Drug Holidays – what are they and when to consider

A drug holiday is a conscious decision to stop a medication.  The reasons to do so usually revolve around “seeing if I still need it” and side effects.

I was interviewed by Sara Klein in Prevention Magazine on this topic.

Click here for the story!

http://www.prevention.com/health/drug-holiday-facts

The path to wellness begins with a proper diagnosis

Ebola in the US – what’s next!?

Last month, the first Ebola patient was brought to the US – a physician infected in Africa and brought back to the US for treatment.  I reviewed Ebola and that case in a earlier post on 8/2/14. That was a controlled transfer, just as the 2 other known cases transported to the US for treatment were. On September 30th, the first case of newly diagnosed Ebola in the US occurred, in a person who had recently traveled from West Africa to Dallas, Texas.

Once in the US, he went to an Emergency Room for fever.  He was sent home with antibiotics. He returned 2 days later when his symptoms had progressed and his travel history was noted. He was quarantined, tested and diagnosed with Ebola.  Why he was discharged after the first visit has been blamed on a computer error and then on poor communication between the intake nurse and the doctor. Since I wasn’t there I can only hypothesize that the truth is somewhere between.

Since being admitted to the hospital, his immediate contacts have been isolated and a HazMat team is cleaning the apartment where they stayed.  The CDC is monitoring about 50 more people he may have had contact with and so far, no one has developed fever – the first sign of Ebola.

What does this mean for the US now?

Ebola is a virus, causing fever, body aches, headache and sore throat. Unlike most viruses, it can also cause internal bleeding. You need to have symptoms to be contagious, and the incubation period – the time from exposure to symptoms is 2 to 21 days. Treatment is mostly supportive – meaning fluids and oxygen, although experimental treatments are in use as well.  It is likely that the death rate, nearly 50% in West Africa, would be much lower in the US due to better facilities, quarantine and access to care.

Ebola is spread by fluid contact – meaning you need to directly come into contact with secretions from an infected person – similar to HIV or Hepatitis.  It is not an airborne virus – meaning a cough or sneeze won’t spread it.  It also does not live long on surfaces. Therefore, if none of this person’s contacts develops symptoms, then the current US outbreak will be over.

That said, it is likely that another traveler will bring the virus to the US. Modern air travel makes this more likely, even with screening at both the departing and arriving airports.  Vigilance in the doctor’s office and Emergency Department will be needed to quickly identify potential cases – and most importantly, a travel history!

For updates from the CDC

The path to wellness begins with a proper diagnosis 

 

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