Although flu season officially starts in October, public health officials in Riverside, California have already reported the first “flu-related” death this year, a 4 year-old child.
And being that Australia’s flu season began a couple of weeks early, US health experts are bracing for the start of ours this month.
We still, however, cannot predict how “severe” this year’s flu season will be, but here are the answers to the most commonly asked questions about the flu.
Flu season has begun already. It typically starts in the Fall, and ends late Spring. So the range is described as October to May with it peaking December to March.
It is difficult to predict, but already this early in the season we’ve had a flu-related death. As the season unfolds, more cases will be reported by the CDC’s Flu View.
The flu is caused by a virus. Multiple strains of virus’ can cause the flu. The virus itself can be lethal, however the greatest risk comes with what it does to your immune system, thereby putting one at risk of secondary infections. Pneumonia is the number one cause of flu-related deaths. Secondly, it can exacerbate existing conditions such as asthma, seizures, even promote preterm birth, hence those who are pregnant or have preexisting medical conditions are urged to get vaccinated against the flu. Moreover those who qualify should get the pneumonia vaccine as well.
According to the CDC, the trivalent vaccine covers for these three strains of the flu virus:
Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).
These vaccines are aimed at providing protection against the Swine flu, and some influenza A and B strains.
This year, those over 65 will have three options for their flu vaccine.
Fluzone High-Dose – a higher dose flu vaccine that will hopefully allow their immunity to protect against the flu longer
FLUAD – the trivalent flu vaccine with an adjuvant to stimulate more of an immune response.
Flublock Quadrivalent – provides protection against 4 strains.
This year, the CDC allows use of the nasal spray vaccine as it has shown to have improved efficacy from prior years. However, it is only recommended for those who are between the ages of 2 and 49 and cannot be given to those who are pregnant or who have compromising medical conditions as outlined by the CDC.
All individuals 6 months old and older unless specified by their medical provider.
The average immune system takes a couple weeks of to prime, so we suggest getting the flu shot before the season starts…or peaks. However, experts recommend to still get the flu vaccine to anyone who missed early vaccination.
Most individuals allergic to eggs can still get the flu vaccine, but if the allergy to eggs is severe (anaphylaxis, angioedema, difficulty breathing), the CDC recommends notifying your medical provider and being in a facility to monitor you if you do get the flu vaccine.
No. The flu vaccine has a “killed” version of the virus meaning it’s not an active virus (as opposed to a live attenuated vaccine, a weakened down version of it). A “killed” or “inactivated” vaccine merely has the pathogen particles to induce an immune response. Additionally, when one states they got the flu despite the flu shot it could be that the flu shot only protects against 3 – 4 strains and they were infected with a rare strain not covered by the vaccine.
The average effectiveness each year hovers around 60%. Last year’s efficacy was much lower and this year’s has not been predicted as of yet. Australia is still reporting active cases on their Department of Health website.
For some, the immune response that ensues can make one feel mildly ill, but should not resemble the flu. Those who state they got the flu “immediately” after receiving the shot, might have already been exposed and had not had a chance to produce immunity prior to their exposure.
A cold comes on slower and less severe. Flu symptoms are more abrupt and can include:
There are antiviral medications available, such as Tamiflu, to treat the flu. Antibiotics, however, will not work since the flu is not caused by a bacteria but rather a virus. However, if a secondary bacterial infection takes over, antibiotics may be used.
Besides vaccination, avoid being around those who are sick, thorough hand washing, and take good care of yourself. A balanced diet, exercise and sleep regimen can help boost your immune system.
Wishing you health this season!!
The FDA has announced that samples of ranitidine, an H2 Blocker used for upset stomach, reflux and ulcers sold generically and under the brand name of Zantac, were found to have the contaminant N-nitroso dimethylamine (NDMA). This is one of the chemicals that prompted the generic ARB blood pressure medication recalls last year.
There have been no reports of users becoming ill and no recall has been suggested at this time. In animals, NDMA is known to cause liver and lung cancer. In humans its carcinogenic risk is unknown, however the CDC states it may cause liver function impairment and cirrhosis.
The FDA writes:
The investigation is ongoing and more needs to be looked at when it comes to this manufacturing process suspected to result in these “impurities” being made.
Last year NDEA was also found in the generic blood pressure medications that were the subject of recall, however has not yet been suggested as being present in ranitidine.
N-Nitroso-N-methyl-4-aminobutyric acid (NMBA) was the third chemical detected resulting in the latest two recalls of losartan, an angiotensin receptor blocker commonly used to treat hypertension (high blood pressure). It is believed to have been created during the manufacturing process of the generic drug.
NMBA, according to Toronto Research Chemicals, is a known carcinogen in a wide range of animal species.
Last Fall, ScieGen Pharmaceuticals, Inc. recalled certain lots of Irbesartan, a similar angiotensin receptor blocker used in blood pressure management.
The recalls initially began last summer when FDA recalled a number of lots of valsartan due to an “impurity,” N-nitroso dimethylamine (NDMA) that is known to cause cancer in animals. Weeks later they additionally found traces of N-nitrosodiethylamine (NDEA).
According to Reuters, earlier last summer, the MHRA, Medicines and Healthcare Products Regulatory Agency, located in the UK, said the appearance of the impurity, N-nitroso dimethylamine (NDMA), came after a change in the process for making valsartan at one facility owned by Zhejiang Huahai Pharmaceuticals, a company in Linhai, China.
With NDEA, data is limited, but due to its classification as a nitrosamine and its prevalence in tobacco smoke it is classified as a probable human carcinogen.
According to New Jersey Department of Health’s website, NDEA has been linked to liver, lung and gastrointestinal tract cancer in animals.
Losartan, valsartan and Irbesartan are medications in the class of angiotensin receptor blockers (ARBs) used for high blood pressure and congestive heart failure.
Those taking either tablet for their blood pressure are urged to not abruptly stop their medication but rather check with their medical provider and pharmacy to see if their particular prescription is involved in the recall.
I suspect more recalls will follow as processes may be similar across multiple pharmaceutical facilities and NMBA, NDMA and NDEA are byproducts that may not be individually unique to just one “brand” of medication manufacturing.
The CDC is currently investigating close to 450 cases of vaping related illness and 5 reported deaths. A recent study in the New England Journal of Medicine has found evidence of lipoid pneumonia in a case where a 21 year old became sick after vaping nicotine and tetrahydrocannabinol (THC) daily.
Macrophages, which are scavengers that rid the body of pathogens and other harmful substances in the body, were found to be “lipid-laden,” or full of a fatty substance. They suspect this fatty substance to be caused by inhalation of Vitamin E acetate that was only present in marijuana vaping products and not the average nicotine e-cig. Vitamin E is commonly used in hand creams, moisturizers and as a supplement due to its oily nature, but is not to be inhaled.
Since the lungs are designed to oxygenate the lungs and exchange out carbon dioxide, oily substances can clog the works.
Experts say the Vitamin E acetate is not believed to be apart of regular e-cigarettes that do not vape THC, the psychoactive component to marijuana.
This is a developing story….
The FDA is investigating 127 reports of seizures in e-cigarette users (up from 35 this Spring).
Many were teenagers and young adults.
Since 2010 the agency has received multiple reports but is unclear if e-cigarettes actually caused the seizures or if there were underlying medical conditions predisposing the neurological disorder.
The 92 additional cases since this April is concerning and the FDA is working to determine if vaping contributes contributes directly to serious neurological conditions.
In April FDA Commissioner Dr. Scott Gottlieb tweeted:
Dr. Ned Sharpless, current acting FDA Commissioner, is encouraging people to report adverse events as, “Additional reports or more detailed information about these incidents are vital to help inform our analysis and may help us identify common risk factors and determine whether any specific e-cigarette product attributes, such as nicotine content or formulation, may be more likely to contribute to seizures,” (Reported by CNBC).
A seizure occurs when there is abnormal electrical activity in the brain. If the electricity doesn’t conduct properly, brain function gets disrupted. This could lead to convulsions (involuntary jerking movements), loss of muscle tone, changes in senses such as vision, hearing and smell, loss of bladder control, loss of consciousness and sometimes stroke, brain damage and death.
Nicotine toxicity has been linked to seizures. E-cigs sometimes contain more nicotine than cigarettes alone.
A study published by the American Heart Association found nine different E-cig flavors to impair blood vessel function, which can impair heart health.
Endothelial cells, which delicately line blood and lymph vessels, were found to become inflamed at low concentrations of some vapor flavors. And at high concentrations of others, exhibited cell death. Nitric oxide production, necessary for vessel dilation to improve blood flow, was impaired as well. These are often the same changes seen in early heart disease.
The 9 flavors (and the chemicals within) cited in the report to cause the endothelial inflammation and/or damage were:
Strawberry flavoring appeared to have the most adverse effect on the cells.
Many other flavors were not included in this study, so it's unknown how safe they may be.
For more on the study, read here.
An alternate study published last November looked at vaping flavors and their effects on heart muscle cells.
For more on this study, read here.
The moral? Just because we love the taste of something, doesn’t mean its safe to inhale.
A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.
Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day. They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10mg/ml. That dose would be commonly consumed by many humans who vape.
They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.
Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.
In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:
Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.
A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children). E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).
The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucus production and a sweeping out of carcinogens trying to make their way down to the lungs.
More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.
For more on the study read here.
Last week, experts warned that many chemicals in vaping liquid may change to toxic substances (once heated) that can irritate the lungs.
Last year one study reported that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.
Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:
We’ve known for some time that vaping fluid could contain chemicals that turn toxic once heated, but this study shed light on e-cig metal components causing metal leakage to the vapor making contact with delicate respiratory epithelium (lining).
Reported by Forbes, Rich Able, a medical device marketing consultant, stated the following, “the FDA does not currently test any of the most popular vaping and e-cigarette instruments being manufactured at unregulated factories in Asia that source low-grade parts, batteries, and materials for the production of these devices,” suggesting that “the metal and parts composition of these devices must be stringently tested for toxic analytes and corrosive compounds.”
These chemicals may act as neurotoxins, affecting our nervous system, cause tissue necrosis (cell death) and even multi-organ failure. Moreover, they can affect how our immune system reacts to other chemicals as well as foreign pathogens, affecting our ability to fight other diseases.
Although studies have suggested e-cig vapor to be safer than tobacco smoke, not enough research has been done, in the relatively few years vaping has been around, looking at how heat-transformed chemicals and leaked metals affect our breathing, lungs and other organs once absorbed into the body.
Reports of former Vice President Joe Biden’s eye turning “bloody” surfaced this week. He was speaking at a CNN hosted town hall on climate change when reporters noticed his left eye turned blood red.
The condition however is called a “subconjunctival hemorrhage” and is harmless, but needs some explanation.
The conjunctival is a vascular membrane that lines the eye and lids. When a blood vessel breaks, hemorrhages, it appears dark beefy red over a portion of the white part of the eye.
Sometimes these hemorrhages occur when one incurs trauma to the eye or rubs it aggressively, but most often it occurs spontaneously within a week or two as the blood gets cleared by body mechanisms.
However, of note, a subconjunctival hemorrhage could happen when blood pressure rises, such as during a sneeze, laugh, strain when stooling, or cough. It could also happen if one has a bleeding disorder, or inability to clot.
Although the subconjunctival hemorrhage is benign, those who incur one might consider having their blood pressure checked and labs to ensure they have strong clotting abilities.
Editor’s note: Technically, National Blood Donation Day is September 5th, as Doc D. notes. BUT National Blood Donation week continues through the week ending on the 9th, so here you go.
This year September 5th is National Blood Donation Day. Blood banks all across America are holding drives to increase our nation’s blood supply.
Governors from nearly all states have proclaimed State Blood Donation Days to show their support.
Every two seconds, someone needs blood.
The American Red Cross provides these startling statistics:
We wear red today to show our support.
To donate blood visit the following sites:
Donating blood is a simple process that takes less than 45 minutes. For those who cannot donate blood, hosting a drive can be just as life saving and easy to do. Blood banks can host a drive at work on site or through a bloodmobile in the parking lot, with no cost to the host.
Almost all of the United States have declared State Blood Donation Days to help combat our nation’s blood shortage as part of National Blood Donation Week (NBDW).
This year National Blood Donation Week is September 2nd-0th with September 5th being National Blood Donation Day.
The movement began in 2015 when Nationally Syndicated Radio Host Dr. Daliah Wachs, asked Governor Brian Sandoval to proclaim Nevada Blood Donation Day to help fight the state’s blood shortage. The next year she took this movement national asking all governors to proclaim state blood donation days.
From our September 4th post:
Governors in just about every state have already proclaimed September 5th to be their state Blood Donation Day for 2018.
Oklahoma has proclaimed the month of September - Blood Donation Month.
Alaska proclaimed the month of July - Blood Donation Month.
“Blood and platelet donations are currently being distributed to hospitals as fast as donations are coming in, and more donations are needed, especially type O, to replenish the blood supply,” said Laurie Nehring, communications director for the American Red Cross. “We appreciate Dr. Daliah’s efforts to educate the public about the importance of regular blood donations.”
Emergency rooms treating trauma victims, hospitals treating anemic patients, and medical clinics replenishing low blood levels in cancer patients require a steady supply of blood products.
38% of the U.S. population is eligible to donate blood but less than 10% actually do.
“The unified effort across America to proclaim state blood donation days around the Labor Day holiday comes at an important time for patients,” said Mitzy Edgecomb, Blood Systems Vice President, Donor Marketing & Communication. “Blood donations often drop dramatically during the summer months and over holiday weeks when regular donors take time away to enjoy family vacations. We appreciate and applaud the governors from the multiple states who have called attention to the ongoing need for blood donations and thank those who step forward to make a life-transforming impact on others by giving blood.”
Donating blood is easy and takes less than one hour. Many places of work can hold blood drives so employees don’t have to take off work (plus you get yummy cookies).
A case report in Annals of Internal Medicine describes a teen who went “blind” from a junk food diet.
A 14 year-old boy described as a “fussy eater” presented to his doctor with fatigue after years of eating meals rich in fries, white bread, chips and processed meat. He was told to take supplements when they found him to be iron and B12 deficient but progressively over the next 3 years he began to suffer from vision loss. Upon lab testing he was found to be deficient in iron, copper, selenium, Vitamin D and Vitamin B 12. And upon further testing was found to suffer from optic neuropathy.
He was further treated with supplements and now is under the care of specialists including nutritionists and eating disorder specialists.
His condition stabilized but reportedly he still has deficits such as blind spots in the middle of his vision (central scotoma), rendering him “legally blind.”
This wasn’t the first case of nutritional optic neuropathy.
Above is a picture of the fundi of a 28 year-old male who suffered from central vision loss as a result of his diet which consisted of heavy alcohol use. The progression of his disease has stabilized with intervention but he too has had to learn to adapt to his central scotoma.
Our eyes need vitamins such as A, a variety of B’s, C, E, and omega-3 fatty acids to name a few. Vitamin D is crucial for bone health and for protection against diabetes and cancer.
Most fast food is rich in carbohydrates, fats, salt and preservatives, and lacking in rich nutrients and amino acids.
So comes the question, are the majority of our youth “malnourished?”
Unless our children are eating diets rich is fruit, vegetables, whole grains, protein, dairy and health fats, they could be at risk of not receiving vital nutrition.
Vitamin supplementation helps but may not satisfy all the nutritional needs of a growing child. Hence in addition to the millions of children who suffer from malnourishment due to poverty, millions more are expected to suffer similarly as a result of poor diet choices.
This is a developing story.
70 year-old music legend, Edward Mahoney “Eddie Money,” revealed in a video released by his realty TV series “Real Money” that he has stage 4 esophageal cancer.
The episode airs on AXS TV on September 12 and discusses how he went in for a routine screen when he was diagnosed.
He recently underwent heart valve surgery and reports say he also battled pneumonia.
Despite the cancer having spread to his liver, lymph nodes and stomach, he appears optimistic saying cancer has come a long way since the 1950’s and 60’s and “everyday above ground is a good day.”
Esophageal cancer can occur anywhere along the gullet/food pipe. There are different types such as adenocarcinoma (lower portion near the stomach), more commonly seen in Caucasians, and squamous cell carcinoma (middle to upper esophagus) more commonly seen in African Americans. It’s the 6th common cause of cancer death worldwide and comprises 1% of all cancers diagnosed in the US.
According to the American Cancer Society, estimates for 2019 include:
Early esophageal cancer may not exhibit any signs. However if it progresses, symptoms may include any of the following:
Although esophageal cancer appears to afflict men more than women, risk factors include:
There are a variety of treatments for esophageal cancer including surgery, chemotherapy and radiation.
Super Bowl Champion Quarterback and Bronco’s General Manager John Elway revealed to TODAY that he was diagnosed with a debilitating hand condition 15 years ago. After he retired in 1999 he developed contractures, or permanent bending of his fingers. It affected both his ring fingers such he couldn’t straighten them out and subsequently couldn’t hold a football.
In the interview he states,
“Viking’s Disease”, or Dupuytren’s Disease, is thought to have originated in the Viking population and spread throughout Northern Europe during the 9th and 10th Century. It wasn’t until French physician, Baron Guillaume Dupuytren, described the flexion of the fingers and hand contortion that it received its modern name of “Dupuytren’s Contracture.”
In Dupuytren’s disease, the fascia, or fibrous layer that surrounds the muscles and tendons underneath the skin in the hand becomes thickened and tents, or tightens around the local area. This can cause a contracture, or pulling of the finger to a position in which they can’t extend or straighten back out.
Risk factors for Dupuytren’s disease with resulting contractures include:
Treatments include conservative measures such as steroid injections, enzyme injections and therapy and in more severe cases surgical options are available.
John Elway states he chose to go the conservative route and forewent surgery. It was successful and he now has normal movement of his fingers but the condition can return. The football legend is currently a spokesperson for the Facts On Hand Campaign, raising awareness of this common condition.
Jeffrey Epstein's cause of death has been ruled a suicide by hanging; however, there a series of conspiracy theories that suggest he was strangled. There are some distinct physical findings that would differentiate the two.
66 year-old Jeffrey Epstein, who recently pleaded not guilty of sex trafficking charges, was found dead in his jail cell on August 10. He had recently been on suicide watch and reports initially suggested he had hung himself by his bed sheet.
However, the results of the financier’s autopsy suggest he sustained trauma consistent with hanging (after preliminary reports suggested strangulation). How do forensic experts tell the difference?
With hanging, one drops from a height and suspends, incurring a fracture of a neck bone which in turn may sever the spinal cord.
A severe blood pressure drop can ensue and the victim may die within minutes
As seen above, a “hangman’s fracture” is seen with hyperextension injuries where the pars interarticularis on the pedicle of the C2 vertebrae becomes fractured. The distance of the drop is crucial in determining the success of the execution. A drop to long could cause beheading, a drop too short could cause strangulation.
If they do strangulate ...they asphyxiate (lose air flow), or lose blood flow from their carotid arteries being compromised.
From a capital punishment standpoint, hanging is one of the most common and barbaric ways to execute. Three states still have this form of execution as an option if lethal injection is not available (DE, NH, WA).
Strangulation occurs when one compresses the structures of the neck causing decrease air and blood flow. It could be executed using a ligature (scarf, sheet, cord) or by one’s hands. Moreover, it can occur if a hanging drop is improperly calculated. Many times the hyoid bone is fractured (1/3 of all homicides) as its think U-shape is vulnerable to the forces of strangulation.
So injuries incurred can be similar in both strangulation and hanging, especially if the latter is done improperly and ineffectively severs the spinal cord.
However, since hanging causes a blood pressure drop and strangulation causes a backup of pressure into the head due to vessel constrictions, on autopsy one may find more signs of hemorrhage (retinal hemorrhages) and swelling (brain edema) during strangulation than accurate hanging.
The start of the school year may be the most exciting time of the year (well maybe just for parents…) However going back to school can bring on a slew of health issues, so let’s look at how we can prevent them.
The most basic and easiest thing we can teach our children is to wash their hands whenever they touch something dirty, use the restroom or before they eat. True we need to be exposed to germs to increase our immunity, but some of these germs aren’t friendly and bring on colds, flu, rashes and intestinal bugs when we’re not expecting it.
If a child skips breakfast or eats primarily sugar and carbohydrates, they not only face immune system weaknesses but also poor attention, concentration and ability to do well in school. Make sure your kids eat a good breakfast with protein and Vitamin C-packed fruits before heading for the school bus.
If the kids were accustomed to staying up late and now have to wake up at 5:30 in the morning, they might spend much of their school day nodding off. Insufficient sleep has been linked to obesity as well as poor immunity so get them on a regular schedule of a bedtime that will allow 8-10 hours of sleep a night.
Chances are your child grew an inch this summer, so shoes and clothing may be a little tight. Use the finger tip rule for pants and shoes to make sure there is room to grow. And avoid accessories that your kids can chew on, swallow or can lose as they will concentrate more on the lost earring than what the teacher is saying.
Back to school can bring on anxiety in many children and make sure you have open conversations to allow them to share their fears. Bullies make themselves apparent the first few days of school, and your child may be getting wet willies, wedgies or their lunch stolen right under the teacher’s nose.
If joining the PTA doesn’t appeal to you, at least make buddies with parents of children in your kid’s class as they will be the first to notify you if lice, pink eye or sore throat is making the rounds before a school may.
If you child walks to or from school or a bus stop, educate them on how to avoid strangers and what to do if approached by one. Consider driving your child if you think they are at risk.
In 2006, a study published in BMC Public Health, found teachers to suffer more from ENT (ear, nose and throat) ailments, dermatitis, bladder infections, bronchitis, conjunctivitis and varicose veins than those who work in other professions. Teachers are on the front lines when it comes to cough and cold season as they come into contact with hundreds of children a day, many of whom are contagious prior to knowing they are symptomatic. Once the fever shows itself, parents may keep the child home but the student already exposed others earlier in the day.
Standing on one’s feet for extended hours does a number on the peripheral vascular system, manifesting in leg swelling and at times, varicose veins. And when breaks are infrequent, bladder infections brew since one can’t visit the bathroom when they need.
Long work hours during the week prevent many educators from seeing a health care provider and many health plans don’t have providers who work on the weekends. Teachers can very easily put their own health care needs on the back burner during a long school year.
Taking care of school business is paramount during the school year but parents, teachers and kids need to still put health and safety.