June 10th, 2014 | The Blog
Lyme disease cannot be taken lightly. It was first diagnosed in Connecticut about 40 years ago.
There are 300, 000 cases of the disease in the U.S. annually, mostly in the Northeast area of the country. U.S. Centers for Disease Control and Prevention (CDC) is concerned about the spike in Lyme cases but state that death from this disease is rare.
The majority of Lyme disease cases are found in the Northeast and the Midwest areas of the country.
The disease spreads by deer tick or black-legged tick (Ixodes scapularis) bites.
Immature ticks called nymphs infect most people with the disease. The nymphs are smaller than 2 mm making them difficult to see on the skin.
The Lyme disease bacterium is called Borrelia burgdorferi.
Ticks must be attached to the skin for 36 to 48 hours to transmit the disease. It is important to check skin daily to prevent transmission of Lyme disease.
Concerning Physical Symptoms
Early localized symptoms of Lyme disease can appear 3 to 30 days after a tick bite.
If a round, target-shaped rash appears anywhere on the skin, it is important to seek medical care, especially if the rash grows in diameter. Some rashes grow to a 12-inch diameter. Some people describe the rash as a bull’s-eye. The rash is called erythema migrans.
Other symptoms of the disease include:
Progression of Lyme disease can evolve with the following symptoms:
Heart inflammation caused by Lyme disease has become a growing health concern, especially in the Northeast. About 1% of diagnosed cases experience endocarditis or heart inflammation.
It is important to note that a small bump or area of redness at a tick bite site, which disappears in 1 to 2 days, is NOT an indication of Lyme disease.
Lyme Disease Diagnosis
Lyme disease diagnosis is based on physical symptoms, known exposure to infected ticks and lab testing to validate the disease.
Treatment Plan for Lyme Disease
To remove an embedded tick, use tweezers, grasp the tick as close to the skin surface as possible and pull it straight out. Then, clean the area with alcohol or soap and water.
A several week course of oral antibiotics is the treatment of choice. The most common antibiotic medications include: doxycycline, amoxicillin or cefuroxime axetil.
Endocarditis, a serious complication of Lyme disease, is treatable with antibiotics. The antibiotics, usually intravenous, used in this situation include: ceftriaxone or penicillin. In rare cases, it requires the emergency placement of a cardiac pacemaker.
It is important NOT to use a match or coat the bite area with Vaseline, as some people have advised in the past. The theory that this will make the tick detach itself is not true.
The main goal of Lyme disease prevention is to first avoid tick bites. If a tick is found on the skin, it is to remove the tick as soon as possible.
Lyme disease can cause serious, debilitating, long-term health issues if it is not diagnosed in the early stages of development.
Looking ahead in healthcare, a human vaccine for Lyme disease is being investigated. There is currently a Lyme disease vaccine for dogs.
The best Lyme disease prevention advice from the CDC includes:
About 10% to 20% of patients diagnosed and treated with antibiotics for Lyme disease will go on to have recurrent symptoms. This is called Post-treatment Lyme disease syndrome or chronic Lyme disease and usually takes months to resolve.
So, Lyme disease can be prevented with a little extra caution and coverage while outside and a full skin/body check for ticks upon return to the indoors.
June 3rd, 2014 | The Blog
Middle Eastern Respiratory Virus (MERS) is a virus that presents with respiratory symptoms and an accompanying fever. It is caused by a coronavirus, MERS-CoV.
The U.S. Centers for Disease Control and Prevention (CDC) is concerned about the future evolution and global spread of the MERS virus.
The MERS virus is a close relative of the Severe Acute Respiratory Syndrome or SARS virus that killed over 8,000 people throughout the world in 2003.
Where It Is
MERS was first diagnosed two years ago, in 2012, in Saudi Arabia. Together, the World Health Organization (WHO) and National Center for Immunization and Respiratory Diseases at the CDC have confirmed almost 400 cases in a total of 19 countries since it first appeared in Saudi Arabia.
The MERS involved countries, according to WHO and CDC, include:
U.S. Cases of MERS
Health care worker in the Midwest who had traveled to Saudi Arabia was confirmed to have the first U.S. case MERS in May 2014. There was a subsequent case in Florida. Both patients fully recovered.
How It Spreads
MERS is a contagious disease and spreads through close contact with an infected person. According to the CDC, the risk to the general public is extremely low. It does not spread easily in public settings like a retail store or mall.
The virus is thought to have originated from an animal source. MERS has been found in camels and bats so crosses species.
MERS is more dangerous to people with pre-existing health conditions or weakened immune systems than it is to a fully healthy individual. The average age of those who contract MERS is 51 years old.
Symptoms of MERS
Strangely enough, some infected patients can be asymptomatic while other die from the disease.
The classic symptoms of MERS are similar to those of pneumonia. They include:
Diagnosis of the Virus
The CDC has developed molecular diagnostics to accurately diagnose cases of MERS. The diagnostic test for MERS is available at state health labs, the CDC and some international labs. It is called a polymerase chain reaction or PCR).
The CDC also participates in the public health preparedness plan for the U.S.
Treatment of the Disease
There is no vaccine to prevent MERS but the plan to develop one is in discussion among healthcare entities, especially the CDC and WHO.
Isolation of an infected patient is implemented immediately to prevent the spread of MERS to those who come in contact with the patient, especially health care providers.
Direct patient care for the virus includes supportive respiratory care, which is palliative rather than curative.
Outcome of the Disease
Worldwide, about 30% of people who have contracted the virus have died.
The best way to prevent contracting MERS is with simple and typical infection control protocols, which include:
The CDC does not yet recommend changing travel plans to areas with confirmed cases of MERS. There is an Alert (Level 2) only; this delineates special precautions like hand washing, avoiding anyone who is sick and monitoring one?s own health while in the area and upon return to home.
Anyone who travels to countries in the Arabian Peninsula or surrounding areas and develops a fever and respiratory illness within 14 days should seek immediate medical attention.
May 27th, 2014 | The Blog
Shingles are a painful reminder of the chickenpox that so many, now adults, suffered as a child. Chickenpox and shingles are caused by the same virus, the varicella zoster virus (VZV).
About 1 million people a year in the U.S. get shingles.
The varicella zoster virus stays in the body after a person has chickenpox. It remains inactive in the body’s nerve cells for many years. In some people, it can stay inactive or dormant forever. When the virus becomes active again, it causes shingles, not chickenpox.
Shingles are not contagious. It is important to note, in a rare case, someone who has not had the chickenpox or has not receive the chickenpox vaccine can be infected with the varicella zoster virus by someone with shingles. A person who has never had chickenpox can get chickenpox from a person with shingles because it is the same virus.
Shingles is also called herpes zoster. It is a painful localized skin rash that presents as a band or strip on one side of the face or body. Other symptoms of the illness include: fever, headache, chills and nausea. Complicated cases can lead to pneumonia, hearing problems, blindness, encephalitis (brain inflammation) or death.
More than 99% of Americans over 40 years old have had chickenpox, even if they do not recall having the illness. Anyone who has had chickenpox can get shingles.
The risk of getting shingles increases as a person ages, especially for those over 50 years old. The disease is also more common in those with weakened immune system or those on immunosuppressive drugs.
Most people recover from shingles. People usually do not get shingles more than once.
The Actual Sickness Explained
Shingles develops in stages. The first signs of the illness are headache, sensitivity to light and feeling flu-like symptoms without the usual fever.
Next comes itching, tingling or pain in a specific area of the body followed by a developing rash a few days later. The band of rash evolves into blisters, which eventually crust over.
The process takes two to four weeks until the blisters heal. People experience different extremes of the rash; some are mild while others result in scarring.
Some people report dizziness or weakness, vision changes and long-term pain at the sites. One in five people with shingles suffer from severe pain or post-herpetic neuralgia after the rash disappears. This is a lingering problem.
Medication is the usual course of treatment and includes anti-viral and pain medicine.
It is important to keep any open areas on the skin clean, in order to prevent an infection from developing.
An important preventive treatment is getting the shingles vaccine. It is available the older population, over 60 years old, to prevent shingles.
The Shingles Vaccine
The shingles vaccine is a one-time vaccination. It lowers the risk of getting the disease and makes a case of shingles milder if a vaccinated person does get the disease. It lessens the pain and helps the rash clear faster.
The vaccine is only given to people 60 years and older. It offers the most effective results for those 60 to 69 years old. There is no maximum age for receiving the vaccine.
The shingles vaccine does not treat an active case of shingles or post-herpetic neuralgia, which is the lingering pain after the rash is gone.
Who Should Not Be Vaccinated?
There are a few populations who should not receive the shingles vaccine. They include:
In well-populated trials, the shingles vaccine reduced the risk of developing the disease by 51% and the risk of developing post-herpetic neuralgia by 67% before it was approved for use.
The vaccine is effective for at least six years and possibly longer.
Adverse Reactions to the Shingles Vaccine
There is no thimerosal, a preservative containing mercury, in the shingles vaccine.
There have been no serious adverse reactions to the vaccine reported. The most common side effects include:
Some people have reported a chickenpox-like rash at the injection site. If this occurs, the area should be covered until the rash is gone.
It is safe for recently vaccinated people to be near infants, children, pregnant women and those with a weakened immune system. There is no report of anyone contracting chickenpox from someone who has been vaccinated for shingles.
The U.S. Advisory Committee on Immunization Practices (ACIP) recommends the vaccine. Interestingly, the U.S. Food and Drug Administration (FDA) approve the vaccine for people age 50 to 59 years but the CDC does not have a recommendation for this age group.
Current practice is to immunize people 60 years and older.
May 19th, 2014 | The Blog
A cup of tea fixes everything; well, almost everything. The comforting hot beverage is the answer to a broken heart, a bad grade and to some minor, and not so minor, health issues.
Here are some truths about a cup of tea:
A few cups of tea a day are good for you.
Tea leaves contain antioxidants found in the Camellia sinensis plant, from which tea originates. Antioxidants prevent cell damage by countering free radicals.
There are differences between the varieties of tea.
There are 3 main varieties of tea: green, black and oolong. They are each processed differently:
Blended teas are another flavor option.
English Breakfast tea is one of the most popular blended teas. It contains Ceylon and India teas to deliver a smooth, traditional flavor. Most blended teas contain tea leaves from a variety of locations around the world.
Drinking black tea (versus water) with a meal can lower the body’s iron absorption.
A recent study compared iron absorption when drinking black tea versus water with a meal. The black tea drinkers lowered their iron absorption rate by 79% to 94%. The preliminary results of the study suggest that tea should be a between-meals beverage.
Freshly brewed tea has the most antioxidant effect.
Fresh brewed tea has more antioxidants than instant, decaffeinated or bottled tea. Three cups of green tea everyday is the most antioxidant-rich formula, especially in Asian countries where tea is a main beverage choice.
Steeping hot tea for 3 to 5 minutes potentiates the most antioxidants.
Interestingly, 85% of tea consumed in the U.S. is iced tea.
Tea does not reduce the risk of cancer.
There is no scientific evidence at this time that drinking tea reduces the risk of developing cancer, although some studies have suggested this link.
Green tea might help reduce the risk of heart disease.
Green tea manufacturers say that their product reduces heart disease risk factors by lowering body weight, blood pressure and cholesterol levels. The U.S. Food and Drug Administration (FDA) has denied a request for the manufacturers to post this particular information on the product labels pending more scientific evidence supporting their claim.
Green tea consumption bears monitoring by some populations.
Green tea contains more caffeine than some other tea choices. People who should not consume more than 1 or 2 servings a day, according to the American Dietetic Association (ADA) include those who are:
Or have been diagnosed with:
Green tea consumption by children still needs more research to determine the effect, good or bad.
Blood sugar or glucose levels are possibly impacted by green tea.
This statement appears to be true, based upon some recent studies. This runs tandem with the speculation that green tea helps lower body weight and fat content. More research on the subject needs to be done.
Herbal teas are in another category.
Herbal teas are a compilation of tea leaves, roots, bark, seeds and flowers from plants other than the traditional Camellia sinensis plant. These additives are not included in the standard green, black and oolong tea research studies.
The Bottom Line
Tea is comforting and tea is basically a good beverage. As with all things in life, medical or otherwise, everything is good in moderation.
Offer your patients a nice cup of hot tea when they are feeling down and out with a cold or the flu. A spoonful of honey added into the mix is always soothing.
May 12th, 2014 | The Blog
Midwives have been doing it for decades. That is, delivering babies in water to ease birth pain and speed up the delivery time.
This practice is called aquatic labor. It is not considered a standard choice but, rather, an alternative birthing method.
A woman who is pregnant needs to make a choice about her delivery options, given that it is expected to be a normal delivery. Her options include:
The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) report that there is scant scientific information about underwater births coupled with several reports of near drowning over a ten-year span, which keep this birthing option from becoming more common.
While water births are increasing in popularity, there is no accurate count of the number of babies born via this method in the U.S
According to water birth supporters, these are the benefits:
There are the skeptics who list the following as detriments of a water birth:
Pro or con, there are certain guidelines established for a water birth that must be followed to safely delivery the baby. They include:
Where Can a Water Birth Take Place?
A water birth can take place at home, in a birthing center or in a hospital. The delivery can occur in a bathtub, hot tub with temperature turned down or any other pool of water.
In a hospital setting, there are medical care devices like an underwater Doppler to monitor the fetal heartbeat and also the option to have an intravenous (IV) inserted to receive medication as needed.
Who Should Be Excluded From This Birthing Option?
There are certain populations that should not attempt aquatic labor. They include:
A Compromise for Now
Some researchers agree that sitting in a tub of warm water during the early stages of labor can be beneficial in easing a woman?s pain. There needs to be more research done to determine if actually giving birth underwater has enough benefits and few enough risks to allow it to be a recommended method of giving birth, rather than an alternative option.
So for now, laboring in a warm pool of water can be beneficial but a woman should discuss the risks and benefits of actually delivering her baby underwater before making the final decision.
May 5th, 2014 | The Blog
Everyone has heard of the 5-Second Rule. Is it really true? There are scientific study results dealing with this dropped food issue.
The famous 5-Second Rule states that any food dropped on the ground is okay to eat if it has been there for five seconds or less.
5-Second Rule Facts
The popular Mythbusters group proved in the past that bacteria could be transferred to dropped food in as few as two seconds. This remains a fact, in some cases, but other groups, which offer some interesting information, have done further studies.
Another group at Ashton University School of Life and Health Sciences in England have come up with the following. They studied the transfer of E. coli and Staphylococcus aureus from the floor to the dropped food in three to thirty seconds.
There were several important variables in the study:
Who Follows (or not) the 5-Second Rule?
Interestingly, the majority of Americans already follow the 5-second rule, scientifically proven or not. Here are the numbers:
Here is a real truth, the population is more likely to eat a dropped cookie or candy but not so much, dropped cauliflower or broccoli.
Bacteria, including E. coli, are everywhere, which can cause foodborne illnesses like fever, diarrhea and flu-like symptoms. These illnesses can present within 24 hours and up to a week after exposure. With the time of onset varying so much, many people do not relate a 5-Second Rule food drop with an illness that occurs up to a week later.
Foodborne illnesses are not usually serious for the majority of the 76 million Americans who suffer from them each year. But, there are some serious cases, according to the U.S. Centers for Disease Control and Prevention (CDC).
Annually, about 300,000 of the affected public are hospitalized and 5,000 die from such an illness. The deaths are most common among young children, elderly and those with a weakened immune system.
The Bottom Line
Here are a few final thoughts and scientific findings about the 5-Second Rule:
There is no guarantee that there are no bacteria on dropped food. There will always be that risk. So, the longer the food is on the floor, the more bacteria it will attract.
The best advise: eating a piece of toast off of a carpeted surface is the safest choice. The 5-second rule is real.
April 28th, 2014 | The Blog
Everyone and everything dies, eventually. That is the reality of life itself.
What does it mean to die? How many people actually discuss their feelings about death with loved ones and friends? The subject is uncomfortable to discuss but help is available.
People need to talk about death.
Death Cafe Origin
The concept of a death cafe started in England in September 2011. John Underwood, a self-appointed death entrepreneur, hosted the first cafe. He based the gathering on an idea of Bernard Crettaz, a Swiss sociologist, who stated that talking about death leads to authenticity. Moving forward with the concept, John Underwood says that, death cafes exist because of a belief that more authenticity is needed in the world. Death denial is an omnipresent feature of Western consumer capitalism.
The general feeling is that the more death is discussed, the more fully a person can live without fear. The fear of death leads the present culture to turn away from aging and live in a youth obsessed world.
The idea and development of death cafes is slowly spreading across the U.S. Awareness is spreading on the Internet, especially at? www.deathcafe.com
Death Cafe Concept
The basic concept of a death cafe includes the following points:
Attendees are split into groups of 5 to 8 people. They talk for several hours. Facilitators circulate and listen to the ongoing conversations. If a participant is identified by the facilitator as needing further counseling, they are given information about where to seek more help.
Some participants are those who have survived cancer, other serious illnesses or those who have had brushes with death. If their family members do not want to talk about death with them, a death cafe offers an outlet to openly talk to others.
Participants are people of all ages, usually more women than men, aging baby boomers, children who need to talk about grandparents death, those who are working or retired and beyond.
The purpose is to get people to talk about death so they are not afraid when the time comes, either for themselves or those they love.
Cafe topics vary. Some popular topics, which are discussed at death cafes include:
Why Eat Cake at the Meeting?
Eating is a life-sustaining process so eating cake at the death cafe is important. It makes things normal.
It is important to note that death cafes offer an opportunity for discussion about death but are not meant to provide grief or personal counseling or act as end-of-life planning sessions.
The Future of Death Cafes
There is an Association for Death Education and Counseling (ADEC) in the U.S., that is an information resource about death cafes.
Currently, there are about 560 death cafes throughout the world. They are in 40 cities in the U.S. The concept of death cafes is spreading but will take some time.
Most people envision dying in a comfortable setting, surrounded by family members and friends. They want to be grateful for the life they lived and thank those who shared their life. They do not want to be lying in a hospital bed, filled with tubes and hooked to a respirator. They need to talk about death, what it means to them and how they want to face it head-on. Death cafes are the vehicle for such a discussion.
April 21st, 2014 | The Blog
Cardiac pacemakers save lives. That is a fact. The traditional cardiac pacemaker is placed in the upper left chest with wires or leads threaded into the heart, where the pacing occurs. The traditional device is a visible and palpable under the skin on the chest wall.
All that is about to change with the debut of the newest, smallest pacemaker, Medtronic’s Micra Transcatheter Pacing System (TPS). This new device will change the world of the cardiac healthcare industry.
The Specifics of the Device
The Transcatheter Pacing System is small, in comparison to the traditional device. It is 1/10th the size of a traditional pacemaker or about the size of a nickel or 5-cent coin. The new device is an all-inclusive, one piece system with no generator or traditional wires or leads. It has a long, 10-year, battery life.
The new pacemaker is implanted through the femoral vein via catheter and is placed inside the heart.
The Benefits of TSP
There are many benefits to the new cardiac pacemaker, which include some of the following:
How the Device Works
The TPS is placed inside the heart via a femoral vein catheterization. The tiny pacemaker attaches onto the endocardial tissue or heart wall with tines. It can be repositioned within the heart, if needed.
Pacing signals or the delivery of electrical impulses that pace the heart rate are sent through the electrode tip at the end of the implanted device.
The End Result
The Medtronic?s Micra Transcatheter Pacing System brings implantable cardiac devices to a whole new level. Both the patient outcomes and device efficiency are significantly improved with this cardiac device update and new technology.
April 14th, 2014 | The Blog
Getting a new printer has just gone to a whole new level. The 3-D printer can make wonderful arts and crafts projects but it can also produce so much more. That so much more has to do with life-changing health issues.
3-D printing, also called additive manufacturing, is changing the medical world in several ways. The printed objects are used in real time and also used as prototypes for practice and to fine-tune upcoming complicated surgical procedures.
3-D Printing Explained
3-D printing technology and uses have dramatically changed and multiplied over the past several years. The high-resolution, plastic 3-D models, some of which provide down to 16 microns accuracy or the size of a miniscule droplet in a cloud, are works-of-art.
Since a variety of materials can be used to mimic the different structures in the body like bone, skin and blood vessels, the 3-D printer has many applications. The 3-D renditions are printed from a patient’s computed tomography (CT) scan images. This helps to capture the unique anatomy of each patient.
Who makes 3-D printers?
There are several companies who provide this 3-D capability with their product. Two popular manufacturer options include:
There are also companies, such as Shapeways, from which a client can order completed 3-D printing services.
How It Works
The actual 3-D printing is done this way:
Benefits of the 3-D Printer
There are many uses and benefits for 3-D printing. They include:
Some healthcare facilities are making 3-D printed models as standard protocol for every patient being treated in their clinic. This is especially popular in cerebrovascular surgery centers. Many physicians call this capability the cutting edge of neurosurgery. It makes impending surgery safer and minutely accurate.
The 3-D printer has been used for many different things, some of which include:
A Supported Windpipe
A population of babies have benefited by 3-D printing. Fragile, underdeveloped windpipes are supported by a flexible, plastic 3-D splint to hold the airway open until it is strong enough to work on its own.
A Look at the Prosthetic Hand
A prosthetic hand is exorbitantly expensive, especially as a child grows and the hand needs to be adjusted to their changing body size. Depending upon the quality of the prosthetic, the cost can be $10,000-$80,000. Many patients cannot afford the cost.
Out of financial necessity, the dad of a young son became inventive and created a $5.00 prosthetic hand. The $5.00 covers the materials to actually print the hand. Then, add on $150 in other necessary parts. This is still a real bargain, thanks to their MarkerBots 3-D printer. Every new hand requires 3 or 4 printings, each of which takes one to two hours to print. Each new version of the hand has better capabilities.
There is a website called www.thingiverse.com, where there are designs for toys, mechanical parts and medical devices in the 3-D printer world. This is the cutting edge of the future in some medical fields.
April 7th, 2014 | The Blog
So, you are with a patient, friend or family member or caring for a patient when they get the news. They have cancer. It does not matter where the cancer is located or what stage of cancer the doctor tells them. The fact is that, they have cancer. What now?
A patient’s response to getting the news of a newly diagnosed or recurrent case of cancer varies but is most often not a happy one. No one ever wants to hear those words.
A group of breast cancer patients being treated at Massachusetts General Hospital, in Boston, MA, recently participated in an online survey to discuss their emotional response to receiving the news that they have the dreaded disease. Their participation has brought this survey option to light.
Cancer Patient Registry
The online survey is called the Cancer Experience Registry. The link to the site is: https://csc.cancerexperienceregistry.org.
A non-profit patient advocacy organization, the Cancer Support Community, manages the registry. The site has been up and running for nearly one year. There are over 6,000 cancer patients registered in the national registry.
Personal information from the survey is not publicly shared. Researchers analyze the information and the general results are shared with the medical professionals caring for cancer patients.
The hope is that the information from the surveys will provide the healthcare community with information about where in the cancer care process there is a lack of patient support and information.
The purpose of the registry is to encourage cancer patients to share their personal experiences with cancer.
The survey takes each patient 30 to 45 minutes to complete. The questions posed to the patient include information about:
The Cancer Experience Registry site plans to add a caregiver’s section by June 2014. This will add another and very necessary dimension to bettering the care of cancer patients.
The Survey Outcome
The three main results, so far, show the following:
The registry will ultimately benefit the greater community of cancer patients and survivors. The information collected will serve to give healthcare providers the data they need to improve the overall physical and emotional well being of their patients. Questions that are not asked in a routine office or clinic visit are found on the survey. This survey goes beyond the routine clinical questions and looks at the personal and emotional aspects of a cancer diagnosis.