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Worth County, Iowa
Northwood · Kensett · Manly · Grafton · Fertile · Hanlontown · Joice

Worth County Public Health Bulletin Board

by Stephanie Seemuth, D.O.

TICS AND LYME DISEASE

In the woods the violets are blooming, the columbine are nodding on their long stalks and the ticks are here.  The nymph stage of the deer tick, May through July, is the time it poses the greatest threat of transmission of Lyme disease to animals and humans.  As the ticks mature, in late summer and fall, they can still infect but are not so likely to do so.

 Lyme disease may affect the joints, the skin, nervous system, and heart.  It usually starts with a red, circular rash at the site of a tick bite.  This rash can grow in size from 5 to 15 cm and could also be irregular, triangular, or oval.  It may be warm and itchy but is usually painless.  Early symptoms may include fever, aching, and joint pain.  As it spreads (disseminates) more rashes may appear; Bell’s palsy of the face, mild eye infections, and joint swelling may also appear.  The symptoms usually develop within 7-10 days after the bite, but some people will have no symptoms for several months up to a year after the bite.  The treatment for Lyme disease is antibiotics.  A person is not immune to having Lyme’s disease after having it once, it can happen again. 

 How to remove a tick?  The best way is with tweezers and pull straight back, do not twist as you may leave a piece of the tick behind.  Don’t crush the tick with bare hands and do wash your hands after removing it.  Drown the tick in rubbing alcohol or flush it down the toilet.

 How to avoid ticks?  Stay on trails when hiking and avoid tall grass.  Insect repellents containing DEET can be used.  The concentration should be no higher than 15% for children and 30% for adults.  Permethrin can be used on clothing, NOT on skin.  Follow the directions carefully and consult the pharmacist, especially when using these on children.  Always wash off the repellent when you come back indoors.

 Prevention means keeping deer and rodents out of your yard.  Keep the lawn mowed, clean up around bird feeders, put the woodpile in a sunny area off the ground, and clean up brush and leaf litter around your home.  Wear long pants tucked into socks and long sleeved shirts when in tick areas.  It is helpful to wear light colored clothing so you can see the ticks more easily.  Check for ticks immediately after coming in; the most common areas for them to hide are the armpits, back of the knee, groin, scalp, and back of the neck.  Check your pets, too.

 Enjoy the outdoors!  We had such a long winter, the woods and parks are going to be a special pleasure this summer.  Simple precautions will make for a healthy time.

 Water, Water Everywhere...

Summer 2008

Warm weather (finally!) is here; heading for the pool, lakes and rivers for summer fun is something we look forward to and that fun should not be marred by catching an illness from the water.

 Most of the bacteria are killed by chlorination of the water, but a parasite called cryptosporidiosis is not affected by chlorine and causes 60% of the cases of waterborne gastric illness.  In 2007, Iowa reported a total of 610 confirmed cases.  Many of these were from water exposure in lakes and pools; other cases occurred in day care centers or had children enrolled in the centers

 The symptoms of crypto are frequent, watery diarrhea, and cramping belly pain.  There may also be nausea and vomiting.  Children under two are especially susceptible, but people who handle animals, especially cattle, those who are immune compromised, and anyone who has contact with an infected person can get it.  Crypto is found in the stool of an infected person or animal and is spread by putting in your mouth or swallowing something that person has come in contact with.  Toys, hands, eating utensils, may be contaminated by someone who has not properly washed their hands after toileting or changing diapers.  You may also get crypto by swallowing pool, lake water, or drinking water, contaminated with the parasite.  The water can be contaminated by runoff of sewage or by someone swimming who has the disease.  You must swallow this parasite to become ill—it is not transmitted by blood.

 How to prevent the spread of crypto?  Wash hands after using the toilet and changing a diaper--wash the child’s hands too.  Don’t swallow pool or lake water or get it in your mouth.  Do not go swimming if you have diarrhea, and stay out of the water for two weeks after it resolves; stay out of child care, school, and work until diarrhea has stopped.  Do not drink unpasteurized fruit juices or milk.  Wash all raw fruits and vegetables before eating; change diapers away from the side of the pool, and use “swimming” diapers.

 The small wading pools that are so popular are strongly discouraged by both the Academy of Pediatrics and the American Public Health Association because “small wading pools do not permit adequate control of sanitation and safety, and they promote the transmission of infectious disease.”

 Treatment?  Get plenty of fluids and consult with a physician before using anti-diarrhea medicine.  A medicine called nitazoxanide (Alinia) may also be used.  Young children, elderly, pregnant women, and immune compromised people are at greater risk of serious illness.  Always consult your physician about diarrhea that is persistent or returns.

SUMMER 2007

The HPV (human papilloma virus) vaccine is the first vaccine developed which prevents certain kinds of female cancers as well as pre-cancer conditions and genital warts.  This vaccine contains four viral types (hence its designation as quadrivalaent) which account for 70% of cervical cancers and 90% of genital warts.  The vaccine is made from non-infectious HPV-like particles.  However, women should continue to follow regular Pap smear screening because the vaccine will not protect against all HPV types and also, there is no evidence that the vaccine will have any affect if a woman already has an HPV infection or genital warts.  HPV infections can be present with no symptoms and the body’s immune system will get rid of them; there is no test currently available to tell whether a person has already had the infection.  Pap smears do screen for HPV if the specimen shows dysplasia.  It is also important to realize it will not prevent other sexually transmitted diseases. 

Why are physicians so concerned about HPV infections?  These HPV infections can become chronic and that is when they go on to develop cancer of the cervix, one of the most common cancers women develop.  The non-cancerous HPV can develop genital warts which also may become chronic.

The current recommendations are to begin the vaccines at age 11-12 years before sexual activity occurs.  Women ages 13-26 may also receive the vaccine; while it is true there is no test available to tell if a person has had the virus, few young females would have been infected with all four types of virus found in the vaccine so would benefit.

The vaccine is given in three doses; the first two doses are given one month apart and the third dose, three months later.  The duration of the protection is thought to be four years.

Cancer of the cervix previously caused more deaths than any other type of female cancer.  The widespread use of the Pap test has significantly reduced this number.  Now we can offer two approaches to prevention of this cancer; primary: safe sexual practices and HPV vaccination and, secondary: pap smears with HPV screening and removal of pre-cancerous lesions.  This vaccine is 95-100% effective against cervical neoplasia and 99% effective against genital herpes caused by the serotypes in the vaccine.

Worth County Public Health has the vaccine available or contact your primary care physician.  This is an important new tool in preventative medicine!

Ticks: the Lyme disease tick is carried in its immature stage by the white-footed mouse and in the mature stage, by the white-tailed deer.  It is so small that many do not see the tick when it bites; it may be 3 to 32 days before symptoms occur.  The usual first symptom is a red raised lesion that expands and resembles a bull’s eye but as many as 25% of people never have this skin lesion develop.  Other symptoms are flu-like and, if untreated with antibiotics, 60% of patients will develop arthritis, especially of the large joints.

Prevention, as always, is easier than treatment!  When in the woods and fields, wear long pants tucked into boots, long sleeves, and insect repellent.  Check carefully for the tick when camping and report immediately to a physician if you have a suspected bite.

Bats ARE a protected species but common sense is important.  Recommendations are to never handle a bat without gloves; if a bat is found in the bedroom of a child or adult who might not be able to communicate being bit, it must be assumed to be rabid until proven otherwise.  Contact your vet or the public health department for testing.

Skunks are dangerous because they are the largest reservoir of rabies in the state of Iowa.  There is no rabies vaccine effective for them so they should not be adopted as pets; skunks can be born with rabies so if you are tempted to keep a baby skunk…don’t!

And a reminder:  be sure your tetanus shots are up to date.  Gardeners need to be aware that puncture wounds such as having a thorn stick you, can cause you to have tetanus; it grows best without air so these are especially dangerous.  Stay up to date!

Summer is a great time to dig out those discarded resolutions.  The weather lends itself to outside activity (most of the time,) so a walking program has a real chance of succeeding.  Exercise is helpful with any change you have wanted to make, from stopping smoking to alleviating depression.  The most common reason for avoiding regular exercise?  “I’m on my feet all day at my job…I must get enough exercise there” or “I’m just too tired when I get home.”  The problem with exercise in the work place is that it is not continuous so does not raise your heart rate.  You may be tired when you get home from work but that is not the best time to exercise anyway…the ideal time is right after supper.

Begin a walking program with just walking five minutes, any speed, turn around and walk back home.  Increase by five minutes every five days until you walk 15 minutes before turning back; distance and speed do not matter, time does!  There you will have 30 minutes/daily and you should do this five days a week.  If you take any kind of medicine for your heart, blood pressure, or breathing, (asthma or lung disease) you should ask your doctor before starting this or any other exercise program.

Eating lighter is easier in the summer, too.  If your triglycerides are high, try cutting in half the amount of bread you eat, make a real effort to have a green and yellow vegetable at supper, and get in three fruit servings a day.  Again, if you are diabetic and taking medicine or insulin for it, talk to your doctor before changing your diet. 

The Public Health department offers screening of lipids to give you a starting baseline.  Call first so you can fast correctly for the test.

Some good things that happen:  A weight loss of just ten pounds will make your blood pressure go down significantly; an exercise routine, done five days a week, can reduce changes of some kinds of cancer; lower your lipids and boost your mood; and, these new ways of treating your body with kindness…it is the only one you will have…will become habits with the ability to more easily follow through on those resolutions!

Reducing Cholesterol Reduces Health Problems--12/27/2006-Cholesterol, anti-oxidants, fats:  trans, poly, mono-all these scientific words can be confusing.  And then there are the medicines to control the levels of these in the blood:  statins, bile acid sequestrants, niacin, and fibric acids.  The confusion was cleared up by a patient saying, "If it looks good, smells good, and tastes good, it's not on my diet!"  While not really true, it does seem as if a lot of favorite foods have health concerns.  Definitions may be helpful.

Cholesterol is a waxy substance in blood whose purpose is the repair of cell walls and the formation of some hormones.  The two major types of cholesterol are LDL a lipoprotein that carries cholesterol and deposits it on blood vessel walls and body organs; HDL is a lipoprotein which acts as a scavenger and will remove LDL from the blood.  Cholesterol comes from animal food we eat and is also made by the liver; some diseases can also make the cholesterol level go up-a low functioning thyroid, diabetes, and kidney failure, as well, rarely, as a genetic disorder.  High levels most commonly come from poor eating habits, excess weight, and little exercise.  Triglycerides, another form of fat, are a source of energy but too much will clog arteries and also cause inflammation of the pancreas. 

Fats are more complicated but it is easy to check food labels if you keep in mind the saturated and trans fats are the most harmful and are found in tropical oils (coconut, palm, and cocoa butter) and also margarine.  These are commonly used in commercial cookies, crackers, and cakes.  Monosaturated fats are best and occur in olive, peanut, and canola oil.  These , in recommended amounts, are especially useful in blocking oxidation.  This is the process body cells go through to absorb fats and cholesterol. 

The most popular medications for elevated cholesterol are the statin group.  This medicine will block the substance the liver requires to make cholesterol.  The liver is then forced to use up its store of cholesterol and starts removing it from the blood.  Bile acid sequestrants are medicines which pull cholesterol from the intestines.  The liver needs cholesterol to make bile acids so this increased need (because of the sequestering) makes the liver take cholesterol from the blood.  Niacin is a B complex vitamin which will reduce triglycerides and LDL cholesterol but can be harmful to the liver, and causes a tendency to diabetes and gout.  It also causes many people to itch but is inexpensive and, if tolerated, will work well.  Fibric acids are used principally to reduce triglycerides but can't be used in combination with the statins as that can cause muscle inflammation.

The combination of diet and exercise are helpful and usually tried before medications are given.  The diet to reduce cholesterol levels should be high in fruits and vegetables because they have antioxidants; this slows the process of absorbing fats and cholesterol in the arteries; red meat, no more than three times weekly (patients complain they will either start clucking, gobbling, or grow gills-not so) and cutting back to half the amount of bread and starchy foods eaten, as well as using low fat milk are all helpful in decreasing the amount of cholesterol you put into the body.

The Public Health Department will check your blood but it must be a fasting specimen to be valid.  Twenty four hours before the test, have no alcohol; the evening before the test, eat a low fat supper and after midnight, do not eat or drink anything except water.  Diabetics (either on insulin or medication) should have their usual bedtime snack but should not take their insulin or medicine in the morning until after the test.  However, if the blood sugar gets too low, treat it immediately with sugar.

Numbers to aim for:  LDL less than 130 - HDL 60 or more - Triglycerides less than 150.

Reducing the cholesterol levels in the blood will significantly reduce the risk of heart attack or stroke.  Well worth the effort!

Immunizations--8/16/2006-Quarantine—the word brings memories of the big yellow sign on the telephone pole at the edge of the yard and on the front door announcing to everyone that my sister and I were once again “infectious” and down with whatever illness was currently epidemic in our town; we caught them all.  One memorable year, when I was in first grade and my sister in second, we spent most of the time in quarantine, beginning with measles, progressing to chicken pox, and finally whooping cough.  Because the sibling of a sick child was contagious too, Karen had to stay home and wait until she came down with the symptoms, usually ten days to two weeks.  It became a very long year, and we had “home schooling” from our mother out of necessity.  Quarantine was the only means to protect others from these diseases; now of course, we have immunizations for them.  The last polio epidemic occurred in the 50’s and most of us can remember the warnings to stay out of public places such as swimming pools and movie theatres.  The first vaccine for polio was administered with a sugar cube, and I always thought this should establish a trend rather than the shots; but, of course, it wasn’t long before the polio was included in the diphtheria and tetanus shot!

All children in Iowa have a requirement for vaccinations before entering school; many pre-school and day care programs are now requiring them at age four.  For quite some time, our department nurses would go to kindergarten round-up and offer the shots there.  It was decided this association of the unpleasant shots with school was probably a poor introduction to the fun of learning!  It was discontinued, but the immunizations are offered in regular clinics and can be scheduled at the office for the convenience of parents. 

Memorial Day always brings a trip to the family graves and while visiting the old cemetery of Lawn Hill outside Stanhope, we noted the many graves of very young children.  Many of these children died from diseases we rarely see anymore; the high fevers and eye problems from measles, the certain death from tetanus, the disabilities of polio if the initial illness was survived…all have been almost completely eradicated by the regular immunizations we take for granted.

Adults tend to forget about keeping the tetanus immunization up to date; this should be done every ten years.  It is especially important for farmers and others who might suffer puncture-type wounds to stay current.  Mumps became an epidemic this year and if you are not sure if you got two MMR shots, a titer should be drawn to see if a booster is needed.  Many colleges are now requiring students who live in dorms to get the meningitis vaccine. 

High Blood Pressure--7/19/2006-High blood pressure affects 50 million Americans and is defined as blood pressure greater than 140/90. 

Blood pressure is simply a measure of the force of blood through the vessels and until the early 1900's was evaluated by the physician palpating the radial (at the wrist) pulse and noting its "tension, volume, and force."  Dr. Harvey Cushing brought the instrument back from a trip to Italy and started its use at Johns Hopkins but this cuff simply occluded the blood and the pulse was palpated; this basically gave only the top number so provided little additional information and the physician evaluation of the character of the pulse was still considered superior.  The cuff did not catch on with physicians until the stethoscope was used to hear the two sounds.  Interestingly, the stethoscope was reserved to only physicians and it wasn't until the 1960's that blood pressure measurements by nurses, using the stethoscope, became a standard nursing practice.

Blood pressure should be measured while sitting, with the arm at the level of the heart.  Both arms should be evaluated and the higher pressure reading used.  It should be checked at least one hour after eating and caffeine, thirty minutes after smoking, and you should not be taking cold or cough medications, which can raise it significantly.

Standards for acceptable blood pressure are changing.  In the "old days," blood pressure was 100 plus your age for the systolic (top) number and the bottom number (diastolic) should not be over 90.  Normal is now considered to be less than 130 systolic and less than 85 diastolic.  For people with diabetes or kidney disease, it should be 120/70.

For some people, diet and exercise will bring the numbers down; a weight reduction of just ten pounds can make a significant difference.  Regular, moderate exercise such as a twenty minute daily walk is also helpful.  For one third of our hypertensives, reducing salt in the diet is helpful and the DASH diet is effective.

Taking the BP at home is helpful; bring your machine to the doctor's office or to the public health office and check it for accuracy.  If your BP goes up the minute you walk into the doctor's office this will give a more accurate reading!

Hypertension has very few symptoms until it has done damage; have it checked regularly.  The public health nursing staff will check it for you if you stop by our office.

Worth County Transit System--6/21/2006-Six thousand, one hundred and fifty-four is the number of passengers the Worth County transit system has served so far this fiscal year--a very important benefit to our citizens.  Trips to medical and dental appointments, dialysis treatments, adult day care, Opportunity Village, and Voc Rehab are all destinations of passengers on the two transit buses run by the Worth County Public Health Department.  The buses travel both within the county and outside it; they also furnish city transit within Manly but not in Northwood who has its' own city service.

The Public Health Department contracts with NIACOG (North Iowa Area Council of Governments) who leases the buses to Worth County for $1 a year.  The expenses to our department--maintenance, gas, and staff to drive the buses, are all reimbursed back to us from NIACOG.  Worth County taxes fund a 65 cents per capita rate for this service and NIACOG then budgets (currently) $72,500 yearly for this service.  The rates for riding the bus are set by NIACOG; round trip outside the county is $10 with seniors and disabled getting a lower rate of $4.  Students may take the bus for the lower rate.  Mercy has a Silver Advantage program which pays for visits to their facilities and Mayo also has a program.  The bus drivers have that information with them.

Access to medical care is a concern in all rural areas; the transit service has proved a reliable entity and makes one less dependent on busy family members and is another way we can help people remain independent.  Fun destinations may be just shopping, a noon organ recital at a Mason City church, a visit to the art museum, or Music Man Square.

The buses leave about 7 a.m. and try to be back in Northwood by 4 p.m. and are available five days a week.  Four drivers are currently employed by the department:  Howard Patterson, Lynn Chapin, James Stehn, and Allan Thompson.  To schedule a trip, call the Worth County Public Health Department at 641-324-1741.  We're happy to give you a ride!

Senior Health Clinics--Many patients through the years have said, “I’d like to live a really long life but…” and then come the qualifiers:  “I don’t want to become senile or have a stroke and be a vegetable.”  Or, “I don’t want to have a debilitating and painful illness.”  Or, “I don’t want to be a burden to my family.”

Popular magazines all have ideas on how to live long, productive, quality lives, but something physicians have always known is that unless you have a reasonable degree of health, quality is difficult to attain.  One of the best ways you can help yourself to a healthy long life is to take part in what physicians call preventative medicine—the evaluation for diseases before they become symptomatic.

For several years, our Worth County Public Health Department has offered screening physical exams in our Senior Health clinics.  These are done by a Registered Nurse and are available at no cost, but a donation is appreciated.  Two blood panels are offered at just the cost of our supplies; a hearing and audiology evaluation is also included.

In 2005, for the first time, Medicare administrators decided to offer a one-time screening physical for those persons enrolling in Medicare.  The appointment must be made within six months of enrollment, so it is important to take advantage of this when turning sixty-five.  The screening includes an EKG as well as blood tests. 

Patients often wonder what tests Medicare will cover for screening purposes.  (For most tests, Medicare requires a diagnosis.)  There are several that are allowed and two are new, going along with the concept of looking for disease before symptoms are obvious.  A cardiovascular screening panel, testing for cholesterol, triglycerides, HDL and LDL, and a diabetes panel for patients with at least two risk factors can be done yearly.  If a patient has been diagnosed with pre-diabetes, the test may be done twice a year.  This is good news, for hopefully we may find those patients who have blood overloaded with fat and treat them before the arteries become clogged causing a heart attack or stroke; diabetes can be found early before the damage to blood vessels, eyes and kidneys begins.  For men, PSA (prostate specific antigen) may be done once yearly as a screening for prostate cancer and other disease of the prostate.  For women, mammograms are paid for on a yearly basis and pap smears on an every two year schedule unless the woman is high risk.  For those women not of Medicare age, our department offers the Iowa Breast and Cervical cancer program and the guidelines are very generous.  It is intended for women with no insurance, low reimbursement, or a high deductible.  The bone density test, a simple x-ray procedure evaluating for osteoporosis, may be done every two years.

A really unpopular test, but one we hear a great deal about is the colonoscopy, which is recommended for all of us age fifty, and then every five years if no problems are found.  Medicare pays for this procedure done every two years for high-risk patients and every ten years for low risk.

Smoking is such a critical health issue that Medicare will pay for two attempts at quitting every year.  Our Public Health Department also offers a completely free quitting smoking program.

What do we hope to gain from all this testing?  It is anticipated that finding fat in the blood, the use of diet, exercise and sometimes medication will help clear clogged arteries, preventing a stroke or heart attack.  This will also help kidney function and the control of blood pressure.  When early signs of diabetes are found, again diet and medication as well as lifestyle changes will hopefully slow the progress of this all too common disease.  Colon cancer found early can be cured, just as cervical cancer found early with a pap smear, and breast cancer with a timely mammogram.  Until we find the cause of these diseases, our best opportunity for a quality life lies in finding the problems early.

County Board of Health--10/26/2005 -- The County Boards of Health originated in 1866 with the establishment of what were called “local” health boards.  These were comprised of the mayors and councils of the towns and sometimes the township trustees.  They were directed to control nuisances and regulate sources of filth and illnesses.  Not until 1880 was there a State Board of Health.

The State Board of Health was established so statistics could be collected and also so the duties of the local boards could be established.  Local boards could be punished if the duties were neglected.  Many services were begun such as the environmental services, nursing and visiting nursing services.  In 1967, a new Local Health Act was passed, Code 137, and it is basically the code under which we now operate.

Five citizens, one of whom must be a physician, are appointed to three-year terms by the Board of Supervisors.  Current members are Dennis Bartz, Grafton; Darrell Bang, Joice; Caryl Lawyer, Manly; Dr. Stephanie Seemuth, Northwood; and Phyllis Tietjens, Manly.  We are required to meet at least quarterly to oversee the health programs and make and enforce rules for the protection of public health.

Mandates from the State Board of Health must be implemented and when a new chapter is adopted at the state level, we are asked to adopt regulations from the broader mandate for implementation in our county.  An example is a new chapter (68) Control of Lead Based Paint Hazards.

We are encouraged to develop regulations at the county level for the control of lead based paint hazards.  This ordinance will principally affect buildings constructed before 1978; it also deals with soil lead hazard from such buildings and will address cleanup procedures as well as violation penalties.

Perhaps the most familiar programs of the Department of Health have to do with the nursing and home health aids.  We also do health education programs in the county schools as well as our new mentoring program for children.  Immunization clinics for children, adult basic health exams, flu clinics, the transit service which provides transportation within the county and to Mason City and free blood pressure checks are all services offered to county citizens. 

Each county is required to have a sanitarian to work on environmental health issues.  Shane Buenzow is currently working on updating the records of wells and septic systems, and we will have a meeting after the first of the year to explain the regulations concerning septic systems, wells and other environmental concerns.

The Home Health and Housekeeping Aide Services--One of our agency’s most appreciated services is that of the home health and housekeeping aides.  Currently, four women function as aides to provide care in the home.  They are certified nursing assistants and are required to have continuing medical education each year to keep their accreditation. 

The services offered are light housekeeping, planning and preparation of meals, help with personal hygiene such as bathing, and assist with exercises if indicated.  Aides may also do errands such as grocery shopping.

How does one access this program?  A referral may be made by anyone.  Sometimes it comes from a physician who is concerned about weight loss, suggesting poor nutrition or personal hygiene issues; often the referral comes from a family member who is hoping to make it possible for their loved one to stay at home and avoid nursing home placement; or it will come from a neighbor or friend who is concerned for the safety of the person but thinks with some help, independence could be maintained.  Other circumstances where these services are important may be when a person is discharged from the nursing home or hospital and needs help with the convalescent period.

We find there are many older persons who can benefit from the aides’ help to keep them safe in activities such as bathing where there is particular concern for falls, their environment clean, and help with nutrition issues by meal preparation and planning appropriate for age and physical activity level.

The cost of this help is often an issue as many seniors are on a fixed income.  Medicare, TitleXIX, private insurance, or VA benefits may apply.  A per hour sliding fee scale is applied based on number of persons in the household and a personal data form which is filled out by the client.  The Worth County Department of Public Health receives grant money from two principal sources to make up the difference between actual cost and the amount a person pays.  The Iowa Department of Public Health and the Elderbridge Agency are the funding sources with which we work for these funds.

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