Iowa Cat Contracts H1N1 Influenza

A Discussion of Zoonoses

First it was ringworm; now this. According to the Washington Post, a cat in Iowa (name withheld) is believed to be the first case of H1N1 in a domestic animal. It is thought that the cat caught it from a human, although it has not been labeled Human Flu by concerned veterinarians. The 13-year old cat, now recovered, did not comment. At the present time, people in Iowa should continue to feed and pet their cats.

Maybe it's Iowa? The 1918 Influenza Pandemic that killed millions worldwide actually started in Iowa, too. People in Iowa blamed Spain. Recommendations to evacuate the State of Iowa have not been issued. People should not panic.

The H1N1 flu has also been confirmed in two ferrets, which both died. It was not clear if the ferrets lived in, or recently visited Iowa. H1N1 has been found in turkeys. That's nice to hear with the upcoming holiday. My property is overrun by turkeys, so maybe I should consider thinning the population as a public health project?

I guess it is only fair -- pigs and/or birds are the primary reservoirs for influenza that transmits to humans. I sure hope that dogs aren't next. I am not sure I could live in a world where dogs can't kiss you or lick your hand. I sort of like cats, but they rarely are the "lick you in the face" species. I definitely would not be allowing a ferret near my face.

Animal to human transmission of disease is called zoonoses. Probably the most common zoonotic disease that I see in my clinic (other than ringworm - tinea corporis) would be giardia, an intestinal parasite that can live in water sources. Those water sources, like streams or rivers, are typically contaminated upstream by animals that poop in or near them. Of course, fish always poop in the water, but no one seems concerned about this obvious fact. Giardia causes annoying bouts of diarrhea and impressive, both in volume and smell, intestinal gas - two symptoms that would seem to be incompatible, let alone socially problematic. Kids, not known for their high levels of bathroom hygiene, can easily spread Giardia in day-care facilities and schools, and eventually to their parents. I coined my own team for kid-borne diseases called "Pedianosis".

There are hundreds of zoonotic diseases. Perhaps the most famous of zoonotic diseases would be AIDS. HIV infections were thought to be a mutation of a monkey or chimpanzee virus, contracted by humans in Africa that decided it would be a good idea to eat them, or more disturbingly, have carnal relationships with them (an unlikely rumor). One minute, you are having a little monkey tartar; and then you become unusually ill.

Lyme disease, contracted primary from deer ticks is becoming more common as growing populations of deer exist closer to humans. A different tick carries Rocky Mountain Spotted Fever. The son of a medical provider in our clinic came down with Lyme disease a few years ago, thought to be transmitted by a tick found on lizards! My home of course is also a lizard sanctuary. I tend to leave them alone, although the do periodically scare the crap out of me when they peak out from rocks. My initial fear is that his head represents a SNAKE! Wild turkeys apparently cannot catch or desired to eat lizards.

Fleas living on rats caused the Bubonic Plague that killed half the population of Europe in the Middle Ages. Cats have fleas, but fortunately not Bubonic Plague-carrying ones. Bats, skunks, and feral dogs can carry deadly rabies. Pet turtles (as well as eggs and poultry) can carry salmonella. E.coli can be found in meats, especially improperly cooked ground meats sold at certain, unnamed fast-food restaurants. Even snails (not escargot, one of my favorites) cause some serious diseases. Perhaps, the world's most dangerous creature, the one that causes most of the deaths worldwide is the lowly mosquito which carries malaria, yellow fever, and a few other killers.

A few minutes ago, I saw a young man who was bitten on the hand by a feral cat that was living in a car (convertible, if you should inquire) at the auto repair shop where he works. His well-meaning boss offered a cash bonus to anyone who successful caught the cat. The cat was not pleased when he was incarcerated in a plastic milk crate, so he decided he would bite the hand that caught him. It was an impressive infection. At least he didn't get H1N1.

Related Topics:

• Ear, Nose & Throat Message Board with Rod Moser, PA, PhD
• Living Better Newsletter - Wellness news to keep you healthy and strong!

Never Use a Waterpic to Remove Earwax (And Don't Let Your Doctor Do It Either)

There is an interesting posting on the Ear, Nose, and Throat message board from MollieMae01: Water Pick Injury:

boltron / CC BY-SA 2.0

"My 2 year old daughter was being checked for an ear infection (She is in good health and has never had any ear problems or infections before. We also had her ears tested a few months ago by a specialist and they were fine.) and the nurse used a water pick to clean the wax out for clear viewing. My usually quiet daughter screamed like we were torturing her and when the nurse removed the water pick from her ear canal a substantial amount of blood followed."

During the California Gold Rush, huge amounts of rocks and dirt were removed from ancient bedrock by a technique called hydraulic mining (Placer Mining). Water was fired at high pressure to loosen compacted earth. As a matter of fact, my neighbor has an old hydraulic nozzle sitting in his yard as a display. Until this method was outlawed, millions of dollars of gold was extracted. Of course, the sludge clogged streams and rivers, causing devastating floods; the land was marred forever.

Hydraulic mining is not unlike the ear lavage. To safely extract impacted ear wax, it must first be softened, and then it needs to be washed out with a GENTLE stream of warm water. The key point here is "gentle".

The Waterpic was hot in the 1970's. Designed as an adjunct to dental hygiene, the Waterpic proved to be an effective tool, especially helpful for those with braces. It didn't take long before people started finding other, non-dental uses. These were untested and unapproved uses not condoned or encouraged. We had one in our family practice that we used to irrigate wounds, and yes, irrigate ears that were impacted with wax. The most important lesson that we learned was adjusting the force of the pulsating stream. High settings had the potential of splash-backs. You really didn't want to have contaminated water splash back in your eyes or mouth! If the high setting was used for cleaning out the ears, it could easily rupture the eardrum. I must say, that on the low setting, it seemed to be an effective irrigation tool as long as you were careful. The problem with this unapproved use was cleaning the instruments. Medical offices, as you know, are not the cleanest places on Earth. The Waterpic was primarily plastic, and plastic cannot be adequately sterilized between patients. In a busy medical office, you never knew what it was used for previously. After a short while, the Waterpic was permanently abandoned as an ear or wound irrigator. It probably ended up at Goodwill.

Speaking of unintended uses, Q-tips are not promoted as a tool to remove earwax, but yet, they are used for exactly that purpose. Some people - and you know who you are - are literally addicted to Q-tipping their ears every day after every shower. Many will go through their entire lives thinking earwax is dirt, or implies that you are an unclean person, and must be removed. Earwax is one of the most beneficial substances made by the body. It protects the delicate lining of the ear canal and it is antibacterial (prevents skin infections). It should NOT be removed, unless of course, it is deeply impacted. And, in most cases, earwax is deeply impacted BECAUSE people are using Q-tips to pack it in, just like loading a Civil War cannon.

Welch-Allyn, a respected manufacturer of fine medical tools and instruments, re-invented an ear irrigator several years ago for clinic use. It, too, had a pulsating stream, powered by the water pressure from our faucets. The clever design even created a vacuum to catch the extruded chunks of wax. Always a fan of new gadgets, I got one. After using it a few times, I found it cumbersome and messy. My old method actually worked better. It is now sitting in a box somewhere in our clinic. The special faucet adapter is still attached, but I doubt I will use it again. I guess that some clinicians really like it.

The trick in cleaning out the ears is really related to visualization. Unless you can actually see what you are trying to clean out, it is not wise to blindly dig in an ear, let alone try and wash it out with a stream of water. The rubber bulb syringe that comes with commercially-available ear-cleaning kits can work, but the stream is really a bit too large. I always have this fear that someone will fail to read the instructions and jam the bulb syringe in the ear and squeeze. This, of course, would be an automatic eardrum rupture. Since this is the same (or similar) bulb that parents use to suck snot out of their baby's noses, they may think that can suck out earwax. You cannot. If you try and suck out earwax with a bulb syringe, you will simple suck out (and rupture) the eardrum.

Since you can't really look inside your own ear, you will need a trusted friend or partner with a home otoscope. If you start inviting people over to your home, asking them to look in your ear to see if you have a wax impaction, you are going to lose a lot of friends. The Japanese - a culture that seems to be obsessed with clean ears - does have a fiberoptic video device for those who really want to peek inside their ears. I have never seen or used this home model video otoscope, but I suspect the resolution is not that good. Besides, there is always going to be an odd spatial orientation that you will need to overcome. I would love to be able to have a good video otoscope unit in my office so I can show patients their ears, but good ones are really cost-prohibitive. So, the bottom line: If you are going to be cleaning out your own, or anyone's ears, you need to have an otoscope to look FIRST.

A painful, potentially-infected ear should never be washed out...by anyone. In a medical setting, we often have to remove cerumen (earwax) in order to adequately examine the eardrum, but we use a wire loop or cerumen spoon. This is NOT the same as Grandpa digging wax out of his ear with a bobby pin or paper clip. Medical providers learn how to do this, and they have the ability to actually see (with an otoscope) what they are doing. Anyone who blindly digs in their ears with homemade instruments is really a fool. It is only a matter of time before you rupture your eardrum. Q-tips are also Weapons of Ear Destruction, causing many of the unintentional ruptures that I see in the office.

If I do need to lavage an ear, I have several instruments that I use. There is the metal syringe that can be autoclaved, and of course, my homemade ear lavage unit made from a 20-50 ml syringe and a piece of IV tubing or intracath - items not available at the local Walmart. It is really not the tools, but the skill of the person using the tool. I am not bragging, but I have never met a wax impaction that I couldn't beat. It may take me a while, and I may consider blasting from time to time, but in the end, I do get it out. Unlike ENT offices, I do not have an ear vacuum device. I could sure use one though, if my medical group would see fit to cough up the capital expenditure funds. Since my homemade unit costs less than a buck, they are less inclined to order one.

Unlike the old days, I would never use a Waterpic to wash out an ear. If your doctor has one, just say "No thank you." If you see one at Goodwill, don't buy it. If you have one at home and are tempted to use it, I hope I have changed your mind.

If you know what you are doing, have the right equipment, and common sense, ears can be safely lavaged out at home. Sometimes, it is best to leave the job to a medical professional.

Da...da...da...da. Da...da...da...da. Wax Man!

Related Topics:

• Ear, Nose & Throat Message Board with Rod Moser, PA, PhD
• Living Better Newsletter - Wellness news to keep you healthy and strong!

Teenagers Are Just Adults That Haven't Finished Cooking

Last night was my granddaughter's 16th birthday party. As a gift, we have been working on a video tribute to her. My brother spent countless hours weaving a video tapestry of hundreds of her photographs into a beautiful, unbelievably-touching masterpiece. He used three songs; one for each segment: The Eyes of a Child, Please Remember, and She's a Butterfly.

There was not a dry (adult) eye in the crowd of 75 last night. The tears were flowing from gaggle of six grandparents - including two that flew in from Texas for the party, an impressive gathering of uncles/aunts, and the of course, her circle of friends. There was even a very proud great-grandfather in the crowd who became teary-eyed when photographs of Shelby and her now deceased great-grandmother, his late wife, faded onto the large, projected screen.

Shelby's Grammy Sandwich/Photo Credit: Rod Moser

Why did they cry? Memories. Nearly every adult in that room has known Shelby since her first breath. This birthday celebration was held just a few miles from the now-closed Mather Air Force Base where she was born - one of the last babies to be born before the hospital was decommissioned. Her father was in the Navy at the time, during the first Gulf War. Shelby's mother had just gotten out of the Navy. Shelby's great-grandfather, recently deceased, was a Navy officer in World War II. People remembered when she was born, and of course, those that are no longer with us.

Her father (my stepson) is not an overly emotional man, but when his daughter left her cadre of friends to come and hold his hand, it did not go unnoticed. Maybe this helped set off the sob-fest? Even the littlest kids liked it, although they seemed to laugh more at the random naked/bathtub pictures or pictures of Shelby missing two front teeth. The adults cried. Some tried to hide it; others openly wept. Kudos to my brother, the producer, and of course the countless hours he spent at his trusty, and occasionally temperamental, Mac.

Shelby's biological mother left the family when she was only five; her brother was barely two. She has had little or no contact with the children since her untimely departure for a different life. If she ever sees this video, she will cry, too - perhaps for those many years that she missed and will never get back. My stepson became both mother and father for many years before he remarried. Shelby now has a loving stepmother and a new little brother. It was this collective love that has sustained her through these often-painful years, and the reason why she is such a lovely, intelligent, and caring young woman today.

My medical practice has a large population of teenagers. To some people, this would be terrifying, but I really like teenagers. I like the ones that tell me they have been accepted to Stanford or USC on academic or sports scholarships. I even like the ones with pierced lips, spiked hair, ugly tattoos, and their butt-cracks exposed. Teenagers in every generation have expressed their independence a various ways - their clothes, their music, their rebellion against everything adult-like. However, time continues to change attitudes, mannerisms, and fashions. Slowly but surely, like it or not, teenagers evolve into the same adults they now disdain. Teenagers are just adults that haven't finished cooking yet.

Sixteen years seems like a dash. I was working in the Mather Emergency Room the day that Shelby was born. We were there when she went to Disneyland for the first time, learned to ride a horse, swim with a dolphin, and won a 4H ribbon for her rabbit. Sixteen years later, Shelby was sitting on the floor with me, helping with the birth of six new puppies. Sixteen years from now, I expect that I will have already paced around a waiting room (perhaps, more than once) waiting for the birth of a great-grandchild. Sixteen years after that, I may just be a memory in the lives of my children, grandchildren, and (hopefully), great-grandchildren. Maybe when she hears the song, Remember Me, she will do just that.

Don't just give a gift card or money in an envelope. A birthday is a celebration of a life in progress, but it is also a reminder that all of us are getting older. The only birthday gifts that really endure are memories - the precious memories that we help create, preserve, and cherish.

Related Topics:

• Ear, Nose & Throat Message Board with Rod Moser, PA, PhD
• Living Better Newsletter - Wellness news to keep you healthy and strong!

Pet Friendly Hotels?

It has been a while since I have traveled with my pets, since my adult dog, Lexi, hates the car. She shakes and trembles, lies on the floor of the back seat and then throws up. It may be anxiety, since her only car trips now are to the vet or to the groomer - both not high on her list of places to go.

"Herman" / Photo: Rod Moser

Two of my Shelties loved the car. One would actually chase cars while IN the car. We had a van at that time, so she would sit on the front seat until she saw a car, and would then run all the way to back barking at it as it passed. This was annoying. Herman, my late buddy, would try and come with me all of the time; even when I was going to work. As soon as I would open the door, he would jump in. He would lie on the front seat and lick my right hand which rested on the center console. His fearlessness around cars lead to his injury a few years later when his big, bushy tail got caught under my rear tire. He was not able to recover from his injuries after extensive surgery and had to be humanly euthanized. This was one of my saddest days.

About a week ago, I had to take a few days off to put, Cali, one of Lexi's six puppies on the plane to Maryland on Pet Airways. Since the flight left from Los Angeles, about a 7-8 hour drive, my brother and I had to leave the night before. Finding a pet-friendly hotel was a bit more challenging than we anticipated.

There are dozens of hotels near the Los Angeles airport, as you might imagine, but the surrounding communities are not the safest places to stay. We did find a hotel that allows pets near the airport but the reviews were not good; scary in fact. One reviewer referred to this hotel as worse than the Bates Motel. Another advised us to lock our car and doors at all times. We figured that this pet-friendly hotel may have also been crack-friendly and prostitute-friendly, so we canceled our reservation.

There are lots of Internet sites that list pet-friendly hotels, but pet-friendly does not necessarily imply that they are wallet-friendly. Some were terribly expensive, including one pet-friendly hotel that has a one hundred dollar, non-refundable pet deposit! That is $700 in dog money! The lowest pet fee was fifty dollars. Since we were only staying there for about nine hours, we felt those fees were ridiculous.

Photo: Larry & Jeanette Moser

We finally found hotel (one of the chains) located two hours from the airport that allowed pets and did not charge an extra fee. What would this one be like? It turned out that this hotel was one of the cleanest, nicest, reasonably-priced, safest places that I have every stayed - The Hampton Inn Santa Clarita. I think they deserve a plug for being pet (and human) friendly. There were many dogs there, including some scary-looking, but well-behaved pit pulls, but not one was barking or running amok. We did sign an agreement to pay for any pet damage, which of course, there wasn't any. I would stay at this place again, even if I didn't have a pet. They even had a hot breakfast in the mornings that was darn good. I blogged about The Dozen Dirty Places in the past, listing hotels high on this list. I can truly say that this hotel is an exception. If I did the list, I would put my living room or my home office on the list instead.

Photo: Larry & Jeanette Moser

Cali made it safely to Maryland after her thirty hour journey; a longer flight than we originally anticipated. My latest report from Maryland is that she is excelling in house-training and has already been fitted with her life preserver for the boat. It is good that she is house (boat) trained quickly or you could have a whole new meaning for the area on the boat called the Poop Deck.

Photo: Larry & Jeanette Moser

Unlike most of my other dogs, Cali is the one that does not seem to mind car trips. She has already visited my elderly mother (she will be 88 next month) in the nursing home and has made many local car outings without the least bit of car-sickness or anxiety. Out of the six puppies, it seems that my brother got the "good one", although I think all of them are wonderful.

When we go out of town, we hire a house/pet-sitter. In a few years, we would love to buy a tent camper and tour our own country, hitting the best of our National Parks. I would love to take the dogs; not that they would enjoy the trip, but so we wouldn't have to leave them. My brother and sister-in-law do many car (and boat trips) so having a travel-friendly pet is essential. I am glad they got one. Since we have accumulated a menagerie of sorts - three dogs, two cats, tropical fish, and 14 non-egg laying (so far) chickens, we will need that pet/house-sitter for a long time, I am sure. We fantasize with the idea of retiring pet-free, but neither one of us can imagine a life without having a dog (or three) to love and pet.

Photo: Larry & Jeanette Moser

Related Topics:

• Healthy Dogs on WebMD
• Pet Health: The Veterinarian Is In
• Healthy Pets Newsletter

Are You Right-Eared or Left-Eared?

Dean Shareski / CC BY-SA 2.0

What happened to in-flight entertainment? On my recent flights, there were no movies, no headphones for music, and no magazines. I long for the day when flight attendants would cruise the cabin, handing out a variety of magazines. Now, we have to buy our own magazines (at airport prices) and books, bring our own food/snacks, and supply our own entertainment.

The guy across the row from me was happily watching a video and wearing those noise-canceling headphones, periodically chuckling. As soon as the movie was over, he had one of those new electronic books, and started to read a novel. This man was prepared. I bought a TIME magazine at the news stand, but read it all waiting for my flight to leave. This is equivalent to eating all of your popcorn before the movie starts. I started leafing through those in-flight magazines (Spirit) and found an interesting article that I would like to share.

Did you know that 72% of people prefer to listen with their right ear? It is not really due to the fact that you are right-handed either. The left side of the brain specializes in language processing and is neurologically wired to the right ear. Consequently, the right side of the brain that deals with emotional cues is wired to the left ear. Two Italian researchers found that requests spoken into the right ear generates more positive responses than those uttered into left ears.

I find this very interesting, since I am one of those right-eared people. If I hear something subtle outside, I will turn my right ear to the noise. I tend to keep my wife on the right side when she is talking, too. She sits to the right of me when I am driving, and on the right when we are at the movies. When she nags me, she is usually on my right, but now that I have this information, I may turn my left ear in her direction. Of course, I do have tinnitus which is primarily in my left ear, so I suspect my right ear has more acute hearing.

We don’t have any young children in the house anymore, just dogs and puppies. We do have grandchildren, however, so I am going to try and voice those requests to pick up their stuff, or take a shower, etc. in their right ears, hoping of course, for those positive responses. I am going out on a limb here because I don’t think teenagers really respond to either ear, but I am going to try it on our 16-year-old granddaughter.

Related Topics:

• Ear, Nose & Throat Message Board with Rod Moser, PA, PhD
• Living Better Newsletter - Wellness news to keep you healthy and strong!