August 9th, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
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Dr. Jeremy Joslin is a wilderness medicine aficionado and has without question posted the greatest number of intelligent and useful comments to posts at this blog. So, I’m pleased to learn that he has created a very useful iPhone application named TickDoctor.
TickDoctor provides a stunning visual atlas of the most common ticks encountered in North America. Although not yet comprehensive, most common ticks are represented. For each tick species, the user is able to identify males, females, and nymphs. In many instances, there are included images of the engorged female, which often looks very different from its non-fed state.
More than just a beautiful atlas, TickDoctor provides instructions for prevention of tick bites and how to remove them if bites should occur. If a bite has occurred, or if you’re just plain curious, Dr. Joslin has included medically relevant data on each species, describing which diseases have been associated with it.
While this application should never substitute for the advice of a physician, it will help guide you to the identification of the tick in question and provide a framework of reference for dealing with “what to do next.”
I’ve been informed by Jeremy that, “if you have a great photo of a tick and want it considered for the next application update, let me know. You can do this by posting a comment and I’ll follow up with you. We’re always interested in making the atlas better.”
This post, The iPhone TickDoctor, was originally published on
Healthine.com by Paul Auerbach, M.D..
August 1st, 2009 by Paul Auerbach, M.D. in News
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In the June 11, 2009 issue of the New England Journal of Medicine appears an article by Mark Duffy and colleagues entitled “Zika Virus Outbreak on Yap Island, Federated States of Micronesia.” This outbreak occurred in 2007, and was described as a cluster of 108 persons with confirmed or suspected infection, characterized with main symptoms of skin rash, fever, conjunctivitis, and painful joints. Other less common symptoms were muscle aches, pain behind the eyes, tissue swelling and vomiting.
As reported by the authors, there were no hospitalizations, bleeding problems in victims, or deaths. The predominant mosquito culprit was Aedes hensilli. The disease was determined to be mild in this outbreak. Zika virus is in the family of flaviviruses, which include West Nile, dengue, and yellow fever viruses. It has been diagnosed in Asia and Africa, and is transmitted by infected mosquitoes. Before this particular outbreak, there had only been 14 cases of human Zika virus disease previously documented.
The diagnosis was made in this outbreak by sending serum samples from patients to the Centers for Disease Control and Prevention (CDC) Arbovirus Diagnostic and Reference Laboratory in Fort Collins, Colorado.
How did this virus turn up in Yap? The most likely introducer was an infected mosquito or human. So, given the abundance of mosquitoes and propensity of people to travel, we may soon see this disease in other regions around the globe.
image courtesy of www.cdc.gov
This post, New Mosquito-Born Virus Could Come To US, was originally published on
Healthine.com by Paul Auerbach, M.D..
July 27th, 2009 by Nicholas Genes, M.D., Ph.D. in Better Health Network, News, Opinion
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Friends visiting New York City this summer keep asking if it’s safe. As in, will they be catching and suffering from novel H1N1 (swine) flu.
I like to think my friends are pretty sharp, discerning folks (after all, they’re choosing my company) so I have to attribute these inappropriate questions to a wider problem.
For reference, here’s the latest and thought probably not last NYC DOH guideline on H1N1, which notes about 900 hospitalization and 45 deaths in H1N1+ patients over three months. About three quarters of these patients had at least one risk factor such as existing lung disease.
This deaths and hospitalizations are concerning, naturally, but some perspective is in order: as many as half a million New Yorkers have been infected with H1N1, and this spring in US cities, we actually saw a smaller fraction of deaths due to infectious respiratory illness, compared with 2008. Also, for reference, based on data from a few years ago, I’m guessing that any given three month period, there are between 10,000 to 15,000 deaths in New York City.
So why were ED’s swamped in May? Why are my friends still afraid to come to NYC? Dr. David Newman has some thoughts in EPMonthly:
…with constant messages of swine flu lethality on the nightly news, it is little surprise that ED’s in New York City, departments in a chronic state of over-crowding and crisis, were soon bursting at the seams with record volumes. In some institutions daily ED volumes doubled, as EP’s worked through third-world conditions of extreme crowding, questionable hygiene, extended wait times, and swarms of infectious, coughing congregates all within arm’s reach of each other.
The impact is clear: lives were lost. High quality studies have shown repeatedly that when ED’s experience crowding patients in need of rapid, high intensity care are identified later, treated more slowly, and devoted fewer resources. Mortality goes up during crowding in virtually every condition that has been studied, including MI, sepsis, and others. The irony is stark: Once a critical mass is reached, the more that come to be saved, the fewer we can save.
…The overall management of information during the swine flu of 2009, despite some progress in our access to information, was misguided and dangerous. Frantic media outlets drove a nation to fabricated fears, while state-level institutions not only failed to contain or counteract these messages, but also used expensive, fruitless, prescription-only pills, available to most only in their local ED’s, as a means of false comfort. Instead of using honest information to provide safety, comfort and education, the approach created panic, cost money and resources, and took lives.
All of this was preventable and is reversible for the future. There is no reason why the media cannot be recruited into the information dissemination process…
Unfortunately, there is a good reason why: Responsibly framing public health risks is no longer a role that suits traditional media. They’ve decided it’s just not in their interest.
I remarked on this years ago with West Nile virus, which never will never kill as many as, say, food poisoning or swimming pool accidents.
There are many factors driving the public appetite for health risk information — and that’s understandable. I think it’s even ok for news organizations to shuffle around reporting to some extent, to satiate those desires.
But what happened in NYC this spring was media malpractice — night after night, opportunities to put the risks of swine flu in perspective were passed up for breathless reporting. I recall one occasion in which a phalanx of reporters were camped outside a hospital I worked at, providing next to no detail about an infant who died it respiratory distress. It turns out this child did not have H1N1, but communicating that was not a priority — by the next day the lead story was ED’s are overcrowded and schools are closing.
EPMonthly ran a nice sidebar from Dr. Jim Augustine, enumerating the ways in which ED docs can engage the media to get the right message out.
But I’m more encouraged by approaches to bypass traditional media and reach patients directly. Yesterday I heard some encouraging news from the CDC: their emergency twitter feed has over 500,000 followers. Millions saw their videos. This is amazing reach, for public health communication.
It wasn’t enough to help ED’s this spring. But individual hospitals and the CDC is ramping up their use of social media, even as traditional news sources decline in influence. It’s really the first good viral news I’ve heard in a while.
*This blog post was originally published at Blogborygmi*
July 26th, 2009 by KerriSparling in Better Health Network, True Stories
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Earlier this week, I had a bit of a medical issue. Painful urination, high blood sugars, and the constant need to pee. (Ladies, I know you already know what’s up.) Urinary tract infection looming large. I was livid, because it was the day before I was scheduled to travel for this week’s business.
I haven’t got time for the pain, so I called my primary care physician, Dr. CT. “Hi Nurse of Dr. CT! It’s Kerri Sparling. Listen, I’m pretty sure I either have a kidney stone or a urinary tract infection, and I need to rule it out before I leave for a week-long business trip.”
Dr. CT was on jury duty. Damnit. So I had to call a local walk-in clinic, instead.
The clinic was a hole in the wall. Part of a strip mall structure. My confidence wasn’t high, but my blood sugars were and my whole body was screaming for attention, so I knew I had to follow through.
The receptionist was very nice. The nurse was even nicer. They took my blood pressure (110/74), my temperature (98.8) and a urine sample (ew). 
I should have known from the moment the sample cup was given to me that it wasn’t going to be a fun visit. The very kind nurse handed me this —>
That is not a urine sample cup. That’s like a party cup that you use for lemonade on a hot summer day. Not for pee. Oh God.
And then the doctor came in. For the sake of anonymity, we’ll call him Dr. Idiot.
“Hi. I’m Dr. Idiot.”
“Hi, I’m Kerri.”
“Kerri, I see you are here for pain when urinating. Are you urinating frequently? You see, you are spilling a significant amount of urine. I believe we may have found the source of your troubles.”
He closed his file, proud of himself.
“Dr. Idiot? On my chart there I wrote that I have type 1 diabetes. I know my blood sugar is elevated right now, which sucks but at least it’s not a surprise. But that’s not why I’m here. I actually suspect that …”
He cut me off.
“I think we need to address this first problem. You are aware of your diabetes, you say? How many times a month do you check your sugar? You know, with the glucose machine and the finger pricker?”
If I wore bifocals, it’s at this point that I would have slid them down my nose and given him a hard, Sam Eagle-type stare.
“I test about 12 – 15 times a day. But the real reason …”
“You mean a month,” he corrected me.
“No, I mean a day. I have type 1 diabetes. I wear a continuous glucose sensor. And also an insulin pump. I’m very aware of my condition, and I’m also very aware that it’s slipping out of control today because of this other issue, the pain issue. Can we talk about that?”
He looked at my chart again. “So you don’t use a meter?”
“Sir, I use a meter. And a machine that reads the glucose levels of my interstitial fluid. This is in addition to my insulin pump. I don’t mean to be rude but …”
Now he gave me a hard look. “Why the interstitial fluid? Why not the blood directly? I mean, you could have more precise readings with the blood.” He picked up my Dexcom from the chair next to me and pressed a few buttons to light up the screen. (Mind you, he did not have permission to touch it, but I’m again not saying anything.)
“You mean like a pick line? I don’t know. I’m sorry. Ask them?”
“Yes, but it would make much more sense and …”
I just about lost it.
“I’m sorry. I didn’t come here to talk about that. I want to talk about the issue I’m here for. Which is not diabetes. Or your ambitions to know more about CGMs. Please can we address what I’m here for?”
“The sugar in your urine.” With finality, he says this.
“NO. The fact that I think I have a UTI or a kidney stone. Please. Help. Me?”
I kid you not – we went ’round and ’round about this for another ten minutes. He didn’t believe me that I was at least sort of familiar with diabetes. His ignorance included, but wasn’t limited to, the following statements:
- “High sugar causes frequent urination. Maybe that’s why you are peeing often?” (Not because I was drinking a liter of water per hour to flush my system? Nooo, couldn’t be that.)
- “Did you have weight loss surgery?”
- “Grape juice also causes high blood sugar.”
- “That thing should really be pulling blood samples. Pointless otherwise.” (Meaning my Dexcom.)
- “The urinalysis won’t be back until Friday, and in the meantime you should start on a regimen of insulin immediately.”
- And also: “I didn’t peg you for a pink girl.” (Are. You. Serious??)
The end result, after an escalating argument that involved me yelling, “Stop. Talking about my diabetes and PLEASE focus why I’m here!” was a prescription for Macrobid that I could elect to take if my symptoms didn’t alleviate, and the instructions to call back on Friday for official lab results.
“Thank you. Really. Can I go now?”
He at least had the decency to look ashamed.
I’ve had some wonderful doctors over the last 30 years, and my health is better for it. But this guy? Complete disappointment.
*This blog post was originally published at Six Until Me.*
July 23rd, 2009 by Mark Crislip, M.D. in Better Health Network, Quackery Exposed
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While there are many taxonomies of SCAM, one thing almost all alternative therapies have in common is they are originally the de novo discovery of one lone individual. Working outside of the mainstream, they are the gadflies who see farther because those around them are midgets.
Hanneman conceives of homeopathy, the treatment of all disease.
Palmer conceives the cause of all disease and its treatment in chiropractic
Mikao Usui, while having a mid-life crisis, conceives Reiki.
Virgin births all. These pioneers boldly go where no man has gone before.
Others have been less acclaimed after seeking out new life. An example is Virginia Livingston, MD, the discoverer of the cause of all cancer (1). She discovered a bacterium, the cause of cancer, she called Progenitor cryptocides, which, unfortunately only she could grow. Her therapies include an autogenous ‘vaccine” made from your own urine, which will probably preclude widespread use even in alternative therapies circles. I wonder if Jenny would object to vaccines if there were naturally derived from the patients urine?
Discovering a new form of pathogenic microbiology that no one else can see or grow is not uncommon, since people seem to be unable to recognise artifact on slides, be it Oscillococcinum being seen by Joseph Roy 200 years ago or Virginia Livingston in the 1960’s. Sometimes I regret the discovery of H. pylori as a cause of gastritis as it gives the alternative microbiologists a medical Galileo to point at. H. pylori is used as an example, erroneously, of a bacteria causing disease that was laughed at by the medical establishment (Parenthetically, as my flawed memory has it, while I was an Infectious Disease Fellow the data for H. pylori came trickling in. I remember discussing the papers with one of my attendings who was an expert in GI infections. We all thought is was an interesting hypothesis and waited further data with interest. I cannot remember anyone dismissing the idea out of hand with derisive laughter. But then, I remain convinced that infections are the cause of all disease, at least the diseases that matter).
A letter from a reader led me to another lone reseacher who has discovered the cause and treatment of many, if not all, diseases. So may I introduce to you, Trevor Marshall, the developer of the Marshall Protocol. (As I have said many time, I want something in medicine named after me, and it is not the glove breaking during an exam. “Damn, I just had a Crislip. I need to go and clean my nails.” If Swan or Groshong can get some silly little catheter named after them, well, I should be good for some eponym). You have not heard of Trevor Marshall? Often the fate of originality is to languish in obscurity.
The Marshall Protocol has all the characteristics of modern alternative therapy: a single discoverer, a hitherto undiscovered biology, an unproven therapeutic intervention and one of the most aggravating issues in SCAM’s: Taking a scientific truth the size of a molehill and transmogrifying it into a Cascade Range of exaggerated disease etiology and treatment. Unlike most SCAM’s, however, as best as I can tell Dr Marshall does not seem to be in the business of making a business from his discovery, although he does have patent applications for his protocol.
Read more »
*This blog post was originally published at Science-Based Medicine*
Dr. Jeremy Joslin is a wilderness medicine aficionado and has without question posted the greatest number of intelligent and useful comments to posts at this blog. So, I’m pleased to learn that he has created a very useful iPhone application named TickDoctor.
