Should I take antibiotics before a dental procedure if I’ve had a hip, knee or other joint replacement?

Short Answer:  No.

Long Answer:  There has been a fair amount of recent recommendations to take antibiotics before a dental procedure if you’ve had a joint replacement to prevent a hardware infection.  There have been very few reported cases of joint infection after dental procedures or an association between dental procedures and bacteria causing infections in joints because of  those procedures.  There was a case study done from 1997 – 2006 resulting in no significant association between dental procedures and prosthetic joint infection.  So don’t just take it from us, the American Academy of Oral Medicine, the American Dental Association (ADA) in conjunction with the American Academy of Orthopedic Surgeons (AAOS), and the British Society for Antimicrobial Chemotherapy all advise against universal use of antibiotics prior to dental procedures for prevention of PJI or prosthetic joint infection.

Read more from Up To Date website>>

According to the CDC, overusing antibiotics is the leading cause of antibiotic resistance.  Up to one-third to one-half of antibiotic use in humans is either unnecessary or inappropriate.

Read more from the CDC website >>

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Practitioners at Hope Health Family Practice Encourage ALL Parents to Immunize Their Children

  • Imagine you are the parent of a newborn who is too young for a Pertussis (whooping cough) vaccination.  A group in your community has decided not to immunize and an outbreak of Pertussis occurs and spreads rapidly throughout this group.  Your infant is exposed (the library, grocery store, playground, etc…) and contracts this disease which could potentially be fatal.  This has happened, and does happen, and infants as well as other immunocompromised individuals have died from this disease when it could have been prevented.
  • In 1952 38,000 people contracted polio in America alone, according to the Centers for Disease Control. In 2012 there were fewer than 300 reported cases of polio in the entire world.  With more and more parents choosing not to immunize, this number could begin to rise again.
  • If you do not immunize and have never come face to face with a serious disease that is preventable by vaccine, you can thank the rest of your community for being immunized.  The people who choose to immunize are the people who have kept these diseases from making a comeback in our communities.  Again, with more and more people choosing not to immunize, the risk is becoming greater and greater.
  • Vaccines can eradicate disease and prevent serious illness and death. Mandatory vaccination has eradicated diseases that once killed thousands of children, such as polio and smallpox. According to researchers at the Pediatric Academic Society, childhood vaccinations in the US prevent about 10.5 million cases of infectious illness and 33,000 deaths per year.
  • The study that linked autism to childhood vaccines (specifically the MMR vaccine) was retracted and the study’s author, Dr. Andrew Wakefield, stripped of his medical license due to fraud.  Wakefield has been unable to reproduce his results in the face of criticism, and other researchers have been unable to match them.
  • 75% – 94% of the population (depending on the disease) must be vaccinated to achieve “herd immunity” or “community immunity”.   When herd immunity is achieved the number of immunized individuals is high enough to prevent the spread of disease through the population.  This is important!   In order to continue preventing the spread of serious disease that once killed thousands of people, everyone must participate as a community.

The information below is taken from

Community Immunity (“Herd Immunity”)

Vaccines can prevent outbreaks of disease and save lives.

When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for an outbreak. Even those who are not eligible for certain vaccines—such as infants, pregnant women, or immunocompromised individuals—get some protection because the spread of contagious disease is contained. This is known as “community immunity.”

In the illustration below, the top box depicts a community in which no one is immunized and an outbreak occurs. In the middle box, some of the population is immunized but not enough to confer community immunity. In the bottom box, a critical portion of the population is immunized, protecting most community members.

The principle of community immunity applies to control of a variety of contagious diseases, including influenza, measles, mumps, rotavirus, and pneumococcal disease.

Illustration of Community Immunity (also known as “herd” immunity)

Like any medication, vaccines can cause side effects.  The side effects are almost always mild (such as redness and swelling where the shot was given) and go away within a few days. If your child experiences a reaction at the injection site, you can use a cool, wet cloth to reduce redness, soreness, and swelling.

Serious side effects following vaccination, such as severe allergic reaction, are very rare and doctors and clinic staff are trained to deal with them. Pay extra attention to your child for a few days after vaccination. If you see something that concerns you, call us.

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What Does “Gluten-Free” Really Mean? The New FDA Labeling Standard

Earlier this month the Food and Drug Administration (FDA) announced that food claiming to be “gluten-free” must meet a new stringent standard:  Gluten is a protein found mostly in wheat but also is some other grains.  To comply with the FDA’s new rules, products labeled “gluten-free” must contain less than 20 parts per million of the protein—or about an eighth of a teaspoon of flour in 18 slices of gluten-free bread. That’s low enough for most people who have mild to severe gluten allergies to safely consume the product.  This new labeling standard is the same as the European and Canadian requirements.  Manufactures have until August 5, 2014 to comply with the new standard.

There are a few details of this new labeling requirement that are important to know.

·         This standard applies to dietary supplements claiming to be “gluten-free” as well. 

·         Manufactures using the “gluten-free” claim may not have had their product tested for compliance.  The onus is on the FDA to test products making the “gluten-free” claim.  Some manufactures making the claim may go untested or slip through the cracks.

·         Manufactures can use other wording such as “No Gluten Ingredients” or “No Gluten Added” that would exempt them from the “gluten-free” labeling standard.

·         Alcoholic beverages are not regulated by the FDA.  Therefore they are not part of this labeling requirement.

·         Foods that naturally have no gluten can use this labeling as a way of looking more health conscious.

So, while the new labeling is an improvement, consumers must be knowledgeable about the finer points of this new standard.  If you have celiac disease, or some other reaction to gluten, continue to be careful about your food choices and don’t completely rely on the new labeling requirements.

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Nurse Practitioners: Understanding and accepting all that we do

One of the biggest challenges our practice has is overcoming the perception that Nurse Practitioners can’t provide comprehensive primary care.   The health care culture in this country assumes that only MDs are qualified to provide this kind of care.   However, Nurse Practitioners are qualified and have been providing this kind care for years.   Now, as our health care system is struggling to meet the needs of our communities, Nurse Practitioners are finally being recognized and accepted as providers who are providing excellent comprehensive primary care services to people throughout this nation.

Attached is a great article from the NY Times about MD acceptance of the Nurse Practitioner role.


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On-line drug interaction websites: Make sure your medicines/remedies are safe to take together.

Attached is a quick article with links to on-line drug interaction sites.  These sites are designed to help you make sure that your prescription medications, over-the-counter remedies and herbs or supplements are safe to take together.  When you read this remember to contact your prescriber or pharmacist if you have any concerns.  Many medications will say there is a risk for interaction but the interactions are dose dependent.  Additionally, many medications should not be stopped abruptly without the guidance of the prescriber.

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Sitting: Why it is Bad for Us


Many people struggle with getting enough exercise to stay healthy and maintain a healthy weight.   Our days are often consumed with commuting, working behind a desk, doing school work, eating, watching TV or working on a computer.  If anything, our society is moving even more so in this direction as much of our leisure time is taken up with technology and screen activities.    For those of us who do exercise, we hope that our 30-60 minutes of exercise 3-5x per week will be enough to stave off the ravages of sitting too much.   Unfortunately, those faithful exercise sessions, although better than nothing, are probably not enough to do the trick.   

One reason for this may be the need to increase levels of Lipoprotein Lipase in our blood stream.   Lipoprotein Lipase is increased when we use our leg muscles.  This protein is responsible for grabbing onto triglycerides in the blood and transporting them to the cells to be used for energy.  When the levels of Lipoprotein Lipase fall the triglycerides in the blood get stored as fat instead of used as fuel.    It appears that the levels of Lipoprotein Lipase fluctuate throughout the day depending on our level of activity.  Therefore, getting up and moving around every 30 minutes may make a difference in the way triglycerides are utilized in our bodies.  If you move around every 30 minutes in addition to your regular workout, you may stave off some of the ravages of our modern sedentary lifestyle.

Attached is a great article about the research behind this finding and the importance of frequent activity throughout the day.


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Do You Know the Unique Heart Attack Symptoms in Women?

When someone is having a heart attack we often imagine someone clutching their chest and describing the sensation of having an “elephant sitting on their chest”.  While this is often the case, women may experience different symptoms causing a delay in getting appropriate medical care.

Women are more likely to have the following symptoms when having a heart attack:

·         Atypical chest pain that presents in the upper back, shoulders, jaw, neck, arms and upper abdomen.  The pain may not be as severe as one would think.  Often this pain can be confused with heartburn.

·         Shortness of breath that does not necessarily correlate with the activity being done.  Some women describe a feeling of gasping for air like they had run a marathon. 

·         Heavy sweating that is sudden.  It may be difficult to differentiate from a menopausal hot-flash.  Some women describe it as feeling both hot and cold with clammy skin.

·         Unusual fatigue can be described in the days or weeks prior to the heart attack.  The fatigue is often described as profound, limiting even the most simple daily activities, such as making a bed, walking to the bathroom or lifting a laptop.

·         Lightheadedness and nausea can occur during an attack. 

·         Women can also have the classic crushing chest pressure.  However, it is important to remember that heart attack symptoms in women can be much more subtle.

Most of the heart disease risk factors for women are similar to men but there are some differences. 

·         High cholesterol and triglyceride levels.

·         Loss of estrogen after menopause.

·         Weight gain around the belly – usually most prominent during and after menopause.

·         Smoking!!!!   This has been shown to be a bigger risk factor for women than in men.

·         Being overweight.

·         Not exercising.

·         A diet high in saturated fats and refined carbohydrates.

·         High blood pressure and Diabetes.

·         Family history of heart disease.

·         Women in their early fifties can have a heart attack.  So you do not have to be older to have a heart attack.

What can you do to lessen your chances of having a heart attack or suffering a severe heart attack?

·         Know the symptoms.  Call 911 or seek medical care immediately if you experience the above symptoms!

·         Exercise regularly:  That means 30 to 60 minutes a day.

·         Don’t smoke!

·         Maintain a healthy weight.

·         Eat a diet of lots of fruits, vegetables, whole grain, olive oil, monounsaturated fats and complex carbohydrates.

·         Reduce emotional stress.

·         Take prescribed medications properly.

Prevention of heart disease and early recognition of a heart attack symptoms are the keys to preventing serious damage from heart disease.   

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Smart Phone Apps can help you lose weight!

Weight loss apps made for Smartphones and other devices, and on-line food diaries have been shown to improve the chances of successful weight loss.   Why?  These apps and websites make tracking what you eat, ie keeping a food diary, much more convenient and are chocked full of great nutritional information.   Before this technology people often kept a handwritten journal and would have to research the nutritional information if they wanted to count calories and other nutrients.  Now it is so easy.  Some apps even allow you to scan the nutritional bar code right into your phone or device. 

But why are food diaries so important.   A 2008 study of 1,685 people through Kaiser Permanente found that the people who kept a food diary six days a week were twice as likely to lose weight as those who kept a diary one day a week or less.   For years we have known that keeping a food diary is one of the most important things you can do to have effective, long-term weight loss.   Yet, many people have never done it or found it too cumbersome.   Keeping a diary enlightens you on what you eat, when you eat, why you eat and how you eat.    Comments I have heard include; “I had no idea how much I was snacking”, or “No wonder I am starving by dinner, I don’t eat enough early in the day”, or “I never realized how many calories were in that whoopee pie”, or “I didn’t realize how few vegetables I am eating”, or “I didn’t realize my typical lunch was 1000 calories”.   Food diaries also create accountability.  If you know you have to write it down, type or log it in, you will often think twice before going for that whoopee pie.   

Here are five tips to keeping a food diary:

  • Write as you go. Don’t wait until the end of the day to record what you ate and drank.  Have access to you food diary to log your food as you go.
  • Focus on portion size. Practice at home with measuring cups, measuring spoons, or food scales. And be aware that people tend to underestimate how much food they are eating.   Some of the apps have handy measurement tricks, such as… your average size thumb tip (to the joint) is a teaspoon, the palm of your hand is 3oz, or one fist is about one cup.
  • Use whatever type of food diary works for you. It doesn’t matter whether you use scrap paper, notebook, a Smartphone, iPad, or personal computer.  Whatever is easiest and you will use.
  • Don’t skip your indulgent days.  It is tempting to not record those indulgent days.  However, recording them is enlightening and will teach you how to manage the next challenging day that comes along.  Don’t look at it as punishment.  Look at it as a learning curve.
  • Cook at home. You’ll have more control over what you consume, by knowing what is in it and having control over your portions.   Plus it is easier to log homemade food than food from a restaurant. 

Choosing an app or website can be overwhelming.   There are many free ones that are very good so don’t get roped into buying a subscription unless you really like what they offer.  Two websites that I have used are and  There are apps for them too.  Both are free and track exercise as well.   Go online and take a look around at what might work best for you.    

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Why Sit When You Can Walk!

We all know exercise is a key component of overall health. Yet, most struggle to make it a natural part of our day. This three minute talk suggests an easy way to add exercise to our day and get all those things done that always take priority over our physical health. Sometimes it is the little things that can make a big difference in our physical and emotional health.

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Lyme Disease Transmission

To follow up on the deer tick post from the other day.  Many people ask, “why wait for the tick to be on 24 hrs before being concerned about Lyme transmission?”  Well,  there is an enzyme conversion in the tick that has to take place after the tick bites you for Lyme transmission to occur.  This enzyme conversion takes 24 hours to complete.  So, if you think the the tick has been on more than 24 hrs, contact your PCP.

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