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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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12:48 PM
January 11th, 2019

Restless Legs

 

Restless Legs and You

 

Definition

Restless legs syndrome (RLS) is an almost irresistible urge to move the legs. It is not described as painful but can be distinctly bothersome or even excruciating. The symptoms occur when the subject is resting or otherwise inactive, such as in an airplane or movie theater. Restless legs are relieved partially and only evanescently by walking or stretching.

 

Prevalence

RLS affects 5-15% of the US population. Overall, it is about twice as common in women as in men. Restless legs can occur at any age but is more frequent and often becomes more severe after the age of 45.

 

Cause

The cause of most RLS is unknown but there are some associations. Heredity predisposes toward RLS, which is familial in 25-75% of cases; nevertheless, there is no genetic test. Pregnancy also predisposes, and RLS may affect 20-45% of pregnant women.

 

RLS is also associated with folate or magnesium deficiency, diabetes, Lyme disease, and B12 deficiency.

 

Finally, restless legs is associated with kidney disease and iron deficiency. RLS may subside after kidney transplant in patients with kidney failure. Treatment with iron may improve patients whose RLS results from iron deficiency.

 

Course

RLS for which no cause has been identified can usually be treated only symptomatically, not definitively. Although there are remissions lasting days, weeks, months, or even years, such RLS may gradually worsen with age, becoming more frequent and more severe, occasionally involving the upper extremities.

 

Treatment

The most frequent drugs used to treat RLS are the anti-seizure drugs gabapentin and pregabalin or the anti-Parkinson drugs ropinirole, pramipexole, and rotigotine.

 

Non-drug therapies also contribute to the therapy of RLS. Avoiding alcohol, caffeine, and tobacco is suggested, along with the establishment of regular sleep patterns. Moderate exercise, but not just before bed, is also thought to be helpful. Additionally, a warm bath at bedtime as well as leg massage may help.

 

Of course, if symptoms are mild or infrequent, treatment may not be needed.

 

 

Thomas Falasca, DO

 

Further Information

Further information is available at

 

BRAIN

P.O. Box 5801

Bethesda, MD 20824

800-352-9424

www.ninds.nih.gov

 

National Sleep Foundation

1010 N. Glebe Road, Suite 310

Arlington, VA 22201

703-243-1697

www.sleepfoundation.org

 

Restless Legs Syndrome Foundation

3006 Bee Caves Road, Suite D206

Austin, Texas 78746

512-366-9109

www.rls.orgrls.org

 

References

Bozorg, A., & Benbadis, S. (2019, June 25). Restless Legs Syndrome. Retrieved from https://emedicine.medscape.com/article/1188327-overview

 

Restless legs syndrome fact sheet (2001). Bethesda, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health.

 

 

 

 

 

 

 

 

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Protect Yourself from Corona Virus

Protect Yourself and Others from Coronavirus ...See More

Protect Yourself from Corona Virus

Protect Yourself and Others from Coronavirus

 

Here are the simple steps to take for protection from coronavirus.

  •  

    1. Wash hands frequently, especially after sneezing, coughing, blowing the nose, or touching common surfaces as door handles, keyboards, public touch screens, etc.
    2. When possible, sneeze or cough into a tissue and dispose of it safely and immediately.
    3. Wear disposable gloves and change them frequently if there is a need to frequently touch common surfaces.
    4. Avoid coming within three feet of others. Six feet is better even if impractical.
    5. Use disinfectant wipes often on any frequently touched surfaces.
    6. Those over 65 years old should stay at home if there is an epidemic.
    7. At present, masks are helpful only (1 When used by infected people to avoid spreading contagion, and (2) When used by physicians, nurses, and others having very high exposure to potentially infected people.                                                                                                                                                                                                                  
  •  

    While it may not be possible to observe all these precautions all of the time, following them as much as possible, as often as possible, will increase safety from corona virus.

     

    Thomas Falasca, DO

Coronavirus - Latest from CDC Centers for Disease Control

Coronavirus - Latest from CDC Centers for Disease Control ...See More

Coronavirus - Latest from CDC Centers for Disease Control

 

2019 Novel Coronavirus (2019-nCoV) Situation Summary

This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance.

Updated February 7, 2020

 

Background

CDC is closely monitoring an outbreak of respiratory illness caused by a novel (new) coronavirus (named “2019-nCoV”) that was first detected in Wuhan City, Hubei Province, China and which continues to expand. Chinese health officials have reported tens of thousands of infections with 2019-nCoV in China, with the virus reportedly spreading from person-to-person in parts of that country. Infections with 2019-nCoV, most of them associated with travel from Wuhan, also are being reported in a growing number of international locations, including the United States . Some person-to-person spread of this virus outside China has been detected. The United States reported the first confirmed instance of person-to-person spread with this virus on January 30, 2020.

 

Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with MERS, SARS, and now with 2019-nCoV .

 

Source and Spread of the Virus

2019-nCoV is a betacoronavirus, like MERS and SARs, both of which have their origins in bats. The sequences from U.S. patients are similar to the one that China initially posted, suggesting a likely single, recent emergence of this virus from an animal reservoir.

 

Early on, many of the patients in the outbreak of respiratory illness caused by 2019-nCoV in Wuhan, China had some link to a large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Chinese officials report that sustained person-to-person spread in the community is occurring in China. Person-to-person spread has been reported outside China, including in the United States and other countries. 

 

Situation in U.S.

Imported cases of 2019-nCoV infection in travelers have been detected in the US.  Person-to-person spread of 2019-nCoV also has been seen among close contacts of returned travelers from Wuhan, but at this time, this virus is NOT currently spreading in the community in the United States.

 

The US government has taken unprecedented action related to travel in response to the growing public health threat posed by this new coronavirus, including suspending entry in the United States of foreign nationals who have visited China within the past 14 days. Measures to detect this virus among those who are allowed entry into the United States (U.S. citizens, residents and family) who have been in China within 14 days also are being implemented.

 

Illness Severity

Both MERS and SARS have been known to cause severe illness in people. The complete clinical picture with regard to 2019-nCoV is not fully understood. Reported illnesses have ranged from mild to severe, including resulting in death. This is a rapidly evolving situation and information will be updated as it becomes available.

 

Risk Assessment

Outbreaks of novel virus infections among people are always of public health concern. The risk from these outbreaks depends on characteristics of the virus, including how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications).

 

The potential public health threat posed by 2019-nCoV virus is high, both globally and to the United States. The fact that this virus has caused illness, including illness resulting in death, and sustained person-to-person spread in China is concerning. These factors meet two of the criteria of a pandemic. It’s unclear how the situation will unfold, but risk is dependent on exposure. At this time, some people will have an increased risk of infection, for example healthcare workers caring for 2019-nCoV patients and other close contacts of 2019-nCoV patients. For the general American public, who are unlikely to be exposed to this virus, the immediate health risk from 2019-nCoV is considered low at this time.

 

What to Expect

More cases are likely to be identified in the coming days, including more cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in the United States.

 

  • On January 27, 2020, CDC issued updated travel guidance for China, recommending that travelers avoid all nonessential travel to all of the country. 
  • The U.S. government has taken unprecedented steps with respect to travel in response to the growing public health threat posed by this new coronavirus:
    • Effective February 2, 2020 at 5pm, the U.S. government suspended entry of foreign nationals who have been in China within the past 14 days.
    • S. citizens, residents and their immediate family members who have been in Hubei province and other parts of mainland China are allowed to enter the United States, but they are subject to health monitoring and possible quarantine for up to 14 days.
    • CDC has developed a real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test that can diagnose 2019-nCoV in respiratory and serum samples from clinical specimens. On January 24, 2020, CDC publicly posted the assay protocol for this test.
  • CDC has been uploading the entire genome of the viruses from reported cases in the United States to GenBank as sequencing was completed.
  • CDC has grown the 2019-nCoV virus in cell culture, which is necessary for further studies, including for additional genetic characterization. The cell-grown virus was sent to NIH’s BEI Resources Repository for use by the broad scientific community.

CDC Recommends

  • While the immediate risk of this new virus to the American public is believed to be low at this time, everyone can do their part to help us respond to this emerging public health threat:

 

  •      It’s currently flu and respiratory disease season and CDC recommends getting a flu vaccine, taking everyday preventive actions to help stop the spread of germs, and taking flu antivirals if prescribed.
  •      If you are a healthcare provider, be on the look-out for people who recently traveled from China and have fever and respiratory symptoms.
  •      If you are a healthcare provider caring for a 2019-nCoV patient or a public health responder, please take care of yourself and follow recommended infection control procedures.
  •      For people who have had close contact with someone infected with 2019-nCoV who develop symptoms, contact your healthcare provider, and tell them about your symptoms and your exposure to a 2019-nCoV patient.
  •      For people who are ill with 2019-nCoV, please follow CDC guidance on how to reduce the risk of spreading your illness to others. This guidance in on the CDC website.

Vaping and Lung Damage

Centers for Disease Control (CDC) and Food and Drug Administration (FDA) have warned  ...See More

Vaping and Lung Damage

 

Vaping and Lung Damage

 

On September 6, 2019, the Centers for Disease Control (CDC) and Food and Drug Administration (FDA) issued a clear warning about lung toxicity related to e cigarette use. They along with state and local health departments are investigating the cause or causes of this potentially life-threatening disease. The investigation stems from a study of 53 patients from the states of Illinois and Wisconsin who presented to the hospital with lung and gastrointestinal symptoms. A third of those patients required mechanical ventilation and one death were reported in this study. The median age was 19 years.

 

E-cigarette, or more colloquially vaping, usage especially among adolescents has increased exponentially. Recent studies from Monitoring the Future, a 44 year old study, show that the increased prevalence of vaping represents the largest increase in risky behaviors since the initiation of monitoring.  Although used as a means to transition from cigarettes, use of the nicotine still carries with it the risk of addiction.

 

Investigations into the cause of lung toxicity are ongoing, but there are several clues at this juncture. The presence of tetrahydrocannabinol (THC) usage by users and use of black market devices and flavorants appear to be the focus of current investigations. More information will be forthcoming. For now, despite the use as a means of tobacco cessation, it is wise to avoid vaping until investigators have clarified more clearly the cause or causes of lung toxicity. At the same time it is important to continue to remain tobacco-free given the heart, lung and stroke risks which are clearly present.

 

Jeff McGovern, MD

Jeffrey McGovern, MD, FCCP, FAASM

Hand Washing and Avoiding Infections

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

Hand Washing and Avoiding Infections

Hand Washing and 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

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