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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.

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Hepatitis C

The national Centers for Disease Control and Prevention is now recommending that all adults born between 1945 and 1965 — the “baby boomer” generation — be tested for hepatitis C, which is the most common blood-borne disease in the U.S.

It’s a serious problem, because the disease attacks the liver and can be life-threatening if not detected early and treated.

About 4,500 people in Santa Cruz County are infected with hepatitis C, as well as more than 2 million Americans, most of them baby boomers. Another 1.5 million Americans have the disease but don’t know it and may unknowingly transmit the virus to others.

Transmission of hepatitis C occurs most frequently through infected blood, whether from working in a laboratory or a dialysis unit, through infected needles used for tattoos or body piercings or by sharing drug needles.

In a few cases, people have been infected with hepatitis C by sharing objects that may have a tiny amount of blood on them, such as a toothbrush, a razor or tools used for manicures.

Hepatitis C can also be spread by sexual intercourse, but only rarely. For steady sexual partners, there are no recommendations about changing sexual practices just because one partner or the other has hepatitis C. But having two or more sex partners does increase one’s chance of getting the virus.

Hepatitis C advances slowly and silently, often taking up to 20 years to show symptoms. The longer the infection goes undetected, the more liver damage it causes.

Hepatitis C is an infection caused by a virus. It attacks the liver, leading to cirrhosis, a condition in which the liver become scarred and functions poorly.

This ultimately leads to liver failure and even liver cancer, and it is one of the most common reasons for liver transplants. More than 200 individuals in Santa Cruz County may need liver transplants because of liver failure resulting from advanced disease.

Baby boomers are more than five times more likely to have hepatitis C than the general population.

This higher incidence is partly due to exposure before implementation of universal precautions and widespread blood screening for hepatitis C.

Many people in this group no longer recall the events that placed them at risk. A significant number of infected individuals contracted the disease decades ago from blood transfusions, medical procedures and tattoos and through intravenous drug use, even if only once.

Other than baby boomers, those with known risk factors should also be screened. The most common risk factors for any age group are intravenous drug abuse, having multiple sex partners and having had a blood transfusion before 1992, the year hepatitis C screening began.

Detecting the virus is very important, because the earlier it is found, the better the chance for a cure. A simple blood test is all that’s necessary. Recently developed treatments have a cure rate of up to 75 percent, which could save 120,000 lives a year.

Those who know they have hepatitis C can protect their livers from further damage by avoiding alcohol and Tylenol (acetaminophen), which can accelerate liver damage.

The bottom line as I see it is that if you are a baby boomer, especially with one or more of the above mentioned risk factors, you really should get the hepatitis C screening test. If you have no known risk factors, you should at least talk with your doctor about this during your next office visit.

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I want to spend the next few weeks trying to bring you up to date on the most current information concerning swine flu, which is now being referred to by the experts as the H1N1 virus.

Influenza is almost unheard of during the summer months, but we are experiencing quite a few cases in every state of the United States, as well as in most countries throughout the world.

Santa Cruz County has seen proven cases of influenza this summer caused by H1N1. Most cases have been relatively mild. It seems that H1N1 is so far no worse than the regular flu that occurs each winter season. That’s the good news.

The bad news is that I believe, as do many experts in the field, that we could possibly see a worldwide epidemic — a pandemic — of H1N1 beginning this fall. The worst-case scenario could rival the flu pandemic of 1918, during which 650,000 Americans died and there were 50,000,000 deaths around the world.

But we must also realize that 36,000 people die in the U.S. each year during a typical flu season.

I repeat, a pandemic occurring this year as we had in 1918 is only a theoretical possibility. This year’s flu season could be no worse, or even less dangerous, than usual.

Leading scientists agree that influenza viruses are very unpredictable. Therefore, there is no way to predict which of the various scenarios we will see this year. It could be serious or not. Time will tell, but I believe it is better to be prepared.

One method of preparation is through widespread vaccination programs. Most people will need one shot for the regular seasonal flu and another one (possibly two) shots for swine flu. The regular seasonal flu vaccine may be available as early as September, and it is recommended that people get this vaccine as soon as possible. The swine flu vaccine, which is on a crash development program, may be available as soon as October.

Unfortunately, both vaccines cannot be combined into one shot. They may, however, be given as two separate shots on the same day.

Because quantities of vaccines may initially be limited, some form of prioritizing will be necessary. The Center for Disease Control and Prevention has made the following recommendations as to who should be immunized.

Regular seasonal influenza:

• Health care providers

• People age 65 and older

• Pregnant women

• Those with chronic health or immune diseases

H1N1 swine influenza:

• Health care providers

• Pregnant women

• People who live with or care for children younger than 6 months of age

• People between the ages of 6 months and 24 years

• Those with chronic health or immune disorders

Once the demand for vaccine for the above priority groups has been met, and if there is still sufficient vaccine available, then all people who remain may be vaccinated.

One bit of good news regarding swine flu is that people age 65 and older seem to have a greater immunity to it than to the normal flu.

Subsequent columns will deal with what treatment may be available if an outbreak begins, how to prepare yourself and your home for a severe flu epidemic, and how medical providers and hospitals would likely cope with a flu pandemic.

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Shingles is a painful rash caused by the varicella-zoster virus, which is the same virus that causes chicken pox. At the moment, there are many cases of chicken pox occurring in our local grade schools. Anyone who has had chicken pox may develop shingles.

After an episode of chicken pox, the virus can remain inactive, often for decades, in cells of the nervous system. Shingles is caused by a reactivation of the virus, which can manifest as a painful rash, always on one side of the body. The rash can be found on almost any part of the body, but it is usually a band of blisters from the middle of the back to the middle of the chest. Pain often occurs several days before the rash. Less commonly, one can have just the pain and not the rash.

Most of the time, shingles occurs only once, but if it does happen again, it’s usually on another part of the body.

About 20 percent of people will develop shingles during their lifetime. Shingles can affect people of all ages, but it is more common in those older than 50 and much less common in younger individuals. It is sometimes more common in those who have conditions that weaken the immune system, such as medical treatments involving the use of cortisone, chemotherapy and radiation.

Shingles is not life-threatening. A full recovery is usually expected within a month or two, although one may rarely have a complication called postherpetic neuralgia. This condition causes the skin to remain painful and sensitive to touch for months, or even years, after the rash disappears.

Shingles cannot be passed from one person to another, but a person with shingles can pass the varicella-zoster virus to a susceptible person, causing chicken pox. Transmission usually occurs through direct skin-to-skin contact with the blisters of a shingles rash.

Several treatments are available from your health care provider:

  • High doses of an antiviral drug can reduce the duration and intensity of the symptoms. Such medications include acyclovir (Zovirax), valacyclovir (Valtrex) or famciclovir (Famvir). The medicines work best when given within the first 72 hours of symptoms.
  • Pain relievers can help control pain. This usually involves some form of a narcotic, such as Darvocet, Vicodin or codeine.
  • Also sometimes helpful in more severe cases of shingles is the application to the rash of an ointment containing capsaicin, the compound that makes chiles spicy, or a skin patch containing the numbing drug lidocaine.
  • Because shingles affects the nervous system, it may require a prescription of Neurontin for those experiencing severe pain.

Home treatment of the shingles rash involves keeping the rash clean with soap and water, applying cold, wet compresses to the blisters, and, for those not taking prescription pain medicine, doses of Tylenol or Advil as needed.

Preventatives are available in the form of vaccines. All children should be routinely vaccinated for chicken pox, as should any adult who has never had chicken pox. Although this vaccine doesn’t guarantee to prevent either chicken pox or shingles, it can reduce the intensity of the disease and reduce the chance of complications.

There is also a vaccine specifically for shingles called Zostavax. It is indicated for those 60 years and older. In studies of people who were given the vaccine, the incidence of shingles infection was reduced, and in those patients who did develop shingles, the severity and duration of infection was reduced.

The bottom line is that if you have a painful rash, it is better to seek treatment from your health care provider sooner rather than later.

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I’m seeing an unusually high number of strep throat cases in my practice these past few weeks. I’d like to explain about sore throats and strep throat in particular.

Sore throats are caused by many things. Most commonly, they are caused by an infection, usually by viruses and sometimes by bacterial germs such as the strep germ, officially called streptococcus.

The sore throat from a virus is by far the most common variety and is usually accompanied by cold-like symptoms, such as a cough and runny nose. This type of sore throat is really just one of the many irritating symptoms of the cold virus and will run its course without the need of antibiotics. It often lasts three to 10 days. It is rarely associated with a fever.

Strep throat is caused by the streptococcus bacteria and can often feel like any other type of sore throat. It is most common in childhood and tapers off as one gets older. Some lucky people never get it, and some get it often. What’s important and different about strep throat is that if it is left untreated with antibiotics, it can once in a while lead to rheumatic fever, a disease of the heart valves. It can also lead to glomerulonephritis, an inflammation of the kidneys. Strep throat can also cause a fine red rash on the body called scarlet fever, which has a very scary sound to it, but in reality is just a non-serious rash that sometimes occurs with strep throat.

Symptoms of strep throat are sore throat, fever, tender swollen glands in the neck and nausea or stomachache. A white coating in the throat is often a sign of strep but is not fool-proof, because it can also be caused by viruses. There is usually not an associated runny nose or cough with strep throat.

Tonsillitis is an infection of the tonsils, which are the two glands found in your throat on either side of the back of the tongue. Healthy tonsils are usually not visible because they are so small. Tonsillitis is most common in childhood and can be caused either by the strep germ or by a virus. Tonsillectomy (surgical removal of the tonsils), which was done routinely when I was a kid, is now only done in patients with repeated episodes of culture-proven strep tonsillitis.
When you have a sore throat that concerns you, see your health provider, who will listen to your symptoms, perform an examination and often order laboratory testing. The tests are usually either a rapid test that is done in the office and takes about 10 minutes or a culture that will be sent out to a lab and takes 24 to 48 hours for the results. The out-of-office culture is usually done when the rapid test is negative, as a further means of ruling out strep as the cause of the sore throat.

The treatment for strep throat is penicillin or its close relative, amoxicillin. Strep is one of the few infections where penicillin is still the best cure; in fact, people will usually feel better within a day or two after beginning treatment. A child being treated for strep can usually return to school within a day or two if there is no fever and if he or she is feeling well enough. A prescription for 10 days is usually given, and it is important to take it to the last pill, even when feeling better. For those allergic to penicillin or amoxicillin, there are several alternatives, such as Keflex or Zithromax.

Strep throat is contagious, but not as much as the common cold. The best way to avoid either condition is to wash your hands regularly, avoid touching your eyes and mouth and keep a distance from those who are coughing or sneezing.
To alleviate the symptoms of a sore throat, I recommend the following:
n Take acetaminophen (Tylenol) or ibuprofen (Advil) or naproxen (Aleve).
n Gargle with warm salt water (1 teaspoon of salt per 6- to 8-ounce glass of water).

  • Suck on throat lozenges, such as Chloraseptic or Cepacol.
  • Suck on flavored frozen treats, such as popsicles, or just plain ice cubes.

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Pneumonia is a potentially serious infection of the lungs, usually caused by viruses or bacteria.

As opposed to bronchitis, which is a relatively nonserious infection of the lungs’ airways, pneumonia infects the tissue of the lungs, filling the tiny air sacs with pus and other liquid. This reduces the amount of oxygen reaching the bloodstream.

Germs have the potential of spreading from the infected lung tissue into the rest of the body, causing septic shock and possibly death. Although this is not the common outcome, it still accounts for 60,000 Americans dying of pneumonia every year.

Pneumonia symptoms can vary significantly, depending on underlying health problems and the type of organism causing the infection.

More than half of pneumonias are caused by a variety of viruses. These are usually not serious and often last a relatively short time. Because a person with viral pneumonia tends not to be as sick as someone with bacterial pneumonia, such a person is usually “up and about” and therefore is often referred to as having “walking pneumonia.”

Symptoms of viral pneumonia include cough, fever, muscle pain and fatigue. Signs which often occur with bacterial pneumonia include shaking chills, high fever, chest pain and cough. Mucus may be present with either type of pneumonia but is more likely with the bacterial variety.

Pneumonia is not usually contagious.

One of the most common symptoms I see in patients with any form of pneumonia is the extreme fatigue, which can last many weeks after all other symptoms have cleared.

Risk factors for pneumonia are as follows:

  • Age — Adults 65 and older and very young children
  • Chronic disease, such as emphysema, diabetes and heart disease
  • Smoking
  • Recent hospitalization,  surgery or traumatic injury

Pneumonia treatments vary on the type and severity of the illness. Bacterial pneumonia will be treated with antibiotics. The entire course of antibiotics must be taken to prevent relapse and to prevent resistant strains of bacteria from forming. Viral pneumonia technically doesn’t need antibiotics, but because of the difficulty of distinguishing between the two, a health care provider will usually choose to err on the side of treatment, especially because viral pneumonia can sometimes turn into a bacterial infection.

In all cases of pneumonia, one also needs to control fever, drink lots of liquids and get plenty of rest.

Prevention of pneumonia is possible. Because pneumonia is a common complication of influenza, getting a flu shot every year is a good idea.

There is a false assumption held by many that getting a pneumonia shot will prevent one from getting any type of pneumonia. Not so. A pneumonia vaccine is available, but it is only effective for the pneumococcal pneumonia germ. It might not prevent one from getting this form of pneumonia, but having the vaccine can decrease the infection’s potentially fatal side effects. The vaccine is usually recommended for those who fall into the previously mentioned “risk factor” categories and can be administered any time after 2 years of age or at least once to anyone after age 65.

It’s a good idea to seek medical care if a person has a cough with shortness of breath, chest pain, chills and fever or feels much worse after a bout of cold or flu. Pneumonia is a serious infection, but for the average person, if it’s caught in time and treated properly, it should cause no lasting harm.

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We are in the flu season. Influenza, often called the flu, is a virus affecting the respiratory tract, causing illnesses ranging from symptoms of a severe cold to life-threatening infections such as pneumonia.

It often affects up to 10 percent of the entire population and is associated with an average of 36,000 deaths a year throughout the United States. Most deaths occur in the very old or the very young, or in those with chronic illnesses.

Influenza is transmitted by direct and indirect contact via respiratory droplets from coughing, sneezing or just shaking hands. The incubation period is several days, and contagiousness can last as long as a week after the symptoms begin.

The best way to limit its spread is by frequent hand-washing with soap and water for 15 to 20 seconds and by limiting close face-to-face contact with others when symptoms are present.

It is very important to know the difference between the common winter cold and influenza. As opposed to a common cold, influenza has these distinguishing characteristics:

  • Very sudden onset
  • Fever
  • Aches
  • Sore throat

At the onset of influenza symptoms, people often say they feel as if they had been “run over by a truck.”

The treatment for influenza is mostly symptomatic care: plenty of rest, Tylenol or Advil (ibuprofen) for fever and aches, and maintaining adequate liquid intake. There are drugs available from a doctor which, if taken within the first 48 hours of influenza symptoms, may shorten the course of the illness by a day or two. Those are recommended for elderly or chronically ill patients with influenza symptoms.

Being immunized with a flu shot or the inhaled FluMist vaccine significantly lessens one’s chance of getting the flu. But, as with any treatment, there is no guarantee of 100 percent success. One can still get a bad viral upper respiratory infection during the winter months, even after the flu vaccine, but one should be protected from the far more serious influenza.
Most people who receive the flu shot have no bad reaction to it. Some people might experience redness and swelling at the injection site lasting a few days. One cannot get the flu from a flu shot, because it is made from a deactivated, dead virus. The benefit of the flu shot far outweighs the minimal risks.

Although the ideal time for a flu shot is from mid-October through November, the flu season can extend through May. As of this writing, the County Health Department reports very little influenza activity, but if history repeats itself, it could arrive soon.

Watch for flu shot clinics.

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