Happy New Year! A momentous year? It is the 200th anniversary of the War of 1812. My grandniece will enter first grade. I will celebrate my 36th wedding anniversary and my 60th birthday. 2012 is the year of my 35th medical school reunion. We citizens will be inundated with exaggerations, half truths and damn lies as this is an election year.
My friends and former colleagues will be moving into their new ER. More rooms, more space, a new entrance and the same inept administration. The patients will be waiting at least as long but will be more likely to be on a stretcher than in the waiting room. I treated a young woman recently who lives 5 minutes from LGH and has a primary care doctor on the LGH medical staff. She had been vomiting and having diarrhea. She called the LGH ER and was told that the wait was at least 3 hours. Unless the policy has changed, giving wait estimates is not allowed. She drove 20 minutes to NVMC and was placed on a stretcher on arrival and was seen and began treatment within 5 minutes. Press-Ganey gold.
Today I received an e-mail from the ER director of LGH. It was a reminder of the schedule and agenda for the next two ER department meetings. The fact that I haven't been a member of the LGH ER department since June 2011 seems to have escaped his attention. He, of course, was the person who fired my aged ass. Removing me because I was labelled a "disruptive physician" does not seem to have resolved any of LGH's ER problems.
It has been a strange winter. Warmer than usual and with almost no snow. The flu season seems relatively benign. A particularly nasty and wide spread gastroenteral virus is keeping the ER census high. Many health care workers have experienced the misery of this "GI bug". A national dilemma of shortages of common medications has added to the burden of this epidemic. NVMC ran out of injectable Zofran.
The reports in the mainstream and medical press has given many reasons for the shortages. The drugs are all generic and therefore have much lower profit margins that newer, patented meds. Middlemen, who take their cut between the pharmaceutical manufacturers and the hospitals, clinics and pharmacies, seem to be price gauging. Money is the root of all evil.
One of my new duties is reviewing charts for patients who return to the ER within 48 hours. Many are for continuing symptoms of their initial visit. Some ran out of their pain meds and need more of the same. The purpose of this quality assurance exercise is to try and find issues that may lead to better clinical practices. The slow pace of the night shift af NVMC gives me time to do my part to improve care for our patients.
The world's oldest ER doc wishes everyone a Happy, Healthy and prosperous 2012.
Thursday, January 12, 2012
Saturday, December 17, 2011
Lazy Saturday
Due to the vagaries of the scheduling fairies, I haven't worked since 9/7 night shift. I will return to Nashoba on Monday and then will be working 11 out of 15 nights. Never volunteer to work the holidays. A and I are in Starbucks while our housekeepers are earning their Christmas bonus.
No fantasies today. I am anchored in the reality of the present. A has been home, sick with the flu this past week. She did get a flu shot but only 1 1/2 weeks ago. Word to the wise, get your flu shot in September. The immunization takes up to 6 weeks to reach maximal effectiveness.
I felt sad on Thursday night. I was not in attendance at the LGH ER Xmas party. Sally's pictures were a bitter sweet reminder of happier times. I don't miss the chaos of the LGH ER, just the many wonderful people who work there.
I wonder if Nashoba's Christmas eve will be decked with sick kids and depressed patients. My thoughts will be with our friends the H's who host an annual "Feast of the Seven Fish" on Christmas eve. I am sure that my buddy Scott will send a care package with A for my Christmas day meal.
The World's Oldest ER Doc loves Christmas. The music, the food, the lights, "White Christmas", "It's a Wonderful Life", the spirit of good will, all make for a joyous holiday season. I reminisced with my mother yesterday about my childhood holiday memories: playing dreidl with the rolls of pennies and nickels from my Grandpa; sharing the wonderful food prepared by our neighbors the Pace's; hoping for snow on Christmas morning: and knowing that my mother, not Santa filled my stocking on Christmas eve.
To my friends, readers and people of the blogosphere. Have a wonderful Christmas, a happy Chanukah, a Kwanzaa with joy, and to all a Happy, Healthy, and safe 2012.
No fantasies today. I am anchored in the reality of the present. A has been home, sick with the flu this past week. She did get a flu shot but only 1 1/2 weeks ago. Word to the wise, get your flu shot in September. The immunization takes up to 6 weeks to reach maximal effectiveness.
I felt sad on Thursday night. I was not in attendance at the LGH ER Xmas party. Sally's pictures were a bitter sweet reminder of happier times. I don't miss the chaos of the LGH ER, just the many wonderful people who work there.
I wonder if Nashoba's Christmas eve will be decked with sick kids and depressed patients. My thoughts will be with our friends the H's who host an annual "Feast of the Seven Fish" on Christmas eve. I am sure that my buddy Scott will send a care package with A for my Christmas day meal.
The World's Oldest ER Doc loves Christmas. The music, the food, the lights, "White Christmas", "It's a Wonderful Life", the spirit of good will, all make for a joyous holiday season. I reminisced with my mother yesterday about my childhood holiday memories: playing dreidl with the rolls of pennies and nickels from my Grandpa; sharing the wonderful food prepared by our neighbors the Pace's; hoping for snow on Christmas morning: and knowing that my mother, not Santa filled my stocking on Christmas eve.
To my friends, readers and people of the blogosphere. Have a wonderful Christmas, a happy Chanukah, a Kwanzaa with joy, and to all a Happy, Healthy, and safe 2012.
Saturday, December 10, 2011
Doc Quixote Part 4
Despite signs to the contrary, I am not delusional. I am aware of the current year. It is my choice to view the world from a unique perspective. The age of my corpus is not the same as the age of my animus. The chivalry of my hero Don Quixote serves as a guide for my writing.
My aged mother, the duenna Dulce, resides in a residence for the elderly. Her physical and mental frailties are commensurate with her advanced years. We sat together in the sun room yesterday and I shared a cine of her great grandchildren dancing. Her creased face shone with joy. She was her usual pleasantly confused self. Her worsening memory, she counts as an asset, as she says that she doesn't remember the bad times. When I arrived at the elder hostel, she insists that she must attend to her hair. Only when she has brushed and combed her snow white locks, does she feel ready to face the day.
The shallowness of youth was the weapon that wounded a cherished friend. A former health giver at the hospice on the Merrimack, this sharp witted, compassionate, and scarlet haired damsel was wounded by a knave. The seniorita was betrayed by one she loved. The cad violated the trust that binds a couple beyond the formalities of the church or the state. My friend's heart will heal. My fondest wish is that someone worthy of her love will enter her life.
On arriving at the Hospice of the River Valley on a recent night, my presence was urgently requested at the bedside of one who's breathing tube had become dislodged. I rushed to the unit of intensive care and beheld a person of considerable weight. The short, thick neck and low level of oxygen gave me pause. The learned anesthesiologist, S Rao Mallampati and his associates had developed a score that predicts the difficulty in passing a breathing tube into a patient. The most challenging airway would rate a 4 on this classification. The unfortunate sufferer in front of me was a 4. The one advantage of my advanced years, is the more than three decades of experience that resides in my mens. With the assistance of the excellent nurses and respiratory therapist, I was able to insert the needed airway. I returned to my work station in the accident ward. Minutes later, the UIC called to tell me that the collar that seals the airway had failed. Once more I attended to the penitant's bedside and using a long wand placed through the defective tube, I removed that damaged hose and passed a new (carefully checked) tube over the wand.
Most nights at the Hospice of the River Valley, the penitants that seek care are few and their needs, though urgent to they and their loved ones, are usually not a threat to life or limb. My boon companions in the accident ward, the nurses and clerks, and I stand ready to offer relief, and compassion to those in need.
My aged mother, the duenna Dulce, resides in a residence for the elderly. Her physical and mental frailties are commensurate with her advanced years. We sat together in the sun room yesterday and I shared a cine of her great grandchildren dancing. Her creased face shone with joy. She was her usual pleasantly confused self. Her worsening memory, she counts as an asset, as she says that she doesn't remember the bad times. When I arrived at the elder hostel, she insists that she must attend to her hair. Only when she has brushed and combed her snow white locks, does she feel ready to face the day.
The shallowness of youth was the weapon that wounded a cherished friend. A former health giver at the hospice on the Merrimack, this sharp witted, compassionate, and scarlet haired damsel was wounded by a knave. The seniorita was betrayed by one she loved. The cad violated the trust that binds a couple beyond the formalities of the church or the state. My friend's heart will heal. My fondest wish is that someone worthy of her love will enter her life.
On arriving at the Hospice of the River Valley on a recent night, my presence was urgently requested at the bedside of one who's breathing tube had become dislodged. I rushed to the unit of intensive care and beheld a person of considerable weight. The short, thick neck and low level of oxygen gave me pause. The learned anesthesiologist, S Rao Mallampati and his associates had developed a score that predicts the difficulty in passing a breathing tube into a patient. The most challenging airway would rate a 4 on this classification. The unfortunate sufferer in front of me was a 4. The one advantage of my advanced years, is the more than three decades of experience that resides in my mens. With the assistance of the excellent nurses and respiratory therapist, I was able to insert the needed airway. I returned to my work station in the accident ward. Minutes later, the UIC called to tell me that the collar that seals the airway had failed. Once more I attended to the penitant's bedside and using a long wand placed through the defective tube, I removed that damaged hose and passed a new (carefully checked) tube over the wand.
Most nights at the Hospice of the River Valley, the penitants that seek care are few and their needs, though urgent to they and their loved ones, are usually not a threat to life or limb. My boon companions in the accident ward, the nurses and clerks, and I stand ready to offer relief, and compassion to those in need.
Wednesday, October 5, 2011
Doc Quixote, Part 1
Hello, my name is Miguel Dulce Cervantes. I am a healer of bodies and souls. In the land of La Massachusetts, I reside with my wife, Dulcinea, and my faithful companion Magnus Panza. Some say that I am delusional. They are wrong. My visions are real, and I act as befits a knight of the Brotherhood. There are ogres, trolls, and malevolent giants in this land.
When it is time to battle the forces of evil, I don my armament. My raiment, maroon or blue blouse and pantaloons, keep me safe from the microbes and fluids that afflict and ooze from those in need of my care. My coat of white, bears my name and title for all to see. I hide from no one, friend or foe. Lights of complex design, machines that make images, hearing devices and my strong but sensitive fingers allow me to delve into my patients soma and psyche.
My last campaign endured for nigh three decades. I fought alongside brave and compassionate allies. Ultimately, I was defeated by the White Wizard and his coven. The lies and perfidity of these spawn of pergatory, drove me from the field of battle and nearly crushed my heart. Others were cast out by the Wizard and his hand maidens. Wounded, the survivors of the battle kept their spirits up and continued their good deeds at other hamlets in the land. My dear Esmirelda suffered greatly at the gnarled hands of the Great Witch. Esmirelda of the Mountains persevered. She faced famine and poverty but prevailed.
My advancing age has diminished my strength and stamina. My hands and heart remain commited to the cause. I will continue to tilt at the giants with my lance, even when others see only windmills. In the course of time, I shall share my adventures with you. Adios!
When it is time to battle the forces of evil, I don my armament. My raiment, maroon or blue blouse and pantaloons, keep me safe from the microbes and fluids that afflict and ooze from those in need of my care. My coat of white, bears my name and title for all to see. I hide from no one, friend or foe. Lights of complex design, machines that make images, hearing devices and my strong but sensitive fingers allow me to delve into my patients soma and psyche.
My last campaign endured for nigh three decades. I fought alongside brave and compassionate allies. Ultimately, I was defeated by the White Wizard and his coven. The lies and perfidity of these spawn of pergatory, drove me from the field of battle and nearly crushed my heart. Others were cast out by the Wizard and his hand maidens. Wounded, the survivors of the battle kept their spirits up and continued their good deeds at other hamlets in the land. My dear Esmirelda suffered greatly at the gnarled hands of the Great Witch. Esmirelda of the Mountains persevered. She faced famine and poverty but prevailed.
My advancing age has diminished my strength and stamina. My hands and heart remain commited to the cause. I will continue to tilt at the giants with my lance, even when others see only windmills. In the course of time, I shall share my adventures with you. Adios!
Thursday, September 29, 2011
Achoo 2
In prior blogs from 4/2010 and 9/2010, I bloviated as to the signs and symptoms of colds and respiratory allergies. Recently I have seen patients and coworkers who were not sure if they had a cold or "hay fever".
Colds are upper respiratory tract infections caused by rhinoviruses, coronaviruses and adenoviruses. An adult may average 2-4 colds per year; school aged children up to 12 colds per year. The cold virus enters one's body as an aerosol of viral particle (think sneezes), or by touching a surface that has been contaminated with a cold virus and then touching your eyes or nose. The symptoms of a cold (runny nose, sore throat, cough and low grade fever) lasts 7-10 days but may persist for as long as 3 weeks.
Allergies to plant pollens trigger the misery of seasonal allergic rhinitis. Red, itchy eyes, runny and/or congested nose are the most common symptoms. Post-nasal drip may trigger a cough, especially at night. Sinus pressure and pain may develop as the turbinates (fleshy masses in the nose) swell and block the outflow tracts of the sinuses.
The presence of a fever would indicate that one has a cold. Nasal mucous that is thick and yellow is more common with a cold. Allergic rhinitis usually produces watery, clear drainage. Allergy symptoms come on abruptly after exposure. Brushing the dog may release pollen that has settled on Fido's fur and achoo.
Seasonal allergies occur when the source of pollen or other offending allergen are in the atmosphere. My personal pollen poison is ragweed from August until the first frost. Colds may strike at any time of the year but are more common in the Northern Hemisphere from September to April.
Over the counter cold and allergy preparations are equally effective (ineffective) for colds and allergy symptoms. Allergic rhinitis and conjunctivitis have prescription remedies that are not appropriate and may worsen or prolong a cold. Steroid nasal sprays are very effective in treating allergic rhinitis. They diminish the IgE release of histamine by MAST cells and certain white blood cells.
The use of Neti pots, echinacea, zinc sprays and lozenges, large doses of vitamin C and a steaming bowl of chicken soup have all been recommended as treatments for colds. All are probably harmless and useless. At least the chicken soup tastes good.
The ER sees lots of patients suffering from the annoying symptoms of colds and allergies. The 24/7 availability and the lack of primary care providers contribute to this use of the ER for non urgent problems. The caring ER staff stand ready with boxes of tissues and lots of compassion to help differentiate the cause of your nasal symptoms and prescribe the correct treatment.
Colds are upper respiratory tract infections caused by rhinoviruses, coronaviruses and adenoviruses. An adult may average 2-4 colds per year; school aged children up to 12 colds per year. The cold virus enters one's body as an aerosol of viral particle (think sneezes), or by touching a surface that has been contaminated with a cold virus and then touching your eyes or nose. The symptoms of a cold (runny nose, sore throat, cough and low grade fever) lasts 7-10 days but may persist for as long as 3 weeks.
Allergies to plant pollens trigger the misery of seasonal allergic rhinitis. Red, itchy eyes, runny and/or congested nose are the most common symptoms. Post-nasal drip may trigger a cough, especially at night. Sinus pressure and pain may develop as the turbinates (fleshy masses in the nose) swell and block the outflow tracts of the sinuses.
The presence of a fever would indicate that one has a cold. Nasal mucous that is thick and yellow is more common with a cold. Allergic rhinitis usually produces watery, clear drainage. Allergy symptoms come on abruptly after exposure. Brushing the dog may release pollen that has settled on Fido's fur and achoo.
Seasonal allergies occur when the source of pollen or other offending allergen are in the atmosphere. My personal pollen poison is ragweed from August until the first frost. Colds may strike at any time of the year but are more common in the Northern Hemisphere from September to April.
Over the counter cold and allergy preparations are equally effective (ineffective) for colds and allergy symptoms. Allergic rhinitis and conjunctivitis have prescription remedies that are not appropriate and may worsen or prolong a cold. Steroid nasal sprays are very effective in treating allergic rhinitis. They diminish the IgE release of histamine by MAST cells and certain white blood cells.
The use of Neti pots, echinacea, zinc sprays and lozenges, large doses of vitamin C and a steaming bowl of chicken soup have all been recommended as treatments for colds. All are probably harmless and useless. At least the chicken soup tastes good.
The ER sees lots of patients suffering from the annoying symptoms of colds and allergies. The 24/7 availability and the lack of primary care providers contribute to this use of the ER for non urgent problems. The caring ER staff stand ready with boxes of tissues and lots of compassion to help differentiate the cause of your nasal symptoms and prescribe the correct treatment.
Monday, September 26, 2011
STRESS
Everyone is stressed. The economy tanking, global warming, government failing, spouses, kids, in-laws, bosses UGH!!!
Animals, including we humans, have mechanisms in place to deal with stress. The classic example of an acute stress is the big dog coming at you. Fight or flight response originates in the hypothalamus. This area at the base of the brain releases hormones that start the body's response to stress. The adrenal glands pump out adrenalin, aka epinephrine, and cortisol. Heart rate and respiratory rate increase, blood pressure rises. Glycogen stores in the liver and muscles begin to release glucose into the blood stream. The immune system, digestion, reproduction and growth processes are all suppressed. This is a necessary survival mechanism. The acute stress response was very helpful when our ancestors lived a perilous existence on the plains of Africa or when involved in the innumerable wars humans have fought.
The sympathetic nervous system is responsible to turn on the fight or flight reaction and the parasympathetic system tamps the reaction down.
When the stress response is triggered by a deadline at work, or being stuck in a traffic jam the effects on one's body are deleterious. When stress is chronic because we are always behind at work, stuck in traffic, or in a toxic relationship, the damage to our body is real and potentially lethal. Chronic stress with its waves of stress hormones leads to heart disease, sleep disorders, digestive problems, depression, memory impairment and even worsening of certain skin diseases.
Some people are more vulnerable to stress because of genetic or environmental factors. Anxiety disorder, panic attacks, and depression have genetic components. These mental health conditions prime the pump of the stress response. Children who are neglected and/or abused are also more likely to have severe and persistent stress responses. Events in one's life such as being the victim or witness to trauma may lead to PTSD (post-traumatic stress disorder). High pressure jobs (ER doc, nurse, PA, tech, secretary) often lead to chronic stress. Loneliness, and social isolation also contribute to chronic stress.
There are things one can do to mitigate stress, short of living in a cabin in northern Maine with your family. Eating a healthy diet (skip the fried twinkies), exercising regularly, and getting adequate sleep would be an effective antidote to our modern stressful world. Being in a happy relationship, and having friends and family to share one's life are also helpful. Having a sense of humor and practicing relaxation techniques (such as yoga, meditation, tai chi, or just listening to music) have all been shown to lower blood pressure and heart rate and decrease the levels of stress hormones in the blood.
My stress levels have diminished since I was forced to leave my job at The Hospital. My beloved wife and caring daughter had been encouraging me to leave The Hospital because of the stress. I would arrive for work and find angry, stressed patients who had been waiting up to 6 hours to be seen by a physician. My new job is low volume and low acuity. My patients don't have to wait to be treated. I am mostly stress free. Maybe my hair will change back to black.
Illegitimi non carborundum, don't let the bastards grind you down!
Animals, including we humans, have mechanisms in place to deal with stress. The classic example of an acute stress is the big dog coming at you. Fight or flight response originates in the hypothalamus. This area at the base of the brain releases hormones that start the body's response to stress. The adrenal glands pump out adrenalin, aka epinephrine, and cortisol. Heart rate and respiratory rate increase, blood pressure rises. Glycogen stores in the liver and muscles begin to release glucose into the blood stream. The immune system, digestion, reproduction and growth processes are all suppressed. This is a necessary survival mechanism. The acute stress response was very helpful when our ancestors lived a perilous existence on the plains of Africa or when involved in the innumerable wars humans have fought.
The sympathetic nervous system is responsible to turn on the fight or flight reaction and the parasympathetic system tamps the reaction down.
When the stress response is triggered by a deadline at work, or being stuck in a traffic jam the effects on one's body are deleterious. When stress is chronic because we are always behind at work, stuck in traffic, or in a toxic relationship, the damage to our body is real and potentially lethal. Chronic stress with its waves of stress hormones leads to heart disease, sleep disorders, digestive problems, depression, memory impairment and even worsening of certain skin diseases.
Some people are more vulnerable to stress because of genetic or environmental factors. Anxiety disorder, panic attacks, and depression have genetic components. These mental health conditions prime the pump of the stress response. Children who are neglected and/or abused are also more likely to have severe and persistent stress responses. Events in one's life such as being the victim or witness to trauma may lead to PTSD (post-traumatic stress disorder). High pressure jobs (ER doc, nurse, PA, tech, secretary) often lead to chronic stress. Loneliness, and social isolation also contribute to chronic stress.
There are things one can do to mitigate stress, short of living in a cabin in northern Maine with your family. Eating a healthy diet (skip the fried twinkies), exercising regularly, and getting adequate sleep would be an effective antidote to our modern stressful world. Being in a happy relationship, and having friends and family to share one's life are also helpful. Having a sense of humor and practicing relaxation techniques (such as yoga, meditation, tai chi, or just listening to music) have all been shown to lower blood pressure and heart rate and decrease the levels of stress hormones in the blood.
My stress levels have diminished since I was forced to leave my job at The Hospital. My beloved wife and caring daughter had been encouraging me to leave The Hospital because of the stress. I would arrive for work and find angry, stressed patients who had been waiting up to 6 hours to be seen by a physician. My new job is low volume and low acuity. My patients don't have to wait to be treated. I am mostly stress free. Maybe my hair will change back to black.
Illegitimi non carborundum, don't let the bastards grind you down!
Saturday, August 27, 2011
Hype
All Irene, all the time. Hype. Snow storm, hurricane, heat wave; local news stations love a good/bad weather story. People are encouraged to prepare for Armageddon. The ER is effected by this hype. Every child with a fever must be checked out before the winds/ snow/ rain arrives. Local media hype medical issues as well.
Years ago I was in my final hour of a busy 10 hour shift. A mother arrived with her school age child and said she wanted her offspring to be checked for meningitis. There had been a recent local case of a teenager dying from bacterial meningitis. This distraught mother's child had not been exposed. Her concern was because the child had vomited once. She pointed out to me that vomiting was one of the signs of meningitis. She had watched the news broadcast the night before. I bit the inside of my cheek to keep from laughing. I asked the child, who was happily sucking on a popsicle, if he had a headache, or any pain, and if he felt nauseous. The answers to all my questions were in the negative. I was finally able to convince the mother that her precious did not need an lumbar puncture. I assured her that we would be ready if junior developed the headache, neck stiffness, fever, and vomiting that might indicate a diagnosis of meningitis.
The recent medical hype concerns the discovery of mosquitoes carrying the West Nile Virus (WNV). Lots of cans of insect repellant will be purchased to protect the citizenry from this disease. Some years, the mosquito-borne disease being hyped is EEE (eastern equine encephalitis).
Lets look at the facts. In 2009 there 720 cases of WNV in the entire US. The incidence of neuroinvasive disease (meningitis/encephalitis) was 0.13 per 100,000 people. The incubation period after exposure from an infected mosquito is 3-6 days. The number of cases of infection is very low compared to the number of people exposed. When someone develops encephalitis/meningitis, the fatality rate is 5-10%. The fatalities are mostly in the elderly. If a patient is in the 90-95% survival group, they usually make a complete recovery.
EEE tends to occur in outbreaks that may last for years. In 2005 Massachusetts and New Hampshire had a combined 11 cases of EEE. The 7 human cases in NH were the first cases in 41 years. Of the 11 patients who were diagnosed with EEE, 4 died. The incubation period for EEE is 5-10 days. There are about 20 cases in the US per year. The case fatality rate is 1:1000 for adults, 1:50 in children, and approaches 1:1 in infants. The overall case fatality rate is 50-75%. Most patients who survive EEE have permanent disability.
The treatment for both WNV and EEE is supportive. There is no specific medication or therapies. How high on one's list of health care problems are these 2 diseases? Next weekend is Labor Day. I predict that more people will die from accidents on the road and waters of Massachusetts than will be diagnosed with WNV and EEE combined.
I am in favor of educating people as to the risks of infectious diseases. Wearing long sleeves and long pants, using DEET containing insect repellants, and avoiding the peak times for mosquito activity are all good practices. When I walk my old pooch in the woods, I wear white scrub pants, and a long sleeve shirt that contains insect repellant. I tuck the pants into my white socks. This outfit serves the additional advantage of reducing my exposure to the deer ticks that carry Lyme disease (please refer to a recent blog on Lyme disease).
My concern is that exposure to the pesticides used to control mosquito populations may in the long run cause more wide spread neurological sequelae. There will always be risk. We must assess the degree of risk. The actions taken to mitigate the risk should be cost effective and not cause excessive damage to the environment or the people and animals in the area. As I have tried to stress in my blogs, be prepared. Read and listen to the media sources. Do your own research into the actual risks. Common sense approaches are your best protection.
Irene is now being downgraded as to wind velocities and rainfall amounts. The local food and home supply purveyors are counting the recent purchases made by the people who believed the hype. My wife and I have lots of snacks ready. We have a generator that runs on the natural gas. The ice/rain storm of December 2008 was not hyped as a severe storm. The power outages were devastating being both widespread and long lasting. Our house flooded because our trusty sump pump runs on electricity. Ready; come on Irene.
Years ago I was in my final hour of a busy 10 hour shift. A mother arrived with her school age child and said she wanted her offspring to be checked for meningitis. There had been a recent local case of a teenager dying from bacterial meningitis. This distraught mother's child had not been exposed. Her concern was because the child had vomited once. She pointed out to me that vomiting was one of the signs of meningitis. She had watched the news broadcast the night before. I bit the inside of my cheek to keep from laughing. I asked the child, who was happily sucking on a popsicle, if he had a headache, or any pain, and if he felt nauseous. The answers to all my questions were in the negative. I was finally able to convince the mother that her precious did not need an lumbar puncture. I assured her that we would be ready if junior developed the headache, neck stiffness, fever, and vomiting that might indicate a diagnosis of meningitis.
The recent medical hype concerns the discovery of mosquitoes carrying the West Nile Virus (WNV). Lots of cans of insect repellant will be purchased to protect the citizenry from this disease. Some years, the mosquito-borne disease being hyped is EEE (eastern equine encephalitis).
Lets look at the facts. In 2009 there 720 cases of WNV in the entire US. The incidence of neuroinvasive disease (meningitis/encephalitis) was 0.13 per 100,000 people. The incubation period after exposure from an infected mosquito is 3-6 days. The number of cases of infection is very low compared to the number of people exposed. When someone develops encephalitis/meningitis, the fatality rate is 5-10%. The fatalities are mostly in the elderly. If a patient is in the 90-95% survival group, they usually make a complete recovery.
EEE tends to occur in outbreaks that may last for years. In 2005 Massachusetts and New Hampshire had a combined 11 cases of EEE. The 7 human cases in NH were the first cases in 41 years. Of the 11 patients who were diagnosed with EEE, 4 died. The incubation period for EEE is 5-10 days. There are about 20 cases in the US per year. The case fatality rate is 1:1000 for adults, 1:50 in children, and approaches 1:1 in infants. The overall case fatality rate is 50-75%. Most patients who survive EEE have permanent disability.
The treatment for both WNV and EEE is supportive. There is no specific medication or therapies. How high on one's list of health care problems are these 2 diseases? Next weekend is Labor Day. I predict that more people will die from accidents on the road and waters of Massachusetts than will be diagnosed with WNV and EEE combined.
I am in favor of educating people as to the risks of infectious diseases. Wearing long sleeves and long pants, using DEET containing insect repellants, and avoiding the peak times for mosquito activity are all good practices. When I walk my old pooch in the woods, I wear white scrub pants, and a long sleeve shirt that contains insect repellant. I tuck the pants into my white socks. This outfit serves the additional advantage of reducing my exposure to the deer ticks that carry Lyme disease (please refer to a recent blog on Lyme disease).
My concern is that exposure to the pesticides used to control mosquito populations may in the long run cause more wide spread neurological sequelae. There will always be risk. We must assess the degree of risk. The actions taken to mitigate the risk should be cost effective and not cause excessive damage to the environment or the people and animals in the area. As I have tried to stress in my blogs, be prepared. Read and listen to the media sources. Do your own research into the actual risks. Common sense approaches are your best protection.
Irene is now being downgraded as to wind velocities and rainfall amounts. The local food and home supply purveyors are counting the recent purchases made by the people who believed the hype. My wife and I have lots of snacks ready. We have a generator that runs on the natural gas. The ice/rain storm of December 2008 was not hyped as a severe storm. The power outages were devastating being both widespread and long lasting. Our house flooded because our trusty sump pump runs on electricity. Ready; come on Irene.
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