Thursday, October 10, 2013

Danger for those going to Mecca

LATimes story about the worry that MERS, the new "SARS" or respiratory illness that can be fatal, may be spread throughout the world when pilgrims come home from the Haj.
Severe coughs or flu-like symptoms could be a sign of infection with the Middle East Respiratory Syndrome Coronavirus, or MERS-CoV, as the virus is known — and an indication that the infection, thus far detected only in the Middle East and Europe, had spread to the U.S.
Or such symptoms could be nothing significant, just the typical illnesses pilgrims pick up every year during the crowded hajj.
ignore the ignorant comments: The Saudis are quite strict when it comes to the pilgrims and considering the numbers who go there, the deaths are few.

If I remember correctly, some people who attended a Catholic meeting spread SARS...
and catching illnesses in closed airplanes is a major problem for anyone.
we had our forehead temperatures scanned when we traveled by air back then, and our clinic was warned to check for SARS for anyone who had traveled from Asia or Canada.
but SARS was easily spread person to person, including some cases that seemed to be airborne rather than close contact.

MERS is not spread person to person, although there are one or two reports that indicate that a person might have caught it from another, and there have been two nurses in Saudi, one a Filipino who died, who contracted the disease, probably from a patient.

and small pox has been spread when a Somali patient gave it to a few others a decade or more ago.

Wednesday, October 9, 2013

Smelly testing

Improbable research reports on a test for Alzheimer's using peanut butter. 

“Results. The mean odor detection distance of AD patients’ left nostril (5.1 cm), and not their right (17.4 cm), was significantly less (F(3,90) = 22.28, p < 0.0001) than the other groups…. “Conclusion. This non-invasive and inexpensive left–right nostril odor detection test appears to be a sensitive and specific test for probable AD.”

actually, losing smell sensitivity is a traditonal way to test for early dementia, including HIV related dementia. This is why testing for smell is part of the neurological exam.  Usually we tested by opening a small bottle full of coffee grounds, but this webpage suggests using soap for some reason.

On the other hand, as this BMJ article notes: Hardly anyone does it nowadays in routine exams.


When was the last time you asked a patient about their sense of smell? When did you last perform any test of smell identification? Probably never is the answer to both questions. And if you ever did, I expect it was an afterthought and you had to send the clinic nurse scurrying off for an orange or some coffee grains, or worse still you dug out those prehistoric smell bottles that are more appropriate for reviving the dead than assessing the rhinencephalon (the smell brain). Ammonia is useful for cleaning metal. Tinct. asafoetida – the smell of flatus – is an important ingredient of one of the Pentagon’s most repugnant smells ‘US Government Standard Bathroom Malodor’, which causes volunteers to scream and curse within a few seconds...

Loss of smell is called anosmia, and the reason we rarely do the testing is that there are so many reasons for it that testing doesn't give you a lot of information.
LINK from webMD:

Nasal congestion from a cold, allergy, sinus infection, or poor air quality is the most common cause of anosmia. Other anosmia causes include:
  • Nasal polyps -- small noncancerous growths in the nose and sinuses that block the nasal passage.
  • Injury to the nose and smell nerves from surgery or head trauma.
  • Exposure to toxic chemicals, such as pesticides or solvents.
  • Certain medications, including antibiotics, antidepressants, anti-inflammatory medication, heart medications, and others.
  • Cocaine abuse.
  • Old age. Like vision and hearing, your sense of smell can become weaker as you age. In fact, one's sense of smell is most keen between the ages of 30 and 60 and begins to decline after age 60.
  • Certain medical conditions, such as Alzheimer's disease, Parkinson's disease, multiple sclerosis, nutritional deficiencies, congenital conditions, and hormonal disturbances.
  • Radiation treatment of head and neck cancers.

In other words, the person is more likely to suffer from a cold than Alzheimer's disease...

Thursday, October 3, 2013

WTF stories to docs

Drudge has a  headline saying one Democrat said he hasn't read the 10 000 pages of regulations, but presumably docs will have to do so or risk a raid from the FBI?

So the AMA (which emails me but I don't belong to them anymore) has a email telling you these stories:

Add "" to your address book to ensure delivery. Trouble viewing? Read this edition online.

Hello Nancy
Wednesday, Oct. 2, 2013
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This Week's News
Senators call for one-year EHR meaningful use extensionSenators call for one-year EHR meaningful use extension
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yes, we now have to be "educated" in the new health system. Never mind spending time trying to learn about diseases. We now need the equivalent of a speed reading course, a course in the language of "bureaucratese", and of course know all the signs and symptoms of not obeying big brother.

Then there is the abusurdity of the opiod regulations. Put a lable on the bottle, so that when the druggies steal our dying patient's medicines that they know they are addictive and dangerous.

Like other things from Obama's minions (and in this I point out the lopsided statistics of gun crime as the elephant in the living room), this ignores the real problem: a society that loves to get high. I mean, hey, when the biggest TV show on line is about a meth dealer, it's not like we try to portray people as evil, is it? (Or maybe the program did: a lot of moral people thought it did, but then a lot of good "christian" women liked 50 shades of grey: but here I stand with Janet Evanovich, who said she saw it as a lopsided relationship of abuse being romanticized.)

Luckily, I am retired, and too fuzzy minded and out of practice enough not to care. The only people I see are employees etc. with viruses.

Speaking of viruses: I just saw one of our (part time) drivers and his family all with flu like symptoms and fever. I saw an employee last week who also lived on a farm with the same thing. Sounds like an influenza epidemic. I'll have to check the news and my cousin Dr. Angie to see if there is a flu epidemic, or if something else is going on.