Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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3:43 AM
June 23rd, 2019

Measles Has Returned

Measles Virus

 

Measles has returned. After having been declared eliminated in 2002, measles has returned, right here in northwest Pennsylvania. Certainly, a closer look at measles is timely.

 

History

 

In the ninth century, the Persian physician Rhazes was the first to describe measles. In 1757, the Scottish doctor Francis Home first attempted to make a vaccine.

 

Because of measles high level of contagion, it spread rapidly in island nations with no intrinsic immunity. An 1848 outbreak in Hawaii killed nearly a third of the population. An 1875 outbreak in Fiji likewise killed nearly a third of the population, in only four months.

 

In 1916, 12,000 people died of measles, three out of four of them being children under 5-years-old.

 

By the 1950s, deaths dropped to 400-500 a year, mostly because of antibiotics and public health measures. However, there were still an estimated 48,000 hospitalizations a year from measles-related ear infections, diarrhea, and pneumonia. An estimated 1000 children a year developed measles related encephalitis causing intellectual disability or death.

 

Finally, with school vaccination requirements and federal funding, measles was eliminated in the US in 2002. However, with some Americans desiring not to vaccinate, measles has begun to reappear.

 

Contagion

 

Measles is one of the most contagious diseases. At least 90% of susceptible household contacts will acquire the disease from an infected patient. Patients are typically contagious for over a week, beginning 3-5 days before the rash first appears until 4 days after. However, patients with immunodeficiency may remain contagious for the duration of the disease. Measles is transmitted by respiratory droplets, which remain infectious for 2 hours whether in the air or on surfaces.

  

Susceptibility

 

Although the measles virus is usually regarded as affecting mostly children, persons of all ages are susceptible. Conditions dramatically increasing susceptibility are malnutrition, pregnancy, vitamin A deficiency, and immunodeficiency. Causes of immunodeficiency are AIDS, leukemia, cancer chemotherapy, and corticosteroid therapy.

 

Symptoms

 

The onset of symptoms typically occurs 7-14 days after exposure.

 

Symptoms typically include a high fever (often 104 degrees Fahrenheit), cough, runny nose, and inflamed sensitive eyes. An itchy rash usually appears a day or two later. The rash characteristically progresses from the head to the trunk to the arms and legs. Patients are usually most ill during the first or second day of the rash. With recovery, the rash disappears in the same order. The rash may not appear in severely immunocompromised patients.

 

Complications

 

While measles usually resolves unremarkably, when complications occur, they can be quite serious. Complications include pneumonia, reactivation of tuberculosis, blindness, hemorrhage, hepatitis, pancreatitis, and viral infections of the heart.

 

In pregnant women, measles can cause preterm labor, preterm birth, and spontaneous abortion.

 

Finally, 1 in every 1000 patients may develop measles encephalitis. Measles encephalitis can be fatal in 10% of victims and cause permanent brain damage in others. Rarely, measles can result in behavioral and intellectual deterioration and seizures beginning an average of 10 years after the measles episode.

 

Public Health Hazard

 

Measles is a public health hazard because of the seriousness of the complications and the potential to affect a large number of susceptible people in a short time. For this reason, measles has been a reportable disease in the US since 1912. Additionally, respiratory isolation is recommended for hospitalized measles patients during their period of communicability. A final recommendation is that exposed, susceptible healthcare workers be excused from work from the fifth to the 21st day after being exposed to measles. The US Centers for Disease Control certainly takes measles seriously.

 

Treatment

 

The treatment of measles is largely supportive. Fluids are used for dehydration from the fever, diarrhea, or vomiting. Medications to reduce the fever are also considered appropriate. Antiviral drugs are sometimes used, but without specific FDA approval. Vitamin A supplements appear to help prevent eye damage and blindness and have been associated with reduced mortality. Human immune globulins may modify the disease if administered soon after exposure, before symptoms develop.

 

 

Prevention

 

Fortunately, measles is largely preventable. A single dose of measles vaccine administered to a child older than 12 months induces protective immunity in 95% of recipients. However, endemic transmission of measles may return if measles immunity falls to less than 93-95%. A second dose recommended for school-age children renders immunity to 95% of those still susceptible after the first dose, a total protection rate of 99.75%.

 

Conclusion

 

Measles, once considered eliminated has returned. It is a public health issue for two reasons. First, the complications of measles can be severe, including blindness, neurological disability, and death. Second, this highly contagious disease can infect great numbers of people within a short time. But, inoculation against measles can confer almost perfect protection. Hopefully, after the current visitation, measles will not return.

 

Thomas Falasca, DO

 

References

 

Haelle, T. (2019, February 06). Why It Took So Long to Eliminate Measles. Retrieved June 4, 2019, from https://www.history.com/news/measles-vaccine-disease

Measles. (2019, May 30). Retrieved from https://emedicine.medscape.com/article/966220

Measles | For Healthcare Professionals | CDC. (n.d.). Retrieved from https://www.cdc.gov/measles/hcp/index.html

Measles | History of Measles | CDC. (n.d.). Retrieved from https://www.cdc.gov/measles/about/history.html

 

Measles Has Returned

 

 

 

 

Measles has returned. After having been declared eliminat ...See More


Measles Has Returned

Measles Virus

 

Measles has returned. After having been declared eliminated in 2002, measles has returned, right here in northwest Pennsylvania. Certainly, a closer look at measles is timely.

 

History

 

In the ninth century, the Persian physician Rhazes was the first to describe measles. In 1757, the Scottish doctor Francis Home first attempted to make a vaccine.

 

Because of measles high level of contagion, it spread rapidly in island nations with no intrinsic immunity. An 1848 outbreak in Hawaii killed nearly a third of the population. An 1875 outbreak in Fiji likewise killed nearly a third of the population, in only four months.

 

In 1916, 12,000 people died of measles, three out of four of them being children under 5-years-old.

 

By the 1950s, deaths dropped to 400-500 a year, mostly because of antibiotics and public health measures. However, there were still an estimated 48,000 hospitalizations a year from measles-related ear infections, diarrhea, and pneumonia. An estimated 1000 children a year developed measles related encephalitis causing intellectual disability or death.

 

Finally, with school vaccination requirements and federal funding, measles was eliminated in the US in 2002. However, with some Americans desiring not to vaccinate, measles has begun to reappear.

 

Contagion

 

Measles is one of the most contagious diseases. At least 90% of susceptible household contacts will acquire the disease from an infected patient. Patients are typically contagious for over a week, beginning 3-5 days before the rash first appears until 4 days after. However, patients with immunodeficiency may remain contagious for the duration of the disease. Measles is transmitted by respiratory droplets, which remain infectious for 2 hours whether in the air or on surfaces.

  

Susceptibility

 

Although the measles virus is usually regarded as affecting mostly children, persons of all ages are susceptible. Conditions dramatically increasing susceptibility are malnutrition, pregnancy, vitamin A deficiency, and immunodeficiency. Causes of immunodeficiency are AIDS, leukemia, cancer chemotherapy, and corticosteroid therapy.

 

Symptoms

 

The onset of symptoms typically occurs 7-14 days after exposure.

 

Symptoms typically include a high fever (often 104 degrees Fahrenheit), cough, runny nose, and inflamed sensitive eyes. An itchy rash usually appears a day or two later. The rash characteristically progresses from the head to the trunk to the arms and legs. Patients are usually most ill during the first or second day of the rash. With recovery, the rash disappears in the same order. The rash may not appear in severely immunocompromised patients.

 

Complications

 

While measles usually resolves unremarkably, when complications occur, they can be quite serious. Complications include pneumonia, reactivation of tuberculosis, blindness, hemorrhage, hepatitis, pancreatitis, and viral infections of the heart.

 

In pregnant women, measles can cause preterm labor, preterm birth, and spontaneous abortion.

 

Finally, 1 in every 1000 patients may develop measles encephalitis. Measles encephalitis can be fatal in 10% of victims and cause permanent brain damage in others. Rarely, measles can result in behavioral and intellectual deterioration and seizures beginning an average of 10 years after the measles episode.

 

Public Health Hazard

 

Measles is a public health hazard because of the seriousness of the complications and the potential to affect a large number of susceptible people in a short time. For this reason, measles has been a reportable disease in the US since 1912. Additionally, respiratory isolation is recommended for hospitalized measles patients during their period of communicability. A final recommendation is that exposed, susceptible healthcare workers be excused from work from the fifth to the 21st day after being exposed to measles. The US Centers for Disease Control certainly takes measles seriously.

 

Treatment

 

The treatment of measles is largely supportive. Fluids are used for dehydration from the fever, diarrhea, or vomiting. Medications to reduce the fever are also considered appropriate. Antiviral drugs are sometimes used, but without specific FDA approval. Vitamin A supplements appear to help prevent eye damage and blindness and have been associated with reduced mortality. Human immune globulins may modify the disease if administered soon after exposure, before symptoms develop.

 

 

Prevention

 

Fortunately, measles is largely preventable. A single dose of measles vaccine administered to a child older than 12 months induces protective immunity in 95% of recipients. However, endemic transmission of measles may return if measles immunity falls to less than 93-95%. A second dose recommended for school-age children renders immunity to 95% of those still susceptible after the first dose, a total protection rate of 99.75%.

 

Conclusion

 

Measles, once considered eliminated has returned. It is a public health issue for two reasons. First, the complications of measles can be severe, including blindness, neurological disability, and death. Second, this highly contagious disease can infect great numbers of people within a short time. But, inoculation against measles can confer almost perfect protection. Hopefully, after the current visitation, measles will not return.

 

Thomas Falasca, DO

 

References

 

Haelle, T. (2019, February 06). Why It Took So Long to Eliminate Measles. Retrieved June 4, 2019, from https://www.history.com/news/measles-vaccine-disease

Measles. (2019, May 30). Retrieved from https://emedicine.medscape.com/article/966220

Measles | For Healthcare Professionals | CDC. (n.d.). Retrieved from https://www.cdc.gov/measles/hcp/index.html

Measles | History of Measles | CDC. (n.d.). Retrieved from https://www.cdc.gov/measles/about/history.html

 

Type-2 Diabetes

Type-2 diabetes afflicts almost 27 million Americans. The prevalence has more than doubled in the last 30 years. The ...See More


Type-2 Diabetes

 

Type-2 Diabetes and You

 

Prevalence

 

 

In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes, according to the American Diabetes Association (ADA). The Center for Disease Control (CDC) reports that over 90% of these patients had type-2 diabetes. The ADA further reports diabetes as the seventh leading cause of death in the US, being an underlying or contributing cause in over 250,000 deaths in 2015.

 

The US prevalence has more than doubled in the last three decades, largely because of the increased prevalence of obesity. The increase is most concerning among adolescents and young adults.

 

Type-2 Diabetes 

 

Important distinctions exist between type-1 diabetes and the much more prevalent type-2 diabetes.

 

Type-1 diabetes results from the body’s inability to produce insulin due to the destruction of insulin-secreting beta cells in the pancreas. Patients with type-1 diabetes require lifelong insulin therapy. Although onset frequently occurs in childhood, the disease can also develop in adults.

 

Type-2 diabetes results from a combination of diminished insulin secretion by the pancreas and “peripheral insulin resistance.” This “peripheral insulin resistance” is a shorthand way of saying that (1) the glucose is impaired from getting into the muscles and tends to stay in the blood, (2) that the liver produces increased glucose, and (3) that there is an increased fat breakdown. Patients with type-2 diabetes may require oral medication or oral medication plus insulin.

 

Type-2 Symptoms 

 

Many type-2 diabetes patients exhibit no symptoms; the disease can begin insidiously. By the time of diagnosis, some patients have had the disease for 4-7 years and have already begun sustaining eye, nerve, and kidney damage. Other patients have earlier and more obvious symptoms such as excessive eating, drinking, urination, and weight loss.

 

Type-2 Risk Factors

 

Major risk factors for type-2 diabetes are

• Age greater than 45 years

• Weight greater than 120% of desirable

• Type-2 diabetes in a first-degree relative

• Ancestry: Hispanic, Native-American, African-American, Asian-American, or Pacific Islander

• High blood pressure or cholesterol-triglyceride problems

Diabetes during pregnancy or delivering an infant weighing more than 9 pounds

• Polycystic ovary syndrome

 

Complications of Type-2 Diabetes 

 

The death rate among people with diabetes is about twice that of people of the same age without diabetes. Some of the major complications of diabetes, fatal and otherwise, are diabetic retinopathy, end-stage kidney disease, neuropathy/vasculopathy, and cardiovascular disease.

 

Diabetic retinopathy is a major cause of blindness in adults; it accounts for 12,000-24,000 newly blind persons every year. However, laser surgery and appropriate follow-up care can reduce the risk of blindness from diabetic retinopathy.

 

About 44% of new cases of end-stage kidney disease in 2008, were among diabetics. That year, over 200,000 people with diabetes were on dialysis or had received a kidney transplant.

 

Diabetes is the leading cause of lower limb amputations not occasioned by accident. Diabetics have an estimated 15- to 40-fold increase in the risk of lower limb amputation over non-diabetics.

 

For coronary heart disease, the risk is 2-4 times greater among diabetics than among non-diabetics. Cardiovascular disease is the major source of mortality in patients with type-2 diabetes mellitus.

 

Prevention of Type-2 Diabetes

 

For prevention of type-2 diabetes in patients at risk (see “Risk Factors” above), the American College of Clinical Endocrinologists recommends

  •      • Weight reduction
  •      • Proper nutrition
  •      • Regular physical activity
  •      • Treatment of high blood pressure
  •      • Aggressive management of cholesterol-triglyceride problems

 

Weight management is especially important. In some overweight patients, a 5% body weight reduction maintained over three years was effective in reducing the diabetes risk by 58%.

 

While the Mediterranean diet receives most of the good publicity, it seems that any balanced diet, with good calorie management, satisfies the proper nutrition requirement.

 

A worthwhile recommendation for regular physical activity is 30 minutes of aerobic activity five times weekly.

 

For the treatment of high blood pressure and the management of cholesterol-triglyceride problems, the primary care physician now has substantial options to balance good control with safety and comfort.

 

Treatment of Type-2 Diabetes 

 

The goals of treatment are to reduce the risk of complications affecting the eyes, kidneys, nerves, blood vessels, and heart. The foundations of treatment are lifestyle changes involving diet, exercise, and health education. The risks of complications are further reduced by medications to control blood pressure and cholesterol/triglyceride problems. 

 

There are now multiple medications to control blood sugar levels. Frequently, oral medications are sufficient. These can work by decreasing the liver’s production of glucose, decreasing intestinal absorption of glucose, improving the body’s sensitivity to insulin, or increasing the secretion of insulin. Some promote glucose excretion by the kidneys.

 

Injectable medications are also available. These may stimulate insulin release in response to food ingestion and may prolong the life of insulin-secreting cells in the pancreas. These injections may need to be administered anywhere from twice daily to once weekly. They may be used alone or in combination with oral medications or insulin.

 

Insulin is typically associated with type-1 diabetes, but can also be useful in type-2 diabetes. Varieties include rapid-acting, short-acting, intermediate-acting, long-acting, and ultra-long-acting. These have durations anywhere from 3-5 hours to 24-42 hours. Finally, an inhaled insulin powder now exists that is rapid-acting and is taken just before a meal.

 

Many options for treatment exist and the physician can design an appropriate one for the individual patient. The goal is to find a treatment that controls the disease, that fits the patient’s life, and that can be continued over a lifetime.

 

Conclusion

 

In brief, type-2 diabetes is a widespread problem in the US. It is increasing among adults and young people as the obesity epidemic prevails. Type-2 diabetes has life-shortening and life-curtailing complications. The cornerstone of treatment is a change in lifestyle. Aiding this is a growing list of medication options. The key for patients is to work with their physician to plan a treatment that works, that fits, and that endures.

 

 

Thomas Falasca, DO

  • Thomas Falasca, DO

 

References 

 

Aathira, R., & Jain, V. (2014, October 15). Advances in management of type 1 diabetes mellitus. Retrieved from https://www.wjgnet.com/1948-9358/full/v5/i5/689.htm

 

Bullard, K. M., Cowie, C., & Lessem, S. (2018, March 29). Morbidity and Mortality Weekly Report (MMWR). Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a2.htm

 

Khordori, R. (2019, February 26). Type 2 Diabetes Mellitus. Retrieved from https://emedicine.medscape.com/article/117853-overview

 

Statistics About Diabetes. (n.d.). Retrieved March 1, 2019, from http://www.diabetes.org/diabetes-basics/statistics/

 

 

 

Avoiding Infections

An ounce of prevention is worth a pound of antibiotics. Preventive hygiene is still the best way to avoid infectious ...See More


Avoiding Infections

Avoiding Infections 

 

 

In the past century, science and medicine have provided many weapons to use on infectious diseases. There are antibiotics for many bacterial diseases, antivirals for some viral diseases, antimycotics for many fungal diseases, and even surgery for localized infections. But, the best way to deal with an infectious disease is still not to have it. Prevention remains a tool against infectious disease, indeed, a most efficacious tool with few drawbacks except the modest energy needed to employ it. 

 

 

Hand Washing

We touch our hands to our faces, according to some studies, an average of 20 times per hour. But the mucous membranes of eyes, nose, and mouth provide easy access to the body for germs, especially for viruses because of virus’ small size. It would be best for us to keep our hands away from our faces, even when the hands appear clean. However, this is sometimes not practical. Consequently, hand washing is important.

 

According to the Centers for Disease Control (CDC), frequent hand washing in a community reduces diarrheal illnesses by 31% and respiratory illnesses by 21%.

             

 

How to Wash Your Hands

Hand washing is not always intuitive.

 

First, use plenty of warm, running water and sufficient soap. At faucet temperature, the warmth of the water is not sufficient to kill germs, However, it renders hand washing more comfortable and, therefore more likely to be maintained for a time sufficient to be more effective.

           

Second, use sufficient soap and rub hands together. The idea is not to kill germs, but to remove them. The soap loosens germs from the skin and the rubbing dislodges them for carrying away by the water. Be sure to wash front and back, all fingers, between the fingers, and under the nails for at least 20 seconds. Twenty seconds is about the time it takes to hum two repetitions of the Happy Birthday Song.

 

Third, for drying, cloth towels may transfer other people’s germs. Better are electric hand dryers as found in public restrooms. To further avoid transferring germs to your hands, press the dryer’s on-off switch with your elbow. Nevertheless, paper towels, although the least ecological hand-drying option, are the most hygienic. Be sure to use a dry paper towel to turn off the faucet and to touch the door handle when leaving a public restroom. If there is no used paper towel depository by the door, let the paper drop to the floor, the maintainers of the public restroom will get the message to provide a depository.

 

When to Wash Your Hands

Although frequent hand washing is important, there are times when it is essential, such as

 

Before 

  •      Touching your mouth, including eating, drinking, and tooth brushing.
  •      Helping a sick person.

 After

     Using the bathroom.

     Changing diapers.

      Touching high-hand contact surfaces such as doorknobs, elevator buttons, handrails, and poles and handles on busses, trains,             

          and subways.

     Helping a sick person.

     Blowing your nose.

     Touching an animal, animal feed, or animal waste.

     Touching garbage.

     Tying shoes.

 

Before and after

     Helping a sick person.

     Treating a cut or wound.

     Preparing food.

 

Unfortunately, in some investigations, only 31 percent of men and 65% of women washed their hands after using a public restroom.

 

Hand Sanitizer

Hand sanitizers are a potent hygienic weapon when hand washing is not available. However, while hand washing removes germs and harmful chemicals, hand sanitizers only inactivate some of the germs. Hand sanitizers are less effective when hands are visibly dirty or greasy as the dirt can protect the germs from best contact with the sanitizer. Further, it is senseless to use the sanitizer to smear dirt more widely!

 

As with hand washing, rub front and back of hands, all the fingers, between the finger, and under the nails. Rub until the hands are dry.

 

Sanitizers should contain at least 60% ethyl alcohol, which inactivates germs by denaturing the proteins of bacteria and viruses. This only takes about 15 seconds. Unfortunately, sanitizers do not work well against norovirus, which is the most common cause of gastrointestinal illness in the United States.

 

Children should use hand sanitizers only with adult supervision as swallowing hand sanitizers can cause alcohol poisoning. Children may be particularly likely to swallow hand sanitizers that are scented, brightly colored, or attractively packaged. Hand sanitizers should be stored out of the reach of young children.

 

Fingernails

Fingernails can provide a cozy place under which germs can hide. Fingernails should be kept short, and the undersides should be cleaned frequently with soap and water. Finally, keep any remaining germs away from the mucous membranes of the mouth by not biting fingernails.

 

Routine fingernail care should also be done hygienically. Before use, nail clippers and files should be properly cleaned, even sterilized, if used among a number of people, as in a nail salon. Also, cuticles act as barriers to infection; avoid cutting or disrupting them.

 

In the Kitchen

The kitchen sink can be a source of spread for many germs. The kitchen floor just in front of the sink often has more bacteria than the trash can. Washing chicken in the sink can transfer intestinal germs such as campylobacter or salmonella from hands to sponges and to faucet handles. The sink should be washed often with special attention to faucets. Wet sponges can be sterilized by placing in the microwave for two minutes.

 

In the Bathroom

Flushing a toilet can disperse bacteria into the air and contaminate anything within a three-foot radius. Because of this, it is important to close the lid before flushing and to keep toothbrushes away from this radius.

 

Sharing cosmetics may result in sharing bacteria. Sharing toothbrushes can pass on such blood-borne viruses as hepatitis B and C, and infectious mononucleosis. Sharing razors may share MRSA (methicillin-resistant staph aureus) as well as blood-borne viruses.

 

Since children, and some adults, may not be conscientious about bathroom hygiene, it is essential to frequently clean bathroom light switches and door handles.

 

At the Front Door

Taking off shoes on entering the home and leaving them at the door keeps the house cleaner and avoids tracking in allergens and germs.

 

Although entering the front door in winter conveys a sense of warmth and comfort, the truth is that when the cool air in the house is heated, even with a substantial humidifier, it becomes capable of absorbing more moisture. It thus dries out the mucous membranes of the home's inhabitants, increasing violation of the mucous membranes by germs.

 

Disinfectants

Bleach contains hypochlorous acid, which attacks proteins in bacteria and some viruses. It is a powerful disinfectant, said to be about 99% effective.

 

Vinegar, thanks to its content of 5% acetic acid, is a disinfectant said to be 90% effective against bacteria and 80% against viruses. It kills flu virus but not staph. Although less effective against bacteria than bleach, it is cheap, nontoxic, and biodegradable.

 

Electronic Devices

Electronic devices can be an unsuspected source for germ transfer. One research project found thousands of bacteria on an Amtrak touch screen in the train station. Cold and flu germs can live on such hard surfaces for up to 48 hours. Swine flu has been shown to survive in this environment for up to five days. Hand washing, or at least hand sanitizer use, is essential after use of public touch screens.

 

Even personal electronic devices can transfer germs. One study showed 16% of cell phones to be contaminated with intestinal bacteria. It is imperative to clean the phone regularly, especially after lending it to someone, and to be careful where laying it down.

 

On Airplanes

Despite the public perception that the major airplane exposure is breathing recirculated contaminated air, the air in a plane is well-protected by high-efficiency filters, which remove more than 90 percent of known particulate matter.

 

A bigger concern than recirculated germs is low cabin humidity, about 10% when flying at 30,000-35,000 feet. This dries the mucous membranes of the noses and throats of passengers. Consequently, the mucus becomes too thick for easy movement and it remains longer in the upper respiratory tract. This gives entrapped germs more time to penetrate the passengers’ mucous membranes.

 

The most significant airborne exposure on a plane comes from fellow passengers. The most dangerous neighbors on a plane are those sitting within a two-seat radius since bacteria and viruses from coughs and sneezes do not readily transmit more than six to eight feet.

 

Airborne exposures aside, the usual concerns about contact surfaces remain, also on a plane. The worst exposure is the airplane bathroom, which has the exposures of other bathrooms but complicated by smaller space. Other important contact exposures on an airplane are seat-back trays and aisle-seat handles.

 

In a Hotel

Hotels are in the hospitality business and usually try to present a clean appearance. Nevertheless, germs are frequently abundant on bedspreads due to the difficulty in cleaning them. Light switches and bathroom floors are often contaminated with intestinal bacteria. However, the dirtiest site in the hotel room is usually the TV remote control.

 

Meanwhile, in the hotel restaurant, menus are the biggest carriers of germs, followed closely by the pepper shakers.

 

At the Gym

Keeping any cuts or injuries fully covered is imperative when working out at the gym. It is also essential to use the solutions and towels provided to wipe down the equipment before using it.

 

Plantar warts virus and athlete’s foot fungus can easily infect those going barefoot on gym floors and locker rooms. Wearing shower shoes in the shower and locker room is critical.

 

For yoga aficionados, it is important to bring one’s own yoga mat and to wear socks when not on it. 

 

At Work

One of the most important rules to follow for work is not to go if you are contagious. This rule is becoming easier to follow now that there are increased opportunities to work from home.

 

If someone at work is coughing or sneezing, maintain a social distance; as mentioned, six to eight feet is usually sufficient.

 

Other precautions to observe at work are

  •      Covering coughs and sneezes.
  •      Washing hands frequently.
  •      Regular cleaning of often-touched surfaces.

 

Flu Shot

Since meticulously following all of these precautions is not always possible, it is important to get an annual flu shot. The flu virus spreads from person to person through droplets coming from the nose and mouth when a contagious person coughs, sneezes, or talks. The flu virus may also spread when someone touches a surface with flu virus on it, and then touch their eyes, nose, or mouth. An annual flu inoculation helps protect from these exposures.

 

Conclusion

Again, the best way to deal with an infectious disease is not to have it. Prevention is a most efficacious tool with few drawbacks except the modest energy needed to employ it. 

 

Thomas Falasca, DO

 

Sources and Recommended Reading

Centers for Disease Control and Prevention. https://www.cdc.gov.

Fox, B. (2015). Introduction to Infectious Diseases. Chantilly, VA: The Great Courses.

Handwashing: Clean Hands Save Lives. (2018, October 09). Retrieved from https://www.cdc.gov/handwashing/index.html

Water, Sanitation & Environmentally-related Hygiene. (2011, February 01). Retrieved from      

     https://www.cdc.gov/healthywater/hygiene/hand/handwashing.html

Water, Sanitation & Environmentally-related Hygiene. (2009, December 30). Retrieved from  

     https://www.cdc.gov/healthywater/hygiene/hand/nail_hygiene.html

High Blood Pressure

High blood pressure afflicts 75 million adults in the United States and the prevalence dramatically increases in pati ...See More


High Blood Pressure

Incidence

High blood pressure afflicts 75 million adults in the United States and the prevalence dramatically increases in patients older than 60 years. In the African-American population, high blood pressure is more common, more severe, develops earlier in life, and has more long-term serious consequences.

 

Definition

The medical term for high blood pressure is hypertension. but ongoing high blood pressure is really not a matter or "feeling tense." High blood pressure, or hypertension, is the pressure inside of the arteries during heart contraction and between heart contractions. The pressure during contractions is the diastolic pressure, the lower number.

 

Normal blood pressure varies, but normal blood pressure would be 120/80. High blood pressure exists when the systolic number is consistently 140 or above, or the diastolic number is consistently 90 or above, or the person is taking blood pressure medication.

Consequences

High blood pressure is a major risk factor for stroke, myocardial infarction, heart failure, vascular disease, and chronic kidney disease.

 

For every 20-point systolic or 10-point diastolic increase in BP above 115/75, the is a doubling of the death rate for both ischemic heart disease and stroke.

 

Hypertension, within 5 years of its diagnosis, increases the risk of diabetes 2.5 times.

 

African-Americans with hypertension have a 1.5-fold higher risk than hypertensive whites of fatal stroke and a 4.2-fold higher risk of end-stage renal disease.

 

Causes

The causes of most cases of adult hypertension are still unknown.

 

Some cases of high blood pressure are caused by toxins, herbals, and drugs. the most common offenders are alcohol, cocaine, nicotine, ephedra, licorice, some nasal decongestants, cyclosporin, and some of the ibuprofen-type drugs.

 

A common cause of hypertension may be oral contraceptive use. Up to 5% or oral contraceptive users may develop hypertensions. The risk is higher for obese women, those with mild kidney disease or a family history of hypertension, and for those over 35 years of age.

 

Obstructive sleep apnea is another common cause of high blood pressure. These persons have 10 or more episodes per hour of sleeping during which their breathing stops or diminishes to a very low level. Frequently these people exhibit a large neck circumference, unusual snoring, and excessive daytime sleepiness. Treatment of the condition with positive pressure oxygen masks, position adjustments, or dental appliances effectively lowers the blood pressure.

 

Less frequent causes of hypertension are adrenal tumors, kidney disease, underactive thyroid, and overactive thyroid or parathyroid.

 

Treatment

The good news is that hypertension is effectively treatable and that many of the long-term consequences are avoidable. However, hypertension is a chronic condition and treatment and control requires long-term adherence to lifestyle modification and/or medication regimen.

 

Lifestyle Modification

Lifestyle modification is most effective when 2 or more modifications are combined. Modifications to consider are:

  • Weight Loss - A weight reduction of 22 pounds can lower systolic blood pressure by 5-20 points.
  • Reduce Sodium -  Limiting salt to no more than 6 grams (1 teaspoon) daily can lower systolic pressure by 2-8 points.
  • Limit Alcohol -  Limiting alcohol to 1 ounce daily for men or 1/2 ounce daily for women can achieve a systolic blood pressure reduction of 2-4 points. One ounce of alcohol is approximately equal to 24 ounces of beer or 10 ounces of wine.
  • Ensure adequate intake of potassium, calcium, and magnesium.
  • Stop Smoking
  • Exercise - 30 minutes daily of aerobic exercise can reduce systolic blood pressure by 4-9 points.
  • Healthy Diet -  Eating a diet rich in fruits, vegetables, and low-fat dairy products can lower systolic blood pressure by 8-14 points.

Medication

Your physician had more medications than ever from which to choose the right one for your individual blood pressure problem. the right choice depends on your age, the severity of your hypertension, your other medications, your other medical problems, and previous medication intolerances.

 

More than one medication may be appropriate, because the severity of the hypertension, because they work better together, or to reduce side effects from a larger dose of a single drug. Some medications even work better in African-American patients!

 

Conclusion

Hypertension can be a silent killer, stalking you when you don't "fell tense." Learn whether your blood pressure is normal. If it is not, see your doctor. Treat it seriously. Treat it for life and enjoy the healthy years ahead.

 

Thomas Falasca, DO

View this interesting video on high blood pressure - causes, symptoms, and treatment!

 

 

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