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Be Well for Parents - November 2011 Issue

Feature: HPV Vaccine – Why Your Daughter (and Son) Need It

Feature: HPV Vaccine – Why Your Daughter (and Son) Need It

If adults had the opportunity to be vaccinated against a potentially deadly form of cancer, few would refuse. But when it comes to the human papilloma virus (HPV) vaccine, all sorts of feelings get in the way. That’s because the vaccine protects against two forms of cancer caused by a sexually transmitted virus – but is most effective when given before sexual activity begins.

At issue is a vaccine thought to be 100 percent protective against the four strains of HPV that are responsible for 70 percent of cervical cancer cases. When transmitted during sex, HPV can cause genital warts and has a 90 percent likelihood of evolving into cancer of the cervix or anus.

Additionally, about 25 percent of all squamous cell cancers of the head and neck (70 percent of those occurring in the back of the throat, base of the tongue and soft palate) are thought to be caused by the HPV virus.

The risks of these cancers is serious as many adolescents turn to oral and anal sex to avoid pregnancy or to be with same-sex partners.

A dose of reality

The HPV vaccine was approved by the FDA in 2008 for girls ages 9 to 26. But since HPV is sexually transmitted, that protected only half the population. So in 2010, the vaccine was also approved for boys age 11 to 26 – to slow the spread of the virus and to protect against anal cancer.

Yet the HPV vaccine has been slow to catch on. Fewer than half of teenage girls and only 1.4 percent of teenage boys have received the vaccine. This disturbs Jo Ann Jackson, MD, an adolescent medicine specialist in Cleveland Clinic’s Willoughby Hills Family Health Center.

“Many kids will get HPV from their first sexual contact, and a significant percentage of kids become sexually active by age 14," she says.

Worse, they may not know they have HPV for many years. Additional sexual encounters spread the virus to others, while the risk of cancer itself grows.

Better late than never

“Once a child has had sexual contact there is no way to tell if he or she has been exposed to the HPV virus, or whether the strain of HPV they contract is one of the four covered by the vaccine,” explains Raul Seballos, MD, Vice Chairman of Preventive Medicine at Cleveland Clinic.

“If a child is vaccinated after contracting one of the viruses, it will still offer protection against the three other strains of HPV. Yet it is still possible for the child to develop cervical, anal, or head and neck cancer from the strain they have.”

That’s why the Centers for Disease Control and Prevention advocate the vaccine for children before they reach the age at which sexual activity commonly begins.

Fears unfounded

Fear about the vaccine’s safety is a common reason for refusal to vaccinate. HPV has been purported to cause such serious disorders as Guillain-Barré and mental retardation. Nothing could be further from the truth, says Dr. Jackson.

She assures parents that the vaccine is safe: “No reported side effects have proven to be the result of the HVP vaccine. The rate of Guillain-Barré after vaccination is about the same as it is in the general population, and mental retardation is not even on the radar screen.”

The cost – $100 per shot for three shots – is covered by most insurance providers but can be a legitimate concern for some families.

Cancer concerns outweigh all else

Without a doubt, pediatricians are most frustrated by parents who refuse to give consent for the vaccine for fear that it will be construed as permission to have sex.

“It has nothing to do with when a child decides to first have sex. It is about protecting your child from cancer at some point down the line,” says Dr. Jackson.

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Tip: Controlling Kids’ Weight Is a Family Affair

Tip: Controlling Kids’ Weight Is a Family Affair

Body mass index (BMI) isn’t the be-all and end-all when it comes to health — especially for kids. But an elevated BMI, calculated from height and weight, can serve as a wake-up call. Ask your child’s doctor for guidance, and make sure kids get up to one hour of physical activity and up to five fruits and vegetables per day. Working together, families can ensure a healthier future for all.

Parents Children's Health Essentials – November 2011 Issue

Feature: Prediabetes — A Wake-Up Call

Feature: Prediabetes — A Wake-Up Call

You may be at risk for diabetic complications even if you don’t have diabetes — if you are among the 79 million Americans estimated to have prediabetes.

“Prediabetes disposes you to increased risk of developing diabetes and implies that your risk for heart attack is already increased. It should be a wake-up call for adopting a healthier lifestyle,” says Robert Zimmerman, MD, Director of the Diabetes Center in Cleveland Clinic’s Department of Endocrinology, Diabetes and Metabolism.

Diabetes increases the risk for heart attack. Yet many heart attacks occur when blood glucose levels are not quite that high — a condition the American Diabetes Association calls prediabetes.

A matter of degree

In diabetes, the risk for cardiovascular disease is two to four times higher than normal. In prediabetes, that risk is 1.5 times higher than normal. Without preventive measures, prediabetes may become type 2 diabetes in three to 10 years.

Doctors use the same tests to diagnose diabetes and prediabetes. Diabetes is diagnosed when:

  • Hemoglobin A1c levels are 6.5 percent or more
  • Fasting blood sugar is 126 or more, or a glucose level two hours after eating is 200 or more

Prediabetes is diagnosed when:

  • Hemoglobin A1c levels are 5.7 to 6.4 percent
  • Fasting blood sugar is 100 to 125 (called impaired fasting glucose)
  • Two-hour glucose is 140 to 199 after a glucose challenge (called impaired glucose tolerance)
A sticky – and serious – situation

Glucose is sticky and adheres to red blood cells. Type 2 diabetes causes glucose to build up in the bloodstream. Over time, impaired circulation of the blood to organs and tissues can result in heart attack, stroke, kidney failure, blindness and amputation.

The incidence of type 2 diabetes and prediabetes is rising along with the incidence of obesity, but genetic and environmental factors also come into play.

“There is a high incidence of type 2 diabetes in patients whose parents have the disease,” says Dr. Zimmerman. "Yet people with a genetic tendency to develop diabetes if they become overweight may not get diabetes if they maintain a normal body weight.”

The best way to lower your risk

Whether you have prediabetes or diabetes, the higher your blood glucose level, the greater the risk of complications. There are two paths to lowering risk: lifestyle change and medication.

A 2002 National Institutes of Health study documented superior results from diet and exercise. Eating a low-carbohydrate, low-fat diet and getting 35 minutes of intense exercise five days per week reduced the rate of diabetes by 50 percent. It also led to a 10 to 12-pound weight loss.

Taking a pill to lower your blood sugar may seem appealing, but the first-line antidiabetic drug metformin lowered the rate of diabetes by just 30 percent.

“We now know that people with prediabetes can delay or prevent the onset of type 2 diabetes through lifestyle changes. In my opinion, if lifestyle interventions make you healthier, it's the way to go,” says Dr. Zimmerman.

“Medications have potential side effects and are less effective. Exercise may help reduce weight, blood sugars and blood pressure.”

If diet and exercise are ineffective, Dr. Zimmerman then recommends a trial of metformin.

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Parents Children's Health Essentials – November 2011 Issue

Free Guide: Pediatric Pain Program

Free Guide: Pediatric Pain Program

Children and teens in chronic pain can reach the point where they no longer enjoy school, sports or hanging out with friends. Learn how our innovative Pain Rehabilitation Program helps kids and families reclaim their lives.

Recipe: Grilled Chicken & Vegetable Pasta Toss

Recipe: Cinnamon Apple Cranberry Crisp

This tasty dessert is perfect for a fall potluck. It features cranberries, an excellent source of disease-fighting phytochemicals and antioxidants that reduce overall inflammation in the body. The vitamin C and fiber in apples and other ingredients help to boost immune function and regulate digestion.


6 medium apples, peeled and sliced
1 cup dried cranberries
1 teaspoon ground cinnamon
1 tablespoon lemon juice
¾ cup old-fashioned oatmeal
¾ cup all-purpose flour
½ cup brown sugar, packed
1/3 cup light butter
½ cup black walnuts, chopped

  1. Heat oven to 375° F.
  2. In a large bowl, mix apples, cranberries, cinnamon and lemon juice. Spoon into ungreased 11″ x 7″ or 12″ x 8″ glass baking dish.
  3. In another large bowl, mix remaining ingredients with fork until crumbly. Sprinkle over fruit mixture.
  4. Bake for 35 to 40 minutes or until apples are tender, juices bubble, and topping is golden brown. Serve warm.

Makes 8 servings


Per serving:
Calories: 307
Total fat: 9.5 g
Saturated fat: 2.7 g
Cholesterol: 9.9 mg
Sodium: 70 mg
Total carbohydrate: 55 g
Dietary fiber: 5.8 g
Sugar: 33 g
Protein: 4.4 g
Potassium: 247 mg

Recipe from our Children's Hospital Pediatric Nutrition Support Team

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Parents Children's Health Essentials – November 2011 Issue

Let's Move It! Free Mobile App

Let Cleveland Clinic and your mobile phone keep you motivated. More than just a pedometer, our free mobile app offers walking challenges, a calorie tracker and videos to encourage and inspire.