Wednesday, August 29, 2012

Prevention is Key for West Nile Virus

The end of August is West Nile Virus season in the United States and this year has been a bad one with the most reported infections and deaths from the disease.  By August 30 there were a total of 1,590 cases nationally with 66 deaths, according to the Center for Disease Control (CDC).  That is a 40% rise in just one week!

 For West Nile Virus, birds are the vector.  Mosquitoes who bite infected birds can  pass the virus on to humans.  The virus is amplified over the summer in bird populations and hotter than normal temperatures this summer may be a factor in the increased cases we are seeing this year.  It is not spread by human-to-human contact or from other animals to humans.

West Nile Virus is spread by the bite of an infected Northern House Mosquito (Culex pipiens). It was first discovered in 1999 and since that time over 30,000 people have been sickened by the disease.  According to the CDC, 75% of this year’s serious cases have been reported from 5 states (Texas, Louisiana, South Dakota, Oklahoma and Mississippi) and almost half of all cases have been reported from Texas.  So far this year 34 cases have been found in California.

Most people who are bit by West Nile Virus carrying mosquitoes will have no symptoms at all.  For the ones who do become ill, the infection is usually mild.  Flu-like symptoms can appear 3-14 days after a bite and include:
  • Fever
  • Aching muscles and head ache
  • Swollen lymph glands
  • Skin rash

Four out of five people will never know they are infected and will have immunity for life from West Nile Disease.  But people over age 50 are at the highest risk for developing severe West Nile Disease.  Healthy, active older adults who spend time working and exercising outdoors can develop severe disease.  Also people who are immune-suppressed or are fighting off other illnesses can get extremely ill with West Nile Virus and even die.

 The severe symptoms include high fever, encephalitis, headache, neck stiffness, vision loss, convulsions and even paralysis.

To diagnose West Nile Virus, the doctor will do a blood test or a cerebrospinal tap to test for antibodies to the virus.  A 2nd blood test is needed two to three weeks later to confirm the diagnosis.

There is no treatment for West Nile infection and there is no vaccine.  All the care is supportive.

Here are some tips to protect against West Nile Virus:
  1. Eliminate standing water including flower pots, plastic containers, wading pools, and roof gutters. Fill birdbaths with fresh water at least once a week.  Mosquitoes are aquatic and they must have standing water to develop from egg to adult.
  2. Wear light colored clothing, long sleeve shirts or long pants, especially in the evening when mosquitoes are most active.  Mosquitoes are attracted to dark colors.
  3. Mosquitoes are attracted to sweat and perfumes. 
  4. Use mosquito repellent if outdoors, especially from dusk to dawn.  Sprays and lotions containing DEET are the most effective but use products with 30% or less DEET and for children use 15% or less.  Oil of lemon eucalyptus, a plant-based repellent is also effective.  Repellents don’t kill mosquitoes; they just make you less attractive.
  5. Sonic repellants do not work but smoke pots and citronella candles can help.

Remember this:  The chance of becoming ill from West Nile Virus is quite low.  But if you are older and will be outdoors in a mosquito-infested area, make sure you protect yourself with clothing and chemical repellants.  There is no treatment so prevention is key.

Wednesday, August 22, 2012

EverythingHealth Favorite Summer Things

Ahhhh...Summer.  There are some things that are just so good...EverythingHealth wants to share them.  Now that Oprah is no longer around to share her favorite things, we will fill the void.  You may have some to add. Here are our Favorite Things for Summer:

Vitamix  -  It is not just a blender.  The Vitamix is one of the wisest investments you can make and it may just change your life.  Make smoothies, low fat ice cream, juice, sauces and salsa. Unlike a juicer, there is no pulp to waste.  All of that vegetable and fruit fiber stays with the drink and the combinations for green smoothies are amazing.  The best prices (and a cool demo) is at Costco.  After using it several times a day, our Vitamix failed the low speed.  One phone call to the company was all it took.  We had no receipt or warranty, but they said send it in. (and we really missed it that week)  It was returned good as new, no charge.  Now that is service!

Home Grown Vegetables - If you have sunshine and a deck or rooftop, you can grow your own vegetables.  Home grown organic tomatoes and zucchini are fool-proof.  Basil and lettuce are a cinch and not much space is needed.  Here is what can be done in just one  4X4 area.  It is so simple if you follow the steps in "All New Square Foot Gardening" by Mel Bartholomew.  No digging, no tilling, no fertilizer.  All organic and healthy.

Neutrogena Wet Skin Sunblock Spray -  It's our new favorite.  It works even on wet skin and is waterproof.  Best of all, it is so cooling when you are exercising.

Vacation Time - It doesn't have to be exotic and even a "staycation" can be wonderful if you unplug and do something different.  Americans do not take enough vacation time...period.

A Good Book-  And what would a vacation be without a good summer read?  "Gone Girl" is great escapism...a modern marriage with a suspenseful twist that keeps you reading for hours.  Humans are so complex!

What are some of your favorite healthy things?

Tuesday, August 21, 2012

Amazing Survival

Do you think anyone could survive such an injury?  This 24 year old construction worker in Rio de Janeiro, Brazil survived after a 6 foot metal; bar fell from above and pierced his scull right between the eyes.   And yes, he was wearing a hard hat!  He arrived at the hospital conscious and talking.

 The doctors performed a 5 hour surgery and pulled the metal bar out from the front of the skull in the same direction it had entered the brain.  So far, so good. The Brazilian doctors said he is lucid and showing no negative signs post op.

I would say he "dodged a bullet...or dodged a big bar" on this one.

Friday, August 17, 2012

Drug Seeking Patients

Chronic pain and how to treat it  is a big topic in the medical world right now.  In one study, 39% of patients coming to the Emergency Department with pain reported an underlying chronic pain syndrome.  Prescription drug seekers can overlap with patients who have true acute pain and need relief.  We want to provide pain relief, yet we know that many of these prescription drugs get diverted and used for non-medical conditions. 

After marijuana, prescription drugs are the most commonly abused drugs of 12th graders.  More than cocaine, meth or other drugs that we worry about,  kids are getting into their parents medicine cabinet.   These prescriptions are getting into the wrong hands.

 Doctors and pain clinic owners in three states were charged today with distributing prescription drugs in Kentucky, an area that is rampant with abuse.  One doctor prescribed more than 125,000 Oxycodone pills from September 2006 until July 2011.  And in Florida, several doctors were arrested this week for running a "Pill Mill" and pocketing millions of dollars.

Those are the egregious cases and jail is the best place for these physicians.

 Most physicians, however,  are caught in the difficult role of providing adequate pain relief for acute and chronic conditions and balancing that with the addictive potential of narcotic medications. 

Most Emergency Department Physicians (and nurses) and every Primary Care Physician who has a few years of practice under her belt can spot a drug seeking patient.  The tall tales are absurd and follow certain patterns:

  •  "I lost my prescription".  Variations on this theme are that the pills fell in the toilet, were eaten by the dog, hamster or (insert animal here).
  •  "The pills disintegrated".  The pills got wet, got mixed with noxious substance, the container opened and they got dirty.
  •  "I'm allergic to other pain relievers".  This one is usually the new patient who gives the history of trying everything you mention,  but only Vicodin or Oxycontin or Demerol will work.  Period.
  •   "My prescription was stolen".  Common tale.  Lots of theft, it would seem.
  •   "I have recurrent (insert condition here) and need the medication on hand.  (kidney stones, bowel obstruction, migraine headache, back pain, menstrual pain, sickle cell anemia...)
  •   "My pain is a 10 out of 10" .  All the time

Chronic pain is truly debilitating and we doctors want to relieve pain and help patients get back to their normal lives.  But we can be the problem as well as the solution.  Each narcotic prescription we write has the potential to harm as well as help and we have to be conscious of our own prescriptions and how they are used.  My wish would be for a strong pain reliever with no side effects that is not addictive.  Problem solved!

Wednesday, August 8, 2012

Nutrition Labels May Be Wrong

I eat a handful of almonds a day because they are "healthy fat" and the crunch and taste are so good.  But I have always wondered about the caloric intake and how it might adversely effect my constant focus on weight loss.  I am happy to report on a study published in The American Journal of Clinical Nutrition that shows what we thought we knew about almonds and their effect on weight may be all wrong.

The objective of the study was to determine the energy value of almonds in the human diet and compare it with the value calculated from prior known measures known as "Atwater factors".  The Atwater system has been used for over 100 years and nutritionists and government labeling of foods have depended upon it to predict fat digestibility, heat combustion and caloric content of foods.   The Atwater measurements have influenced the USDA National Nutrient Database for Standard Reference and this reference is used to report on  protein, fat and carbohydrates contained in a serving of almonds.

 These researchers found that the directly measured digestibility of fat and carbohydrates in the diet were actually decreased when almonds were eaten daily with the food.   These fell far below the Atwater predicted values, which had overestimated the energy content by 32%.    This means, rather than adding calories, simply adding a handful of almonds to my diet could result in more than a pound of weight loss a month.

In summary, the way we have been measuring and reporting calories, carbohydrate and fat consumption may be wrong for other foods as well as nuts.  The nutrient labels that guide us use the Atwater General factors but these researchers found, in the case of almonds, that those labels may be off as much as 26%.  The new method used in this study to measure the energy value of a single food is a significant improvement over past methods and older inaccurate methods may need to be revised so we actually know that labels are correct.

I look forward to more studies on nutrition that single out my favorite foods and show they are not fattening.

Wednesday, August 1, 2012

Thanks for the Honor

I was honored to be the featured Doctor this month in San Francisco Medicine,  the publication from the San Francisco Medical society.  It is a good interview.  Read it here

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...