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Archive for August, 2010

CPR Updated

What would you do if you saw someone collapse and fall to the ground in front of you? Some might panic and do nothing. Some might at least call for help, and others might attempt some form of CPR.

There’s good news for both the person who has collapsed and the bystander who needs to help out. The rules of CPR have changed, and they can’t be any simpler.

In the recent past, we were advised to do mouth-to-mouth breathing as well as chest compressions. I think many were confused as to how often to do the breathing and how fast to do the chest compressions. I’ve known many people who rightfully were hesitant to do mouth-to-mouth on a stranger, and I think that very fact kept people from getting involved in the first place.

It has been reported that only a third of those who suffer a cardiac arrest receive CPR from a bystander, and without CPR, there is virtually no chance of survival.

New research confirms that, for bystanders without training, doing only chest compressions on adults is enough to restore life. It is now known that continuous, uninterrupted chest compressions will deliver sufficient oxygen to the heart and brain, eliminating the need for mouth-to-mouth breathing. Making CPR easier means more lives have the potential to be saved.

A person who goes into cardiac arrest usually has gone into a heart rhythm called ventricular fibrillation. This means that the heart beats so fast and irregularly that the heart cannot pump blood, and therefore the body is completely deprived of oxygen. Without circulating oxygen, a person cannot survive more than seven or eight minutes.

In these crucial minutes, if a heart is given an electrical shock by trained medical personnel, it has a chance of its rhythm being changed back to a regular one, restoring the oxygen flow to the body.

So, to answer my opening question, here’s what to do when you see someone collapse and they are unconscious and not breathing:

First of all, when at all possible, call 9-1-1 to initiate an emergency medical response.

Then, immediately begin chest compressions. Position both hands on the center of the breastbone and press down, hard, about 100 times a minute. Do not stop until emergency medical crews arrive or you are too exhausted to continue.

I recently read in the local paper about a 50-year-old bicyclist who collapsed from cardiac arrest. A bystander who saw him was willing to perform CPR, and the man survived and is doing well. I believe that he, his wife and his children are happy that someone was willing to perform CPR on him.

Just think how meaningful it would be to save the life of a stranger — much less that of a loved one.

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In my July 16 column, I explained what to do when you’re bitten by a tick. Today, I will describe the symptoms of Lyme disease, which is carried by some ticks.

Quite often, after an obvious tick bite, a red rash may develop at the site of the bite within the first 24 to 48 hours. A rash that develops this quickly after the bite is usually an allergic reaction to the saliva of the tick. It rarely grows beyond 2 inches, needs no treatment and disappears within a few days.

The actual Lyme’s rash, called erythema migrans, is reported to occur in up to 80 percent of infected tick bites. Some would argue that it occurs less often. It is described as a red rash that is usually neither itchy nor painful. It develops a few days to a few weeks after a tick bite and is likely to be the first sign of Lyme disease. The rash most often continues to get larger over a period of time and will grow to be well over 2 inches, possibly 8 to 12 inches or more, and may last for several weeks. This rash may sometimes develop a pale appearance in the center, causing a bull’s eye shape, but this does not happen consistently enough to be a sure sign of Lyme disease.

Either during the time of the rash or shortly thereafter, other symptoms of Lyme disease may appear, which resemble common flu-like symptoms:

**Fever and chills

**Malaise (achiness)

**Headache

**Achy joints

The rash and the above flu-like symptoms are considered early Lyme disease. When treated properly during this stage, most infections are completely cured.

If the above symptoms do not occur, are not recognized or are not treated properly, then one might develop late Lyme disease manifested by the following signs:

**Severely painful joints

**Involvement of the nervous system, including Bell’s palsy (facial paralysis) and inflammation of the brain, spinal cord and peripheral nerves (known respectively as encephalitis, meningitis and peripheral neuropathy.)

n Heart problems, such as serious irregularities of the heart rhythm and inflammation of the heart muscle

Treatment for late Lyme disease involves months of heavy duty antibiotics with no guarantee of a complete cure.

Over the years of my practice, I have come to realize what a difficult and incompletely understood disease Lyme is. It is difficult to diagnose, because a significant number of those with Lyme disease don’t even recall being bitten by a tick. “Typical” symptoms may actually be very atypical or not present at all. Laboratory tests are not as accurate as we would like, and there is disagreement as to which tests are best.

There is also controversy as to the most effective treatment for early and late Lyme disease. There are “Lyme specialists” whose opinions vary greatly and whose treatment may seem excessive compared with traditional practitioners.

I personally follow the more traditional route, but because I feel that we don’t yet have all the answers on Lyme disease, I am open to “non-traditional” therapy as long as it seems to have good results and causes no harm. Research continues to improve the best treatment for this disease.

The bottom line is that whether you are aware of a recent tick bite or not, if you develop an unusual, unexplainable rash or if you develop flu-like symptoms, especially outside of the flu season, you should visit your doctor and discuss the possibility of Lyme disease.

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What is one to do after being bitten by a tick?

Ticks are tiny arachnids closely related to mites. There are many types of ticks in the United States, many of which are capable of transmitting infections. The risk of developing any of those infections depends on the type of tick, the geographical location, the season of the year and, especially in the case of Lyme disease, how long the tick was attached to the skin.

The risk of illness depends a great deal on where one lives or visits. People in a few areas of the United States are at a high risk of Lyme disease, especially in the mid-Atlantic, upper Midwestern states and several counties in northwestern California.

In Santa Cruz County, it is reported that 5 percent of ticks carry the Lyme bacteria, with the area around Nicene Marks State Park in Aptos having a somewhat higher concentration of Lyme risk.

Although many people worry after being bitten by a tick, the risk of acquiring an infection is quite low, even if the tick has been attached to the skin, has fed and actually carries the infectious Lyme germ.

Neither the tick’s body nor its head burrows into the skin. Instead, the tick attaches by its mouthparts. An infected tick can transmit an infection only after it has been attached, taken blood from its host and fed for 24 to 48 hours. An unattached, non-engorged tick can not have transmitted an infection.

There are an untold number of popular methods for removing an attached tick, including burning the tick, applying nail polish to its body, smothering it with oil and twisting it either clockwise or counterclockwise, and so on. These methods are ineffective and may cause the tick to inject more of its infected fluids into its host, thus increasing the chance of infection.

The proper method of removing a tick is to use a fine pair of tweezers and grasp the tick as close to the skin as possible. Pull it straight out, gently but firmly, without jerking or twisting. After removing the tick, wash your hands and the skin around the bite thoroughly with soap and water.

If, after removal, you see anything remaining in the skin, this represents tiny mouthparts of the tick. It is not the tick’s “head,” and it cannot increase the risk of transmission of Lyme disease once the tick body is removed.

There is some controversy concerning what to do if the tick’s mouthparts have remained in the skin. Technically, these mouthparts are no worse than having a small wooden splinter in your skin. Don’t waste your time trying to pull them out with a pair of tweezers, since the mouthparts are stuck together with small barbs and actually glued together.

If you’re brave, you can attempt to remove them after cleaning the area with alcohol, using a sterilized needle to tease them out as you would a splinter. If the bite was in a noncosmetic (unseen) area, the mouthparts can be left alone and will most likely fall out over time; but there is the chance they won’t and may leave a small bump. If the bite site is in a noticeable part of the body and you do not wish to deal with it, you can visit your doctor and have them removed.

Once the tick has been removed, it can be sent to a laboratory to have it tested for Lyme disease, but the tests are not perfect and may give either a false positive or false negative result, which can lead to confusion as to how to proceed with further treatment. Furthermore, it’s possible to have been infected by another tick of which you were never aware, and if symptoms should arise after the known tick tests negative, there’s a risk you might not seek treatment, believing you are not infected.

Therefore, it is more important to learn to recognize the symptoms of Lyme disease, because they might show up even after a negative test result. Anyone who exhibits Lyme symptoms needs to seek immediate evaluation and treatment from a doctor. I will discuss more about signs and symptoms of Lyme disease in a future column.

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