A Hepatitis A outbreak has now been declared in Clark County Nevada.
According to the Southern Nevada Health District, 37 cases have been reported since the start of this year.
Drugs and homelessness have contributed to the outbreak but it can be spread by eating contaminated food.
Per the CDC, 20,133 cases, with 11,595 hospitalizations have been reported in multiple states including Ohio, Tennessee, West Virginia, Kentucky, Indiana, Florida and Arizona to name a few. According to the CDC, California and Utah have declared their outbreaks’ over. 191 deaths have been reported since the outbreak began in 216.
Hepatitis A is a disease that affects the liver. Its caused by a virus (Hepatitis A virus) that is most commonly ingested. Poor hand washing and/or contaminated food are likely culprits. It’s transmitted by the fecal-oral route, where food or drink contaminated by fecal matter enters another person’s GI tract. Sexual transmission of Hepatitis A has been reported during activities involving oral-anal sex.
Hepatitis A can live outside the body for months, so unclean dining areas can be contaminated and transfer to food.
Those who are immunosuppressed run the risk of dying from the infection.
Symptoms of Hepatitis A include:
There is no specific treatment for hepatitis A. Most hepatitis A infections resolve on their own.
We usually recommend rest, fluids, and offer medications to help with nausea and vomiting.
For liver injury we avoid medications and alcohol that can worsen liver damage. The liver will usually recover within months after hepatitis A infection.
There are vaccines for Hepatitis A included in the childhood vaccination schedule. Those older who weren’t vaccinated as a child can get the vaccine from their local provider or health department. Many states require all health care and food workers to be vaccinated.
The best form of prevention however is good hand washing, dining area hygiene, and cooking food thoroughly.
For years we’ve been hearing stories of children being diagnosed with brain tumors or liver disorders based on followers viewing their picture on social media and alerting parents to suspicious findings. Now a study, published in PLOS One, finds 21 different medical conditions to be revealed based on the vocabulary people use when posting on their timeline.
Penn State and Stony Brook medical researchers reviewed thousands of Facebook status updates and found certain keywords surface more often with those having specific conditions.
For Diabetes, for examples, key words included: pray, family, blessed, very, thank, thankful, doctor, blood, hospital
For Sexually Transmitted Illnesses, there were many expletives as well as the terms cry, scream, away, guess, wow and babe
For Drug Abuse, there were many expletives as well as well as the terms nobody, everybody, stop, call, text and bored
For High Blood Pressure, terms that commonly surfaced included doctor, blood, hospital, mother, good, peace, rip.
The concept of using a “digital language” to help identify certain risk factors is nothing new when it comes to mental illness but is virgin territory when we discuss endocrinology conditions such as diabetes.
More research obviously needs to be done, however, this study demonstrates that not only can our physical actions tune a medical provider into our pathology but so can our social media behavior.
The National Weather Service has issued “excessive heat warnings” for many parts of the Southwest United States. It’s the first of the season for many states, so don’t be unprepared.
This occurs “within 12 hours of the onset of extremely dangerous heat conditions”. This means that the heat index (air temperature and humidity) will be greater than 105 degrees for more than three hours a day for at least two days in a row and the night-time temperatures will not drop below 75 degrees. Although many of us may live in areas where this occurs each year, the onset can be one of the most dangerous times. Symptoms such as heat cramps, heat exhaustion and heat stroke must be identified.
At first when one feels symptoms, it may come in the form of heat cramps. Heat cramps are painful spasms that occur in the muscles of the arms and legs and even abdomen. We believe that when one loses fluids and salts from excessive sweating, cramps ensue. Its important in these cases to get the person out of the heat, hydrate them with sips of fluid and electrolytes and massage the body parts affected.
If one does not leave the heat and come indoors, the next risky event that can occur is heat exhaustion. This worsens as the victim sweats profusely becoming more and more dehydrated. They could also have cramps but nausea may ensue, they may look pale and clammy and their heart rate will increase to try to compensate for the lost fluid. These individuals may become dizzy, weak and even faint. Immediately bring the person indoors, lie them down, elevate the feet, give sips of fluid, cool down the body applying cool and wet cloths to the underarms and body, and contact medical authorities if symptoms continue or worsen.
Heat stroke will occur if a vulnerable person does not get out of the heat in time. It is a medical emergency and can be fatal. If an individual has heat stroke 9-1-1 must be called immediately. Bring the victim indoors away from sunlight, lie them down, remove unnecessary clothing, cool their body with cold compresses and watch for signs of rapidly progressive heat stroke in which they have difficulty breathing, seize or lose consciousness. If they are unconscious you cannot give them fluids. Only if they are alert, awake and able to swallow will you be able to give fluids. Do not give medications to reduce the fever such as aspirin or acetaminophen since their body may not be able to metabolize them properly and this could make matters worse.
Young children and elderly individuals may have issues adjusting to the outside environment and may be more prone to dehydration. Those with medical conditions such as heart, lung, thyroid disease can be at risk as well. If you’ve ever suffered from heat stroke you can be vulnerable again. And many medications could make you susceptible such as diuretics, vasodilators and beta-blockers for blood pressure and antidepressants. The biggest risk comes when we are unprepared. Having an unusual cool week prior to a heat warning could preclude many from taking proper precautions. Staying indoors, checking air conditioning and fan devices to make sure they work properly, wearing cooler clothing is just the beginning. Stocking up and planning to hydrate frequently is paramount because when death occurs to excessive heat, dehydration is the main culprit.
Bring your pets in doors, and watch your kids, friends and family members frequently. If they are beginning to sucumb to the heat, they may be quiet and not be able to voice it.
Avoid drinking alcohol in the heat. It can dehydrate you more and worsen the situation.
Avoid excessive exercise when outdoors and make sure to make use of shady areas.
The summer and early fall offer exciting and fun ways to enjoy nature. Don’t let the heat get to you. Remember….if you can’t take the heat, get out of the…..well heat…….
The latest potentially deadly challenge sweeping social media is the “Vacuum” or “Trash Bag” Challenge.
In this feat, one climbs into a garbage bag, while a friend or parent sucks air out of the plastic bag until the inmate topples over.
Bringing people to the point of falling (or if putting the bag over their face) of asphyxiation can cause a plethora of health issues including fractures, respiratory failure, stroke and death.
And even if parents appear to be supervising or performing the challenge and the child comes out unscathed, dangers lurk as the child could try to reproduce the challenge with their friends, this time putting the bag over one’s head.
This Spring another stupid challenge swept social media called the “Shell On” challenge in which teens Snapchat videos of themselves eating through fruit skin, cardboard boxes and plastic bags containing their food.
Although this appears to not be as dangerous as the Tide Pod or Boiling Water Challenge, it can cause choking and asphyxiation.
Last year we learned of the “Boiling Water Challenge” in which kids drink boiling water from a straw or have it poured all over their body. Then they topped it off with a more dangerous challenge, the “Fire Challenge.”
The Fire Challenge is executed by pouring rubbing alcohol on one’s body and then setting oneself on fire. A video records the victim running into a tub or shower to wash it off, and this trend has gone viral.
Unfortunately it’s one of the most dangerous. A 12 year-old girl from Detroit who participated in this challenge is undergoing multiple surgeries to repair burns afflicting close to 50% of her body.
Multiple cases of the “Fire Challenge” have been reported over the years, including a 12 year-old boy from Georgia.
One would think children, especially teens, innately know that fire is dangerous but maybe the younger generation has been so protected that they haven’t experienced the basic concepts of danger and inadvertently underestimate its force.
Challenges that involve dangerous stunts have been around for some time. The Choking Challenge induced children to suffocate themselves for the high of feeling asphyxiated. The Tide Pod Challenge tempted kids to put colorful cleaning packets in their mouths, hoping they wouldn’t burst.
The Cinnamon Challenge sparked thousands to inhale the common kitchen spice and cough till they puked. Then the Condom Challenge offered two options where one dropped a condom filled with water on a friends face, or snorted one through the nose.
We adults can’t for the life of us figure out what the reward is in performing these challenges, but presume its fame and awe among friends and social media followers. But these challenges prove dangerous and in some cases deadly. Unfortunately the YouTube Clips never show the after effects of these pranks…maybe they should.
This week the CDC reported their findings of thousands of children being enrolled in school without any waiver for vaccine exemption.
As states aim to limit parental choice to limit vaccination based on religious objections, the country is fighting multiple outbreaks, including Measles, Mumps and Hepatitis A, which are potentially preventable with vaccination.
When the CDC looked at data submitted by 27 states, the majority of unvaccinated or under-vaccinated children in 10 states lacked waivers.
Which brings to question, are other reasons at play when a child is not vaccinated rather than religious or medical objections?
When a family adheres to the vaccination regimen, office visits are need at 1 month, 2 months, 4 months, 6 months, 12 months, sometimes 15 months of age, and 4 years old – 6 years old, in addition to any other follow ups deemed necessary by the medical provider.
Most medical offices that provide vaccines are only open during the weekday, hence a parent who cannot take off work to bring their child in the doctor may have difficulty adhering to the vaccination schedule.
And then when asked why their child wasn’t vaccinated, it may be less embarrassing to cite “religious reasons” rather than fear of losing income or one’s job when taking off for the doctor’s visit.
I suggest weekend or night “vaccination clinics” at schools to make parents aware of alternative times to vaccinate and increase access to those who may not be able to leave their job during the weekday.
Memorial Day is this weekend and the country honors those who have sacrificed for our freedom. Many of us will travel and enjoy the outdoors. However, according to a study by the National Coalition for Safer Roads, Memorial Day Weekend is the most dangerous holiday for road and highway accidents. Additionally, water injuries, including drownings may rise this weekend. Grill injuries can occur, and throughout the US we are seeing record high temperatures. We need to stay safe out in the sun, by the grill, in the water and on the roads.
Record heat and extended time outdoors can increase the risk of heat illness. Hydrate, stay in the shade and protect your skin from damaging UV rays.
Sunscreen with an SPF of 30 or greater should be applied 15-30 minutes prior to going outside and reapplied every two hours or more often if swimming.
Avoid excessive alcohol as it could accelerate dehydration and put one at greater risk of injuries and heat exhaustion.
For more on heat exhaustion and heat stroke read here.
In 2012, a man caught on fire after spraying sunscreen prior to heading over to the grill. He sustained multiple second degree burns.
Sunscreen may be flammable, so make sure it is dry prior to grilling or use a lotion instead of spray on.
Keep the grill outdoors but away from low roofing, branches, and trees. Watch the little kids and keep them and the pets away from the barbecue.
Assign someone to watch the grill if you need to step a way during grilling.
Do not add lighter fluid to already ignited coals.
If someone does catch on fire, remember to have them stop, drop and roll on the ground until the flames expire. Call 9-1-1 and remove any jewelry or tight clothes around the area..
If a minor burn injury does occur, run it under cool (not cold) water for 10-20 minutes. Avoid applying ice to the burn as it can damage the skin. Also remove nearby jewelry.
Bandage and see a medical provider if concerned with your injury.
Avoid drinking alcohol when swimming or engaging in water sports.
Make sure you are in arm’s reach of your kids in the water.
Use life vests while boating and make sure the kids are wearing appropriate sized vests.
Never swim alone. Always have a buddy.
Know your route to avoid you checking your GPS app while you drive.
Allow extra travel time and don’t rush. Expect travel delays coming home as well.
Consider leaving a day or two early or a day or two late to avoid congested traffic.
Drive the speed limit and avoid tailgating, leaving at least 2 seconds between you and the car ahead of you.
Make sure you have plenty of water, supplies and a first aid kit in the car in case you get stuck on the highway.
Have a happy and safe Memorial Day Weekend!
One of the leading causes of death in hospitalized patients is much more complex than once thought.
Septicemia is an infection that enters one’s blood stream. This can result in Sepsis, a life threatening condition that occurs in response to the blood infection. Its definition has been fluid over the years as more research reveals it’s a disease process.
IMAGE FROM TRISTATEHOSPITAL.ORG
Now researchers in a study published in JAMA describe 4 separate subtypes of Sepsis. These include:
α phenotype had fewer abnormal laboratory values and less organ dysfunction;
those with the β phenotype were older, had greater chronic illness, and were more likely to present with renal dysfunction;
those with the γ phenotype were more likely to have elevated measures of inflammation (eg, white blood cell count, premature neutrophil count [bands], erythrocyte sedimentation rate, or C-reactive protein), lower albumin level, and higher temperature; and those with the δ phenotype had elevated serum lactate levels, elevated levels of transaminases, and hypotension
Dr. Christopher Seymour of the University of Pittsburgh School of Medicine, states in Medical Express, “Right now, our treatment approach to sepsis is basically ‘one size fits all,’ whether you are a 40-year-old with influenza complicated by [a] staff infection or an 80-year-old with multiple comorbidities and biliary sepsis,” he said, adding that international sepsis practice guidelines recommend the same bundle of care for everyone.”
Current goals in medicine aim to treat the patient rather than the disease, and as we need to individualize treatment for those with high blood pressure, cancer and diabetes, we need to as well with acute, deadly diseases such as sepsis.
The Trump Administration has vowed to put an end to “surprise medical bills.” But this may be easier said than done.
Reports of “sticker shock” have exponentially grown over the years and consumers want transparency of what their health care visit is going to cost. However, the average physician, nurse practitioner, physician assistant, hospital, medical center, etc. don’t know themselves until the insurance company sends an EOB “Explanation of Benefits” delineating what is discounted, what is covered, and what is the patient responsibility.
So to start, President Trump is asking Congress to address those charges incurred by “out of network” facilities to which patients go to in an emergency setting. Wanting to hold “insurance companies and hospitals accountable,” President Trump wants to put an end to patients getting charged for “services they did not know anything about, and sometimes services they did not have any information on.”
Can he do it? Politicians on both sides of the aisle want to help curb health care costs, but both sides want to get the credit. There’s race to see who could do more for healthcare before the 2020 election.
There’s a few reasons why cost transparency in an emergency medical setting is challenging.
Firstly, insurance companies aren’t transparent to hospitals. They only inform the medical facility of the out of pocket costs once they take weeks to review the claim. This can be streamlined and cut down in time with software, but same day pricing by an insurance company is impeded by the need to see if the patient paid (or will pay) their premiums that month, or if they are still employed and have the same active insurance.
Secondly, patients don’t always know what their diagnosis is when they walk up to the front counter. Some may think they have a “cold,” but actually end up having a bout of pneumonia. Some may think they have a “stomach bug,” but after CT confirmation, learn they have appendicitis. Hence until the medical provider performs the evaluation and testing, a diagnosis and then “cost to treat”, cannot be given.
Finally, patients may not prefer the “cost factor” added into their facilities’ decision making. If they pay a certain amount for a visit and end up needing more pain control, a repeat breathing treatment, or some extra bandages, they may not want to have to take out their wallet, sort of speak, each time they need more services.
As a physician who, for years, pleaded with insurance companies to give us an idea of what they would want a patient to pay, I’m for any campaign to increase price transparency and offer patient’s more choice. However, since medicine and health can be unpredictable, coming up with predictable “costs” may prove difficult.
Those who have had their appendix removed may be at 3X greater risk of later developing Parkinson’s.
Researchers at Case Western Reserve University and University Hospitals Cleveland Medical Center looked at 62 million health records from 26 institutions throughout the US and found that those who had an appendectomy, surgical removal of the appendix, had a 3-fold risk of developing Parkinson’s later in life.
Internal medicine second year resident and study author, Dr. Mohammed Z. Sheriff, states,
Researchers suggest more research to be done, with investigational focus on gut health as it relates to neurological health.
Parkinson’s disease is the second most common neurodegenerative disorder, next to Alzheimer’s, and the most common movement disorder that affects 1% of the world’s population over 60 years old. In the US, 60,000 new cases are diagnosed each year. It affects several areas of the brain, primarily the substantia nigra, altering balance and movement by affecting dopamine producing cells.
It was first described in 1817 by James Parkinson as a “shaking palsy.”
Common symptoms of Parkinson’s include:
and patients may later develop…
Most cases are idiopathic, meaning the disease arises with no specific cause. However some cases are genetic and multiple genes have been identified that are associated with the disease.
The average age of onset is 60, but some cases may occur as “early onset”, before the age of 50, and if before the age of 20, it is known as juvenile-onset Parkinson’s.
Men appear to be more affected than women at twice the rate.
Risk may be enhanced with a history of head trauma.
Exposure to herbicides and pesticides has been linked to an increase risk of Parkinson’s as well.
Average progression rates can last years to decades, however, earlier onset disease may manifest much quicker.
Although there is no cure for Parkinson’s, symptoms can be treated by a variety of measures.
In general, it is not a good idea to panic about anything. The panic itself often causes more harm than the original threat.
Crisis situations, real or contrived, lead to new intrusive laws that the public would never accept otherwise. We supposedly cherish freedom, but if we believe that the world will end if we don’t act NOW, then we may clamor for the government to save us. Cynical politicians bent on increasing their power never let a crisis go to waste.
Something like the Green New Deal—the end of our comfortable, prosperous lifestyle—takes a truly apocalyptic threat. But to eliminate our freedom to decline a medical treatment, the threat that “millions will die” of measles is evidently enough. Or if not millions (most older people had measles and recovered fully), a few especially vulnerable children, who can’t be vaccinated themselves, might catch measles and die.
There are several hundred cases of measles nationwide, more than in 2014, and bills are being pushed through state legislatures to eliminate all but very narrow exemptions to the 60 shots now mandated for school attendance.
In New York City, people are receiving summonses based on Mayor Bill de Blasio’s emergency order. Everybody, adult or child, who lives in four ZIP code areas must get an MMR shot or prove immunity, or face the prospect of a $1,000 fine ($2,000 if you don’t appear as ordered). Your religious exemption is overridden. The threat of 6 months in prison and the prospect of forcible vaccination were removed before a hearing on a lawsuit brought by five mothers. The judge dismissed the case.
Health Commissioner Oxiris Barbot said that the purpose of the fines is not to punish but to encourage more people to proclaim the message that vaccines are safe and effective. Get it? If you say something to avoid a fine, that makes it true.
It’s about the need for herd immunity, they say. We need a 95 percent vaccination rate for herd immunity to measles. With only 91 percent or so we are having outbreaks! If we could just vaccinate another 4 or 5 percent!
Mayor De Blasio has a point about vaccinating everyone. Adults are getting measles because their shots have worn off. It is likely that we have survived for decades with a large part of the adult population vaccinated—but not immune. So where do the mandates stop?
Outbreaks have occurred in populations with a near-100 percent vaccination rate. Was it vaccine failure? Or was the vaccine not refrigerated properly? Or was a claimed outbreak real? One in Ann Arbor, Michigan, was called off when a special test, a reverse transcriptase polymerase chain reaction (RT-PCR) showed a vaccine-strain measles virus rather than a wild-strain measles virus. Some 5 percent of vaccinees may get an illness that looks like measles, but it is just a “vaccine reaction.” Can they shed live virus? Yes. Should you keep your immunocompromised child away from recently vaccinated people? Just asking.
Like all medical treatments, vaccines are neither 100 percent effective, nor 100 percent safe. Read the FDA-required, FDA-approved package inserts. Arizona defeated a law that would have required making these available to parents in obtaining informed consent. (You can get them on the internet.) Vaccine Court has paid out about $4 billion in damages—recently for two children with severe brain damage from encephalopathy (that’s brain inflammation) after a fight lasting about 15 years. Just incidentally, they had an autism diagnosis also. Parents bring their severely injured children to hearings. You won’t see these children on tv, only pictures of babies with measles. No “fear-mongering” allowed about “rare,” possibly coincidental problems from vaccines.
There are trade-offs with vaccines: risks and benefits. But in the panic about measles, the right to give or withhold informed consent—fundamental in medical ethics as well as U.S. and international law—is being sacrificed. And so is free speech. The AMA wants to censor “anti-vaccine” information on social media. I happened on a factual article by investigative reporter Sharyl Attkisson, but was not able to retweet it because it had been removed.
The threat of infectious diseases is real and increasing. We need more robust public health measures, better vaccines, and improved public knowledge and awareness. Deploying vaccine police and shutting down debate will erode trust in health authorities and physicians, although more people may get their shots. But such heavy-handed measures will not defeat the enemy—measles and worse diseases.
Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions, if expressed, are her own and do not necessarily reflect the opinions of GCN. Her column can often be found at www.pennypressnv.com. Her column has been reprinted in full, with permission.