October is the start of our push to get everybody vaccinated against influenza. This year we’ve got the vaccine early, unlike previous seasons. As always, you can’t get the flu from the vaccine - it only has pieces of the viruses. This year’s has fragments of two A strains - Moscow and New Caledonia and one B strain - Hong Kong. The vaccine is free for Medicare patients and $25 for others. We recommend it for everyone who isn’t allergic to it. Remember, it prevents up to 42% of work/school absences from respiratory illness also.

All of our patients on Prempro and other estrogen replacement therapies should have heard from us concerning the Women’s Health Initiative. The WHI Prempro arm was stopped by the safety monitoring committee after analysis showed increased risk of heart events (7 per 10,000 women years), stroke (8), blood clot to the lung (8), and invasive breast cancer (8) compared to no drug. There was some benefit: less colorectal cancer (6) and less hip fractures (5). The safety committee allowed a Premarin only arm of the study to continue; that study is supposed to be complete in 2005.

At present, I do not recommend estrogen replacement unless "hot flashes" etc are intolerable.

Mary Huvane, R.N. joined our staff in September and has already met many of you. She has a strong background in cardiovascular nursing as a CCU nurse at Westchester Square Hospital in the Bronx.

Vitamin E: Among the most frequent questions we get concern vitamin E. Here’s what we know:

Heart: it does not help – but it doesn’t hurt either

Memory & thinking appear to be enhanced according to several studies, the latest at the University of Illinois, which showed a 1/3 reduction in the rate of cognitive loss in those with the highest E intake

Prostate - several studies have shown up to a 1/3 reduction in prostate cancer.

Eyes: does not prevent development or progression of age-related macular degeneration

Colds - E does not help, but seems to increase illness severity

Bleeding - there’s no effect unless you’re on blood thinners.

The closing of Valley Woods Pharmacy has inconvenienced many patients. And it’s caused an overwhelming amount of work for us, even with the computer system. Please call ALL of your renewals and questions into our Rx line 914 962-3182. Please allow a day for them to be faxed out. And please remember – "triplicates" for controlled substances must be mailed or picked up. State law does not allow either faxing or phone-ins.

1) Memantine is a new drug in clinical study for moderate/severe disease. The drug has shown promise in US multi center studies: cognition, behavior and activities of daily life all improved compared to placebo.

2) Blood pressure: There’s evidence that a diastolic ("bottom number") BP over 95 increases the risk of the disease by 80%. And a systolic of 140-159 does the same; over 160 raises the risk 240%!

3) Cholesterol: levels of 251 or more increased risk 3-fold; conversely, cholesterol lowering "statins" such as Lipitor and Zocor may cut the risk of AD by 79% (according to a Boston University study).

4) Vitamins: E, B-6, B-12 & folate all show benefit.

5) Anti-inflammatories: ibuprofen, naproxen & Celebrex may help.

6) Estrogen? The hormone is in on-going studies for AD prevention.