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ebola

Update: A second U.S. case has been confirmed, the first of a citizen contracting Ebola within United States. The patient is a nurse who tended the original patient. Although this is concerning, it is not alarming because I feel that the health profession is putting in place comprehensive treatment protocols to prevent further spread of this disease.

There has been one confirmed case of Ebola virus infection in the United States where a man traveled from Liberia in Africa, to Dallas, Tex. to visit relatives.

His symptoms developed only after being in the U.S. for a few days. The very word “Ebola” brings a shudder to many people — as well it should, since the mortality rate is so high amongst its victims.

Ebola infection is caused by a virus. As I’ve stated many times previously, viruses cannot be treated with antibiotics, therefore there is no successful treatment of Ebola.

Those infected with Ebola need top-notch critical care for any chance of survival.

The current Ebola outbreak began in West Africa. As of this writing, it has infected approximately 7,500 people, of which 3,500 have died. This is a very high mortality rate and is what makes this disease so scary.

Various international health organizations are converging on the affected African nations to do everything possible to prevent the spread and to keep the epidemic localized.

There is a tremendous need for trained health care workers with adequate equipment to help contain the virus in those underdeveloped countries.

The good news is that Ebola is not as contagious as other virus-caused diseases, such as the common cold or influenza.

At this time, it is not believed to be spread by respiratory droplets — such as from coughing or sneezing.

It is spread by contact with an infected person’s skin or body fluids — especially vomit, diarrhea, and blood.

It is also spread, perhaps to a lesser degree, with contact of infected saliva, sweat, tears, and open wounds. It is not thought to be passed from air, water, or food.

You can’t get Ebola from an infected person until they are showing obvious symptoms.

Ebola infection manifests after at least one week from the time of exposure, and one may become critically ill within just a few days thereafter. 

Symptoms of Ebola include:

- Sudden fever as high as 105 degrees Fahrenheit.

- Intense headache, weakness, sore throat, as well as terrible joint and muscle aches.

- Profuse vomiting and diarrhea.

When death occurs, it is usually due to internal bleeding and generalized organ (kidney, heart, and lungs) failure.

At this time, only supportive care is available utilizing intravenous fluids and blood transfusions. A human vaccine is being developed as quickly as possible.

All hospitals and large clinics such as mine, the Palo Alto Medical Foundation, have put into place strict protocols for the screening, isolation, and treatment of Ebola patients, as well as for protecting other patients and medical staff.

I have never seen this level of preparedness for a disease in my entire 41 years of medical practice.

This level of preparedness is a good thing, not only for the very rare possibility of an Ebola epidemic, but also in case of epidemics from other virus-borne deadly diseases — such the influenza epidemic seen in 1918.

In conclusion, I want to reiterate that the current Ebola infection is very unlikely to spread throughout the United States and that the isolated cases that will continue to show up will be well-controlled by our increasing level of health care preparedness.

flushot

It’s time for me to make my annual plea for everyone to get their flu shot. In today’s column, I’d like to answer common questions I hear about influenza and the flu shot.

- Can’t I get the flu from the flu shot?

This is a very common myth and proven to be wrong. You cannot catch the flu from the flu vaccine. The flu vaccines that are given by needle are made with viruses that are killed (inactivated), and cannot cause an influenza infection.

- I’ve had the flu shot previously and I got the flu anyhow.

This is possible, but not likely, in that no vaccine is 100 percent effective.

- I’ve never had a flu shot and have never had the flu.

Consider yourself lucky, and as in most cases, one’s luck will usually wear out. Don’t take a chance, this could be the year.

- The flu is no big deal.

Tell that to those who have not survived a bout of influenza, or to the worker who misses a week or more of work, as well as the student missing time from school. Besides, having the flu can make you feel very miserable.

- I worry that it could be harmful to my baby/child to have yet another vaccination.Babies have a higher incidence of death due to influenza. There is no proof that the flu vaccine worsens or changes the effects of the other routine childhood vaccinations. The recommendation is that everyone from six months of age and older should receive the flu vaccine.

- I have already gave a chronic disease and I take lots of medications. Do I really need a flu shot too?

All the more reason to receive a flu shot since the flu is the most deadly for those with chronic medical conditions.

- I have a tremendous fear of getting a shot.

The flu vaccine is available as a nasal spray and is approved for those between the ages of 2 to 49 years of age. It has been proven to be more effective than the shot in children 2 to 8 years of age. The viruses used to develop the nasal spray flu vaccine are alive but weakened (attenuated).

- I’m pregnant, won’t a flu shot harm my baby?

Not only has the flu vaccine injection been proven to be safe during pregnancy, but is highly recommended for pregnant women in any trimester of pregnancy. Only the injection form of flu vaccine and not the nasal spray should be used in pregnancy.

- I’m 35 years old and healthy, do I really need a flu shot?

In 2009-10, the swine flu (H1N1 virus) took a particularly heavy toll on the age group 18 to 64 years of age. Better safe than sorry.

- Any reason I absolutely shouldn’t get a flu shot?

There are a few reasons, the most common being a prior allergic reaction to a flu shot or a severe allergy to eggs. The vaccine should be delayed if you have an illness with a fever.

- When should I get the shot?

The flu season typically begins as early as October and can last until late spring. Flu shots are currently available and I advise getting it sooner rather than later. It takes about two weeks after receiving the shot for it to become effective.

- Where can I get a flu shot?

Most major pharmacies such as Rite Aid, Walgreens and CVS, provide flu shots on a drop- in basis, as well as through most primary care doctor’s offices. Larger medical groups such as mine, the Palo Alto Medical Foundation, will have special drop in flu clinic days. For children, call your child’s primary care provider to find out how they are to receive a flu vaccination.

- How much will a flu shot cost me?

For most people it is free, either because they have a government insurance plan such as MediCare or MediCruz, or they have private insurance. For those who have no such coverage, the out-of-pocket cost of flu vaccine is between $30 to $50 depending on which vaccine is given.

AbPain

At one time or another, all of us have experienced abdominal pain. It is one of the most common complaints seen in emergency rooms.

Most of the time, it is not caused by a serious medical problem, but when it is serious it can be life-threatening. In this article, I’d like to differentiate between mild pain symptoms and more serious symptoms that would cause you to seek urgent medical care.

There are an abundant number of causes of abdominal pain too numerous to mention in this article, but there are many signs and symptoms of abdominal pain of which you should be aware.

What are the most common causes of abdominal pain?

- Indigestion, constipation, ulcers, and gas.

- Stomach flu and food poisoning.

- Food allergies and lactose intolerance.

- Gallstones and kidney stones.

- Urinary tract infections, pelvic infections, ovarian disease, endometriosis, and menstrual cramps.

More serious causes include:

- Aneurysm (swelling with possible rupture) of the aorta.

- Decreased blood supply to the intestines (ischemic bowel).

- Appendicitis, diverticulitis, and cholecystitis (infections of the appendix, the colon, and the gallbladder respectively).

- Bowel blockage (obstruction).

- Cancer of any of the intra abdominal organs especially of stomach, colon, or liver.

- Pancreatitis (inflammation of the pancreas).

- Pneumonia.

- Heart attack.

Seek immediate medical help or call 911 for abdominal pain that involves:

- Severe sudden abdominal pain.

- Vomiting blood, having blood in your stool, or if your stool appears tar colored.

- Tenderness over your abdomen, or if it feels rigid when you touch it.

- Pregnancy either confirmed or suspected.

- A recent injury to your abdomen.

- Pain and difficulty breathing.

- Mild abdominal pain that does not improve within 24-48 hours, or becomes more severe or frequent, especially if occurring with vomiting.

- Diarrhea for more than several days, especially with fever or blood.

- Fever over 100 degrees with your pain.

I have tried to simplify the complex subject of abdominal pain. Obviously, this is not all-inclusive, but my goal has been to have you understand those symptoms that should prompt immediate medical attention. This information is from my personal experience to serve as a guideline in dealing with abdominal pain.

As I always say, in spite of anything you may have read or heard about, if you have any symptoms that concern you, or just doesn’t seem right, seek medical care.

Of course, as with most problems with your health, it’s much better to deal with them sooner rather than later.

neuropathy

As part of my cancer treatment journey, I have developed a pretty severe case of peripheral neuropathy of my feet. I was warned that the chemotherapy could cause neuropathy, but I didn’t know it would be quite this uncomfortable.

Peripheral neuropathy is caused by damage to certain nerves — mostly the sensory nerves — which deal with touch, pain, and heat. Most of the time, the problem starts in the fingers and toes and can worsen to include the feet, legs, and hands.

Causes of peripheral neuropathy include:

- Diabetes (the most common cause).

- Chemotherapy.

- Alcoholism.

- Vitamin deficiencies.

The most common symptoms are:

- Pain, burning or tingling of fingers, toes, hands and feet.

- Muscle weakness and balance problems.

- Loss of sensation to touch.

- Difficulty using fingers for tasks such as buttoning one’s clothing.

Measures that may help relieve the symptoms of neuropathy:

- Acupuncture, massage, physical therapy and reflexology.

- Relaxation therapy.

- Prescribed medications such as pain medicine, lidocaine patches, capsaicin cream, and anti-depressant and anti-seizure medications.

- Vitamins and supplements such as vitamins B1, B6, B12 and alpha lipoic acid. Check with your doctor for proper doses and any other treatment options.

How to take care of yourself:

- Because neuropathy can cause poor balance, remove throw rugs and clear up any clutter.

- Put grab bars near shower, bathtub or toilet.

- Protect your hands and feet where sensation is decreased and be aware of very hot or cold temperatures.

- Don’t drink alcohol.

- Check hands and feet for cuts, scrapes, burns or any other signs of injury.

If you think you are having any of the symptoms of neuropathy see your doctor for evaluation and suggested treatment.

child-immunization-macon-nc

According to a recent public health alert, California is experiencing an epidemic of pertussis, with over 5,000 cases reported this year.

Santa Cruz County has had at least 60 known cases (twice the number as last year) and probably many more cases, which have not been reported or have yet to be diagnosed.

Pertussis, also called whooping cough, is a highly contagious infection of the lower respiratory tract, involving the lungs. It usually manifests as a mild persistent cough, but can advance to a severe cough. Often in children, this cough is followed by a high-pitched intake of breath that sounds like “whoop” – thus the name “whooping cough.”

Pertussis is caused by a germ which is a bacteria and not a virus. It is passed from an infected person who sneezes or coughs and therefore spreads infected tiny droplets into the lungs of anyone who may be nearby.

Once in the lungs, the germs can cause an infection, thereby creating inflammation and narrowing of the lung’s breathing tubes. This produces the cough and the characteristic whooping sound.

Infants are particularly vulnerable because they are not fully immune to whooping cough until they’ve received at least 3 immunization shots.

This leaves those 6 months and younger at greatest risk for catching the infection.

The pertussis vaccine one receives as a child wears off in 5 to 10 years, leaving most teenagers and adults susceptible to the infection during an outbreak.

Also, more parents are choosing not to vaccinate their children, thus lowering the number of immunized individuals. This, coupled with the fact that newer vaccines are less potent than the older ones, has increased transmission of pertussis.

The diagnosis of pertussis is often delayed or missed in infants because early symptoms are often mild and the serious cough may not begin for days or even weeks later.

A severe infection in infants can be fatal, although this is thankfully rare. Three infant deaths due to pertussis have been reported in California since the beginning of the year.

One must consider pertussis for anyone with a cough lasting more than 2 weeks, especially when the person generally feels well, coughs worse at night, and has prolonged coughing spells.

The vaccine for pertussis is combined with the tetanus and diphtheria vaccines which are routinely given to children in their first years of life, and to adults every 10 years.

Besides infants, those who especially need the vaccine protection are pregnant women in their third trimester because they will soon have contact with their unprotected infant.

Mothers have been found to be the greatest source of transmitting whooping cough to the newborn. Infants can also be protected by vaccinating those people who have close contact with them.

This “family” protection has been highly successful in protecting susceptible infants.

Tests are available to diagnose pertussis. The decision whether or not to test should be left to your doctor.

Antibiotics can be effective especially when given soon after symptoms begin. After several weeks of symptoms, they are much less effective.

Family members can also be prescribed preventative antibiotics. Remember that pertussis is caused by bacteria and can usually be treated with an antibiotic, but if you just have a bad cough from something like routine bronchitis, which is caused by a virus, antibiotics are not effective.

Your doctor will be able to determine the proper diagnosis and treatment.

Bottom line: I recommend to immunize your children and keep immunizations up to date for yourselves.

Terry

I am in remission of my multiple myeloma cancer. The three months of chemotherapy last fall and winter did a great job in knocking out most of those cancerous plasma cells which were taking over my body. The stem-cell transplant I was originally to have following chemotherapy has been canceled. I will have my blood tested regularly to monitor my remission. My thanks to Dr. Michael Wu and his wonderful caring staff at the Palo Alto Medical Foundation oncology department who did a superb job treating my disease.

I discovered that one doesn’t necessarily have to leave Santa Cruz for state-of-the-art cancer care that I found right here through my group at PAMF. I sure wasn’t used to being — nor particularly enjoyed — being on the patient side of the doctor/patient relationship. It was a humbling experience and has taught me more about patients and patience along my journey.

Unfortunately, I am suffering from a fairly severe neuropathy of my feet from the chemo drugs, and this is currently adversely affecting my ability to walk normally. I do, however, feel it’s a small price to pay for my successful cancer treatment. I’m told the neuropathy should improve with time. I’ll try to be patient, (not one of my virtues however).

Another little complication I had in the past month, most likely unrelated to my cancer or treatment, is a condition of my heart called constrictive pericarditis. This occurs when the sac of tissue surrounding the heart (the percardium) becomes inflamed and tightens in on the heart, causing the heart to pump less efficiently.

This threw me into mild heart failure with significant shortness of breath, swelling of lower extremities and general fatigue. Dr. Neil Sawheny, one of my cardiologist partners at PAMF, is treating me for this unexpected complication and I seem to be responding well and improving day by day.

In general , my overall well-being is improving significantly. I feel as though my life as I once knew it is being slowly restored. Once my neuropathy shows signs of improvement, I hope to return to work at least half-time.

I’ll give myself a break to work a bit less since I’ve now been practicing medicine for the past 40 years, 27 years in urgent care Scotts Valley. I love my staff, my patients, many of whom I’ve come to know quite well. Most of all, I love the satisfaction I receive in helping make people feel better and in maintaining their good health.

My thanks to all of you who have mailed get-well cards or sent email messages for my recovery. I am a strong believer in the power of prayer and I know your prayers for me have been heard.

My personal lesson from my cancer experience is this: If you have any health symptoms that seem unusual to you or are lasting longer than you think they should, see your doctor for a work up. If everything checks out OK and your symptoms soon improve, then be thankful.

If something serious like cancer is found, the sooner it’s treated the better the outcome. This a proven fact. Also, for those many of you who are healthy, give thanks every morning that you can begin a new day.

My best wishes to you for long healthy lives.

Bone

Osteoporosis literally means “bones with holes.” It occurs from bone losing calcium faster than it can be replaced. New bone creation doesn’t keep pace with the removal of old bone. The bone is weaker, less dense, and easier to break than healthy bone.

There are come common risk factors and you they are unchangeable. For instance, your sex. Women, especially post menopausal, are much more likely to develop osteoporosis then men, but men aren’t off the hook. There are at least 2 million men with osteoporosis and this will increase as men begin to live longer. The older you get, the greater the chance of developing osteoporosis. You’re also at a greater risk if any close relatives have had osteoporosis and Caucasion and Asian women are at a greater risk.

The reduction of sex hormones, estrogen for women and testosterone for men, also contribute to osteoporosis. Dietary factors associated with osteoporosis include low calcium intake, eating disorders and stomach bypass surgery. Certain medications, especially corticosteroids such as prednisone and cortisone, can contribute to osteoporosis.

Lifestyle choices also can put you at a greater risk for osteoporosis. Smoking tobacco and drinking alcohol, especially more than two drinks a day, will put you at greater risk, as will a sedentary lifestyle and a lack of exercise.

Bone fractures, especially of the hip and spine, are the most common complications of osteoporosis. A fall can easily break a hip, causing disability and even lead to death. Spinal fractures can occur with or without an injury. Sometimes a sneeze or cough can cause a fracture.

The best way to diagnose osteoporosis is to measure bone density. This can be done by a machine that uses low levels of x-ray to measure the strength of your bones. Your doctor can order this for you.

Osteoporsis can be treated with drugs called biophosphonates. Your doctor would have a choice of one of several of these drugs to treat you. Use of the sex hormones estrogen for women and testoterone for men can also be useful in treating osteoporosis. Some controversy exists over the use of these hormones. Your doctor will explain the risks and benefits.

So, to avoid osteoporosis, avoid excessive consumption of alcohol, don’t smoke, try to avoid falls, exercise regularly, and consume adequate amounts of calcium. It is recommended that the total daily calcium intake from diet or supplements not exceed 2,000 mg. daily for people over age 50. Consume adequate amounts of vitamin D, which is necessary for your body to absorb calcium. Talk to your doctor about what dose would be best for you.

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