are under- or uninsured.
Symptoms of pertussis: In the absence of a more likely diagnosis, persons with the following symptoms should be suspected of having pertussis:
· Cough lasting for > 2 weeks PLUS 1 of the following
o paroxysms (violent fits) of coughing
o inspiratory whoop
o post-tussive vomiting
o apnea (with or without cyanosis) in an infant < 1 year old
· Keep in mind that infants < 6 months of age, partially vaccinated children, adolescents and adults frequently do not have the characteristic whoop and may have other atypical features.
If you suspect someone of having pertussis based on their signs/symptoms, please DO ALL 4 of the following steps:
- Collect both a PCR and culture of nasopharyngeal secretions for Bordetella pertussis.
o For the PCR test, consider ordering a PCR Respiratory Panel that offers same-day results for common respiratory pathogens, including Bordetella pertussis. Clearly, use your clinical judgment to balance the costs of any tests you order with the utility it can offer in the diagnosis & management of your patient. PCR tests can be falsely negative or falsely positive if not ordered appropriately, so make sure to order only in patients who have the signs & symptoms of pertussis.
- Please note that we do NOT perform testing for pertussis at Buncombe County Health and Human Services.
- If you have to send a patient suspected of having pertussis elsewhere for lab work, please be sure to provide them a mask to wear.
- Macrolides are first-line treatment. For adults, the easiest option is Azithromycin 500 mg PO x 1 day, then 250 mg PO daily on days 2-5.
- If allergic to macrolides, prescribe TMP/SMX (160 mg/800 mg) PO BID x 14 days.
- See Table 4 at this link for dosing regimens for children as well as other macrolide dosing https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4
- Persons suspected of having pertussis should refrain from all public activities, staying home from school, childcare, extracurricular activities, places of worship, and work until they have completed the first 5 days of appropriate antibiotics.
o They especially should avoid contact with infants & young children and pregnant women.
- Persons suspected of having pertussis who choose not to take antimicrobial treatment should stay isolated at home for 21 days from their onset of cough or until their cough resolves, whichever occurs first.
- Per NC law, medical providers must report all suspected and confirmed cases of pertussis to your local health department within 24 hours.
o For Buncombe County, call our Communicable Disease Control nurses at 250-5109 (available 24/7/365).
o It is very helpful to our investigation if you can tell us if the person suspected of having pertussis has any high-risk contacts (infants, pregnant women, or persons with an underlying medical condition that may be worsened by pertussis).
§ Be aware that when BCHHS Communicable Disease nurses conduct pertussis investigations and find symptomatic contacts to suspected or known cases, we ask these persons to see their primary care provider for testing and evaluation.
For more details on pertussis, see https://www.cdc.gov/pertussis/clinical/
Our Communicable Disease nurses are also available for consultation if you are uncertain of how to proceed or want to talk through a scenario. Please call them at 828-250-5109 anytime you have questions.
May 11, 2018
Dear fellow WNC providers,
I am proud to announce that UNC Gillings School of Global Public Health will be starting a Masters in Public Health Program this fall in Asheville. Applications for this program will open later this month and classes will begin August 21.
May 11, 2018
“Our patients deserve from us the very best health advice and I am certain, after having reviewed this data over the past few years, that lifestyle medicine (better nutrition, more exercise and stress management advice) is what we should be routinely discussing with our patients who suffer from chronic diseases such as obesity, diabetes, hypertension, dyslipidemia, and cardiovascular disease."
May 9, 2018
The Western North Carolina Independent Physicians Association developed a series of brochures to welcome new patients to member practices.
May 3, 2018
You can be part of a young, progressive group committed to community service, health parity, academic excellence, and the transformation of healthcare in Western North Carolina.
May 3, 2018
Project Access has added insulin and inhalers to our formulary in order to assist your uninsured patients so that they can get the medications they need.
April 30, 2018
"Human beings are designed well," says Dr. Gus Vickery. "We are designed to have long, healthy lifespans. We should not suffer from chronic diseases and we should not have to rely on medications to stay alive."
April 30, 2018
Robyn Latessa, MD, director and assistant dean at the UNC School of Medicine (SOM) Asheville Campus, and four of the program’s students were inducted for membership this month in Alpha Omega Alpha (AOA), a national medical honor society that recognizes excellence in scholarship, research, service to others, and professional and community leadership.
April 18, 2018
Physicians for a National Health Program leader Dr. Ed Weisbart will speak on “What Does ‘Medicare for All’ Mean for Medical Practice, Physicians, Patients and the USA?”
When: Tuesday, May 1, 2018 - 12:30 – 1:30 PM
Where: All Souls Cathedral Zabriskie Hall, 9 Swan Street, Asheville
April 18, 2018
As most of you know, over the last several days there have been ICE raids targeting the Spanish speaking communities in Buncombe, Henderson, and McDowell Counties. As of now, WLOS and the Citizen-Times report that 17 people have been detained. Sadly, that number is expected to rise. Our patients and interpreters tell us that people have been targeted when leaving places of worship, dropping their children off at the bus stop for school, arriving at medical clinics, and leaving the grocery store.
April 16, 2018
Hillcrest Apartments is a public housing community serving low-income residents who face multiple economic and social barriers to achieving self-sufficiency. Residents face physical and mental health problems and many lack insurance or primary care doctors. For eight years, the Women’s Wellbeing and Development Foundation (WWD-F) has been working in the Hillcrest community to promote healthier lifestyles.
April 11, 2018
Dr. Robert Kline has shared an article with the Western Carolina Medical Society that he wrote for Physicians for a National Health Program. Dr. Kline eagerly wanted to share with his colleagues from WNC.
March 15, 2018
The Mountain Area Health Education Center (MAHEC) in Asheville, NC has partnered with a national maternal child health collaborative to test a new model that it helped to develop for assessing mothers’ health during well-child visits.
The goal of this screening tool is to reduce low birth weight and preterm births, which account for more than 70 percent of infant mortality, where the US ranks among the worst of all industrialized nations.