The Wildebeast

We are off to see the wildebeast cross the river as the great migration is taking place right now in Tanzania.  EverythingHealth will be on vacation for the next few weeks.  Scan the right side of the page for the best of health blogs and happy reading.

Cholera in Haiti

Water for the Hospital Emergency Room

 Is anyone paying attention to the plight of Haiti anymore?  Unfortunately the rebuild (after the earthquake on Jan 12, 2010)  never really happened and Haiti seems as poor and troubled as ever.  Over 800,000 people still live in makeshift tent encampments. Now they are plagued with a cholera epidemic that just won't stop.  It is nearly impossible to eradicate cholera when sanitation is poor, clean water is scarce and people have no resources.

Thousands of Haitians live in rural communities that are isolated because of poor roads and no real facilities.  Many of these villages are inaccessible to cars or trucks.  Poor water hygiene is the cause of cholera in these areas and rains flush contaminated soil into the rivers and people get infected.

The Port Au Prince Hospital after the Earthquake

Cholera strikes very quickly and children especially become dehydrated from massive diarrhea within hours.  Treatment is not difficult if it can be started in time but the death rate has already surpassed 5,500 since the epidemic began in October.  Where there are no roads, no hospitals and no health facilities, there is essentially no prevention or treatment for Cholera.  Death follows.

Despite my interest in Haiti, I have been unable to understand the government (or lack of) and why the billions of dollars in pledged aide has been so ineffective.  We have Presidents Bill Clinton and George W. Bush in partnership with other governments who pledged to help rebuild Haiti from the ground up.  What has happened?

After the Earthquake, Hospital Tent

According to National Public Radio, the Pan American Health Organization has decided a large scale cholera vaccination campaign should begin in Haiti.  One drug manufacturer offered to donate tens of thousands of vaccines but the Haitian government turned it down because they were worried about civil unrest among people who couldn't get the vaccine.  That type of thinking just baffles me and I wonder why there is not more hard diplomacy in Haiti to get the government to do the right thing for its people.  If the government is unable to manage the rebuild and put in infrastructure for roads, agriculture, water systems and basic health care, despite the billions of pledged dollars, somehow the international community should take over.

When was the last time Secretary of State, Hillary Clinton visited Haiti?  Why is there not an outcry from other Nations, including the U.S. at what we are seeing just a few miles from our borders.

Partners in Health is still on the ground providing health care.  Doctors and Nurses from San Francisco have not forgotten Haiti and another mission to work with local doctors and provide supplies and training is underway.  As great as this is, it is just a drop in the ocean of misery for Haiti.

A large scale solution is needed and it must be undertaken by the government of Haiti.

Italians Not Following The Mediterranian Diet

For years I have touted the health benefits of the "Mediterranean Diet" and encouraged patients to eat like the Europeans.   Fresh farm vegetables, olive oil, fish and red wine have been linked with longevity and good health.  I just read in NPR news that young Italians are forgoing the eating patterns of their elders and are imitating the "U.S. diet".  The result is soaring obesity, just like in the United States.

According the the article, young Italians ages 6-12 are sitting in front of the TV and are eating fast foods and soda.  In just three generations, the eating habits and activity of kids has changed from their healthy grandparents.  Italian health officials say obesity is reaching epidemic proportions.

Part of the diet changes are a result of the global industrial diet of meat, fat and sugar.  These cheap foods are in abundance and actually make "Mediterranean" food look expensive.  Fish, olive oil, fresh vegetables and fresh fruit are more expensive than a McDonalds hamburger.  A 16 oz coke can be bought for a dollar in the U.S. (about $.71 eu).  I haven't seen an Italian supermarket lately but in the U.S. you can always find huge containers of soft drinks on sale.

I find these changes rather sad to read about.  We can only hope that parents, educators and even our governments will start putting resources into education, quit subsidizing the corn industry and  try to turn these bad eating habits around.

Answer to Yesterdays Medical Challenge

The answer to yesterdays medical challenge is #5-medial nail dystrophy due to trauma.  Here is another photo that is from chronic picking of the cuticle and pushing back the cuticle.

The other answers were good guesses but none of them cause the median (middle of nail) changes.  Traumatic dystrophy from nervous picking is actually quite common.  Other traumas to the nail bed can cause the nail to grow abnormally.  If the nail matrix is damaged, the nail will not grow out normally.

Thanks for the great and astute guesses.

This Weeks Medical Challenge

This weeks challenge is from Consultant Live.  This 56 year old man was noted to have these thumbnails at his physical exam.  The remainder of his nails were normal.  He denied trauma and worked as a banker.  What is the diagnosis?

1. Psoriasis
2. Vitamin K Deficiency
3.  Lichen Planus
4.  Onchomycosis (fungus)
5. Median nail dystrophy due to trauma

The answer will be posted tomorrow.  Click on comments and let me know your diagnosis.

Sixteen Pound Baby Born in Texas

A woman in Texas gave birth to a baby boy who weighed in at a whopping 16lbs, 1oz.   The average size of a newborn is about 7 lbs so this one was considered huge.  This was the 4th child for the mom who had gestational diabetes during pregnancy.  Between 2 and 10% of pregnant women develop this condition.  Women who have a body mass index (BMI) over 30 or who have a strong family history of diabetes are most at risk.  Women who gain excessive weight during the first trimester are also at risk but most women have no risk factors.

One of the dangers of gestational diabetes is giving birth to a big baby.  The placenta produces hormones that spur growth of the baby and the baby gets more sugar than he needs.  Large babies are a problem because they usually need to be delivered by Caesarean section.  There is also increased risk of hypertension and preeclampsia.

The largest baby on record, according to the Guinness Book of World Records, was born in Canada in 1879.  That baby weighed 23 lbs, 12 oz but died 11 hours later.  Recently an Indonesian woman gave birth to a 19.2 lb infant.

Massage Therapy Relieves Chronic Back Pain

The Group Health Research Institute of Seattle, Washington has published a study in Annals of Internal Medicine that showed massage therapy may effectively reduce or relieve chronic back pain.  I am a big believer and supporter of massage therapy and have wondered why it is not a covered benefit for treating back and neck pain.  Even medical benefits savings plans offered by employers (where you put aside your own pre-tax dollars to be used for medical care) do not allow massage. Patients who get massage for musculoskeletal conditions do better and utilize less pain meds, yet is is seldom prescribed and rarely covered by any insurance plan.

This study confirmed what I have known for a long time.  They looked at relaxation massage and structural massage, which focuses on correcting soft-tissue abnormalities.  At 10 weeks they found that participants (age 20-65 years) who had chronic low back pain responded to both types of massage.  In fact, the patients receiving massage were twice as likely as those receiving usual care to report significant improvement in both pain and function that lasted 6 months. 

Back pain is one of the most common maladies of humans.  It's time we recognize the benefit of "laying on of hands" by a skilled massage therapist. 

Uterine Environment and Autism

Two news events got people talking today.  One was that Casey was deemed not guilty of killing little daughter Caylee ( "O.J. all over again", I heard repeatedly).  I must admit I was rather surprised....

The second was the results of two new studies that were published in the Archives of General Psychiatry.  One of them stated that environmental factors during pregnancy might contribute as much as genetics in the development of autism spectrum disorders.  The 2nd study conducted by Kaiser Permanente Northern California found a 3 times higher risk of autism if the mother took antidepressants in the first trimester of pregnancy. 

With the incidence of autism disorders increasing over time to the current range of 3-6 per 1,000 births, these studies are of interest to millions of parents and professionals.  Autism affects boys at a rate of three times more than girls,  and is usually detected by the age of 3.   The cause has been maddeningly unknown.

While genes certainly play a part (as they do in most every disorder) other theories and assertions have been dis proven.  It certainly does not have anything to do with "poor mothering" or "lack of maternal bonding".  Those theories did more harm than bloodletting in the 19th century!  The link between autism and vaccines has been thoroughly debunked.  If you believe in science and research, you must believe that vaccines are not the cause and finally leave that one in the dust.

This new study looked at 192 pairs of identical and fraternal twins.  One of the twins in each pair had classic autism.  Some of the other twin sibs also had classic autism or Asperger's syndrome, a mild disorder in the autism spectrum. 

           
(sidebar:  Rent "Temple Grandin", a great movie that shows a super high functioning autistic woman who changed the world of animal husbandry)





The study found that autism spectrum disorders occurred in both twins in 77% of the male identical twins and in 50% of the female identical twins.  Since identical twins share the exact same DNA and genes, you would expect a 100% autism rate in identical twins.  The rate was even lower in fraternal twins. (who are like any other brother and sister sibling).  The rates of autism in non-twin brothers and sisters is even lower still, suggesting conditions that the twins shared in the womb played a role in developing autism.


The second study found an elevated risk of autism in children whose mother took SSRI antidepressants (Prozac, Zoloft, Celexa, Lexapro) during the year before delivery.  Although the risk was low (2.3%), if a pregnant mom took antidepressants during the first trimester, the risk of autism was 3X higher than mothers who didn't take SSRIs.

So what does all of this mean?  The studies do not tell us what intra-uterine factors might play a role in autism.  It could be diet, infection, stress, differences in blood flow. It could be a number of different factors that just happen to come together at a certain developmental time.  We just don't know.  Presumably the uterine environment is the same for both twins and the mom is the same but we know twins do not develop exactly the same.

Scientific breakthroughs usually happen when a study helps us ask even more questions.  These new studies give us clues and raise more questions.


As for Casey Anthony, she will have to live in her own hell.