Friday, October 30, 2009

Sick

Sorry for the lack of new postings. So much in the news and lots of commentary I'd like to give, but I'm afraid I have been sick with the H1N1 for the last week and a half. Miserable. Will try to post all about it next week.

Friday, October 9, 2009

Chronic Fatigue Syndrome Virus

Researchers have identified a virus thought to be the cause of chronic fatigue syndrome. This virus, called XMRV -- xenotropic murine leukemia virus-related virus -- was identified in a significant number of patients with CFS. It is a retrovirus. Similar to HIV, this virus replicates via RNA. This suggests that antiretrovirual drugs used for HIV may help patients with CFS. They is also some research with suggests that XMRV may be responsible for prostate cancer as well.

I wonder how many other cancers are associated with viruses. And there is need for work on the epidemiology of XMRV. How is it transmitted? How can we prevent transmission?

We have long suspected CFS was caused by a virus. There has been some suggestion that it was a rickettsial infection (similar to Lyme disease). In fact, I see many patients with CFS diagnosed with Lyme, although the fit with that diagnosis often seems tenuous. What an exciting discovery.

Thursday, October 8, 2009

Military Mandatory H1N1 Vaccine

While it is no surprise that the military would mandate pandemic H1N1 vaccine, this article is interesting. The military vaccination program will really be a big experiment in safety. With such large numbers of personnel receiving vaccine (millions), it should be clear relatively quickly if there are any immediate safety concerns.

In the words of one commander (quoted in the article referenced above):"Because I can compel people to get the shots, larger numbers will have the vaccine... They will, as a percentage of the population, be vaccinated more rapidly than many of us. So we may see some objective results, good or not, of the vaccinations."

Here's hoping they are all good. (There are people out there who argue that 'Gulf War Syndrome' is a result of the anthrax vaccine, although the science behind that argument is grossly lacking).

In related news, my health department received the first shipment of vaccine -- a very small allotment of H1N1 flumist. The doses were given to local hospitals and offered to public health clinical staff (those with direct patient care). We expect the vaccine to slowly trickle in.

Meanwhile, numbers of people infected continue to climb. I am curious to see when we will reach the peak in the epidemic curve. Before long we will have herd immunity; it remains to be seen how much of that will be from natural immunity (having had the disease) or artificial (vaccination).

Monday, October 5, 2009

Tamiflu in the River

Intriguing thread on ProMED about Tamiflu contamination of rivers in Japan. Apparently, when we take Tamiflu, we pee out the active form of the drug. Our Tamiflu-pee then travels through the sewage system and eventually ends up back in the environment.

This process has been found with a number of drugs. Several studies of the river which flows into the lake where my drinking water comes from have found high levels of antidepressants and birth control in the water. So we have mellow fish who don't reproduce (That's a joke of course, but the medicine is there and it gets in the fish).

Drugs in the water can have an effect the wildlife and one wonders (suspects) if we end up drinking them again. In the case of Tamiflu, there is a potential for waterfowl to consume the water and breed resistance. The studies that have been done so far suggest that the Tamiflu will survive through the water treatment process. There is a potential for all of us to drink the water and breed resistance.

While the CDC continues to stress limited use of Tamiflu, patients often demand the drug, and some healthcare providers continue to use it liberally. In recent weeks, a child with no underlying health conditions died in area and the media covered it judiciously. The child was taken to the doctor and had rapid results positive for influenza A. The child did not meet the recommendations for receiving Tamiflu and was not prescribed the drug. A few days later the child died. A sad, tragic story, to be sure. And speaking as a parent and not a public health official, if my child were diagnosed with influenza, after hearing that story I would be afraid. You never know which patient will be the one that goes horribly wrong. Many, many parents have called me, terrified because their kid has flu but their doc won't give them Tamiflu. In 99% of those cases, their child will be fine. But there's that 1% chance. That risk that your child will be the one on the news next time.

Friday, October 2, 2009

Obesity

A friend of mine had gastric bypass surgery several months ago. Prior to the surgery, she was, to use the clinical term, morbidly obese. She tried all the usual weight-loss routes – special diets, pills, programs – without success. She was diagnosed with type II diabetes, hypertension, and a host of other ailments (including suffering a fractured tibia – her leg couldn’t support her weight).

Since the surgery, she has lost more than 100 pounds. Her diabetes and hypertension have resolved, and aside from the loss of much of her hair, she feels great.

She used to be very self conscious. Despite the push for eduction on obesity, 99.99% of people who are obese know they are fat (especially if they are women). She tried very hard never to be seen eating in front of others, because she was afraid that they judged her with every bite she put in her mouth. When she did go out to eat, she said that she planned the excursion in detail prior to leaving the house. She always ensured that wherever she went has tables and no booths – because she knew she could not fit into a booth and wanted to avoid the embarrassment of having to explain should a host attempt to seat her in one.

For the first time in her life, she bought a pair of jeans last week. They never fit her right before.

For the first time in her life, she rode carnival rides this weekend. She was too big to ride them before.

I never realized all the small things she worried about that I took for granted.

She feels so much better, and is much happier overall with her life.

I feel like I should wind this up with some powerful insight into weight and health, but really I just wanted her to know I am proud of her.