Dirty Places, Part 10: Dirty Jobs

The world is filled with dirty places, but I am starting to run out of places that I have identified. I watched a few episodes of a series called "Dirty Jobs" today, so it reminded me of some of my own past (and present) dirty jobs.

While in high school, I worked at a game farm in Farmington, Pennsylvania. My job was to raise quail for the hunting reserve; ten thousand per year to be exact. That many quail, as small as they are, produce an impressive amount of quail poop that needed to be cleaned.

We also had a small zoo on the property, so I quickly developed more than a casual relationship to the excrement of bears, raccoons, opossums, porcupines, deer, elk, rabbits, bobcats, and dingo dogs. My job, of course, was to feed the animals and clean their cages. Although this job may sound disgusting for some people, it really wasn't a bad job, once you get used to the smell.

When I entered the medical profession, I graduated from animal droppings to the fine art of dealing with human poop, from performing rectal examinations (someone has to do it), to examining stool specimens for ova and parasites. Medical people have to deal with many of the more disgusting human afflictions, like perirectal abscesses, embedded foreign bodies, horrible infections, squirting blood, and the shear joy of removing an impacted tampon (that happens quite often -- read on).

Every medical provider has their tasteless stories, mostly told around the dinner table much to the horror of our non-medical guests.

In a past Blog, I talked about my experience of teaching a mother how to insert a rectal suppository in her ill child. Just a little warning to put down your sandwich before reading it: The child also had diarrhea.

Until Hepatitis B, HIV, and other blood-borne pathogens took front page, most medical professionals did not give much thought to getting blood all over our hands. Not any more. We glove up and protect our clothes and eyes when dealing with blood now.

One evening in the Urgent Care, a man was brought in with a chain saw injury on his lower leg and foot. High on the list of Stupid Human tricks, this man decided to duct tape his chain saw (turned on, of course) to a long pole in order to cut a branch out of his reach. When the saw vibrated out of his duct tape, it landed on his leg and foot.

He told me that he quickly decided not to catch it, but thought he could at least break its fall by sticking out his leg. This frightened man must have missed that high school lecture where people are told to put PRESSURE on a bleeding wound. He decided to wrap a black, garbage can liner around his foot and leg to catch the blood. Catch it, it did. By the time he arrived at the Urgent Care, the bag was full. As we were lifting him onto the examination table, the bag broke. A tsunami of blood flooded the exam room. Once the bleeding site was identified, it only took a few minutes to patch the hole. The amount of blood did not justify the relatively small laceration the saw caused. It could have been much less work.

A year or so later, we saw yet another chain saw injury. This time the guy dropped the saw in his lap. Fearing that he had cut off both Frank and the Beans, I announced that he only nicked his leg. His penis, assuming it was the same size as before the incident, was miraculously intact.

Draining an abscess is another of our dirty medical jobs. Abscess does NOT make the heart grow fonder! Perirectal and pilonidal abscesses have got to be the stinkiest. Many seasoned medical professionals have gagged when opening and draining these little gifts of nature. It takes quite a while to air out the office after these procedures.

The removal of an impacted tampon is yet another stinky task for medical provider in primary care. In the busy bustle of daily life, it is not uncommon for women to insert a second tampon sometime during their menses, forgetting that another one is in place.

Soon, their menstrual period will end, but days or even weeks later, they will begin having a very smelly vaginal discharge -- one that cannot be improved by showering or other hygiene measures. Believing that they have a monster of an infection, they present to our office.

As soon as an experienced medical provider enters the examination room, this relatively-common scenario is suspected. A pelvic examination will quickly reveal the malodorous culprit. It then will be extracted, quickly wrapped in inside-out examination gloves, a plastic bag, and disposed of in a sealed container...outside. Case and problem solved for the embarrassed woman.

The care of human afflictions can be viewed as a dirty job to some, but this is the profession we chose. Human beings are vulnerable to disease, subject to the ravages of nature, and unbelievable lapses in judgment. I would much rather enjoy the glamorous practice medicine than clean another quail pen.


Related Topics: First Aid and Emergencies, 7 Key Traits of the Ideal Doctor

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Medical Mistakes, Pt. 1: Prescription Errors

To err is human; but to err as a medical provider is not tolerated by our society. Medical providers are among the few professions where mistakes - any mistakes - are not really permitted. Doctors, allied health professionals, pharmacists, nurses and others are held to a much higher standard than most other professions.

We all know that humans are not perfect. So, why are we horrified and shocked when imperfect humans, who are providing complex and highly technical care for other imperfect humans, make mistakes? Fortunately for all of us, not all mistakes are deadly.

I have been providing primary medical care for over three decades, yet I remember a time when entire prescriptions were still written in our secret language, Latin. As a matter of fact we still use many Latin abbreviations on our prescriptions today.

Unless your patient was an ancient Roman, they had no idea what they were taking. When new labeling requirements put an end to this archaic madness, my physician partner felt that much of the "magic" of medicine would now be lost to lay people.

Patients would look up their medications and start having all of those listed side effects. Patients would discover that their strong pain medication was just an expensive aspirin. Many medical providers at that time felt that a little knowledge was a dangerous thing, and it was considerably safer to keep patients barefoot and stupid. Something as simple and basic as the proper labeling of medicines caused patients began to hold their medical providers more accountable -- Step One for checks and balances.

The Internet has really changed the way we prescribe -- people want to know what they are taking and why, and it is our responsibility to provide that vital educational component. Patients are no longer mindless sheep reaching out for their mystery prescriptions with hungry hands.

Written prescriptions are quickly becoming a thing of the past in favor of electronically-transmitted ones. Busy practitioners have legionary poor handwriting, but write in their charts and on those pieces of paper that you present to your pharmacist.

Coupled with our use of Latin abbreviations, they are basically unreadable by the average patient, and sometimes unreadable by an experienced pharmacist. Pharmacists spend a great deal of their day calling prescribers to interpret their chicken scratch, or to correct overt written mistakes: Step Two in checks and balances.

There are so many medication names that are similar, but dangerously different. A misplaced decimal point on a dosage could kill someone. Even basic math mistakes require clarification. For example, "Take one tsp TID for 10 days. Disp: 100 ml." TID is Latin for "three times per day". A teaspoon is 5 ml, so why not just write it that way? Besides, if this person is to take the drug for ten days, they would need 150ml., not 100!

A side note: The teaspoon in your utensil drawer is unlikely to be exactly 5ml. Measure it sometime. Unless you use a proper measuring teaspoon (difficult to get in a kid's mouth), the spoon that you use to stir your tea could be 2ml to 7ml - a clear set-up for under-dosing or overdosing. Parents who claim the pharmacist either gave them too much or too little medication most likely measured it incorrectly when administered.

It is not uncommon for a medical provider to mistakenly write a prescription for penicillin or amoxicillin, even when it is known that you are allergic to this class of drugs.

Your medical provider may even ask, "Are you allergic to Augmentin?" The name "Augmentin" gives the uninformed patient no clue that it contains a high dose of amoxicillin, so you may reply that you are not allergic.

At this point, the only check and balance to a potential drug allergy error would be your own research, or the pharmacist. And, the pharmacist ONLY knows if you are allergic to penicillins IF you tell them. People who shop pharmacies to get cheaper drugs may fail to inform them of their drug allergies.

If I treat a patient for a urinary tract infection, I may tell them I am prescribing a sulfa drug called Septra. Because insurance companies mandate that less-expensive generics be substituted unless otherwise specified, the patient will likely to be very confused when they read their prescription bottle at home and it says sulfamethoxazole-trimethoprim - the generic name of this drug.

Unless I inform the patient that Septra has a different generic name, they may assume I made a mistake and choose not take it; or assume that the pharmacist gave them someone else's prescription. This is why patients need to listen carefully when the pharmacist (or their own medical provider) offers drug information.

The root of the word "assume" can be broken down to "Make an ASS out of U and ME". In medicine, providers should not assume anything.

We should not assume that people know that a suppository is inserted in the rectum -- I have had patients complain about their taste. We should not even assume that all patients know the suppository must be unwrapped first!

My pharmacist friend once got a complaint that the prescribed suppository did not dissolve - it came out with the foil still on it. He now writes "Unwrap suppository and insert in rectum" as part of the standard instructions. Just like those odd instructions on your blow dryer that warns you not to use it while taking a shower, medical providers often have to be painfully clear with instructions to avoid unintentional errors.

Related Topics: WebMD Video: Cut Hospital Errors: Device Double-Checks Medications, Protect Yourself from Prescription Errors

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Dirty Places, Part 9: Homes

Unfortunately, high on the list of dirty places must include our own homes. I am not talking about clutter and disarray, but rather sources of contamination. My wife claims that my home office is a mess, not unlike the city dump. I disagree, since I know the exact location of all of the items in my office. I would prefer not to have clutter, or use my floor as a desktop, but it seems to work for me. That is why we have doors.

There is only so much room in a person's office. I have a desk, two file cabinets, three printers, a fax machine, a copy machine, three book shelves, a huge case of antique medicines, a cluttered closet, and 15 drawers of stuff. Yes, stuff...my stuff. My garage and workshop is no different.

The real dirt and contamination in a home will be found primarily in the kitchen and bathrooms. I do most of the cooking, but I am not a big fan of cleaning the kitchen or bathrooms, at least to the satisfaction of my wife.

Any food preparation area is subject to bacterial contamination. For instance, when you are preparing raw chicken, some of the chicken juice drips onto the countertop. You may wipe it off with a wet cloth or sponge, but all that does is spread any contamination to other surfaces. If you cut up the chicken on a wooden cutting board, you will contaminate the cutting board. The knife that you used is also contaminated, as well as the faucet handle that you used to turn on the water.

Salmonella is a common contamination found in poultry and is one of the most common causes of bacterial gastroenteritis (food poisoning). If you leave that cutting board, wet cloth/sponge, or knife sitting around, someone else may use it (unwashed) to cut up some raw veggies.

Undercooked or raw eggs are another source of Salmonella. In the Rocky movie, where the Italian Stallion downed a dozen raw eggs, all I thought was "Salmonella". Perhaps the scene where he was running at full-speed through the streets of Philadelphia may indicate a desperate search for a bathroom. In families were there are many people in the kitchen at various times, using utensils and surfaces, the chance of having some hidden cross-contamination is very high.

Many people marinate poultry and meats at room temperature. Wrong! It does not take long for bacteria to rapidly multiply to disease-causing proportions at room temperature, so marinate in the refrigerator. And, when you choose to have your hamburgers "rare" or "medium-rare", you are asking for it. Raw or undercooked meats, particular ground meats, can harbor the bacteria E.coli.

Bathrooms in homes are certainly not as dirty as those in gas station restrooms, or movie theaters, or are they? Toilet areas may be highly contaminated with enteric (intestinal) organisms: the toilet seats and bowl, the flush handle, towels, door knobs, light switches, faucets handles, etc. Studies have shown that flushing a toilet with the seat open may splash and aerosolize microorganisms, spreading them all over the place, even on your toothbrushes. Moist bathtub and shower areas are prime breeding grounds for fungus, such as those that cause Athlete's Foot.

During a hygiene lecture several years ago with fifty medical students, I purposely "contaminated" some surfaces with a chemical called Germ-Glow - a fluorescent dye that glows under an ultraviolet light source. I sprayed the back of a sign-in clip board, the door knobs of the two shared bathrooms, the toilet flush handles, the light switches, and pencils.

Medical students are well aware of the importance of handwashing, and not touching their eyes or noses. Not one person admitted to breaches in personal hygiene, but when the lights were turned off and the ultraviolet light turned on, that class glowed purple. Students had purple noses, ears, lips. There were even some purple crotches and butts! I found evidence of Germ-Glow just about everywhere after one hour.

Some Reasonable Tips for Decontaminating the Kitchen:

1. Use a glass or plastic cutting board, never wood. Clean in with soap and hot running water after each use, and put it in the dishwasher every day.
2. Use contaminated knives and utensils once, or wash carefully after each use.
3. Cleaning is not the same as disinfection. Use a bleach solution* to clean all surfaces and cabinets, or use disinfectant spray on things that you do not want bleached. (Not all surfaces can be cleaned with bleach, so be careful).
4. Don't leave marinating foods at room temperature. Leave items such as mayonnaise in the refrigerator until you are ready to use it.
5. Wash your hands often and well. Avoid putting contaminated hands into utensil drawers or touch objects that may become equally contaminated.
6. Sponges are bacteria reservoirs, containing billions of germs. You can zap a wet sponge in the microwave for a minute to help kill those stealth germs, or use paper towels, or a clean cloth.
7. Clean the most contaminated (food preparation) areas LAST, so you will not spread microorganisms to other areas.

Some Reasonable Tips for Decontaminating the Bathroom:

1. Clean and disinfect surfaces that are most likely to be contaminated often, even every day. This includes the toilet, toilet seats, flush handles, door knobs, faucets, sinks, and light switches.
2. Use paper cups only.
3. Disinfect the tub or shower pan often.
4. Mop the floors with a disinfectant, especially the area around the toilet.
5. Change hand-drying towels often.
6. Close the lid before flushing the toilet.
7. Keep your toothbrushes covered and in a drawer.
8. Wash your hands thoroughly and carefully after using the toilet.
9. Clean the most contaminated areas, such as the toilet LAST. Use disposable latex gloves.

Related Topics: Food Safety Tips for Warm Weather, Allergy and Asthma-Proof Your Home


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If you're just now joining us, you'll want to read Public Toilets (part 1), Airplanes (part 2), Your Doctor's Office (part 3), Hotels and Motels (part 4), Restaurants (part 5), Dirty Movies (part 6), Daycare and Preschools (Part 7), and Pools, Waterparks and Beaches (Part 8)

Dirty Places, Part 8: Pools, Water Parks and Beaches

I have been accused of being a militant germophobe with my Blog series on Dirty Places. Perhaps I am. I realize that we all live in a world teeming with pathogenic microorganisms, but I just feel that an Ounce of Awareness is worth a Pound of Disease. I have really enjoyed the hundreds of comments and stories that my readers have shared. I wish that I could respond to all of them, but I know that this subject is near and dear to many people.

Working in pediatrics, I am painfully aware every day that children practice a considerably lower standard of hygiene than other creatures that share this planet. I absolutely love kids. I high-five them with their unwashed hands. I pick them up, hug them, tickle them, and of course, examine them. I get sneezed on, kissed, bit, slimed, peed, and pooped on quite regularly - an inherent risk of my chosen profession. At least in the clinic, I have some measure of infectious disease control with frequent hand-washing and disinfection. The outside world inhabited by children is often less controllable.

Several years ago, we had our grandchildren to the local water park for the medical group annual family picnic. Dylan, age two, was newly potty-trained (sort of) and was happily splashing around in the kiddie pool. Much to our horror, Dylan decided that pooping in his bathing suit was both convenient and appropriate, seeing how he was in water.

This was a Triple-F moment that we all fear: Floating. Fecal. Flotsam. Panic-stricken parents grabbed little children and quickly extricated them from the pool, not unlike the mad rush out of the ocean in that Jaws movie, or the Baby Ruth scene in Caddy Shack.

"Don't touch it!" "Get out of the water!" Now, I was sort of oblivious at the moment, but due to the intensity of the screams, I expected to see a shark fin or something.

As the chlorine/urine-laden water began to calm, I spied the culprit - the little Turd of Concern. Accusatory fingers pointed at Dylan. I desperately wished that is was a shark fin. The water park Haz-Mat crew rushed to the scene and yellow-taped off the area, as the pool was drained and decontaminated. Dylan, with his vibrant red hair, was quickly identified throughout the rest of the day as the kid who closed down the children's pool. It was yet another proud moment for the Grandparents.

I find it difficult to believe that any pathogens could live in a highly-chlorinated public pool, but it does. We all know that a large portion of that water is urine (usually sterile, but gross nonetheless). Fecal (enteric) contaminants, like E. coli is also commonplace in swimming areas, including beaches.

You would think that the vast volume of ocean water would dilute enteric bacteria, but not always. Whales poop in the water, too, and I imagine that their drooping are much more impressive than Dylan's little gift. A recent article in the LA Times talked about these fecal contaminants. I am glad I didn't read it before our recent week at the beach in San Diego.

It is estimated that up to 1.5 million people develop health problems and illness from beach and surf contamination. Health officials carefully monitor "acceptable fecal limits" and close the beaches quite often when those levels climb. To me, there really is no thing as acceptable fecal limits. I am not happy about acceptable limits of rodent and insect parts in our food either.

Keep in mind that not all beach fecal contaminants come from those naked kids running through the surf, or from parents burying dirty diapers (Yes, they do!) in the sand. Some of those contaminants come from storm drains and sewer overflows.

It is not uncommon for local officials to fine RV owners caught dumping their holding tanks, filled with raw sewage, into the storm drains. People often use storm drains as outside garbage dumps, disposing of any number of disgusting items, like hypodermic syringes, dead cats, or diapers. Some of that untreated water eventually makes it to the ocean where currents keep it conveniently near the shore for our recreational pleasure.

While at Club Med in Mexico twenty years or so ago, I swam into some watermelon rinds and floating paper off the resort beach. I was told by the locals that they dump this stuff into the water at night when the tide goes out. Apparently, someone was late the day before and the garbage did not head out to sea. I suspect this practice no longer exists at Club Med. I can't say, since I never went back again.

It is going to be 106 today and I would love to be at the beach, contamination or not. When the thermometer hits that triple-digit, I am not that picky about potential beach contamination. I take my chances, just like all of us. I just hope that I am not one of the 1.5 million people that go home with vomiting and diarrhea every year from a day at the beach.

Related Topics: Summer Risks vs. Realities, Indoor Swimming, Asthma Link?

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If you're just now joining us, you'll want to read Public Toilets (part 1), Airplanes (part 2), Your Doctor's Office (part 3), Hotels and Motels (part 4), Restaurants (part 5), Dirty Movies (part 6), and Daycare and Preschools (Part 7).

Dirty Places, Part 7: Day-Care and Pre-Schools

By this time, most of you probably feel that I am germophobic, but I am not. I am very germo-aware, however.

For nearly ten years, my PA wife and I taught a course for day-care providers in the Sacramento area, called "Pediatrics for Child Care Providers". This class was required for community licensing. Hygiene practices and infectious disease recognition was a significant part of this all-day course.

In a previous entry, I came out in favor of parents taking care of their own children, rather than sending them off to day-care. The Blog comments went about 50% in my favor, but some adverse comments made me fear for my life.

There is a medical term called zoonosis, which means diseases that we catch from animals. I coined my own term for diseases that we catch from our kids called pedianosis.

As much as we love our kids, you have to admit the children practice a considerably lower level of hygiene than adults. Children are inherently social and touch everything. Cleanliness is not natural for them. Children also have immature immune systems that make the attract germs like Velcro; germs that they freely share with us or their classmates.

A generation ago, children were first exposed to grouped care when they started kindergarten; about age five. By this age, children have a more challenged immune system, but they still got sick. Now, children are starting day-care as infants, perhaps the most vulnerable age for acquiring infectious diseases.

While some day-care facilities are cleaner than some homes, and certainly cleaner than hospitals or restaurants, they are still a depository for infectious disease. Day-care providers use gloves when they change diapers, they disinfect surfaces and clean toilet areas often. Despite those preventative efforts many community outbreaks, such as pertussis (whooping cough), measles, mumps, Strep/scarlet fever, infectious diarrhea, hepatitis A, and chicken pox can be traced back to day-care.

Most medical charts have a section called a problem list. This is where we indicate if you are a smoker, have high blood pressure, etc. In pediatrics, I include day-care attendance on the problem list, since these children are more likely to be exposed to disease, and more likely to get them. From simple colds and flu to more serious, even life-threatening illness, children in day-care can get them all.

Middle ear infections are the most common reason that children are brought for medical care. Studies have shown that colds are the most common predisposing factor for ear infections. The second most common predisposing factor is day-care attendance (the SOURCE of those colds).

Since working parents have to miss work to bring children for care, day-care illness have a huge impact on the workforce. Most missed days for working parents are related to child illnesses. Parents quickly run out of sick days, so many will just go to work when they are ill, spreading their own illnesses to co-workers - the unwanted gift that keeps on giving.

We read much about doping in the media - the practice of giving drugs to enhance performance. Do you know that doping takes place in daycare? Some parents are so desperate to get to work that they will send ill children to day-care anyway. Parents have admitted to me that they will administer acetaminophen or ibuprofen to the kids in the mornings to suppress a fever that would otherwise exclude them.

They also send kids who have potentially infectious diarrhea, sore throats, and rashes. They administer antihistamines so noses will not drip; as well as cough suppressants. Many of these drugs cause kids to be hyperactive. As soon as those pre-medications wear off -- about four to six hours after coming to day-care -- many of these stealthily-ill children will mysteriously get fevers, runny noses, or start coughing again.

Parents will be contacted to pick up their sick kids, but the damage has been done. They may have already started their own day-care epidemic.

Some childhood illnesses, like colds, are inevitable -- viral infections can be spread a day BEFORE you know the child is sick. However, when parents purposely send a newly-sick child to day-care, then should realize the impact that this selfish act will have on the entire community.

When you start your children in day-care, you need to expect they will get sick, sometimes in the first week. And, they will also be infecting YOU. It adds a whole new meaning to the expression, "What did you bring home from school today?"

What can you do to limit the spread of day-care illnesses?

1. Don't send your child to day-care if they are ill. Your job is important, but not nearly as important as the health and well-being of your child.
2. Practice good hand-washing and use hand sanitizers. Set a good example.
3. Change school clothes as soon as you get home. Those clothes are very likely to be contaminated.
4. Discourage poor health practices that you observe, such as nose-picking, open coughing/sneezing.
5. If your child seems to be constantly ill, consider a smaller, home day-care setting rather than larger facilities.
6. Keep your child well-immunized.
7. If your child's doctor diagnoses an infectious disease, make sure to report it to the day-care facility so they can react according. During cold and flu seasons, a higher level of hygiene and disinfection should be actively practiced.
8. Many day-care facilities send home exposure reports. Rather than panic, educate yourself about any potential exposure. Use WebMD and the Member Boards wisely and often.
9. Don't insist on antibiotics from your medical providers unless they are clearly needed. The overuse of antibiotics is one of the primary reasons for the emergence of resistant strains.
10. Your child can return to day-care when they are well; and when they are no longer considered contagious.

References:

• Diseases Associated with Day-Care
• Day Care Diseases - Why they spread

Related Topics: WebMD Video: The Dirty Truth on Handwashing, WebMD Video: Surviving Kids' Germs

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If you're just now joining us, you'll want to read Public Toilets (part 1), Airplanes (part 2), Your Doctor's Office (part 3), Hotels and Motels (part 4), Restaurants (part 5), and Dirty Movies (part 6)

Dirty Places, Part 6: Dirty Movies

Movie theaters can be a major source of infectious disease spread. Theaters are crowded, often with people who may be ill. Children's movies are probably worse if anyone ever chose to test this assumption. Since many viral infectious diseases are contagious a day BEFORE you know you are sick, microorganisms can be innocently spread.

I can't imagine how many people use those same seats day after day without any disinfectant ever touching them. I would be shocked if those seats and seat arms are ever cleaned. During the winter cold and flu season, it is not uncommon to hear a cacophony of coughs echoing throughout the auditorium. An uncovered cough or sneeze can spray fresh microorganisms several rows away.

This is not an innocent spread of disease, but rather a form of urban biological terrorism. During the 1918 Influenza Pandemic, movie theaters in all major cities were closed.

Then, of course, there are the movie bathrooms that literally see a stampede of yellow-eyed urinators after each movie. In most theaters, the bathrooms are surprisingly clean-looking, but germ-laden nonetheless. My personal experience is limited to the men's room, which I rarely use.

Because of my childhood days of having outhouses at our Junior High School, I have developed an iron bladder, but after those huge $5.00 colas, even iron bladders starts to strain. It is fortunate that men's urinals are much more hygienic than sitting on a toilet seat - a distinct anatomical advantage that men enjoy.

Dave Barry wrote a piece about urinal etiquette that I would like to share. He talked about a bank of five urinals - A, B, C, D, and E. The first man enters and goes to urinal A (or E). The next man automatically heads for the one on the opposite end. Man #3 will go to urinal C. If a 4th man approaches the bank of urinals, he may likely hesitate using urinals B and D, often called the "buffer urinals", and may be forced to use the more-contaminated and much-feared stall.

The floors surrounding the urinals and the stalls are usually sticky with stray pee, often the result of visual impaired men with poor aim, or boys who really don't care. Urine is considered sterile, but no one really wants to step on it, look at it, smell it, or have their shoes stick to it.

It would take a dire intestinal emergency for a man to sit on the toilet, which is usually not flushed. There is nothing worse than a toilet not flushed, except maybe, a warm toilet seat recently vacated by a dubious-looking guy. Those paper seat covers do not work with those automatic flushing toilets. Every time that you carefully lay out that thin, paper seat cover, it flushes before you get to use it.

Movie-users are not big hand-washers (I notice these things). Either they are rushing back to the movie, or trying to avoid the traffic jam in the parking lot, but that two-second cosmetic wash is not going to do anything. Bathroom stall door locks have got to be one of the more contaminated areas of the movie toilet, namely because they are always opened with unwashed fingers.

It makes sense to only open these doors with a wad of toilet paper. Bathroom doors always open inward, so you would need to grab on that worn, metal door handle in order to exit, OR, you patiently wait until someone comes in and then you can jump through the door before it closes again. I have gotten many a stare as I leap through those brief openings. If no one comes in, I have to open it with some paper towels (assuming there are paper towels and not that worthless hand dryer).

Since I work 12 hour shifts in my clinic, I have two days off during the week. If I choose to go to a movie, I will do it during one of these mid-week afternoons when the crowds are sparse and kids are in school. Not only is the theater nearly empty, I can have a choice of seats without fear of a tall, big-haired person plopping in front of me, or some very obese person encroaching into my seat space.

By the way, in absence of a buffer seat, which seat arm is really considered yours? I can usually out-maneuver my wife, but strangers are a different matter. I guess you just have to wait until they move their arm and quickly take possession.

Disease prevention can be as easy as 1-2-3.

1. Wash and sanitize your hands frequently. Avoid touching your eyes or nose -- major entry points for disease organisms.
2. Cover your mouth with a tissue when you cough or sneeze. Droplets can travel four feet.
3. If you are ill, stay home and watch a DVD.

And, if you do get sick, just tell your medical provider that you must have caught it at a dirty movie.

Related Topics: Academy-Award Winning Movie Snacks, Top 9 Jobs Where Bacteria Thrive

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If you're just now joining us, you'll want to read Public Toilets (part 1), Airplanes (part 2), Your Doctor's Office (part 3), Hotels and Motels (part 4), and Restaurants (part 5)

Dirty Places, Part 5: Restaurants

Hepatitis A vaccine is administered to children at age 2, but this highly-effective vaccine is optional (not currently required for most school entries). Optional or not, this is a great vaccine. It protects against the most common form of hepatitis. Most cases of hepatitis that are traced to restaurants are of this type. Hepatitis A is transmitted fecal-orally. In other words, someone's unwashed hands contaminated with feces likely made your salad. In 2003, 510 cases of hepatitis A, including 3 fatalities, were traced to green onions at Chi-Chi's Mexican Restaurant in Pittsburgh, PA, my old stompin' ground. Someone was definitely touching their chi-chi without washing their hands! We had a similar, albeit smaller, outbreak in the Sacramento area.

In 1990's, the world was shocked when several people were infected with various strains of E. coli from two national burger fast food chains. E. coli is another fecal contaminant, and some strains can cause Traveler's Diarrhea (aka Montezuma's Revenge).

Don't forget the ice in restaurants, too. A middle schooler did an award-winning science project earlier this year, proving that fast food ice is dirtier than toilet water 70% of the time.

I spent several days in Hong Kong several years ago and witnessed some new lows in restaurant hygiene. While sitting at my table, I witnessed the waitress wiping out the used bowls and plates with a dirty rag and resetting the table. Shocked, I mentioned this to our native hosts who said that this was common practice to save water. When our piping hot tea arrived, I promptly poured all of it into my bowl hoping to sterilize any contaminants. I can say that I did not get ill, but the potential clearly existed at every place we dined.

In 1986, the FDA banned the use of sulfites on salad. Sulfites were sprayed on lettuce to keep it from browning. Unfortunately, a large portion of the population is allergic to sulfa and many people (myself included) developed an immediate gastrointestinal response to this preservative - namely, diarrhea. While not technically a contaminant, any substance that sends restaurant customers running to the bathroom is bound to be contributory to other types of fecal contamination.

I have family members in the restaurant business, so I try to be real nice if I have to send a particular food item back to the kitchen. I really don't want to particularly rile some hairy-armed, tattooed, ex-con who will send back my item with something "extra". My mother was a waitress and bragged about these deliberate acts of kitchen terrorism. Now I know that is an unfair generalization about cooks, but those guys are working back there in some establishments. Many people remember the Seinfeld episode involving Poppy and his unwashed hands. Several news programs have shocked us with hidden camera video of cooks dropping your steak on the floor or picking their noses. I assume you are nauseated by now, so I will hold further examples.

We do have Health Departments and other government agencies that inspect restaurants for cleanliness, but how many of us would check for violations prior to sitting down to eat? New York City, for example, launched a Restaurant Cleanliness campaign in 2004, with other major cities following. I would love to see those health certificates hanging prominently at places that I frequent.

The problem with cleanliness in restaurants is the human factor. Humans on this planet have varying degrees of personal hygiene and integrity, and unfortunately, restaurants have no way of determining this when someone is hired. The only way to assure compliance to commonsense health and food-handling practices is with careful monitoring. Sure, I see those signs in restaurant bathrooms requiring that all employees wash their hands before exiting, but signs do not imply compliance. This is really as small planet, and we need to look out for each other. Until we have some assurance that our fellow humans are doing their share, you need to seriously look out for yourself and family.

Correction, July 21, 2006: The paragraph concerning E. coli deaths in fast-food chains misstated the name of that restaurant. That information has been corrected.

Related Topics: 5-Second Rule Rules, Sometimes, FDA Panel: No Advantage to Antibacterial Soap

Technorati Tags: restaurant cleanliness, hand-washing, restaurants, Health Department violations

If you're just now joining us, you'll want to read Public Toilets (part 1), Airplanes (part 2), Your Doctor's Office (part 3), and Hotels and Motels (part 4).

Wine, Women, and Weddings

My youngest son was married last Saturday in San Diego. It was a big wedding; a stressful wedding; and a wedding that was not without its minor incidents. The bride (4-foot, 11 inches in heels) took her wedding vows atop a box standing beside my six-foot, four-inch son. She is Jewish. He is Catholic. The official was a former California Supreme Court Judge. The ceremony was your typical Judeo-Christian confusion. In his nervous confusion, my son even forgot to stomp on the glass. In retrospect now, I can say it was a very nice wedding and a good life send-off for my son and new daughter-in-law. They are now on their honeymoon in Kauai.

As the father of the groom, my responsibility was to pay for the rehearsal dinner for about 50 people. The father of the bride paid the bulk of the wedding tab for the 200 or so guests. I know what I had to shell out, but I can only imagine HIS Visa bill next month. Most of the guests were friends and relatives of the bride. There were even some surprise guests, including my wife's first husband and his third wife who spent the night explaining their somewhat distant relationship to my son. Our extended family is so confusing that I once had to make a chart for my puzzled granddaughter who couldn't figure out all of these uncles, aunts, and grandfathers. All of them loved her, so that is all that really mattered.

It is amazing how much booze people can consume when they don't have to pay for it. Personally, I do not drink alcohol. My choice not to drink is not religious or even health-related. I just do not like the taste or the effects of alcohol. Why is it when you refuse to drink alcohol some assume you are a recovering alcoholic? I don't go out and kill people either, but that doesn't mean I am a recovering murderer. I am actually pretty boring when it comes to substances or adult beverages. I never did drugs (even in the 60s), never drank, and never smoked. I am far from Sainthood, but booze is not my vice of choice. If you take me to a good sushi restaurant, you will see a true addict of sorts. I consider myself a "sushitute". Sorry, I am digressing a bit on the topic.

My wife loves wine, but she has to drink it with a guy who prefers diet soda (or water). One of my neighbors has a private winery; our best friends are members of a wine co-op. We live in wine country and yet I do not care for the taste of wine. At the wedding reception, the wine and alcohol was flowing. The DJ played music at a rock concert sound level that played havoc with my tinnitus. He played such timeless wedding classics as "I Like Big Butts". There were no Slovakian polkas or Appalachian clogging from my Pennsylvania hillbilly days. No chicken dance or hokey-pokey. Not that I really care, because I do not like to dance, either. I did my obligatory dances, of course, but I was not particularly comfortable with my awkward, 3rd grade skill level. Our five adult children and wife love to dance. As a matter of fact, our middle son, Benjamin, was responsible for the first injury of the night. And, yes, alcohol was involved. This is another reason why I don't drink -- it could lead to dancing.

During a particularly lively dance number, Benjamin tried to impress the single women with his Fred Astairian dance moves, one of which included jumping over another one of our sons, Alex. Alex tips the scale at well over 200 and, unfortunately, Benjamin did not complete his leap. He landed on his right elbow, sustaining a fracture of this proximal right radius. Since my newly-married son is an ER Nurse, he was the one who took him to the hospital the following morning.

I accompanied Ben and his long arm cast home last night. We did get to pre-board the plane, which is nice on Southwest Airlines. Benjamin had broken BOTH of his arms when he was ten when he tripped during another pseudo-athletic event. This time he has a free left hand, which I find comforting. When you have a son with casts on both arms, you have some logistical disabilities when it comes to using the toilet --a six-week butt-wiping nightmare. Benjamin is becoming a nursing home administrator. I suspect that when I am a frail elder some day, I may be collecting on that debt...tenfold.

Related Topics: The Perfect Bridal Beauty Guide, The Dos and Don'ts of Wedding Weight Loss

Technorati Tags: wedding, stress, honeymoon, alcohol

My Big Brother

My big brother and my best friend turned 63 years old today.

When our father died, my brother was 13 years old; I was five. Having a brother eight years older is a generational barrier when you are five. He was entering high school and I was just starting the first grade. I looked up to him a great deal, but he did not really seem to notice his little brother. He would take me with him periodically to help deliver the newspaper, but after he found a girlfriend, little brothers basically disappear.

My brother was born in Baltimore, MD in 1943, during the war. My father was working as a shipbuilder and welder, an asbestos-related profession that took his life a decade or so later. My brother was born with club feet - a pediatric disorder where the feet are turned backwards. This required him to have a series of painful casts in order to correct this congenital disorder. At age 63, he is still having problems with those feet. The only silver lining of having this orthopedic deformity was that he qualified for a four'year rehabilitation college scholarship. He became the first person in our family to graduate from college, which served as my inspiration to later do the same. Neither one of us saw any future in working in the coal mines. He had bad feet and I was afraid of caves.

When I was 12 years old, I wanted to visit him in college. My mother would not take me, but she did permit me to hitchhike about a hundred miles to do so. Can you imagine allowing your sixth grader to hitchhike! She did drive me six miles away from our rural town so that I could get a better ride along the highway. Six years later, he drove five hundred miles so that he could take me for my first day at college (Again, my mother would not drive me to my own college.) He was the only family member that attended my graduation.

I graduated college at age 22 and was married by then. My brother was 30, also married, and had one child. This was really the beginning of an adult relationship with my brother that has grown exponentially over the years. My brother is the only other person on this planet that shares my genetics and our odd life experiences. There is a Father's Day; a Mother's Day, but there really should be a Brother's Day. My brother has worked for Hallmark Cards for three decades, so he really should suggest that idea. Many people would buy them.

Last weekend, my youngest son who shares my brother's name, was married. We had rented a five bedroom house for the family and it warmed my heart to see a similar relationship that my four sons and daughter have with each other. My brother could not attend the wedding, because he has taken on the responsibility of caring for our elderly mother - the true measure of a caring and loving man. My seriously-ill mother has recently been placed in a nursing home for 24-hour care. Although my mother was never a loving or giving mother, her greatest gift to me is clearly my brother. Happy Birthday, Bro...

Related Topics: The Family Dinner: Nutrition and Nurturing, A Caregiver's Role