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Hepatitis C

Jan, a fifty-something mom, registered some surprise when I listed hepatitis C as one of the things I would test in her bloodwork.  “But I’ve never had jaundice or anything that would say I have liver disease. Maybe I’m tired a lot, but who isn’t?”

I explained that the recommendation is that all “baby boomers” born between 1945 and 1965 get one blood test for hepatitis C even if they have no symptoms.  In fact, the majority of folks with hepatitis C virus (HCV) are without symptoms.  If they do get them they tend to be vague with many other possible causes – things like fatigue, muscle and joint aches, tingling in the extremities and itching.  Due to its minimal symptoms, HCV is known as the “silent epidemic” and many infections go unrecognized and untreated for many years.  But the baby boomer generation comprises about three fourths of the chronic HCV infections so screening them could help diagnose and treat a majority of the as-yet-undetected HCV infections.

HCV is caused by a virus that was finally identified in 1989.  The virus particularly attacks the liver, and 75% of those who get it go on to a chronic infection that continues to damage the liver indefinitely unless treated.  In some 20% this chronic HCV leads to cirrhosis, liver failure and/or liver cancer.  The identification of the HCV led to the development of a blood test for it in 1990 and thus the ability to test the blood supply.  This nearly knocked out the previously common problem of contracting HCV from transfusions.

HCV is so common that about 3% of the world’s population has been infected and there are more than 170 million chronic carriers.  Here in the U.S. less than 2% of the population has HCV, but it nevertheless has surpassed HIV as a cause of death.   Likewise, HCV just edges out alcohol as the #1 cause of chronic liver disease in the U.S.  One of the reasons our bodies has such a hard time killing HCV when we are infected is that HCV can produce a staggering 10 trillion new viral particles each day.

So, how does one catch HCV?  As noted, prior to 1990, blood transfusions were a common way for people to contract HCV.  Nowadays the majority of new hepatitis C infections are from the use of illegal drugs with nonsterile needles or in those who snort cocaine with shared straws. HCV can also be transmitted by tattooing with improperly re-used needles, sharing razors, and acupuncture. The use of disposable needles for acupuncture eliminates this transmission route. Although sexual transmission is less likely it still ranks as the second most common mode of transmission.  Infected pregnant women can also occasionally pass HCV on to their unborn child

If you do have any suspicion that you may be infected, if you were born between 1945 and 1965, or if you have engaged in any of the above-mentioned more high risk behaviors, a simple blood test can rule HCV in or out.  Hopefully, if you get a HCV test it will be negative.   But if the test shows that you have been infected with HCV and that it is still active in your system, there are now some highly effective treatments.  A number of treatments, typically taking about 12 weeks, now result in cure rates greater than 90%.  They are admittedly expensive, but there are a number of programs through which many patients receive help in getting their medications at least partially paid for.  Of course avoiding alcohol and other liver toxins becomes even more crucial for those with HCV.

So the best bet for exposing and eradicating the silent epidemic of HCV infection is a rather simple and inexpensive blood test.  If you’ve never had it tested and have any of the risk factors mentioned, ask your doctor to test you.  It’s far better to break the silence than to let this little virus continue to advance its stealth attack on you and your liver.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835


Heart Failure

My middle-aged patient was both confused and concerned.  “I don’t know what the deal is; I can barely make it the hundred yards to my mailbox and back without huffing and puffing and stopping to rest.  And I’ve never been a smoker, so what’s the deal?”

As it turned out, after a full work-up, the deal was heart failure.  Simply put, heart failure is when the pumping ability of the heart weakens to where it can’t readily keep up with the demands of the body.  It affects nearly 6 million Americans of all ages and is responsible for more hospitalizations than all forms of cancer combined.   In fact it is the number one cause of hospitalization for patients 65 years and up.  Nearly 50% of heart failure patients will die within 5 years of their diagnosis.

What causes heart failure?  There is quite a list of factors that can contribute: everything from blocked coronary arteries, diabetes, high blood pressure, heart valve abnormalities, infections and inflammations, toxins (such as excess alcohol) and certain genetic tendencies.  Often a heart which has been weakened a bit by one or more of these factors is pushed into symptomatic failure by excess salt intake, uncontrolled high blood pressure, a new heart rhythm disturbance such as atrial fibrillation, a heart attack or some serious infection.

Initially heart failure may show no symptoms at all.  However eventually a person may experience a long list of symptoms including shortness of breath with minor exertion or with laying down flat, rapid heart rate, tiredness, puffy ankles, chest pain or heart palpitations.

If you were to experience some of these symptoms and present to your doctor, several things could be done to help diagnose whether you had the beginnings of heart failure.  Of course a thorough description of the course of your symptoms including what makes them better or worse would be undertaken.  Likewise a physical exam (with particular focus on the heart, lungs, and blood vessels), blood tests, an EKG and tests such as a chest x-ray and echocardiogram would likely be ordered to assess the heart’s function.

What if in the end you did indeed have the beginning of heart failure?  You would then be given an idea of how advanced your heart failure was and a treatment plan would be put in place.  Certain lifestyle recommendations such as a low salt diet, quitting smoking or excess alcohol, avoiding certain meds such as NSAIDs (ibuprofen, naproxen), and aiming toward an ideal body weight and modest exercise would be discussed.  Likewise, there are a few meds that have been shown to be beneficial in certain types of heart failure and these would likely be started.  Risk factors such as high blood pressure, high cholesterol and diabetes would need to be carefully controlled.

Of course to pursue a healthy lifestyle to avoid the factors that lead to heart failure would be best of all.  But if in spite of that you or someone you love start showing symptoms of possible early heart failure, have it checked out; the earlier you start treating it with both lifestyle and appropriate meds the better your precious heart is likely to do.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835






Top Docs

Dr. Allsop and Dr. Pardue, the founding partners of Trinity Medical Associates, were voted 2017 Top Docs for Family Practice in Cityview physician poll. This annual survey completed only by fellow physicians showcases the area’s top doctors. This is the list of physicians that other physicians think are the best in their field.  

Dr. Allsop and Dr. Pardue have been nominated and have won many times over the years.  Their dedication to providing the best care to their patients for nearly 25 years is only one reason so many other physicians think so highly of them. 

2017 Top Docs Family Practice


Living and Dying By What We Eat

           “Let food be thy medicine and medicine be thy food.”  This was the advice of one of history’s best known physicians, Hippocrates, who lived around the 4th century B.C.  He must have had an okay idea of things as he apparently lived to around 90 years old when many were dying quite young.  At the same time, our diet isn’t the only determinant of disease and wellness.  Genetics, exercise, toxic habits, chronic stress, accidents, infections and many other factors play into it.

            A recently released study did a statistical analysis of the relationship between certain dietary habits and early death from heart disease, diabetes and stroke.  Ten particular dietary habits were connected with these bad outcomes.  A bit surprisingly, excess intake of salt had the biggest negative impact.  Here you want to be eating non-processed whole foods as much as possible, while avoiding fast foods and, unfortunately, going very carefully with any restaurant food as well.  Most of the salt is already in the food even if you don’t add any at the table.  Read labels, but almost anything in a box, bag, jar or can already has a good bit of salt in it.  Shooting for less than 2 grams (2000 mg.)of sodium per day is a good goal.

            Next in line for increasing early deaths was having too low of an intake of seeds and nuts.  Who knew squirrels were so smart? So, munch on those almonds, but don’t get the super salty variety.  High processed meat intake came in third in negative impact, so try to minimize cold cuts, hot dogs and sausages.  And since low seafood intake (with its healthy omega-3 fats) was another cause of increased early deaths, replace them with tuna or salmon a couple times a week.

            Here we come to no surprise as numbers five and six were too low an intake of vegetables and fruits.  The goal of about four servings of each per day is ambitious but pays off.  And while you’re eating all those fruits and veggies, take a pass on the sugar-sweetened drinks.  The sweet teas, Mountain Dews, full-sugar sports drinks and other sugary drinks drive us toward obesity, diabetes, and earlier death.  Of course water is best.  The non-calorie flavored drinks, though not perfect, can be consumed in moderation.  For the most part, “Don’t drink your calories” is a good motto to go by.  Strikingly, higher intake of sugar-sweetened drinks was the factor with the highest impact on early cardiovascular death in the younger (25-64 year old) population, while salt kicked in more in the 65 and older population.

            A final couple of factors that were negatives were too little intake of polyunsaturated fatty acids (think olive oil, salmon, nuts and similar sources of “good fats”) and whole grains.  Excess intake of unprocessed red meat had only a very minimal negative impact – whew!

            None of us is going to eat perfectly, but some attention toward accentuating the good stuff and passing on the bad stuff can help a lot.  This study showed that almost half of early death from stroke, heart disease and diabetes could be attributed to one or more of these dietary habits.  And with a little attention, you really can find a lot of foods that you actually like and are still good for you.  Don’t believe the line, “If it tastes good, spit it out.”

            In the end we’re told in Psalm 90 to “…number our days that we may obtain a heart of wisdom.”  I do believe our days are ultimately set by our Creator, but He generally works by using means in our life, and a healthy diet can be a potent one.  The idea is to enjoy a healthy diet, not to obsess or stress over it.  Dig in!

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835