Back to School

It’s that time of year in NYC (I know other parts of the country already started) when buses are filled with children sporting back packs, tales of summer vacation are told and germs are spread.
In my office, it is also the time of year in which adults get re-exposed to germs they haven’t seen in years – the kids get a sniffle at best, and the adults (especially new teachers) feel like they’ve been hit by a Mack truck! Why is this?  What is it about “kid germs” that affect adults so severely?
The reason for this comes from our immune systems. The fevers we get and the aches we feel are a result of our bodies response to the infection. The more our immune systems get activated – the worse we feel!
Our immune systems develop memory. That’s why you only get certain diseases once. If you are exposed again later in life – the memory of the infection may have faded – and your body responds in full force.  When you are exposed to similar infections multiple times – or if you are vaccinated against a disease you body can respond faster and with less inflammation – and you don’t feel sick!  An MMR – measles, mumps, rubella – vaccine given in childhood and an adult booster gives enough immune memory to last a lifetime.
To help stop the spread of these infections basic hygiene is our best defense – HAND WASHING with soap and water or hand sanitizer.  Covering our mouths when we cough and sneeze; and taking our FLU SHOTS.
I wrote about flu shots last year.  Recent politics aside, there is no danger of getting the flu from the flu shot.  There can be side effects, depending on if you have an infection brewing or how strongly your immune system reacts to the shot, but there is no live virus in the vaccine to transmit disease.
The strains in this years flu shot are different from last year, and early reports show a good match between flu strains we are starting to see in the public and what is in the shot.  So get your flu shot, and feel better through the season!

Personalized Medicine isn’t necessarily Personal

3 months ago our family dog got sick.  Her liver was very inflamed.  The evaluation revealed copper deposits in her liver.  This was likely due to a genetic defect – very common in several breeds in dogs, but not common in hers.  Despite efforts to remove the copper with medication, the damage was too severe, and we lost her about a month ago.
This prompted some research into her family history – one “cousin” died from liver issues, but it was not known if it was copper related. There is a blood test that can see if a dog had the “copper” gene and my wife and I started discussing what we would have done differently if we had known.   
Since cloning the human genome, we have identified genes and mutations associated with cancer, drug sensitivities and the risk of other chronic conditions.  We have also identified mutations that may not have any impact on health, and others that the impact is unclear or unknown.
Using that genetic knowledge to direct diagnosis and treatment is called personalized or precision medicine. It was mentioned in the Federal Budget for 2016 and the National Institutes of Health is dedicating significant research money to it.  There have been several direct to consumer companies offering to read your DNA and tell you what diseases you are at risk for.

How is this done and what can you really learn?  

Precision Medicine assumes that by running a person’s DNA code you will get results that shows what diseases you are likely to get – heart disease, diabetes, cancer, etc.  For those diseases you already have, it can tell you which medications are most likely to be effective.  Plans can then be developed to treat illness and recommend screening programs based on one’s DNA code – offering medications with the best chance of success to those with the proper codes and not giving them to people who are not likely to respond or be at increased risk of toxicity.
There are already examples of this in use today.  We avoid medications in people with certain genetic markers because they are more susceptible to side effects (people may be more or less sensitive to certain blood thinners based on their DNA). Many cancers, from lung to breast to lymphoma and leukemia have genetic markers run to see what treatments are likely to work. Perhaps the most famous use of genetic testing determining treatment is Angelina Jolie.  She tested positive for the BRCA1 gene greatly increasing her risk of breast and ovarian cancer.  She then elected to have mastectomies and her ovaries and uterus removed before any cancer developed.
Genetic based diagnosis and treatment has the potential to change the way we evaluate risk and treatment.  However, checklist testing and treatment is not personal.  Blind application of data to a person without context (history) reduces medical care to algorithms and formula without the personalization it is supposed to offer. There is a social and ethical side to the use of genetic information that we are just beginning to understand, from privacy laws to insurance regulation to job security.  Would you hire someone you knew had an increased risk of and potentially expensive illness if you were responsible for paying for their care?  Would you marry someone knowing their illness potential?  Have children?  These are all issues that need to be sorted out as we move into this new paradigm for healthcare.
Most importantly, people need good information on what their tests mean.  Many of the kits available now report mutations that aren’t clearly associated with disease.  The FDA ordered one company to stop selling its test and services due to non-compliance with testing regulations.  They have since started selling a very specific test for a single condition, but not a general DNA analysis.  The next age of primary care will involve helping people curate and collate their genetic information.

Do I worry that the genetic classification of diagnosis and treatment will make me obsolete?  

To the contrary, I think it can make me better at what I do.  I already strive to get to know my patients, understand how health or lack thereof fits in the rest of their life.  We discuss risk for future disease, concerns about hereditary and what medicines are best for them.  That is personalized medicine.  Getting to know my patients at the genetic level can only strengthen that bond.  Using the information we get from genetic testing and putting it in the context of the person sitting across from me is how we put the Personal in Personalized Medicine.

The path to wellness begins with a proper diagnosis

Reality Check – why an Internist is important

It was a typical Monday for an Internist – lots of phone calls, catching up on results that came in over the weekend, a full office schedule.  I was about to go see my next patient when my assistant said that Dr. X was on the phone about a patient, could I take the call.  I popped into my next patient’s room and told them I’d be 2 minutes – they said no problem and I went to my office to take the call.

The call was from a sports medicine fellow working with a specialist that I’d sent Mr. Smith to (name changed).  I met Mr. Smith about 2 months ago, he had new onset high blood pressure and complained of back pain.  We’d started some blood pressure medication and he was seeing the sports medicine specialist to design an exercise program for his back.  He’d gotten an MRI as part of his evaluation, and instead of showing the expected herniated disc, it showed metastatic cancer – from where, we did not know.  We called Mr. Smith and had him come in the next day to review his scan.

I met with Mr. Smith and his wife the next day.  I took them through the scan findings, explaining what we could and couldn’t tell.  He told me his back wasn’t too painful, and the specialist was helping manage it.  We talked about a plan – blood tests and CT scans to find the source of the cancer.  I told them I’d speak to an oncologist – and arranged his appointment with him.

Two days later, I had the blood work and his CT results, and we met again.  The news was not good – there were extensive metastases in his spine and it looked like lung cancer – though we still couldn’t be sure.  I sat with the Smiths, and we discussed a plan.  They’d be seeing the oncologist in a couple of days, I’d already sent there results over.  We discussed the next steps, what the oncologist would likely do next.  We talked about how he hadn’t been sleeping well, and that I could help with that.

The Smiths left – and I was drained.  It was very emotional telling someone who felt fine they have metastatic cancer.  Yet we both left the encounter optimistic.  The Smiths understood they have an uphill battle, but together they felt informed, guided and supported.

How Mr. Smith does is mostly out of my hands – yet I know I played a huge roll in getting them ready.  I did all the things I love about medicine – bonded with a patient, made a diagnosis, educated them and got them ready for the next steps.  This is Internal Medicine, and why I do what I do.

E-cigarettes – deterrent or path to addiction

Recently, the CDC published its 2014 National Youth Tobacco Survey – which looks at smoking in middle and high school students in the US.  As a physician, but more as a parent of a newly minted teenager, the results were of great interest – and concern.  While cigarette use declined in high school students, e-cigarettes and hookah use tripled – and surpassed cigarette use for the first time.  E-cigarettes are not regulated by the FDA or subject to current tobacco marketing laws – allowing companies to market directly to teens with flavors more like candy than tobacco – something traditional tobacco companies have not been able to do since the 1970s.
The increase is not surprising – e-cigarettes are marketed as safer, they are easier to access and less expensive than cigarettes.  The real question, and one that comes up frequently in the office, is if they can help people quit smoking regular cigarettes, and are they safer?

Are e-cigarettes safer? 

There is not great data available yet.  What we do know is that the vapor produced contains particles that can irritate the lungs, and that it contains chemical byproducts such as formaldehyde – but in much lower concentrations than traditional cigarettes.  They also contain nicotine, the same addictive drug in cigarettes.  Nicotine affects brain development, may promote tumor growth and interfere with chemotherapy.  Nicotine also constricts blood vessels and increases blood pressure.  That increases stresses on any plaque buildup in a blood vessel – a precursor to heart attack and stroke.

Do e-cigarettes help you quit?

Again, the studies are still in progress.  There is some data that smokers who switch to e-cigarettes refrain from tobacco longer than those who try to quit while still using tobacco.  Neither the World Health Organization or the American Heart Association recommend e-cigarettes as a smoking cessation method.  There is no information yet as to whether those who switch to e-cigarettes quit nicotine completely, or have simply switched from one addiction to another.

How does this affect us?

So, while we await studies to more definitively address the safety question, what am I telling patients about safety?  Obviously, the best choice is not using any nicotine product.  If you are deciding between tobacco and e-cigarettes, it is reasonable (but not proven) to assume there is a lower lung cancer risk with e-cigarettes, but no data on oral or head and neck cancer.  However, since there is nicotine in both products, I advise people that there is still similar heart disease risk.  There is also no path to stopping e-cigarettes, unlike other nicotine replacement methods like the nicotine patch – which gradually reduces the dose delivered.  Studies are ongoing, so hopefully we get good information to make healthy decisions.  In the meanwhile, the FDA is seeking ability to regulate these products, and limit their marketing to children.
The path to wellness begins with a proper diagnosis

Challenge Completed

So many people start the New Year stating what they wish to accomplish, without reflecting on the past year. So for my first post of 2015 I’d like to reflect back on the first year of TheDiagnosisMD.com – and a challenge I undertook.

In the first year of my blog, I posted 34 times – with over 3400 views from 76 countries! Reflecting on what I posted, and the responses I got will help me shape 2015.

My goal for 2015 with TheDiagnosisMD is to make it educational, useful and fun!

In January of 2014, I ran the PF Chang’s Rock n Roll Half Marathon, with my running partner, Dr. Craig Primack. After the race, he suggested we try to run one half marathon a month for 2014. I accepted the fitness challenge. Two weeks later, on a cold morning in Sedona, we ran our 2nd half marathon of the year. It was a fun race, but we had not trained for the hills in Sedona!

After another organized race in March, schedules and races became difficult to match up, so we mapped out several 13.1 mile courses near our homes, and, on December 20, 2014 we completed our 12th Half Marathon in 2014.

Training for this, I ran over 545 miles and 83.5 hours. I went through 4 pairs of running shoes, several minor injuries and 4 toenails. The injuries have healed, and 3 out of 4 toenails are normal again.

So what did I learn?

Consistent long distance running is great for cardiovascular endurance. I have no doubt that at any time I could go run 13 or so miles without worry. However, from an overall fitness perspective I’m the same as I was in January of 2014. Same weight and non-running strength!

When I knew I was running long distances on the weekend – I found it mentally difficult to go for a 3 or 4 mile run during the week – it didn’t seem worth it if I couldn’t run 6 miles – so I ended up stacking the runs and concentrating things on the weekends. So there was less balance to my overall activities.

I’ve always told my patients that moderation was the key to success for health. So it’s time for this physician to heal himself. My goal for 2015 is to be more balanced in my fitness and in life. Challenge accepted.

I look forward to writing more about the topics you are interested in – so let me know what you’d like to learn about!

Wishing you health and happiness in 2015.

The path to wellness begins with a proper diagnosis.

Breast Cancer Screening – In October We Wear Pink

It’s October and that means post-season baseball, (sorry Yankees), football season is in full swing and it is Breast Cancer Awareness month. Many athletes, celebrities and people affected by breast cancer in some way are sporting pink clothes or accessories and advocating for breast cancer screening. Why has breast cancer gotten such universal recognition in the US?

Breast Cancer Statistics

  • 1 in 8 women will get breast cancer in the US
  • About 300,000 women will be diagnosed this year
  • About 2300 men will be diagnosed as well
  • 40,000 women will die from their cancer this year – a death rate that is decreasing due to early diagnosis and treatment advances
  • Breast cancer is the 2nd most common cancer in women – the first is skin cancer
  • Breast cancer is the 2nd leading cause of cancer death in women – the first is lung cancer
  • 2.8 million women in the US are either living with breast cancer or post treatment
  • having a 1st degree relative with breast cancer doubles breast cancer risk
  • 85% of women diagnosed have no family history
  • 8-10% of breast cancers are linked to a genetic risk such as the BRCA gene
    • BRCA-1 carries a 55-65% risk
    • BRCA-2 carries a 45% risk as well as an increase in ovarian cancer risk

Breast Cancer Screening Guidelines

Given the number of women affected by breast cancer, as well as the high death rates and the fact that early detection and treatment have improved survival, one would think there would be little debate about the value of breast cancer screening. However, there are conflicting guidelines regarding screening – what age to start, when to stop, and how often to test.

The American Cancer Society (ACS) recommends yearly mammograms beginning at age 40 and continuing as long as a woman’s health and activity level make it feasible to continue.

In 2009 the US Preventive Services Task Force (USPSTF), a key driver of guidelines in the US, changed its recommendation from the ACS guideline to mammograms starting at age 50 and repeating them every other year, stopping after age 74, and eliminating self breast exams.

This change caused a lot of confusion and backlash, and later the USPSTF “softened” its recommendation to include a section stating that all women should discuss the risks and benefits of breast cancer screening with their doctors and make a decision based on their individual concerns.

So there are somewhat conflicting guidelines, but a decision about breast cancer screening should be based on your preference, your doctor’s assessment of your risks and likely your insurance company’s willingness to pay.  As of now, there have not been any major changes to the reimbursement of mammograms.

So how do we screen for breast cancer?

The main screening tool we use is a history!

  • What age did you start menstruating
  • Do you have a family history of breast cancer
  • Have you had breast surgery
  • Have you ever been pregnant

The answer to these questions add context to the next part of screening – a mammogram. A mammogram is an x-ray of the breast taken from 2 angles with the breast pressed against the machine to give a standard view. That image is evaluated for irregularities that suggest cancer.

There are many variables that go into a mammogram – size of the breast, age, and density are several. Density describes the ambient of breast tissue and fat in a breast. Denser breast make it harder to detect abnormalities on a mammogram. Denser breasts tend to be found in younger women, those who never had children, and athletic women. When this occurs, adding an ultrasound of the breasts can improve the reliability of the results.

MRI has been looked at recently as a screening tool – attractive because it does not use radiation, and can create very detailed images. Therefore, it can detect much smaller abnormalities. Currently this is only recommended for very high risk women.

Another technology recently developed is called Digital Tomosynthesis. Similar to a mammogram, the breast is pressed into position but 11 x-rays are taken instead of two. The images are fed into a computer and a 3-D image of the breast is created and evaluated for abnormalities.

MRI and tomosynthesis are not currently recommended for routine screening.

What do I tell my patients?

  • Every patient is unique, and needs their risk factors evaluated
  • Based on the risk assessment, a mammogram and possibly an ultrasound will be ordered
  • I reserve MRI and tomosynthesis to those women with very high risk
  • Breast implants do not change the need for a mammogram – the implants can be maneuvered out of the image so the breast can be assessed

After the study is done, we will decide when to repeat it – usually yearly based on the ACS guidelines.

One important aspect of breast cancer screening that is overlooked is communication – any test, especially one looking for cancer will provoke anxiety, and I try to get results to my patients as soon as possible. In fact, reducing test anxiety was one of the reasons the USPSTF recommended less testing!

Often there will be an area that was not well seen on the mammogram. In this situation, close up views of the area need to be done – called spot compression views. This does not mean you have cancer – it means a closer look is needed.

Regardless of which screening guideline one follows, one thing must be stressed – if you feel something that does not seem normal to you – bring it to your doctor’s attention! Breast tissue does change and often develops cysts (tender lumps) throughout the menstrual cycle, and where you are in your cycle as well as caffeine intake can influence cysts.  These changes tend to go away at the end of a period. When there is a lump – especially if it persists through a complete menstrual cycle – it is not considered screening and all guidelines stress the need to further diagnose a lump – regardless of age. When discussing self breast exams with my patients I tell them to learn what is normal for them – all breast tissue has some irregularities. If something is different from your normal, see your doctor. It may be nothing but all evidence shows early detection improves outcomes – and ignoring a lump will delay things – either peace of mind that everything is ok or the opportunity to find a cancer early.

The path to wellness begins with a proper diagnosis

Ice Bucket Challenge

For the past month or so we have all seen ice bucket challenge videos of friends, family and celebrities dumping buckets of ice water on their heads, making donations to ALS foundations, and asking others to do the same.  In addition to giving us some good laughs, the campaign has raised over $70 million.  And that is the point.  There are many diseases we don’t have all the answers to, they range the spectrum from infectious, cancerous, autoimmune and idiopathic (a fancy way of saying “we don’t know” and still sound smart.)

For the record, just as the ice bucket challenge was going viral, I was interviewed on the Phoenix NBC affiliate about the health affects of cold water shocks and any health consequences.  Unless you have a predisposition to heart rhythm irregularities it should be a safe activity – just be sure not to fall or have someone drop a heavy bucket of ice on you.

For people diagnosed with a life long illness, lives are altered.  Some diagnoses bring more change than others – depending on how day-to-day life changes come from the diagnosis or treatment.  This emphasizes how important it is to get a diagnosis correct.   The only way to improve the outcome of a diagnosis is through research – for better and earlier diagnostic tests, treatments with better results and less side effects.  Research for clinical treatments is time-consuming and expensive.  There is not enough money available for all the diseases that need more research – leaving many underfunded diseases.  

Most medical research in the US is funded by the National Institutes of Health.  Over $30 billion in grant funding is scheduled for this year.  The competition for funding is fierce and complex.  Most universities have entire departments to help researchers with the process of applying for grants.  Private industry can choose the diseases they invest in, and have improved the lives of millions of people, however, as private businesses they also need to develop products that will be used by many.  It doesn’t make business sense to invest millions of dollars in a product that won’t generate sales to cover the cost of development.

What has filled the gap between highly prevalent diseases and NIH funding are patient organizations.  These groups have, for several decades, brought together people who share a connection to diagnosis, raised awareness and money for research – with direct benefit to those in need.  30 years ago people would whisper the words “Breast Cancer” or “HIV” – today there are huge organizations that have taken these “taboo” diagnoses into the mainstream.  They have raised huge sums of money and affected government policy.  The result: more and better treatments which have resulted in longer, healthier lives for those diagnosed with these conditions.

Many of the non-profits hold events – dinners, fundraising parties and athletic training programs – a personal favorite of mine.  I became involved with the Crohn’s and Colitis Foundation of America in 2010, and joined Team Challenge, their Half Marathon training program.  Together, the NYC team raised over $250,000 and the entire event raised $3.7 million for the CCFA.  For more of my thoughts on exercising for a cause, click here.

Besides the direct money these races or other events raise, there is media attention given to a cause that might not get it otherwise, as well as the stories of the people participating.  Stories of how a diagnosis has affected their life or the life of a loved one, and how being part of an organization dedicated to improving the lives of those affected can bring change.

We can laugh at our videos of cold water drenching (see mine here – Ice Bucket Challenge), cry at some of the stories behind the videos and get annoyed that our Facebook/Twitter/Instagram feeds are being clogged by them, but to those affected by ALS this campaign is life altering, just as the diagnosis of ALS was in the first place.  Just like my work with the CCFA was for me.  Remember, the work done today can mean that the person diagnosed tomorrow has hope and options, not fear and shame.

The path to wellness begins with a proper diagnosis

Language as Medicine

Every culture has its own lingo, a shorthand that allows those in the know to gather information quickly and process it efficiently. I think the first language of medicine I remember is from the 70’s TV show Emergency“get me an amp of bicarb and D50 STAT!”

The language of medicine makes sense to those in it – and sometimes we sometimes forget that others may not speak it fluently. I was reminded of this when my daughter shared a text message with me and I needed to Google half of the “words” until I found a very helpful text translation website!

There are two occasions that I find I use lingo in front of patients.

  1. When speaking to another doctor in front of the patient. Sometimes this is necessary to give or receive information quickly. I try to remember to tell the patient what I am doing and apologize if it seems like I am ignoring them, but it is important in that moment for their care.
  2. Out of habit.  Since lingo is so familiar to me, I slip into it even when speaking to someone who is not – just like saying LOL instead of actually laughing.

Language has the power to frame how a patient interprets the information I give them.  If I present a diagnosis or therapy in a calm voice with familiar words it sends a very different message than information given urgently with very technical language.  The language and tone I use deliver confidence or panic, trust or suspicion.  It is part of the bedside manner that influences my relationship with a patient, and at different times needs to bed differently.  Some patients want to be told what to do, others need to be led to a decision but have the final say.  Most people are somewhere in between.

Another aspect of this is how the vocabulary we choose can change a patient’s outlook.  I have a choice when discussing treatment options for a diagnosis – you can take this medicine or do a treatment.  One is passive and one is active, which impacts how both I and a patient perceive their diagnosis and options.  We tend to reserve active language for more serious diagnoses – you take medicine for strep throat, but you do a treatment for cancer.   While not life threatening, any diagnosis impacts the person with it.  Remember the difference between major and minor surgery – minor surgery happens to someone else, major surgery to you.

How a patient interprets their diagnosis has a huge impact on its outcome.  It effects their understanding of its severity, their role in its management, their likelihood of completing therapy and their trust in their physician.  Attitude about a diagnosis affects the body’s immune system and multiple studies have shown engaged patients have better outcomes.

Done well, good communication is a low-cost, high-value therapy, and when done right does not take any longer than poor communication – and it has benefits down the line for both doctor and patient.  I’d like to think I get this right all the time, but I know I don’t – some patients you don’t connect with at all, sometimes you can’t find the right words.  Much has recently been written about the need for doctors to be good listeners, but we need to be good speakers as well!

 

Ebola Virus – Is truth stranger than fiction?

Earlier today a plane landed in the US carrying a very sick person.  They are being transported to Emory Hospital to be treated for one of the scariest infections that exists – Ebola Virus.  This person contracted the virus in West Africa caring for other victims of the same infection, and is now being brought to a special infection control room for treatment.  Ebola has been featured in many books and movies – usually as a weapon or shown in a widespread epidemic of plague-like proportions.  But what is Ebola, and what is more accurate – truth or fiction?

What is Ebola?

Ebola is a virus and like other viral illnesses, causes fever, body aches, headache and sore throat.  Unlike most viruses, it can also cause internal bleeding, causing it to also be known as “hemorrhagic fever.”  It is native to Africa, and was first found along the Ebola River.  It is thought to live in animals such as monkeys, bats or rodents, but exactly where is unknown.  It can spread to humans from contact with an infected animal, and is spread from infected person to another by contact with body fluids – blood or other droplets.  It is not an airborne virus like the flu.  
Symptoms can be seen from 2-21 days after exposure to infected fluids.  Ebola has a 40-90% fatality rate – which is why it evokes such fear and makes for thrilling subject matter in books and movies.  Outbreaks are usually limited by isolating the sick and preventing further spread of the virus – since humans are not the natural host, the outbreak burns out.

What is happening in Africa?

There have been sporadic outbreaks of Ebola in Africa since we began tracking such things.  The last was 2 years ago in Uganda and The Democratic Republic of the Congo.  Both outbreaks involved less than 100 people.  This pattern has been seen over the past 10 years.  This map shows all cases since 1976 – both locations and number of cases.
In March 2014, the first West African cases were reported, and as of the end of July, over 1300 cases and 700 deaths have been reported in Guinea, Sierra Leone, Liberia and Nigeria.  This outbreak is far larger than the usual outbreaks; in fact this epidemic has more cases than the last 10 years combined.  Why this outbreak is larger and growing is not clear.  Analysis of the current Ebola Virus shows it to be a common form of the virus, not a “superbug” or mutant strain, which would mean that the population is either more susceptible or not able to isolate patients safely to avoid coming into contact with infected secretions.

Treatment

Ebola is a virus, and there is no specific treatment proven to kill the virus.  So, we treat it like we do a cold – support the patient with fluids and nutrition, and hope their immune system will defeat the virus.  There are experimental treatments that have been shown effective in animals, but no human trials have been performed as yet.  Doctors and hospitals have been receiving alerts from the CDC to increase awareness so doctors encountering people traveling from West Africa with fever are evaluated for possible Ebola, and to implement appropriate infection control procedures – just like we do for other contagious diseases.  The patient transported to Emory will be placed in an isolation room and treated by those who train to handle infectious material, limiting the chance of spread of Ebola to the US population.

What does this mean for us?

The average person should not be concerned with catching Ebola, even if you are in the vicinity of Emory Hospital.  Ebola is not an airborne virus – meaning you need to have direct contact with infected droplets to be infected.  You can not catch Ebola by breathing the same air as someone who has Ebola.  In addition, the plane the patient travelled on was not a commercial flight and was set up to prevent the spread of droplets.  Same for the ambulance that took the patient to the hospital.  So I do not think there is a high contagion risk in the US.  The CDC has issued a travel advisory, recommending non-essential travelers leave the affected areas in West Africa, and for those in the US to avoid travel there.  They are also implementing screening and reporting systems to identify and isolate potentially sick people boarding planes from the area, as well as decontamination procedures for the airlines, as they have done with other infections like SARS.  So as frightening as Ebola is, and no matter what happened in that movie you saw, there is little risk of infection to the average person.

The path to wellness begins with a proper diagnosis

Are you ready for the summer? Summer health tips from The DiagnosisMD!

Last weekend we dropped our daughter off in a mall parking lot to take the bus to camp for the next 7 weeks.   Of course, the night before, while thinking about summer, the movie Meatballs was on television, and I laughed and envied her the summer she was about to have.  So, on the way to the bus, between obscure movie jokes I tried to give my daughter some summer health tips, and thought I would share them.

I had the chance to be the camp doctor for a couple of weeks for the past 2 summers, and therefore had a first hand look at some of the summer health issues we forget about when summer is otherwise just a hotter day at the office.  Summer health threats come in several categories – bugs, weather and accidents.

Bugs

Most bugs that bite people are harmless, other than typical itching/swelling – unless you are allergic to that particular bug.  Mosquitoes, bees and ticks are the majority of insects that come out in the summer.  Depending on your location, different diseases can come with them.

Mosquitoes bite and cause skin reactions that swell or itch.  For centuries, mosquitoes have carried illness – Yellow Fever, Malaria, Dengue, and West Nile are several types of infections spread by mosquitoes.  You can not tell which mosquitoes may be carrying infections, so efforts have focused on prevention – spraying areas with standing water where mosquitoes breed, using insect repellent and clothing to avoid bites, and vaccines for those illnesses where available.

The biggest risk to bee stings is an allergic reaction.  If you have a history of severe reactions such as trouble breathing or mouth or throat swelling, then you should carry an Epipen.  An epipen is an emergency injection of epinephrine which can stop the difficulty breathing.

Ticks are another potential source of infection.  On the East Coast, some tick species carry Lyme Disease, Babesia and Ehrlichia, and in the West, Rocky Mountain Spotted Fever.  These infections can be treated with antibiotics, especially when found early.  Of course, the best defense is to not get bit by a tick.  The good news about tick borne illnesses is that a tick needs to be on a person for 24 hours to transmit disease – so regular checking after coming indoors can prevent many infections.

The other bugs that people worry about, especially at camp, are bed bugs and lice.  Neither of these cause illness, but the bites can be itchy and uncomfortable!  Most cases of lice and bedbugs are brought in from the outside – whether it is camp or a 5 star hotel!  Heat kills both lice and bed bugs, so putting all bedding and clothing in the dryer on high for an hour before sending them to camp can reduce the likelihood of bringing it in.  Also, in my experience as camp doctor, I’ve seen an increase in the detail of lice checks – with outside companies with magnifying lights and fine tooth combs being brought in to help check the kids on arrival!

Weather

The next risk in summertime is weather – mostly heat.  When you spend more time outdoors, being active you run the risk of dehydration – not just kids playing, but adults and pets too.  I can’t stress enough how important it is to drink plenty of water.  It doesn’t take much to get overwhelmed by heat.  I ran in NYC last weekend when it was 65 degrees, did 8 miles with a small water break half way through.  This morning, I ran 8 miles in Arizona – 87 degrees at 6am, drank a full bottle of water after 4 miles and had to walk parts of mile 7 & 8!  I needed more than one bottle of water spaced through my run.  My general rule is if you will be outside for more than 30 minutes, bring a water bottle.

Summer is also a time for thunderstorms.  Common sense says to stay indoors during a thunderstorm.  Lightning tends to strike water before land, and higher structures before the ground, so if you are stuck outside during a storm, do your best to get indoors and away from trees and water.  And listen to those weather alerts on your phone – I got stuck driving in a dust storm last week – and the wind was so intense that branches were torn from trees and flying around. I was happy to get home safe!

My last weather related summer health tip – use sunscreen!  The burns from summer sun – intense short exposure – dramatically increase the risk of skin cancer – not to mention wrinkles!

Accidents

With summer activities will certainly increase the rate of getting hurt – bike falls, sports and water activities all carry some risk.  Again, common sense can reduce the risk of severe injury.  Helmets save lives and prevent concussions.  Don’t ride a bike without one.

Never swim alone, and be sure your yard and pool are fenced in – different areas have different laws regarding home swimming pools based on the age of the people/children living there – follow them!  If you are on a boat, use a life-preserver – the name says it all!

My last safety summer tip is simple – leave the fireworks to the professionals.  Too many people end up in the emergency room with burns or missing fingers and toes.

Nothing can completely prevent accidents – they will happen, but you can minimize their impact.  While I was camp doctor we had several campers with cuts, head bumps and even broken bones.   Fortunately, with good planning and training of staff, potential disasters can become another summer memory!

The path to wellness begins with a proper diagnosis