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Means to End Chikungunya Menace? Report Raises Hope

Friday, February 19th, 2010 by Frank Gillingham, MD

New Scientist magazine is reporting a scientific advance that may hold the key to defeating  a mosquito-borne virus that turned dangerous and deadly and has been spreading across the world for the past five years. Carried by the tiger mosquito and driven by the forces of global commerce, chikungunya  virus causes fever, headache, nausea as well as excruciating pain in smaller joints, earning it the nickname “knuckle fever.”  This virulent form first appeared in the islands of the Indian Ocean but has since invaded every continent by way of airports and sea ports.   The CDC highlights some specific reports of recent activity in Indonesia, Thailand and Malaysia on their website, where they also offer advice to clinicians and travelers. 

Now the U.S.  National Institutes of Health (NIH) are reporting a breakthrough in the search for a vaccine by using genetic engineering to create virus-like particles which perfectly mimic the virus without being infectious. Tests with Rhesus monkeys have shown the vaccine to be completely effective against chikungunya. Testing in humans is likely to begin in one to three years.

The NIH’s work with chikungunya  may have ushered in a new era of vaccine production that could prove to be safer and more effective than the many live virus vaccines that are in use today.  It may only be a matter of time before vaccines created from pieces of viruses will replace those derived from whole, live viruses. Diseases such as Kala Azar, sleeping sickness and Dengue fever that afflict travelers to tropical regions do not currently have effective vaccines.  In principle, the creation of vaccines from virus like particles could someday eliminate that problem.

Photo info: http://www.flickr.com/photos/deadmike/ / CC BY-NC-SA 2.0

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Fungus Among Us? Don’t Forget Your Flip Flops

Thursday, February 18th, 2010 by John Wargo

Flurries floated to the ground as my taxi pulled up to the hostel in the Old Town of Stockholm. The facade of the hostel was immaculate and welcoming, unlike other parts of Europe where you truly get what you pay for.

I was stopping over in Sweden to visit my sister who was studying at the University of Stockholm. After a brief stay with her, my itinerary would take me through Finland and the Netherlands all the way down to the boot of Italy where I would catch a plane back to the states. I was pleased that I was able to fit all I needed (or so I thought) in my masterly arranged backpack, a skill inherited from my father.

My room in the hostel was just as expected, simple and efficient, something any Volvo owner would be proud of, with a shared bathroom down the hall. After my red-eye flight I was looking forward to a shower then meeting my sister for lunch. The first thing I looked for was my pair of flip-flops, and my heart dropped. In my mind I could see them sitting on my bedroom floor, across five thousand miles of Atlantic chop. Any (hygienic) college freshman values the flip flop. In the dorms, where 60-70 students share the same 10 showers, the flip flop offers protection from fungi, mycosis, athlete’s foot and any other sort of creepy-crawly hitchhikers that live in bathroom tile city. But I was in Sweden, one of the cleanest countries in Europe. The hostel was tidy and the bathroom looked better than the ones in my college dorm, so it must be okay to go sans flop, right? Wrong. I ended up paying the price in the form of a tag-along all the way to Rome, and he was no “fun-guy.”

Toenail fungus, known by physicians as onychomycosis, will affect 50% of Americans by the age of 70. Fungus infections occur when microscopic fungi gain entry through a small break or abrasion in the nail, then grow and spread in the warm, moist environment inside your socks and shoes. Symptoms of toenail fungus include swelling, yellowing, crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. It is very difficult to cure so prevention is ideal. It helps to wear protective shoes or sandals in public showers, pool areas and gyms, and to avoid borrowing shoes or sharing socks or towels. Keep your feet dry as much as possible and change socks on a daily basis.

If you do develop a fungus, see a doctor.  You will want to be very clear about your symptoms, especially if you are in a foreign country. The common terms that we use in America don’t always translate well in other languages. For example, “athlete’s foot” in Italian is “il piede d’atleta”, but that won’t mean anything to a doctor; the medically correct translation is “infezione micotica.”  Once your condition is diagnosed, expect some common treatments such as trimming or filing affected areas and in severe cases, oral anti-fungal medication.

In conclusion, don’t let foot fungi uproot your travel plans. As inconvenient and unsightly as it is, fungi are easy to prevent — just think cleanliness. Also, don’t forget your flip flops, anytime you pack for a trip!

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Don’t let the cold take a bite from your fun.

Thursday, February 11th, 2010 by Moira Bishop

While you are ice skating, skiing, snowboarding, or hiking in the cold you may not feel the chill, but you still need to protect your skin.  Long term exposure to cold temperatures, or even short term exposure to extreme temperatures can lead to frostbite.

Frostbite is the freezing of your body from the outside in – starting on the outer layers of your skin and working its way to your muscles.  The most common areas for the cold to attack first are the toes, feet, the tip of the nose, the tops and lobes of the ears and the fingers. 

As frostbite sets in the skin will turn red then blue, and as the damage gets more severe, the blue will change to white or yellow or maybe even black.  Likewise the feeling will progress from tingling, leading to burning and then throbbing pain. 

The best way to prevent frostbite is to be prepared for it. Know the temperatures your skin will be exposed to (don’t forget to include the wind chill in your calculations) and dress to protect your skin appropriately:  Dress in layers,  wear warm socks and gloves to protect your hands and feet and wear a ski mask and ear muffs to protect your nose and ears.  If you feel warm or hot while you are out in the extreme cold, don’t make the mistake of thinking this is a reflection of the outdoor temperature. It is probably an effect of your body temperature, so don’t remove the layers protecting your extremities.

If you think you have frostbite the best thing to do is call a doctor.  If this is not an option, take steps to restore the frozen areas to normal temperatures. The best way to do this is to soak or wrap them in warm water.  Using hot water could lead to more burning and skin damage.  Do not rub any of the areas affected and do not let fingers or toes rub together, this can cause further damage.  As the skin returns to normal temperatures, it is common for blisters to develop and skin to become very tender. It can take weeks or months for your skin to return to normal after frostbite. 

In some cases, the effects of frostbite will not show up for months, so if you can’t get to a doctor immediately, get to one as soon as you can.

Because good circulation helps deter frostbite, keep hydrated and avoid alcohol when you are going to be out in the cold.  Diabetics, smokers and anyone else with poor circulation should take extra precautions to stay warm and protected as they are more vulnerable to this condition.

For additional information on frostbite, visit Web MD or see what the Ice Road Truckers have to say about it. 

Take the time to protect your skin before you head out in the cold.  65% of the people who get frostbite will suffer long-term effects – you don’t want to be regretting your haste in the winter as you head for the beach in July.

Photo info: http://www.flickr.com/photos/blac/ / CC BY-NC-ND 2.0
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Traveling Gluten Free

Wednesday, February 10th, 2010 by Emily Moran

Recently, a study was released regarding the increased prevalence of celiac disease. The Mayo Clinic in Rochester, MN analyzed about 9,000 blood samples taken in the 1950s and based on the findings reports that 0.2 percent of that population had celiac disease, but today an estimated 1 percent of the population has it. Celiac disease is a severe intolerance to gluten—a protein in wheat, barley, and rye. As more and more people are diagnosed, more organizations, websites, and blogs have been formed to help people find a variety of foods that are both tasty and gluten free.  

Over time those affected acclimate themselves to the labels, guides and menus available to help them navigate options in their favorite restaurants and grocery stores. But what happens when they go abroad? 

Because there is plenty of helpful information available, the celiac diagnosis does not have to deter anyone from traveling.  The National Institute of Health Celiac Disease Awareness Campaign is a good place to start—the travel section provides an outline of how to plan, travel, and then visit a different country. The Celiac Travel website provides even more detail.  One of the best features is free printable cards in 43 language describing celiac disease and the dietary limitations around them. They’re even available as an iPhone app! In addition to the general travel tips and tools, the “Celiac Travel Stories” section offers user-generated anecdotes and restaurant reviews. (For additional “traveling with Celiac” stories check out Celiac.com.)

The book Let’s Eat Out: Your Passport to Living Gluten and Allergy Free has compiled a list of country-specific Celiac organizations and information sources.  Use this information to help plan for and enjoy a worry free trip abroad. 

Do you have any travel-related or country-specific tips you’d like to share?

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Emerging Antimalarial Drug Resistance – Cause for Alarm

Tuesday, February 9th, 2010 by Frank Gillingham, MD

A report released yesterday by a United States Pharmacopeia program, in partnership with the World Health Organization, cited an increasing level of resistance to Artemisinin – the last affordable drug in the global arsenal against malaria.  The drug resistance is emerging in Uganda, Senegal, Madagascar, Cambodia, Thailand and Vietnam, and is thought to be due in large part to the sale of poor quality versions of Artemisinin in those countries.

The report indicated that between 16 and 40 percent of the drugs marketed as Artemisinin had impurities or did not contain enough active ingredient to be effective.  Drugs will typically lose effectiveness and allow parasites to develop resistance if not given at full strength or for the full recommended course. In the case of malaria, there is no useful replacement for Artemisinin currently available, and many could die or become gravely ill if the current trend continues.

“It is worrisome that almost all of the poor quality data that was obtained was a result of inadequate amounts of active ingredient or the presence of impurities in the product” said Patrick Lukulay, the director of the study.  Senegal had the most disturbing results, with over 40% of the Artemesisin based samples failing quality testing. Lukulay added “There are some countries where donated medicines are not subjected to quality controls, they are just accepted”.  This includes countries in Africa where Chinese products have been given and found later to be unacceptable.

Although results from other countries in the ten country study have not been released, preliminary evidence from the other countries surveyed – Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania suggest that failure rates in at least three of those countries were also high. 

Traditional antimalarial drugs such as malarone, doxycycline, chloroquin and mefloquin are still effective in many parts of the world where the malaria parasite is endemic.  In recent years, Artemesinin has been the last resort in areas where the parasite has developed resistance to these medications. However, for those travelling to sub Sahara Africa or southeast Asia, the risk of contacting Artemesinin resistant malaria is growing.  Although resistance is not yet widespread, it behooves the careful traveler to make sure that any Artemesinin based medication taken for treatment of a malaria infection is of good quality.

Photo info: http://www.flickr.com/photos/lonqueta/ / CC BY-NC-SA 2.0
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Thin Air Way Up There: Take the Risks Seriously

Friday, February 5th, 2010 by Frank Gillingham, MD

If you are planning a mountain climbing, hiking, skiing or snowboarding trip, you may have your sights set on a high altitude destination such as the Peruvian Andes or the ski resorts of Colorado.  These destinations carry with them the thrill of a tingling physical challenge as well as the risk of developing altitude sickness (also known as mountain sickness).

Altitude sickness results from your body’s decreasing ability to absorb the oxygen necessary to convert nutrients to energy because of the thinning of the air as you ascend.   This change results in symptoms that can hit anyone regardless of his fitness level.  In fact, it often strikes younger, more fit members of climbing expeditions and may be less common in those over the age of 50. Tolerance to high altitude varies tremendously between individuals, and can vary from trip to trip for the same individual, though cold weather seems to worsen the effects.

Anyone with chronic medical conditions or a history of asthma, lung or heart problems should discuss travel to a high altitude destination with a physician well in advance of travel. Individuals who suffer from the following chronic medical conditions should never travel to high altitude destinations:

  • Chronic Obstructive Lung Disease (including Emphysema and Chronic Bronchitis)
  • Congestive Heart Failure
  • Sickle Cell Anemia
  • Pulmonary Hypertension

It is common for those visiting a high altitude destination to breathe more frequently and experience increased heart rate and pulse. Dryness of the skin and mucous membranes occurs, as does a minor headache. These are normal characteristics of a body adapting to high altitude.

Severe symptoms such as these, occurring within the first 36 hours at altitude could be indicators of the onset of altitude sickness:  

  • Extreme increase in breathing frequency, with shortness of breath and/or cough
  • Very rapid heart rate with palpitations, chest discomfort or a perception of pulses in the neck and head
  • Severe headache
  • Nausea and/or vomiting
  • Fatigue and sleeplessness

Severe cases of altitude sickness can result in death, so it should be taken seriously. Mild symptoms of altitude sickness can be treated with rest at a stable altitude and acetaminophen or other analgesic (pain medicine).  If symptoms persist for more than 24 hours, seek medical attention. If possible locate a physician who is experienced in high altitude medicine.  Descent to a lower altitude is crucial. Never ascend if your symptoms are getting worse.  Some physicians will prescribe medications such as dexamethasone and/or nifedipine prophylactically for travelers to high altitudes, but this practice is controversial. 

To avoid altitude sickness, allow your body time to adapt to the thinning air, stay hydrated and follow all the normal safe-travel tips.  Food poisoning, jet lag and other situations manageable at regular altitudes will be much worse in high altitudes.

Don’t be up in the air about taking care of yourself; make sure you are grounded with good information and preparation.  Otherwise, you may be grounded longer than you planned.

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Vaccination Recommendations for Travelers

Friday, February 5th, 2010 by Frank Gillingham, MD

In a recent Wall Street Journal post, Avoiding Illness on the Road, Dr. Phyllis Kozarsky, a travel health expert for the Centers for Disease Control (CDC), offered some good advice for travelers, particularly business travelers. 

In this piece Dr. Kozrsky correctly to advises those who are travelling overseas to get immunized, even if coincident with departure.  However, nascent travelers should be aware that protection is not immediate. In the case of the hepatitis A and B vaccines, for instance, full immunity cannot be guaranteed for everyone who receives the vaccine for at least one month.  Long lasting immunity requires a second vaccination anywhere from one month to one year after the first. 

According to the CDC, the only vaccine that is required by international health regulations is yellow fever for those travelling to sub-Saharan Africa and tropical South America. The CDC recommends that this vaccine be obtained at least ten days prior to arriving in an area where yellow fever is endemic.  In addition, the vaccine must be administered at an approved center that can provide the vaccinee an authentic “International Certificate of Vaccination”.  The yellow fever vaccine must be repeated at ten year intervals to remain effective.

Meningitis vaccinations are required in for those travelling to the “meningitis belt” across the middle of the African continent and parts of Saudi Arabia.  The vaccine provides protective antibodies after a week to ten days, with immunization lasting only three to five years.  There are vaccines for encephalitis, an infection of the brain, which must also be administered at least a week or two before travel in order to be protective. 

Those travelling abroad should consult with an infectious disease or travel medicine specialist at least one month prior to trip departure to insure adequate protection against infectious diseases.  Destination specific vaccination requirements can also be found on mPassport.com.

Photo info: http://www.flickr.com/photos/darwinwins/ / CC BY-NC-ND 2.0
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Headed for the slopes?

Friday, January 29th, 2010 by Moira Bishop

Does talk of the upcoming winter Olympics have you channeling your inner Lindsey Vonn or Shaun White? Skiing and snowboarding are great winter activities — fun meets fitness.  Regardless of where in the world you decide to visit to participate in these types of winter sports, there are some safety issues to consider:  protect your head and face, keep warm and know your own abilities and your surroundings. 

Protect your head.  Regardless of how well you ski or snowboard, there are other factors on the slopes that could cause a serious fall.  Other skiers, random patches of ice or just dumb luck can knock you down and knock you out. To limit the seriousness of injuries that you could sustain during such a fall, wear a helmet!

Protect your face. While you are outside on a mountain covered in snow, the elements are constantly attacking your skin. The wind and the sun can burn and dry out your face and lips.  Apply sunscreen to your face every few hours and lip balm as often as necessary.  The glare of the sun off the snow can be blinding, so wear sunglasses or goggles with UV protection.

Keep warm.  If you’re a strong skier or snowboarder, you might feel that the extra layers of clothing are cumbersome and limit your free styling ability.  However, frostbite could take you (or your hands or feet) off the slopes permanently.  Warm gloves, hats, long underwear and socks are remarkably thin and warm these days, so if you don’t like bulk, check out your local REI or ski or snowboard shop.  You want the layer of clothing closest to your body to be made of wool, silk or polyester.  These materials will wick the sweat away from your body instead of trapping it on your skin and making you feel colder.  Trails.com provides a realistic plan for layering that you might want to consult while planning what to pack.

Know your own abilities.  While you will likely challenge yourself during your outing, you don’t want to overdo it.  Going from the bunny slope to a black diamond is not safe, nor is it a good idea to leave your snowboarding lesson and immediately go attempt to perfect the Backside 720. Use your head and plan your progression based on realistic advances.   Regardless of how well you can perform in the snow, even the most talented of us can’t call for help while knocked out cold. So don’t ski or snowboard alone. Always go with someone who you can check in with at regular intervals. 

Know your surroundings.  Before you leave for your outing, do a quick survey of local hospitals or urgent care facilities.  If you do need to be taken for medical assistance, you’ll want to know you’re headed for the best treatment available.  (For a global database of hospitals, check out mPassport.com.) 

Have a great trip! Let us know how it goes.

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Mudslides in Machu Picchu

Tuesday, January 26th, 2010 by Moira Bishop

The heaviest rains to hit Peru in the past fifteen years have caused mudslides with serious consequences today — 4 people have been killed and 2,000 tourists have been stranded in and around Machu Picchu.

Reports from our contacts at Pardo Medical Center based in Cusco, Peru indicate that the heavy rain is not letting up and that is causing problems for transportation.  The trains are not running and the Cusco airport is closed until at least tomorrow, so the only way out is by helicopter.  The clinics are open for anyone who can get to them. 

Like many natural disasters, mudslides cannot be predicted.  If you are visiting or planning to visit a mountainous — or even just hilly — region that has recently experienced heavy rainfall or snowmelt, you may want to reconsider your plans.  

Ideally, you will never be in the path of a mudslide, but just in case, it’s a good idea to note these instructions from the Red Cross:

  • Quickly move out of the path of the mudslide or debris flow.  Moving away from the path of the flow to a stable area will reduce your risk.
  • If escape is not possible, curl into a tight ball and protect your head.  A tight ball will provide the best protection for your body.

Though you don’t want to spend time dwelling on worst case scenarios while preparing for vacation, a few minutes of planning can prove to be invaluable.

Photo info: http://www.flickr.com/photos/comprock/ / CC BY-SA 2.0
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Planning a winter road trip?

Friday, January 22nd, 2010 by Moira Bishop

Whether you’re planning a road trip in your own car or flying to a cold climate and renting a car this winter, you should assemble a winter emergency kit for your travels. In addition to the possibility of getting snowed in there is also a risk for getting stranded on the road.  Because we live in an area prone to snow and ice, my co-workers offer suggestions on what to keep in your trunk for your daily commute and road trips in the winter:

First Aid Kit/Flashlight/Flares – Include these items in your winter emergency kit, and keep them in your car through the rest of the seasons.

Blankets – You’ll want one if you get stranded in the cold somewhere due to an accident or a break down and your car loses power and can’t provide heat.

Boots, Gloves – These will be handy if you have to get out of the car for ANY reason, like walking to get help or if you drift off the road into a snow bank.

Snow Brush/Ice Scraper– Be prepared for whatever visible evidence of winter sticks to your car.

Shovel – Find one that is easy to store (with a short or retractable handle), you’ll find it useful if you get snowed in or plowed in anywhere.

Rock Salt/Sand/Kitty Litter – Put any of these items behind your tires to create traction to help you get out of slippery situations.

Jumper Cables – These are always a good idea, but are especially valuable in the winter when your battery may succumb to the freezing temperatures.

Portable Battery Charger - This is a step-up from just jumper cables; you can charge your battery without the help of another car.  Some models include an outlet so you can use it to charge your cell phone or other devices.  It’s worth the price because you can also use it to plug in small home appliances indoors if the power goes out.  

Windshield Wiper Fluid – Snow, ice and the dust from salt on the roads can constantly coat your windshield as you’re driving down the road.  Make sure that you have a full reservoir of fluid before you set out on your journey and bring a refill so you never have to worry about limited visibility on the road. 

Food and Drinks – Pack items like granola bars, cookies, or trail mix that won’t be affected by the extreme cold and will provide a fair amount of nourishment if you get stuck somewhere. Keep water in your car as well, it may freeze, but will melt eventually and will help you avoid dehydration.  

Did I forget anything?  Share your tips with us.

Photo by: http://www.flickr.com/photos/genista/ / CC BY-SA 2.0

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