Saturday, October 29, 2011

And now for Something Completely Different--Vaccine Preventable Diseases


Meningococcal Meningitis
The measles in a 2 year old.
German Measles (Rubella) 
Chickenpox in adults can spread to the lungs and kill adults and children alike
Cervical Cancer from HPV
 I have a friend who just had a stem cell transplant for CLL.  Please read this blog entry.  He put forth the need for vaccinations better than anything I’ve ever seen by making it personal. His whole blog rocks though...:  Journal from the Plague Year:

http://journalfromtheplagueyear.blogspot.com/2011/10/herd-immunity.html

The Diseases:
Influenza:

Influenza disease:  is a respiratory virus that causes a high fever, generally 102, although not all will get a fever,  severe muscle aches and pains,  stuffy nose, sore throat, fatigue, and cough.  Some people get vomiting and diarrhea, but that is more common in kids.
Complications which can occur include post influenza pneumonia, bronchitis, ear infections and sinus infections and death.
People with the following problems are at higher risk:   asthma or COPD/emphysema, Diabetes, those over 65, pregnant women, People with HIV/AIDS, people with cancer. children younger than 5 and especially younger than 2.


Measles:

There is an unexpectedly high number of cases in the US this year.  Measles had been declared eradicated in the US in 2000.  The cases are imported from abroad where the disease is still rampant.  These unvaccinated US travelers got sick and brought it back to the US and spread the disease in our communities because NOT ENOUGH people are vaccinated now.  Most of the people who got sick in the US from these people were unvaccinated or under vaccinated.

Measles causes fever with rash, cough, runny nose, conjunctivitis.  One out of 10 kids get an ear infection and 1 out of 20 get pneumonia.  For every 1000 children who get measles, one or two die.

Measles is preventable by taking a vaccine. From the following CDC.gov website:
http://www.cdc.gov/measles/vaccination.html#coverage

“Measles can be prevented by the combination MMR (measles, mumps, and rubella) vaccine. In the decade before the measles vaccination program began, an estimated 3–4 million people in the United States were infected each year, of whom 400–500 died, 48,000 were hospitalized, and another 1,000 developed chronic disability from measles encephalitis. Widespread use of measles vaccine has led to a greater than 99% reduction in measles cases in the United States compared with the pre-vaccine era, and in 2009, only 71 cases of measles were reported in the United States.
However, measles is still common in other countries. The virus is highly contagious and can spread rapidly in areas where vaccination is not widespread. It is estimated that in 2008 there were 164,000 measles deaths worldwide—that equals about 450 deaths every day or about 18 deaths every hour.”

Go to the CDC website to read about the vaccine.  It does not cause autism.

Mumps:
There is an ongoing outbreak of mumps in highly observant Jews in Orange County, NY and in NJ. This is a community where there was a high amount of vaccination with 1-2 doses of MMR.  Turns out the mumps vaccine isn’t as effective so in order to prevent person to person spread, you need to make sure even MORE people are vaccinated with 2 vaccine doses.  In this outbreak, they were giving a 3rd dose of MMR to increase the immune response in the schools affected.  It didn’t spread much outside the observant Jewish community.  Speculation includes that possibly the surrounding communities had a higher vaccination rate, or there just wasn’t much intermingling of the affected community with their surrounding non Jewish neighbors.
This article explains it well.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5905a1.htm

Mumps causes fever, headache, muscle aches, tiredness, loss of appetite and swollen and tender salivary glands under the ears or jaw on one or both sides (parotitis).  Most people fully recover. but boys who have reached puberty can get inflammation of the testicles, girls who have reached puberty can get inflammation of the ovaries or breasts.  Meningitis and encephalitis (brain infection) can occur.  Deafness can occur and may be permanent.  It is spread by saliva or mucous from the mouth, nose, throat.  It can be spread by sharing drinks, utensils, touching virally contaminated surfaces(counters, toys, doorknobs, toilet handle etc.).

HPV:
is the cause of cervical cancer in women and head and neck cancers in men.  It causes anal-rectal cancer in people who engage in anal intercourse.  It can cause throat infections through oral sex.  It can be passed through straight and gay sex.  Pregnant women can spread it to their babies during delivery causing warts to grow in the babies throats (Recurrent Respiratory Papillomatosis).  It also causes genital warts.  The types of HPV that cause genital warts aren’t the same as those that cause cervical cancer.
At least 50% of sexually active people will get HPV at some time.  In 90% of the cases, people clear the infection and are fine.  BUT there are over 40 HPV virus types.  Most people don’t even know they have an infection.
There is a vaccine available for boys and girls to prevent them from getting the types of HPV that can cause cancers.  Here is the link to the CDC website:
http://www.cdc.gov/std/HPV/STDFact-HPV.htm#common

Getting the vaccine does not mean that you are condoning premarital sex.  Where did that idea come from?  Would you deny your child Hepatitis B vaccine for that reason?  C’mon now.

DIPTHERIA:
Who’s ever heard of this?  You know why?  We practically never see it here because of immunization against it.  There are only about 5 cases a year in the United States.  It’s in the routine Tetanus vaccine.  In the 1990‘s, when they took it out of the tetanus vaccine in Russia  a while back, it made an amazing recovery and caused many cases and many deaths.  They used to call it the “strangling angel of children”.  It was a leading cause of death in children.
Diptheria is a bacteria that is spread by coughing and sneezing, or contaminated food or objects (milk, utensils).  It infects your throat and nose and causes a gray/black fibrous like covering which can block your windpipe and suffocate you.  It can cause skin infections like above.  Then, once it infects you, it makes a toxin (a chemical poison) that can spread to your heart and cause inflammation of your heart and other organs.  You turn blue, get a watery nasal drainage, have great difficulty breathing, get chills, a barking cough, drooling, fever, painful swallowing and skin lesions may occur in tropical areas of the world.


MENINGOCOCCAL MENINGITIS

Meningitis is an inflammation of the membranes which cover the brain and spinal cord.  Meningococcal meningitis is caused by a bacteria and occurs mostly in children and adolescents.  It is the most common cause of bacterial meningitis in children and the second most common cause of bacterial meningitis in adults.  It occurs in winter or spring and can cause epidemics in boarding schools, dorms, and miltary bases.
It causes sudden onset of fever and chills, altered mental status, nausea and vomiting, purple bruise like areas (purpura) and pinpoint red spots (petechiae), light sensitivity, severe headache, stiff neck, rapid heart rate, and rapidly progresses to death within 24 -48 hours.  The death rate varies from 5-15%.  Young children and adults over 50 are at highest risk of death.  It can cause permanent hearing loss, heart inflammation, seizures, brain damage, seizures, if you survive it.  It is preventable by getting the vaccine, washing hands before and after changing a diaper or after using the bathroom.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001633/

TETANUS

Also known as lockjaw.  It’s caused by a poison made by a bacteria called Clostridium tetani.  The spores live EVERYWHERE and can remain infectious for 40 years.  When the spore gets into a deep wound where there is little oxygen (hence “stepping on a nail” being a risk), the spore releases the bacteria which then makes a poison.  The poison stops the nerves from working and the muscles all over the body go into spasms so severe that they can tear muscles and break bones, especially in the spine.  It starts with mild spasms in the jaw (lock jaw).  The muscles in the chest, neck, back, and abdominal muscles can spasm too. “ Opisthotonus” is when all the back muscles spasm causing the back to arch and to break the vertebrae.
The spasms can affect breathing.  Loud noises can exacerbate the spasm.  They can have difficulty swallowing, uncontrolled urination and defecation, irritability, foot and hand spasms  and drooling.  Often you need to be in a dark room, on massive doses of muscle relaxers (valium like drugs), and to be on a breathing machine.
One out of four will die if not treated.  Newborns with untreated tetanus is even higher.  WITH treatment, < 10% die.

I’ve seen this in a patient from Mexico after childbirth and cutting of the cord with an unclean knife.
This disease is completely preventable with TdaP vaccine, dT vaccine boosters every ten years.  after the primary series is finished as a child.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001640/


SMALLPOX

Small pox is a virus that only infects humans and has been completely eradicated by vaccination.
The disease was eradicated by 1980.  Without vaccination, millions would still be dying from this terrible disease.  It is believed that Pharaoh Ramses V died of smallpox because of scars found on his mummy.  In the 18th century in Europe, 400,000 people died YEARLY of smallpox and 1/3 of the survivors went blind.  20-60% of the infected died from it.  It was 80-98% fatal in London and Berlin during the late 1800’s.
Here is a great article on the history of smallpox:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/


POLIO
Polio is a virus that can cause paralysis.  It is spread by person to person direct contact, mucous or phlegm, or feces.  It grows in your gut and then spreads to your blood and lymph and then causes symptoms.  Children, the elderly and pregnant women are at the highest risk during an outbreak.
Polio has virtually been eradicated in the US.  Outbreaks still occur in other countries amongst those not vaccinated.  It only exists in a few countries in Africa and Asia now.
It has two forms, paralytic, and nonparlytic.  It involves the brain and spinal cord.
It can cause back pain, diarrhea, fatigue, headache, irritability, leg /calf pain, moderate fever, muscle stiffness or pain or spasm, neck pain and stiffness, stiffness in arms, legs, abdomen, or back, rash, vomiting.
Paralytic polio causes abnormal sensations in an area, bloating, breathing problems, constipation, difficulty urinating, drooling, headache, muscle contractions, spasms, pain, and weakness that is only on one side or worse on one side.  stiff neck and back and difficulty swallowing.
I remember my father talking about not being able to go out to the pool because of outbreaks.



 
Polio NOW
Small pox affecting the eyes. It was around up until 1967 in millions
Tetanus in a baby...muscles all in spasm

Thursday, October 27, 2011

Plateau Formations

Plateaus, Plateaus Information, Facts, News, Photos -- National Geographic

I’ve reached a plateau.  If you read the above article by National Geographic, the definition of a geologic plateau is somewhat similar to my situation.  Over decades, forces have lifted up my adipose (fat) tissue and it’s been sculpted into mesas, buttes and canyons.  My butte has become quite massive.  My mesas are kind of lumpy, and my canyons, well, we’re in polite company here. 

The forces that cause a plateau seem to be enormous.  Magma erupts through the crust and forms large plateaus, like the Tibetan Plateau, or the Colorado Plateau.  I’ve just reached a previously unknown plateau (The Carlon Plateau) and the forces that have caused it are just as great.  Inactivity and Menopause.  Well, Perimenopause.  And the Internal Medicine Board.  I believe that the stressors to the plateau were definitely great. 

In the past, my buttes and canyons and mesas were easily worn down by decreasing my dietary intake and exercising.  I could lose twenty pounds easily.  I would lose at least 2 lbs a week and would be able to keep it off without any problems.  Unfortunately, the magma of menopause is fighting my metabolism.  (I always wondered why you got hot flashes-now I know!  It’s magma!)


According to the Mayo Clinic website: “In fact, some research suggests that gaining as little as 4.4 pounds (2 kilograms) at age 50 or later could increase the risk of breast cancer by 30 percent.”
 http://www.mayoclinic.com/health/menopause-weight-gain/HQ01076/NSECTIONGROUP=2

They stated that losing weight is definitely more difficult in the perimenopausal time frame.  Well, that just sucks.  I’ve reached 194 pounds and I’m stuck.  My clothes definitely fit better, and I feel better but I still am plagued by the American Board of Internal Medicine making me rush to finish a Patient Improvement Module or some such thing.  So, instead of free time to start exercising, I’m bringing home more and more work to do. 

The Mayo says that you have to become active.(needs improvement)  You need to decrease calories (done).  You need to have support.  (done--this blog is keeping me in line.  Thanks Guys!).  There is only one thing left to do. 
Damn.

Saturday, October 22, 2011

Chinese Take Out and The Compost Cake

The Actual Cake!
Not Our cake.  Pictures of our compost cake to come...Stay tuned.


I succumbed to exhaustion last night.  I ordered Chinese Take Out. 

Today, Saturday, is my Number One Son’s birthday.  We have a tradition of making each kid a birthday cake ON their birthday.  It started out when the kids were really small and I had a book of cool birthday cakes to make.  Each kid would pick out a cake and we would make it.  Stars, hearts, alien spaceships, desert Island cakes, Monkey heads (that was for my husband), dinosaurs, etc., have been the subject of a cake.  This year, my son wanted a cake that looked like a compost pile.  He had been planning this for MONTHS.  He designed it and got some more ideas from an internet compost cake (Yes, someone had already done it!)  Last night we realized we had to go to the grocery store and buy the ingredients to make the cake today. 

We hadn’t eaten dinner, and I was exhausted.  I knew that venturing into the grocery store was a dangerous event on an empty stomach.  I fortified myself with some cheese and steeled myself to venture down the aisles I never visit at the grocery store. 

Off we went.  The funny thing is, the kids were AMAZED at how much candy and junk food the grocery store sells because we just skip the two or three long aisles of “crap” when we shop.  We really do shop the perimeter of the grocery store and venture down only the frozen food and dairy aisles, and the paper goods and cleaning items aisles.  We had difficulty finding the stuff we needed because we didn’t know what aisle things would be in. 

We managed to purchase the cake mix, the icing, the pretzel rods, the gummy worms, the oreos (to crush into “dirt”), the vampire and wolfman gummies (it’s an unorthodox compost pile), and some Hersheys “drops” which look like rocks.  The kids then realized THEY were hungry and so we went to the Chinese Take Out in the strip mall to order some food. 

I was not starving.  That was good. 
Previously, in my “Before the Phone Call from My Doctor” Days, when we ordered Chinese, we would order 3 or 4 things and have leftovers for  a few days.  Usually we ordered deep fried stuff, stuff with nuts in it (Kung Pao) etc.

I was able to look at the menu and remember that fried, breaded, coated, and sweet and sour stuff were probably not kosher to eat on my new regime.  My daughter wanted egg drop soup, my son wanted Orange Beef (definitely NOT on the list of good stuff) and so I got the tofu and vegetables Yu Shan.  (brown sauce and spicy). 

Usually the danger is that I will fill my plate and have seconds because it tastes so good.  This time, I used a luncheon plate for myself, measured out (eyeballing it) the rice and only took 2 pieces of orange beef and filled the rest with the vegetables and tofu.  I had 1/2 cup of egg drop soup.  Then I cleaned up.  You see, if the food sits out, then it is really easy to have seconds, and to snack on the crab rangoon or the egg rolls.  Fortunately, fortune cookies are only 25-45 calories apiece! 
My daughter set her alarm to 6:30 this am to help me make the cake.  We’ll wait for my son to wake up in order to decorate the cake because therein lies the fun!

 I feel really bloated from all the salt in the food last night, and I’ll skip the scale and be happy with the 195 I got yesterday.  I am six pounds down from the doctor’s office scale.  Now I’ve got to find a way to exercise.

Thursday, October 20, 2011

The Best Laid Plans


The Triple Whammy

Yesterday was the Trifecta of bad days.  Poor sleep, stressful situation (the Boards Exam) and a short time to eat between sections.  Add the overwhelming exhaustion after I got home and didn’t feel like cooking and it could have been a disaster of a day for sticking to my new lifestyle modifications. 

I was absolutely exhausted before the test because I just couldn’t sleep.  Robert Burns Poem “To A Mousie” kept running through my head, “The best laid plans of mice and men often go askew”. 

I chugged iced coffee between the first and second parts of the test.  I was assailed by a food court of wonderful choices, some not so good for you.  I didn’t want to eat heavily and get post-prandial sedation, so I chose sushi.  I chugged another iced coffee.  On the way home, I stopped at an artisanal cheese shop and ordered goodies for the family to try (Camembert, 2 types of brie, a sheep's milk cheese from Wisconsin, some Spanish ham, and a baguette) but didn’t eat any until after dinner with the kids.  We ate leftovers while I stared at the wall and recovered.  I went to bed early. 

My husband is studying for the sleep boards.  He informed me that it is true that poor sleep causes weight gain.  Also, staying up late causes weight gain.  Many people snack when they stay up late.  Many eat to STAY awake.  Then, there are sleep eaters, more common on psychotropic drugs like ambien.  They eat but don’t remember it and they gain weight.  Sleeplessness slows down your metabolism, according to him, but I need to look that one up myself. 

In MY experience, when I’m exhausted, I just stop caring.  I will eat the easiest thing to eat just to get it over with.  Often, that means things which are easily attained, like ice cream, or take out.   If I hadn’t had the left overs from the weekend, I could have ruined my attempts quickly.

Tonight is my late night at the office.  Usually, I bring 2 lean cuisines, one for lunch, one for dinner, and some fruit or baby carrots to much on as a snack.  Unfortunately, my kids ate all the Lean Cuisines and there’s nothing to bring except left overs.  Juan will make shrimp tacos for the kids for dinner tonight.  I’ll probably bring the leftover flank steak in chili sauce and a couple of corn tortillas. 

But remember, The Best Laid Plans of Mice and Men....oft go askew.  Hopefully I won’t go askew. 


Here's a link to Robert Burns' poems:
http://www.robertburns.org/inenglish/extracts.shtml#toamouse

Wednesday, October 19, 2011

Potato Pancake Envy



Yesterday, the kids had Kasias’ Potato Pancakes for breakfast.  They looked and smelled really, really good.  I  wanted one.  I could have had ONE, but everyone knows you can’t just eat ONE potato pancake, and in addition, although they’re good with apple sauce, they’re GREAT with sour cream.  So, I walked away.  I had Potato Pancake envy. 

One small battle in the war won.  At least I haven’t insisted they eat brussel sprouts .

Today I'm taking my Boards Recertification Exam.  Think of me and wish me well.

Tuesday, October 18, 2011

The "Brussel Sprouts Incident"




My sister and I were talking yesterday about the time my mother got a bug up her butt that my sister HAD to eat the  brussel sprouts she’d served at dinner one night.  We think my sister may have been about six years old or so at the time of the “Brussel Sprout Incident”.  It was an early sign of things to come because my mother hadn’t counted on my sisters ability to be so obstinate.  Who feeds a six year old brussel sprouts and really expects them to LIKE them?  It takes introducing a food to a kid about 10 times before they like it, or so I’ve read. ( My kids will eat just about anything).  My sister refused to eat them.   Mom insisted.  Mom said she couldn’t leave the table until she’d eaten them.  Mom left her in the kitchen and turned out the light after we’d finished dinner, leaving her in the dark with her brussel sprouts.  “Even the dog wouldn’t eat them!”, she told me.  She sat there in the dark for 3 hours until my mother dismissed her to bed.  My sister still hates brussel sprouts.  (And she’s still obstinate).

 I suspect that brussel sprouts give her PTSD. 

Sunday, October 16, 2011

Elastic Recoil

recoil /re·coil/ (re´koil) a quick pulling back.

"elastic recoil -- the ability of a stretched object or organ, such as the bladder, to return to its resting position."
Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

One of the down sides of aging is that your body just doesn’t react the way it used to.  For example, it is a lot harder to get in shape, and to keep a shape. In other words, when we get older, our muffin top becomes a blob. 

When you are 20, your skin happily returns to it’s previous shape and maybe the only tell tale signs are some stretch marks.  Something really awful happens somewhere between 40 and 50.  Your elastic recoil, recoils. 

Suddenly, when you lose weight, instead of your abdomen and legs and arms going back to their usual normal shape, you have chicken wings, and loose wrinkly skin where you used to have a muffin top.  You look in the mirror and scream, “NO ONE TOLD ME ABOUT THIS!!!”   I look like my MOTHER!!!  What happened?

It’s like a pair of jeans getting fitted JUST for you , like a second skin, then suddenly you lose weight and they just don’t fit right.   That said, it’s much better to LOSE weight and get healthy if you’ve become overweight or obese as you’ve aged, and invest in “foundation garments” to hold it all in.  I’m just glad they don’t kill whales anymore for the “whale bone”  in said garments.


BTW, all of those lotions and creams and supplements do nothing for "cellulite" and lumpy skin.  The elastin is deep in the dermis where lotions and creams don't go.  So I guess the only thing to do is to exercise!
Boards are in 3  days.  Wish me luck.  I will start to exercise after the Board exams are done!  I need to banish my chicken wings and firm up my muffin top.  Oh let's face it, it's an entire muffin!