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.

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

Masks and Dark Glasses

As a seasoned medical provider, I can't tell you the importance of actually "seeing" the patient. I have always had issues when people come in wearing dark glasses. Since the eyes are the window to the soul, I find it very difficult to have an effective medical encounter with someone wearing dark glasses. When you address a particular medical question, you instinctually look at the eyes for response. Is the person making direct eye contact? If your patient is a teenager, are they "rolling their eyes" at you? Are they gazing downward? Before I start any medical encounter, I ask the person to please remove their dark glasses so I can see them, and not my own reflection.

Morgan / CC BY 2.0

H1N1 flu pandemic has hit our area big time. We set up a "flu station" in the lobby where people can use hand-sanitizers and pick up a surgical mask to wear. When I enter the examining room now, it is not uncommon for everyone to be wearing masks - except me.

Just like the eyes, I also like to see a person's entire face. I want to see if they are smiling, grimacing in pain, or frowning at me. If a person had both a mask and dark glasses, I would just assume they had a big paper bag on their heads. Just like the dark glasses, I ask them to remove their masks once they are in the examination room. I don't know how Westerners can practice medicine in the Middle East. If I saw a person wearing an Islamic burqa, I am not sure how I would react. But at least, could see her eyes.

The Lone Ranger wore a mask, like no one would really recognize a well-spoken man in clean white clothes, riding a white horse along with this companion, an Indian that speaks like Tarzan. Bank robbers and train bandits wear a scarf or bandana over their mouth and nose. Spiderman wears a full face mask apparently so you won't recognize him as Peter Parker. Superman doesn't wear a mask, but uses a pair of dark-rimmed glasses when he changes into Clark Kent - another clever disguise designed to fool idiots. A guy in a ski mask coming to my front door would definitely get a rise out of me.

Josh Westbrook / CC BY-ND 2.0

If someone walked into a bank today, wearing a surgical mask and dark glasses, they would definitely get the attention of the security guards. Halloween is just around the corner, so our pediatric practice allows the staff to dress up, without masks, of course. Masks typically scare kids, even surgical masks. We don't get the Trick or Treat crowd in our rural neighborhood anymore. I sort of miss them.

The first time that I saw people in public wearing surgical masks was in Japan many years ago. Japan is a crowded, but highly-organized and respectful society. When I inquired about the masks, I assumed that people were protecting themselves from the germs of others. To my surprise, it was the people in the masks who were trying to keep their germs to themselves. They had colds or influenza and did not want to infect others. This is a very respectful hygienic practice that we rarely see in the U.S. People on the subways in the U.S. will just about sneeze in your face; or sneeze in their hands just before the grab the hand rails.

I have been exposed to so many cases of H1N1, that I expect that I have some residual immunity. I have been endured numerous sneezes and coughing in my direction. I have held contaminated hands. I have wiped noses of children. If and when the H1N1 vaccine arrives, I am not really sure I need it. I will take it for my patients, of course, but I suspect that I am either immune from prior infections, or darn lucky.

One provider was complaining this week that he had to wear to complete biohazard suit, complete with a battery-powered air filtration system and full spaceman helmet when he was examining a baby in the ICU. The baby was in protective isolation. He said it was impossible to listen to heart or lung sounds using a stethoscope while wearing a space helmet and noisy respirator.

Until this pandemic is over, we must all learn to tolerate people in surgical masks - even when they are surgeons. It could be worse. We could all be wearing those space suits.

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

Doing Your Part

Your Responsibilities as Member of a Community and of the Human Race

In the last two weeks, we are starting to administer the seasonal flu vaccine. You would be surprised how many people are refusing it because they do not think they need it. But, what about the rest of us?

We all share this small planet; a planet with limited natural resources, and a planet that is progressively becoming more polluted and damaged. Globally, steps are being made to limit greenhouse gases, preserving the protective ozone layer, finding cleaner fuel sources, and replacing some what has been exploited and raped over the centuries.

I grew up in a strip coal mining area, where beautiful topsoil was moved aside in order to get at a narrow layer of soft coal. Thanks to the efforts of environmentalists, much of that land has been restored. The air and our streams are no longer stinky and yellow. It was commonplace to run sewer lines directly into a pristine creek. A generation ago, people mindlessly dumped their trash along the side of rural roads, or simply threw out their fast-food bags from a moving car. Thanks to Lady Bird Johnson's efforts, our roadsides are no longer piles of discarded junk and rubbish. Little by little, America became more beautiful when people started caring.

A week ago, we were given evacuation orders when a wild fire threatened our neighborhood. Over eighty homes were burned to the ground. Had the wind changed directions, our home would have been lost, too. The cause of this fire is yet undetermined, but arson is a possibility. A few minutes ago, the Department of Forestry spotter plane buzzed and circled my house. There was another fire; this time only a mile away and the wind was blowing in our direction. The quick efforts of our local fire department quickly got this fire under control. According the Highway Patrol, a motorist threw a cigarette out of the window, starting a roadside brush fire. Throwing a burning cigarette out of a moving car deserves jail time, in my opinion. Of course, they will never catch the culprit.

Are we all doing our share? Do you turn out the lights in rooms that are unoccupied? Do you use energy-efficient bulbs? During the summer months, do you set that thermostat a little higher? Do you drive the speed limit and wear your seat belts? Do you recycle your aluminum cans, glass, and plastic? Are you immunized against vaccine-preventable illnesses? Do you wash your hands? Do you smoke? All of these seemingly little things help our planet and your community. As members of the human race, these are your responsibilities.

As a child, we did not have seat belts in our vehicles. Children were not restrained in infant car seats; they could freely jump from the back seat to the front if they chose. Motorcyclists were not required to wear helmets. So, how does wearing seat belts impact our role in the community or the human race? A non-seat-belted person is more likely to sustain serious head and neck injuries, assuming they are not killed. If they have health insurance, the bills could be astronomical for their care. This will raise rates for all of the other insured people who do wear seat belts. If the person does not have health insurance, the state and federal government will end up footing the bills, and of course, guess who pays the state and federal government through taxes?

Smokers feel that they have a right to smoke. Apparently, "Freedom to Smoke" is protected by our Constitution somewhere. Smokers pay the same insurance premiums as you and I, but of course, smokers tend to get more respiratory illness, such as pneumonia, asthma, or emphysema, use the emergency room more often, and have a higher rate of cancer, requiring expensive surgeries and cancer treatments. Smokers have higher absenteeism at work and lower productivity. Again, the insurance companies (and we non-smokers) foot the bill, as well as the government. When smokers flick their cigarettes out of a moving car and start a fire, someone else still has to pay for those damages. When a person chooses to smoke, they impact more than just their own lungs. They seriously impact ALL of us, directly and indirectly, in so many ways.

If people defend their right to smoke, do they also defend their right not to wash their hands? Is personal hygiene (or the lack of) protected by the Bill of Rights? Someone comes out of a public restroom and doesn't wash their hands. They put their contaminated (poopy) hands on the door handles. A little child touches that handle and becomes seriously ill. The simple act of washing your hands can have a major impact on the community.

There was a major public health effort in the 1950's. If people had the right to refuse vaccinations, no one really exercised those rights. Everyone felt that it was our community responsibility - our duty - to be vaccinated, so that people would not get polio, or measles, or whooping cough. In less than a decade, the incidence of these vaccine-preventable diseases plummeted. Everyone, by getting vaccinated, did their part. These public health efforts have saved millions of lives and billions of dollars, yet now, people feel they have the right to refuse vaccinations for personal reasons...stupid reasons. They don't care if they, or their children get the diseases, and they certainly don't care if they spread it to others in the community. You cannot achieve "herd immunity" unless all or most of the herd has been inoculated. Just like one bad apple making the others rotten, if there is an unimmunized person in a community, the disease will survive. An epidemic starts with one.

There are people in the community that count on "herd immunity". Our efforts to vaccinate ourselves and our children is their only protection. They want others to take any risks, but then expect the insurance companies and society to take care of them if they get one of these serious, preventable diseases. Medical care is God-awful expensive, not just in dollars but in emotional toll. Are their calculable risks to taking vaccines? Sure, very small ones. The risks of serious vaccine reactions are considerably less risky than the chance of getting struck by lightening, but yet people are afraid. Some of these fears are created and nurtured by the Internet, backed up by pseudo-science and charlatans.

Perhaps the real barrier is trust. Since the 1950's, Americans seem to have lost faith in their government, perhaps for good reasons. Remembering thalidomide and other recalled drugs, they do not trust the pharmaceutical companies. They do not trust the FDA that approved these drugs. Often, they do not even trust their medical providers - the people that they chose to participate in their health care. People do not trust banks, the post office, the military leaders, or our President. What happened? Right now, President Obama is trying to make a complacent and mistrusting population aware of the serious health threat that influenza can cause. Millions of Americans died in 1918 and it can happen again. Why don't people listen?

In order for people to share responsibility, we have to have trust. We have to trust that everyone will do their part and not opt out or make excuses. We have to trust our elected leaders and our scientists, and we need to come down hard on those who betray basic, human trust. It has been said that we can trust, but verify. It is perfectly normal to question recommendations, but at some point, it will come down to trust. Do you trust your government? Do you trust your medical providers? Do you trust your own judgments?

As a medical provider, I am on the front line. I had to take four nasal swabs for a pertussis test this week on a 15-month old. The mother does not "believe" in vaccines, so none of her children are immune. I can take care of her because I am immune to pertussis. I took my vaccine. Otherwise, I would be putting my own life at risk. I can take care of people with influenza and other life-threatening illness because I am vaccinated, and this is my job. Vaccines are not perfect; few things in life are perfect, but vaccines are and will remain one of our best defenses. It is much easier to prevent an illness than treat one, I can assure you.

Please do your part. Don't throw trash out of the window. Turn off unnecessary lights and use energy-efficient bulbs. Wear your seat belts or helmets, and secure your children in car seats. Don't smoke, and if you do, stop. Wash your hands. Unless you have a true contraindication, take the recommended vaccines. Be honest and learn to develop trust (again). We live in the same community; on the same planet. We are all in this together.

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Airing Some Dirt

Photo: √oхέƒx™ / CC BY 2.0

Airplane cleanliness was one of my twelve Dirty Dozen that I discussed on a past Blog. My experience on my most recent cross-country flight has not changed my views. Like most businesses, the airline industry has to cut corners. I guess if I had to sacrifice cleanliness for safety, I would chose safety, hands down.

Hurry Up and Wait
We have to get to the airport now about two hours early due to safety inspections, and I did just that. However, I had to wait in line while only a few people checked us in. I had no bags to check. Now that I have my Rick Steve's travel bags, I can haul a weeks worth of clothes and several books, including a suit, into a backpack. My briefcase has my camera (I always carry it) and my essentials - toothbrush, comb, medications, and busy paperwork. Since 9/11, I have been more anxious about flying, so I try to remain busy. As a non-drinker, I do not have alcohol as an anti-anxiety crutch.

I stood (patiently) in line for over an hour. Once I checked in (I should have printed out my boarding pass the night before, but I worked too late and forgot), I was directed to my gate, about a mile away. That heavy backpack wasn't so convenient at this point. As you might expect, there was another line at security.

People were standing around in bare feet and all I could think about was foot fungus. I saw some pretty funky feet in that line. I was wearing sandals, but I had to take them off, too. I didn't think the space between my toes was much of a security risk, but I guess the soles of my sandals could have been an issue. I had gone to great detail making sure all of my liquids - shampoo, cologne - were in tiny bottles. I had nothing sharp, except my wit, of course. For some reason, my bags were set aside for the sniff-test, checking for explosive residue. I do not deal with explosive, so I had no worries, except that maybe I fit the profile of a mad bomber.

Frequent Flyer Seats
I was able to use my frequent flyer miles to upgrade to first class, although there are several degrees of first class. Every time that I do this, I get into seat 6A - the last row of first class. This is really much better than the first row, of course, since this row is the waiting area for the toilet. Not only do occupants in these seats get frequent whiffs from those open doors, but a few whiffs of those anxiously waiting for that one door to open.

I apparently have a huge bladder, since I can hold it for many hours. I don't like to use public restrooms, especially on an airplane. Turbulence tends to start about the time you try and pee anyway.

The last row of seats gets the meals that are not chosen first. On this breakfast leg of the flight, I just knew I would get cold cereal. So, as I ate my corn flakes, I thought about the cleanliness of my tray table that I forgot to wipe off. Was there a pile of used Kleenex sitting there from the previous passenger, recently diagnosed with H1N1 flu? How many sneezes did that tray get? I made sure not to touch it, or sit down my microwave-heated muffin. Between flights, airline personnel will empty the trash, but they do NOT sanitize the trays or arms of the seats. Since germs can remain on hard surfaces for hours, this concerns me.

Announcements
We live in an age of electronic marvels, so why do announcements on a plane hiss and echo like a New York subway. Granted, my hearing isn't what it used to be, but I had absolutely no idea what the pilot or flight attendants were talking about. They could be announcing a water landing, but I would not have a clue. In the event of a water landing, your seat cushion can be used as a floatation device. I can tell you right now, if we were making a water landing, my own seat cushion would not be suitable. I always listen to those safety briefings and notice where the emergency doors are located.

Pull Back and Wait
Airlines treasure their on-time statistics. This is why they pull back from the gate on-time, only to wait another 30 to 45 minutes on the tarmac. We had a 30 minute delay in Dallas, sitting there in the 100 degree heat, and a 45 minute "weather" delay in Washington, DC, on the way home. I don't mind weather delays, since I absolutely hate the storm cloud roller coaster. Once, while flying into Detroit, our plane hit some unexpected turbulence, the kind that will field test those seat cushions. The look on my face must have concerned my elderly female seat mate, because she took my hand and said, "It's okay, honey, I have been in worse than this. You'll be fine."

Seat Mates
On the first leg of my flight, I was entertained, non-stop, by an embittered newly divorced man. He was ragging about his ex-wife, her attorney, and his child support/alimony responsibilities. I picked up a new seat mate in Dallas, a cowboy (naturally). He was pleasantly quiet, drank a lot of free booze, and was miffed that he had to eat a salad for lunch. I sort of aced him out by choosing the last pasta dish.

A seasoned soldier, home from Iraq, shared one of the travel legs. He was Cuban, having immigrated in the late 1960's, after the Bay of Pigs. He still had a Spanish accent.

My seat mate on the way home was a young woman armed with an array of antibacterial hand lotions, wipes, and other forms of disinfectants. I did admire her recognition that planes are not the most sanitary modes of transportation, I think she overdid it a bit. I don't know why these sanitizers have to smell so much like perfume. It reminds me of those old ladies in church who use gallons of cologne to mask unwashed body odor. I coughed a few times from the fumes, which concerned her a great deal. If she had a mask, I am sure she would have worn it, or at least handed it to me. Incidentally, our clinic now has a "flu table" set up, complete with hand sanitizers, masks, gloves, and even gowns for people to use if they want. The airline industry should take a hint.

Idle Time
I had several books and bought a few magazines at the airport. Just likely eating all of your popcorn before the movie starts, I read nearly all of my magazines before the plane took off. My book is a bit boring, so I did nod off a few times. I am so concerned that I will loudly snore that I tend to avoid sleeping on the plane. My last seat mate had loaded a lot of movies on her laptop and was listening to them on some nice Bose headphones. I would glance at the movie from time to time, and wished that I would have brought my own laptop this time. Knowing that my brother, a Born-Again Apple user again, has one, I decided not to bring mine. I was thinking that I was sparing the extra weight, but your own in-flight movies on a laptop are sure a nice distraction for idle time.

Window seats give you the ability to spot clouds that may cause some unexpected bumps. Over California, I spotted several active forest fires - a seasonal threat to many of us who live in wooded areas. When I saw the deep, blue waters of Lake Tahoe, I knew I was nearly home. Soon, I spotted the rice fields adjacent to the airport. It is always nice to travel, but it is even better to be safely home.

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The 2009 Flu Season: Ready or Not; Here it Comes!

In a medical office that cares primarily for children and adolescents, the summer months are very manageable. We even have open appointments on the same day. However, when school starts, the flood gate of illnesses will start to come in.

High on the list of fall season illnesses has got to be influenza. The H1N1 strain of influenza (formerly called the swine flu) still has health officials worried. Now that H1N1 has been officially declared a worldwide pandemic, no one is really sure what will happen when the real flu season begins. Are we going to have thousands or even millions of victims? Should we expect massive school closings and work absenteeism? In this fragile economy, will this pandemic push us over the edge? No one really knows, but planning for the worst-case scenario is probably prudent.

There was a time when I could give away flu shots, even with all of my persuasive arguments. At the opening of a new urgent care facility several years ago, the owner's decided to give free flu vaccines to everyone on our first Saturday. The clinic opened at nine AM. The crowd began forming hours before. By the time we arrived at the clinic, the line of people, mostly an impatient mob of assertive and highly-vocal senior citizens, stretched down the street. Expecting a smaller turn-out, we only had one medical assistant assigned to the flu shot clinic. Even at full pace, the most she could administer was about one injection every five minutes or so (including registration and medical history). That is only about twelve an hour if everything went smoothly. There were at least 200 people in line! You do the math. As the hours progressed and tempers flared with the waiting crowd, someone announced that we were running out of vaccine. Lord, help us if that happened. I was sure that I would be caned to death during the inevitable riot. Some quick thinking resulted in "rain checks" for the ones at the back of the line. They weren't happy about it, but when you run out, you run out.

Because of this past experience, I often fear for my own personal safety when we run out of vaccine in our office. For the last two years, we were frequently required to ration our rapidly-depleting stores of vaccine to the most critical patients. I sure hope that the supply this year will be plentiful. I would hate to see those angry mobs again. The federal government, known for their efficient way of handling public health issues, promises there will be plenty of vaccine to administer. We will see.

Each person may need THREE flu vaccines: one for the regular seasonal flu and two for the new swine flu strain (one now, and then a second booster in a month). Multiply that by the number of patients we see in our clinic every day (over three hundred), and we may have a shortage of medical assistants just to administer them.

A few days ago, I had three patients come in to evening clinic. All had been to an orientation and band camp at the local high school, and all three were very ill with flu-like illnesses. I saw two of them; one was positive for Type A flu (H1N1 is a type A flu) and started on Tamiflu, and the other was negative. My partner saw the third patient and clinically diagnosed him with influenza and started him on Tamiflu. The next day, the news service had picked this up - "Three Confirmed Swine Flu Cases in Local High School." I suspect that one of the parents called the media. First, it takes about two weeks to confirm the one type A case was H1N1 or not, so there are no confirmed cases at the moment. Of course, this would not a newsworthy. As you might imagine, the school system went into panic and sent out phone announcements to all of the parents. This resulted in dozens of people streaming into our office to be tested for H1N1, none of which even had classic symptoms or known exposure.

All three of those students, including the one that may have had H1NI, wanted to go to school anyway, where they would have freely shared their illness with umpteen others. This is exactly how local epidemics begin.

One of the parents worried because a neighbor, three houses down, supposedly died from H1N1, so she was worried if the flu could be airborne this far, or if fleas on rats could have carried it to her home! Apparently, she is confusing influenza with the Bubonic Plague. So much misinformation...

We have not received any flu vaccines in our office, not even the seasonal flu, but I suspect the demand will be high. If the new H1N1 vaccine is approved, and I suspect it will be, then I can only hope that we get our share of vaccine to distribute.

All medical providers hate to ration vaccine, but high on the list of people to get the vaccines first would be the medical providers. It is not that we are looking out for ourselves first, it is just that we are on the front line to get an infection. Since influenza is contagious a day BEFORE, we could be infecting hundreds of people without knowing it.

Ready or not, the 2009 Influenza Season has really begun (or perhaps, never ended from last year). Medical providers are on high alert. Health departments are gearing-up. Are we really ready? That is the big question.

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Three Summer Problems That Get Under My Skin

With the exception of the H1N1 (swine) flu that surprised all of us, the spring and summer months are typically a time when we see a drastic reduction in respiratory infections, like colds and ear infections, and see an increase in "warm weather" health issues.

Soon, schools will be closed for the summer months so the kids can help plow the fields and bring in the crops (sarcasm). Other families will be traveling to their favorite vacation spots, camping, having picnics, hanging out at Little League games, or swimming.

Photo: blmurch

Poison Oak: Like the swallows returning to Capistrano or the blooming for spring flowers, I started to see my first cases of poison oak this week. In our area, poison oak flourishes along a popular bike trail, near the river. All it takes is an innocent brush-by of this toxic plant and you will be rewarded with a pretty impressive, itchy skin eruption a day or so later. Children (and adults) often use the more private, wooded areas as make-shift restrooms, increasing the chance of skin exposure to those more delicate areas. Camping areas that permit open fires often see children actively collecting twigs to add to the smoky fire pit. Being downwind to a poison oak-laden fire will likely expose those happy faces.

Contrary to popular belief, poison oak dermatitis is not contagious. You cannot catch it from another person, but you can catch it from the clothes or shoes they were wearing, or even from the bicycle tires. Any object contaminated with the oily oleoresin of the plant can potentially cause this allergic skin reaction. This oil is very stable and can remain on unwashed objects for a long, long time. The oil can also reside on the fur of your loving pets.

There is really no such thing as a mild case of poison oak if you happen to be the person who has it. It can be absolutely miserable for weeks unless it is definitively treated. I am a big fan of a course of oral steroids (No, not the body-building, Barry Bonds-type steroids). Topical hydrocortisone can only do so much. Treating the itching with colloidal oatmeal baths and antihistamines are usually necessary.

Photo: nicolaitan

Mosquito bites: If it were possible to lose weight by being bitten repeatedly by mosquitoes, I would be thin as a rail. I am literally a mosquito magnet. It can be over 100 degrees, and I will be wearing a long shirt, long pants and hat, smelling of DEET.

Our local mosquitoes still seem to find a hidden place that is unprotected and have lunch...on me. The DEET products do help somewhat, but once I am bitten, I will immediately have an allergic response - big welts that itch like crazy.

I have to plan my garden work during the heat of the day when mosquitoes are not active. I built a bat house, and I never kill a lizard or frog; all creatures that eat them. I would love to eat dinner outdoors on the deck, but I do not lose, yet another battle, with hungry mosquitoes. I have tried Citronella, bug-zappers, and toxic fog to no avail. Even when I am huddled inside, I see them repeatedly pounding on my window glass like those zombies in the Night of the Living Dead.

We are seeing more and more cases of West Nile Fever in our area, so my unique ability to attract mosquitoes has me a bit worried. I have always wanted to travel to Central America and the tropics, but unless I walked around in a huge mosquito net, I would most likely come home with malaria or yellow fever.

Photo: mugley

Sunburn: Humans always seem to underestimate the burning power of the sun - solar radiation. A heard a talk at a medical meeting a few years ago, where the female dermatologist said there should be "no pain treatment" for a teenager with sunburn. She stated that teenagers must experience the pain in its full intensity in order to remember to use sunscreen and protective clothing next time. In Australia, where melanomas are rampant, children are required to wear hats to school as a part of their school uniform. On the beaches, children wear full body swim suits for sunburn protection. It seems that most people in the U.S. are complacent when it comes to sun exposure. Sure, they apply a sunscreen once or twice while at the beach, but many varieties simply wash off after a few minutes in the water. Most have to be re-applied every two hours.

If you do get sunburned (and it is usually your own fault), treat it like any other thermal injury. Cool it down with cold compresses. Take some ibuprofen for the inflammation and use of soothing skin lotions. The best defense is always to avoid the sun, but if you cannot - avoid the sun between 10 AM and 4 PM when the ultraviolet rays are most intense. Use a good sunscreen product that protects against UVA and UVB rays with an SPF (sun protection factor) of at least 30. However, sunscreen is not permission or an excuse for increasing sun exposure.

My brother was diagnosed with melanoma several years ago (it was completely excised) and several of my friends have had melanomas. Nearly every person who is diagnosed with melanoma has a history of at least one, blistering sunburn. Try not to let it happen to you.

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H1N1 Flu: But, They're PIGS!

Photo Credit: Laurel Fan

I knew this would happen. The Swine Flu is not a nice name. It sounds kind of dirty and unappealing. Jews and Muslims do not like pigs; animal rights activists do. The pork lobby and the commodities market for pork bellies do not favor the name. You have to change it, so let's call it H1N1. I guess everyone will know that the "N" stands for neuraminidase. Everyone else can just call it the H1N1 (high-knee) flu.

When there is a pandemic on the horizon, governments must have scapegoats, or in this case, a scape-pig. During the last major pandemic, we called it the Spanish Flu just to tick off Spain who refused to provide information about flu deaths in their country during World War I. We could have called it the German Flu, but everyone already hated Germany and we already named a type of measles after them. It should have been named the Kansas Flu since this is where it started, but Kansas is such a nice place. There is no place like home, Toto.

Later on, we had the Asian Flu or Hong Kong Flu. This may have been more appropriately named, since this strain of influenza did originate in China. God forbid that we call this one the Mexican Flu. Mexicans are having enough problems as it is with those drug wars and a crash in the tourism business. Just yesterday, a patient informed me that their Mexican cruise has been canceled by the cruise company due to the flu pandemic.

I wish they would have had a contest and let the American people name this flu. There could be call-ins and text messages, like the American Idol. How about the al-Qaida Flu? I thought this was a good one until I heard there was a guy in Cleveland named Al Kida. That would not have been fair to him. He already lives in Cleveland. Oops, I did it again. What I meant to say was, "I love Cleveland." WKRP! Wait, that was Cincinnati. Now I have Kansas and Ohio upset. How about the Kim Jong-il Flu? This is another good one; it already has "ill" in the name.

This morning as I was getting my morning flu briefing from Matt Lauer, I discovered that the name was changed yesterday to the it's scientific name - the H1N1 influenza, after many pigs were needlessly slaughtered in Egypt and people stopped buying pork in the grocery stores. Regardless of the reassurance that you cannot catch swine flu from processed pork products or uninfected pigs, people are not convinced. I am sure glad that pigs do not cause autism, or do they? Now, I did it. Oops.

A slip of the tongue or joking can really backfire nowadays. Poor Joe Biden. Much of the morning news was filled with White House spokesmen that were trying to explain what Joe "really meant" so the American people can relax and say, "Whew! Now I feel better." VP Joe is staying home and will not be traveling on commercial airlines, subways, and buses, like he normally does (sarcasm). The air transportation czars were up in arms with the approaching summer travel season defending the cleanliness of their planes. Personally, that would be like defending the cleanliness of those Mexican pigs.

Granted, most commercial airlines do have HEPA filters to scrub the air of pathogens. While this may help a little bit, it is not going to protect you against the sneezer in the seat behind you that just blew up the back of your hair, or the snotty-nose kid that wipes his hands all the way down the aisle to the bathroom, where God knows what happens inside. Between flights, airline personal empty the seat back pouches of all of the trash we stuff in there, including napkins, Kleenex, and I am sure, but have no conclusive proof - dirty diapers. They probably vacuum up the pretzel crumbs at some point at the end of the flight days. Peanuts are no more. They may try and sanitize those stinky toilet closets and load up the TP containers, but they DO NOT SANITIZE those planes. How can they? Viral pathogens can remain on surfaces for hours, and we only have a short time when people disembark and others board. Pathogens will remain on those tray tables, even in the upright positions (germs do not fall off). They will remain on those cloth seats. They are on the call button and that little air deflector that you point at the sneezer behind you. Pathogens are everywhere, so if you are going to get sick, this is the place. I included airplanes high on my list of the Dirty Dozen - the Twelve Dirtiest Places. My feelings have not changed any more than the airline's traditional hygiene practices.

Pigs do have hygiene issues, but we do not hesitate to harvest heart valves from them, or use them to test our pharmaceuticals. It's not bad enough that we make fun of their appearance and eat them, now we have to blame a pandemic on them. Researchers feels that AIDS originally came from monkeys, or from someone monkeying around with monkeys. If that is really true, then why haven't we taken it out on those monkeys? Monkeys are cute, that's why. Pigs? Not so much, although those Vietnamese potbellied pigs are sort of cute in piggy sort of way.

Arnold on Green Acres was not only cute; he was one of the more intelligent mammals in Hooterville. Porky Pig, in spite of the fact that he does not wear pants, is an American icon. Of course, not having genitalia sort of excuses him. People love to "pig-out" or go hog-wild. Actors ham it up. Pigs wear lipstick. Politicians talk about pork-barrel spending. Little girls wear pig-tails. Hell's Angels ride hogs. People hog seats on the bus, assuming they are still riding a bus now that Joe gave 'em up. Sue-EEEEE!


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