It's Back - Legionnaires

You'd think once we identify and treat an illness it should be polite and go away. Just get on its high horse and ride out of town. It's truly disturbing when things like small pox and legionellosis reappear. To paraphrase Michael Corleone: "Just when we thought we were out, they pull us back in."

From the Illinois Daily Herald comes this story: "Three cases of Legionnaires' disease have been confirmed in a lab and seven others are suspected, according to Victor Plotkin, epidemiologist for the Lake County Health Department (The Park at Vernon Hills, IL retirement community). "It appears to be contained and limited to this facility only," he added. The disease, which is contracted by inhaling contaminated mist or vapor, is not contagious and is not transmitted from person to person."

The story began three (3) days before what they've now discovered according to the Daily Herald: "In this case, the suspected source may be the aquatic elements in the atrium of the facility, which includes a rain forest, waterfall and spa. Those facilities have since been shut down. One of the deaths occurred in September, but that case was not indicative of a potentially larger problem, Victor Plotkin, epidemiologist for the Lake County Health Department said. That changed when the health department was notified of a second case earlier this week. Subsequent investigation revealed a third confirmed case and the other suspected cases."

Like the H1N1 virus, detection was not apparent until one death became two. Disease care is not the most efficient or effective for the retention and preservation of life - in our opinion. While the Center for Disease Control and Prevention is in society's benefit it might not be in yours and our benefit. Health care has to start with us not just taking care of ourselves. Granted the number causes of death are largely preventable.

What we didn't know about Legionnaires disease could fill a book but thanks to the Center for Disease Control and Prevention (CDC) we learned: "Legionnaires' disease can be very serious and can cause death in up to 5% to 30% of cases. Most cases can be treated successfully with antibiotics [drugs that kill bacteria in the body], and healthy people usually recover from infection."

While we aren't very good at exercise and eating properly we can look and find danger where we're told to look. Fake water walls, artificial lakes, don't usually attract our attention but we can make an effort not to position ourselves near bodies of water that are natural whether they're spas or decorations. Unfortunately disabled seniors might not be able to remove themselves from such artificial environments where their well meaning caregivers might park them. But you can. Add it to your lists so you or your loved ones don't kick the bucket!

Maryland may have more deaths to the H1N1 virus as compared to the reporting numbers of the District of Columbia or Virginia it's still rated better for health care than DC or VA. Numbers matter as in the H1N1 death statistics but they don't tell the whole picture.

When Pigs Die!

Just as some jurisdictions are starting to begin the claim that the swine flu is starting to decline in severity - a claim which we vehemently are in opposition. What is true is that the deaths aren't substantially greater but that's in terms of overall deaths. What we maintain is that the deaths are preventable and unnecessary. What we maintain is that we don't want to be in those numbers. Just when, we will admit is in other parts of the country, they are starting to claim the worst is over we have the following from the World Health Organization (WHO) reporting: "Clinical signs such as coughing and diarrhoea were observed in a pig farm located in T’ai-Tung County on 19 October 2009."

The American Veterinary Medical Association (AVMA) reported to the World Health Organization that: "On November 5, Taiwan submitted a report to the World Animal Health Organization (OIE) confirming 2009 H1N1 in a swine herd in T’ai-Tung County. Illness was first observed on October 19 and tests confirmed 2009 H1N1 influenza on November 2. Clinical signs observed included coughing and diarrhea. All pigs have recovered from the illness."

What it hasn't done is gotten more severe. It's the most severe flu in over fifty (50) years but it hasn't gotten worst. "The World Health Organization has issued a statement that extensive testing has shown that the 2009 H1N1 influenza virus has not mutated to a more virulent form. In addition, the WHO emphasized that H1N1 infections in pets were "isolated events and pose no special risks to human health."

This H1N1 (swine flu) is not like other flus. This flu is different. From WHO we offer the following evidence:

"(U)nder the right conditions, influenza viruses from different species are capable of mixing and swapping genes (this is called reassortment), resulting in a new virus."

"(I)t is very uncommon for flu viruses to jump between species. However, on October 9, 2009, a USDA laboratory confirmed 2009/H1N1 infection in a ferret."

"On November 4, the Iowa State Veterinarian and the Iowa Department of Public Health announced that a pet cat was confirmed infected with the 2009 H1N1 flu virus. The cat's owners were ill and the cat developed respiratory symptoms shortly afterward. The cat has recovered and there is no evidence at this time that the cat passed the virus to any people."

"Keep in mind that dogs currently have their own flu virus, the H3N8 influenza (canine influenza) virus, going around. So far, this flu virus has only been spread from dog to dog. Dogs infected with the canine influenza virus show the same symptoms as dogs with kennel cough – fever, lethargy, loss of appetite, coughing, and maybe a runny nose."

"There is not a licensed and approved 2009 H1N1 vaccine for pets. The human H1N1 vaccine should not be used for pets. The canine influenza vaccine, which protects dogs from the H3N8 flu virus, will not protect pets against the 2009 H1N1 virus and should not be used in any species other than dogs."

We are not pigs, some of us have been accused of some unclean behavior and have eaten in a way to suggest we could have eaten less, but we aren't animals of the farm variety. Domestic maybe but that's debatable. There is a licensed and approved vaccine that can protect us. We just have to get access to it. What we do stress is that each life is precious and each death tragic. Retention and prevention should be our most pressing mission inspite of our couch like and unhealthy eating habits. We still want to live to make more bad unhealthy decisions.

We will leave you with this ONLY because yesterday was Sunday and we churched. While looking for a way to join the two stories we discovered this bible quote from the New Testament the eighth (8th) chapter of Luke: "Jesus asked him, “What is your name?” “Legion,” he replied, because many demons had gone into him. And they begged him repeatedly not to order them to go into the Abyss. A large herd of pigs was feeding there on the hillside. The demons begged Jesus to let them go into them, and he gave them permission. When the demons came out of the man, they went into the pigs, and the herd rushed down the steep bank into the lake and was drowned.

Is that weird or what?

Sarcoidosis

Let's just call it the Bernie Mac Disease because saying sarcoidosis is a mouthful. While it's not a Black disease (disease that largely strikes African Americans) like sickle cell anemia its more along the lines of AIDS, heart disease, stroke, diabetes, breast or lung cancer.

A definition given by a presenter with a thick accent explains in laymen's terms what the disease is with links to slides and other sources. We think it might be of interests if you're unfamiliar with the disease.

The Bernie Mac Foundation offers this definition: "Following exposure to some still unidentified trigger(s), a patient’s immune system is “turned on” in a way that creates a particular pattern of inflammation. The inflammation can affect any organ in the body, but the lungs and skin are the most common. If the inflammation is allowed to continue, the end result will be scarring of the tissue. The goal of treatment is to interrupt the inflammation so that a damaging scar does not form. Scar formation is more important in certain organs – such as the lungs, eyes, heart and brain/brain coverings/nerves – disease involving these organs would be treated with anti-inflammatory medications. Joint and muscle discomfort would also be addressed with anti-inflammatory medications. Skin involvement is more unsightly than dangerous but also can be treated; many times very effectively, by injecting medication directly into the skin lesion."

The most recent info on sarcoidosis is an interview conducted by our Fox5 Washington. "Kim Carrie Grant, who has been diagnosed with Pulmonary Sarcoidosis, and Doctor Gavin Henry, a board certified surgeon with St. Agnes hospital and Howard County General Hospital joined us with more." The interview is of the talking heads variety which is kind of dull but the information is a personal tale that doctor's would consider anecdotal and therefore unimportant. You and we by our very lives aren't statistically significant. It's only when we're affected in substantial numbers that we're no longer an anecdote.

Flop Flop Fizzle Fizzle

Oh, what a rippoff it is. When the safe and effective turn out to be unsafe and ineffective with lethal consequences we've got problems. When it comes to over the counter and prescription medications for gastroesophageal reflux disease (GERD) what you get isn't always what's good for you. US News & World Report reports that: "In 2008, proton pump inhibitors were the third largest-selling therapeutic class in the United States, ringing up $13.9 billion in U.S. sales, according to IMS Health, a Norwalk, Conn.-based health-care data company. With 113.4 million prescriptions, they were the 6th most widely dispensed retail prescription medications, IMS reported."

The recently released research in this month's American Academy of Otolaryngology -- Head and Neck Surgery was presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, San Diego, CA, October 4-7, 2009. The research precedes the release of Dr. Jonathan Wright's book: "YOUR STOMACH: WHAT IS REALLY MAKING YOU MISERABLE AND WHAT TO DO ABOUT IT" which finds that: "Shockingly, the problem may not be too much stomach acid, but too little! Stomach and other maladies—heartburn, bloating, constipation, and indigestion—may all be the result of too little acid. Antacids and acid blockers may be making the problem worse."

Consumer Reports reported Proton pump inhibitors or: "(PPIs) have been heavily promoted, which has led to overuse in people with garden-variety heartburn. Nexium, one of the most widely-prescribed PPIs is also the most expensive at $240 per month (the cash price you would pay if your insurance did not cover it). Not surprisingly, Nexium was also a top-selling drug in 2008 at a whooping $4.8 billion."

When things are considered safe and effective you don't expect anything else. The question we posed to the FDA is how the heck can that happen especially in a billion dollar industry whose product is not safe or effective. MEDIndia reported this about the study: "PPIs are not effective at treating all cases of gastroesophageal reflux(GERD) and laryngopharyngeal reflux (LPR). In addition to the evidence that acid isn't the only contributing agent in reflux disease, the new study has revealed that there are many unexpected consequences and side effects from this class of drugs."

Until release of the research all news focus has been on the cost to consumers and relative ineffectiveness of the available consumer products both over the counter and prescription. We replaced the loud commercial ridden news report by NBC 9 News Colorado and replaced it with a Consumer Reports video. This another of the studies that demonstrates harm caused by use. While U.S. Food and Drug Administration (FDA) has begun its "Safe Use Initiative" the concern for drugs considered safe and effective that are neither creates a category not likely considered in a cooperative public and private interest environment. With this much money at stake in this financial environment decisions are not likely to fall in favor of the consumer. Be warned. Be forewarned.

No Tree Falls in DC - Flu Stats 11/6/09

If a person dies in DC and there's no one to report it are they still dead? Good news for DC residents as there were no new deaths to flu or pneumonia reported this week. Which for MD and VA was true last year and the year before - however Maryland is still reporting to the Center for Disease Control and Prevention (CDC) the highest death tolls.

Pneumonia/Flu Deaths WEEK 43 2009 2008 2007 District of Columbia Baltimore, MD Richmond / Norfolk, VA 97 639 217 70 702 182 68 548 191 TOTALS 953 954 807

We love Assistant Surgeon General, Dr. Anne Schuchat of the CDC. Her press conferences are always so full of truth and information that they're scary. But we can handle the truth. Here it is (LISTEN) and remember don't panic!

• We wouldn't expect this many states to have this widespread of a disease. Flu can last until May.
• More than half the hospitalizations are in people under 25. 90% of the deaths are in people under 65. A flip-flop from what we see with seasonal flu.
• Two-thirds of the children who died from the H1N1 virus have underlying condition that is increase their risk of this problem. The leading underlying conditions in children who have died are severe neurologic problems like cerebral palsy and muscular dystrophy and asthma in terms of contributing to the severe outcomes.
• People are getting worse. They are not getting better, antivirals may be important.
• I don't think we are at peak as a nation as a whole. What I can say is that disease continues to occur at very high levels now.
  
  

  Total Doses Shipped as of* 10/28/09 11/06/09 Change District of Columbia Maryland Virginia 49,000 306,900 489,700 55,900 523,500 781,800 61% 44% 40% TOTALS 579400 1,361,200 43%

• The other thing to mention is that in pandemics in the past, it's been tricky to predict too far ahead. In 1957 there was a substantial amount of disease in the fall. People thought, pretty much gave the all-clear sign, then there was an increase in severe disease. Another wave in '58. We are very mindful that there's a long flu season ahead and we are going to be attentive to the needs of the population, the efforts to try to protect people going forward.
  
Almost all of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

Now yes, we know that sounds pretty bad but when you're being told the worse isn't it reassuring? That is unless you think its worst than that - which we don't. We think this is as bad as it is. We were concerned that the press wasn't telling us how bad it was. This is straight from the sources' mouth. No spin and that's assuring to us. If it's bad - and we know it is. Tell us its bad and what's being done. We'll take it from there. Now take it from here by taking care of yourself and your loved one. It's going to take more than just washing your hands. Get in line and get your shot. IF you're not feeling well go to the hospital and wait in line and get your shot. Don't wait - because you may survive and most of us will. It's not about the best outcome it's about the worse that could happen to YOU!

And Don't Call Me Honestly!

Doctor, doctor, give me the news, I've got a bad case of lovin' you
No pill's gonna cure my ill, I've got a bad case of lovin' you - Robert Palmer Bad Case Of Loving You (LISTEN)

Sometimes you can't believe what you read especially when you read this WedMD headline: "Cancer Patients Want Honesty From Doctors." Who wants to be lied to when it comes to their health information. Patients might want the doctor to lie to their family and friends or maybe family and friends want the doctor's to lie to us - now that's news.We still think you should read the article and the stories because the story is more complicated than the headline would reveal. Many of the headlines, which are difficult to write, don't quite shed light on the complexity of the results. If the materials aren't publicly published we can't verify. We write (rather) email for more info to the mentioned speakers but they don't usually reply. While the info might be cited it can't always be checked. We just thought you should know! We're on it - as best we can! (YES, we know we said this before - both stories were to be one story but the length of the first precluded us from doing it.)

The story that Reuter's released highlighted: "(A)lmost three-quarters of the patients (72 percent) preferred to be called by their first name, even among elderly patients. There is a greater preference for this among females than males (76 percent to 66 percent), and white patients compared to blacks (74 percent to 56 percent). The study also shows that while 95 percent of all patients want their oncologist to be honest with them about their chances of cure and expected survival, there is a significantly increased preference for honesty among prostate cancer patients versus lung cancer patients (97 to 91 percent)."

Pearlie Mae Frierson Leach didn't mind being referred to by her first name though most doctors respected her age and did not. The doctors were young and overly optimistic about her chances all the while ignoring her mental state. Pearlie Mae could have responded to radiation treatment yet chose to not do so. She had given up when the family and doctors did not. That affected her recovery more than anything else. Her bone cancer would have meant and even greater dependence on pain medication. For Pearlie Mae that was an intolerable future.

Cancer Cholesterol / Cholesterol Cancer?!?!

We blame the researchers and the publications but if we spent the money and got our lazy behinds out to every single medical conference in the country we could get the verification for the information reported in the news. But have you read us? We tire easily and we're not the "Big & Rich" (hey they're not any longer) business we hope to be. What we can report is our experiences with Pearlie Mae Frierson Leach, after whom we are so named. All are articles we suggest you peruse beyond the headlines and the news story.

Many of the headlines (ABC News, US News & World Report, AP, WedMD), which are difficult to write, don't quite shed light on the complexity of the results. If the materials aren't publicly published we can't verify. We write (rather) email for more info to the mentioned speakers but they don't usually reply. While the info might be cited it can't always be checked. We just thought you should know! We're on it - as best we can!

The headline: Low Cholesterol May Be Sign of Undiagnosed Cancer from ABC News yesterday said: "Low total cholesterol may be a sign of cancer rather than a cause, as some researchers have suggested, and men who have low cholesterol actually have a lower risk of developing high-risk prostate cancer, two teams reported on Tuesday."

That headline seemed to contradict this headline from US News and World Report: "Low Cholesterol May Help Prevent Cancer - Two studies dispel longstanding fears about possible connection - Low blood cholesterol levels reduce the risk not only of heart disease but also of cancer, two new studies show."

AP reported using the same research report: "Men may protect more than their hearts if they keep cholesterol in line: Their chances of getting aggressive prostate cancer may be lower, new research suggests." WedMD reported: "Radiation treatment cuts the risk that melanoma will come back in people at high risk for recurrence, a new study suggests. Researchers studied more than 200 people with melanoma at high risk of having their cancer return after surgery because the disease had spread to the lymph nodes."

The original abstract from Cancer Epidemiology, Biomarkers & Prevention (CEBP) concluded: "Results from the two analyses of cholesterol and risk of cancer published in this issue of Cancer Epidemiology Biomarkers & Prevention provide one answer and raise two new questions. Results from the ATBC analysis clearly show that low total cholesterol is unlikely to increase risk of cancer. At the same time, the ATBC results raise a new question about the potential role of high HDL cholesterol and its correlates in reducing risk of cancer."

You had to be there - unfortunately we couldn't and weren't. Hey its not the last time. We're working on other stories and because we weren't there we'll have to wait for responses to our questions from the researchers who tend to be too busy to answer emails. That's just the way it is!