Archive for the healthcare Category

Disaster Prep and Free CPR iOS Apps now on the iTunes Store!

Posted in Environmental Health, global warming, healthcare with tags , , , , , , , , , , , , , , , , , on April 30, 2011 by theseep

While working on my Master’s of Public Health through Walden University, part of my practicum was with the Office of Emergency Preparedness in San Luis Obispo County Department of Public Health (SLODPH). All Public Health Departments and FEMA recommend that families have a disaster kit prepared that will provide 72 hours worth of food and water along with basic supplies in the event of an evacuation, a local disaster, or the need to “shelter in place” if supply chains are cut off. While there is a great deal of information available on these recommendations, I could not find an iOS-based application that provided me with all of the resources that are necessary in an emergency situation. So, I utilized some of the SLODPH materials, FEMA resources, and other research to build the Disaster Prep App.

Disasters can happen at any time, at any place and without warning. In a natural disaster, disease outbreak, terrorist attack or other major emergency, a network of local, regional, stateand federal systems will initiate pre-planned and practiced responses. Beyond the municipal and public health responses, the Centers for Disease Control (CDC) and Federal Emergency Management Agency (FEMA) recommend that you and your family prepare to take care of yourselves as much as possible in a disaster.

Downloading the Emergency and Disaster Preparedness Checklist and Guide and filling in your local emergency information is an excellent start. Collecting some basic supplies (not much more than you’d put together for a camping trip) will also provide the basics for you and your family if and when a disaster occurs. Planning for medium and long-term supply chain disruptions that prohibit your ability to access foodand other necessities is also a good strategy in major disasters. Finally, it is important to be able to “shelter in place” – or stay at home or another protected area away from the impacts of the disaster until it is safe to leave.

The Emergency Preparedness Checklist and Guide provides you a means to collect necessary and information in the one piece of equipment you always have on you – your phone.

Disaster Prep Features:

Disaster Kit Checklists
Personal Medical Record Database with export to email function.
Reminders every 6 months to check/rotate kit supplies
Family Emergency Plan
Insurance and vehicle information
General information on disaster basics
Basic CPR and First Aid information
U.S. Military Survival Manual included!
Ability to import photos and PDF files of EKGs, X-rays, lab results, discharge summaries, and other medical information, or other disaster-related diagrams and information.Planned future updates:
Sync Medical Information with Google Health!
Export Medical Information to PDF
Regular additions of disaster preparedness information
Port to Android
Check out screenshots, more information, and the Free CPR app on evolvingmonkeys.com!

Volatile Organic Compounds, Why They’re Bad, Why They’re In Your House, and Why FEMA Wasn’t Really at Fault for the Trailer Formaldehyde Debacle.

Posted in Environmental Health, ethical consumerism, healthcare, politics, sustainability on March 18, 2009 by theseep

In the course of my classes for my Master’s of Public Health, I’ve been doing quite a bit on environmental health. I’m sorry I’ve been a bit slack on the posts, but it’s because of school so besides a baby blog, I’m going to start posting excerpts from some of my papers and discussions. The bonus is that I’ll be adding citations for references and data support for the discussion. This is from a paper on environmental causes of health problems and exposure to chemicals, the section on volatile organic compounds, or VOCs:

“This problem effects us all in varying levels, but can disproportionally effect those living in areas with concentrated levels of certain chemicals, those that regularly utilize potentially hazardous products, and especially those in developing nations where many modern potentially hazardous substances and products are produced or disposed of. Children, pregnant women, and the elderly are also at greater risk for developing disease from lower levels of exposure (Freedman, et al, 2001). Shifts in exposure can occur quickly as well, as in the aftermath of Hurricane Katrina, where thousands of people were displaced from their homes and many were provided trailers to live in by the Federal Emergency Management Agency (FEMA). It was found later that these trailers, made from standard off-the-shelf building materials, were off-gassing enough volatile organic compounds (VOCs) such as formaldehyde to cause significant health problems in many of those living in them (Final Report on Formaldehyde, 2008). Although it was dismissed by some, offering that these types of trailers were not meant to live in for prolonged periods, these very same materials such as pressboard, melamine, paints and sealants, are used in regular home construction as well and can affect any homeowner given the proper concentrations and conditions.” (Slaughter, Environmental, 2009)

Next is a brief definition of VOCs and some human health effects:

The selected toxicologic agent for discussion is Toluene, described on the Agency for Toxic Substances and Disease Registry website as “among the most abundantly produced chemicals in the United States.” (Toluene: Medical Management, 2007). Toluene is an aromatic hydrocarbon molecule that is a type of volatile organic compound (VOC). It is found abundantly throughout our society, in gasoline, glues, inks, dyes, lacquers, paints, pesticides, cleaners, and other household and industrial products (Olson, 1999). Although exposures and overdoses are seen in industrial accidents, it is also commonly abused through “huffing” or “sniffing” the fumes to produce dizzyness and euphoria. It can produce human toxicity through inhalation, ingestion, skin or mucous membrane exposure, is passed through uterine circulation to a fetus, and is also passed in breast milk (Toluene: Medical Management, 2007). Toluene causes a significant amount of toxicity, often from acute exposures, although chronic exposures occur as well, with effects including skin irritation, corneal abrasions, tremors, ataxia (unsteady gait), nausea, headache, and even renal failure and death in high enough doses. Also, because of it’s physical properties like other VOCs, toluene can cause asphyxiation from concentrated inhalation as well as chemical pneumonitis and respiratory failure from aspiration (Olson, 1999). ” (Slaughter, Online discussion, 2009)

So really, even though FEMA made some mistakes, people getting sick from the formaldehyde levels in the trailers wasn’t their fault. The trailers were actually the fault of the EPA and other regulatory bodies that should have been keeping VOCs out of our building materials in the first place, and a building materials industry that doesn’t always take adequate precautions to protect their consumers. Bottom line – have an idea of what you’re consuming and what’s in it.

There are over 85,000 chemicals used in the U.S. in industry and consumer goods, of which we have full toxicologic data for about 7%. That’s a lot we don’t know. Even though we don’t know all of the effects of many of the chemicals we are being exposed to, there is good scientific evidence that some of the more toxic ones and some of the commonly used chemicals cause significant human health problems, even cancer. Exposures are incredibly variable and many of the severe health effects are often accidental or one-time exposures, occupational, or from long-term, chronic exposures, so most people will probably be just fine. However, we’ll see a few thousand people die or get ill from pesticide exposure here, a few hundred thousand cancers from smoking and other carcinogen exposures there, some kids losing 30 or 40 IQ points from lead exposure in homes and toys, male frogs turning into females or having extra legs, little stuff, not really a big deal, right? OR, we could change the way we regulate chemicals to use the precautionary principle and properly test chemicals for human health risks before allowing them to be sold to consumers. Pretty easy way to save lives and an incredible amount of healthcare spending, really.

References

Agency for Toxic Substances and Disease Registry (2007). Toluene: Medical Management Guidelines. Retrieved on March 12, 2009 from: http://www.atsdr.cdc.gov/MHMI/mmg56.html

Freedman, D., Stewart, P., Kleinerman, R., Wacholder, S., Hatch, E., Tarone, R., Robison, L., Linet, M. (2001). Household Solvent Exposures and Childhood Acute Lymphoblastic Leukemia. American Journal of Public Health. 91:4

Centers for Disease Control (2008). Final Report on Formaldehyde Levels in FEMA-Supplied Travel Trailers, Park Models, and Mobile Homes. Retrieved on December 28, 2008 from: http://www.cdc.gov/nceh/ehhe/trailerstudy/

Olgar, S., Oktem, F., Dindar, A., Kilbas, A., Turkoglu, U., Cetin, H., et al. (2008). Volatile solvent abuse caused glomerulopathy and tubulopathy in street children. Human and Experimental Toxicology. 27:477-483. Retrieved on March 12, 2009 from: EBSCO Database, Walden Library.

Olson, K. (Ed.). (1999). Poisoning and Drug Overdose. Stamford: Appleton and Lange.

Slaughter, C. (2009). Online Discussion. PUBH 6105 Environmental Health Class. Walden University

Slaughter, C. (2009). Environmental Causes of Illness. Final Paper. Course 6115: Social, Behavioral and Cultural Factors in Public Health. Walden University

MRSA: The Basics For The Layperson

Posted in healthcare on July 14, 2008 by theseep

My grandmother ended up with an MRSA toe infection and to give my parents a good understanding of what to worry about and, more importantly, what not to worry about, I wrote this “mini-article” and thought it would be useful for those of you worrying about this up and coming infection.

MRSA, or Methicillin Resistant Staph Aureus, has unfortunately become the norm of skin infections. For the past few years In the ER we’ve been treating almost all of our skin infections empirically for MRSA, since in that time we’ve seen it increasing in frequency, so that more than 50% of our skin infections are now due to it. It’s become endemic and there’s not much you can do to prevent it these days. Don’t get too worried yet, though, it usually doesn’t make you too sick as long as it’s treated, and often times people will have just an isolated infection.

Interestingly, despite our increasingly germophobic culture, using UV-irradiated toothbrushes, largely unnecessary hand sanitizer gels, and the ubiquitous antibacterial soap, we are unfortunately beginning to generate a place for these products, with ever-increasing virulence of viruses and bacteria and a continuing rise in resistance against traditional antibiotics.
These hypersanitation products have not been traditionally necessary, since the human immune system, along with skin anatomy and a commensualistic relationship with “friendly” bacteria, have been enough to fight off the majority of invasive skin infections fairly well. Bacteria, however, are resourceful. They are highly adaptable to environmental pressure, and since they multiply at logarithmic rates, doubling a colony size in as little as 10 minutes time, the opportunity for mutation and the induction of “resistance genes” and other advantageous traits is significant.

The rampant use of antibiotics for agriculture has likely been one of the biggest evolutionary pressures for modern bacteria, with MRSA being cultured in higher rates in factory farm workers than in the general population and resistant E. coli strains being found in various human food products. This has been an interesting biologic process that has significantly increased human disease and has been due in large part to politics and economics rather than common sense and forward thinking. Michael Pollan’s book, “The Omnivore’s Dilemma”, details the whole sordid tale – basically, in the early part of the century, as farmers got better at growing things, due to cheap fuel oil, advances in machinery, petroleum-based fertilizers and pesticides, and other improvements in technology, crop yields increased, generating a huge grain surplus in the 1930’s, driving the price of grain to almost nothing. With all that extra corn, we figured out that we could use the surplus super-cheap grain to feed cattle, the cattle grow quickly and chubbily (the marbling us Americans all like), but at the cost of their health. A ruminant’s stomach has evolved to eat grass, not corn, so feeding cows grain causes liver infections, bloat, and sometimes death in 30% or more of grain-fed cattle if not treated with antibiotics. This is one of the main reasons I’m trying to decrease red meat intake and when I do eat it, stick to grass-fed beef (besides the 10-fold increase in resource use to produce meat over vegetables, and the cruel factory farming techniques used in the industry today). The point is, because of the grain use, we’re using inordinate and otherwise unnecessary quantities of antibiotics to treat whole herds of cows, and we’re seeing an increase in microbial resistance and thereby an increase in human disease as a result.

I’ve come to think of antibiotic resistance as an unending race of technology vs. nature. We will never eradicate disease, and the very act of fighting it pressures it towards resistance. Fighting it too hard leads to more resistance, but not fighting it enough increases human morbidity and mortality. I suppose the answer is informed but cautious prudence in the use of antibiotics.

So what do you do about it? Aside from any political action or dietary change, what happens if you or a loved one gets MRSA? If you end up colonized with MRSA, all it means is that the normal Staph bacteria on your skin are now a bit tougher and more opportunistic, so it becomes easier to get skin infections, infected hair follicles, boils, abscesses, and other tasty low-level infections. Sometimes it can progress to worse problems, but if lesions are drained early, the proper antibiotics are given when needed (Bactrim, a sulfa drug, or a combination of clindamycin and rifampin is best right now where we are, but resistance profiles vary significantly depending on where you live). The biggest mistake I see practitioners make is to give antibiotics instead of draining an abscess. Once you get the pus out (I know, it’s pretty nasty, but welcome to my world), it usually starts to improve fairly quickly and often actually doesn’t need antibiotics at all. So, if you start to get big zits or boils, you actually need to try to “pop” them and allow them to drain. Sometime heating pads or moist heat will help draw a developing abscess to the surface of the skin where it can drain. When we have to incise them, we actually leave a packing in for a few days so that it can start to heal from the inside out, otherwise they seal themselves up and continue to fester. Once you start seeing recurrent MRSA in the household, it’s probably a good idea to have everyone use intranasal Bactoban ointment in the nose, three times a day, for 5 days – this is because a common place for MRSA colonization is the nose. I would probably give the bathrooms a good once-over with some disinfectant, chlorhexidine kills MRSA and we use it in the hospital, but I’ll have to check to see if it’s available to the general public.

After all that, the message is: don’t worry too much, just keep an eye out and take care of infections when they come along.

image from giantmicrobes.com

Pharmaceuticals Found in Washington D.C.’s Tap Water

Posted in ethical consumerism, healthcare, politics, sustainability on March 10, 2008 by theseep

The first thing that needs to be said about this is: please don’t use more bottled water as a result of this finding! There are plenty of other issues with bottled water like higher bacterial content, leeching chemicals from plastics, and the fact that bottled water is an environmental nightmare, using 1.5 million barrels of oil annually for the plastic from the U.S. alone.

Back to the matter at hand: according to the Washington post, trace amounts of a variety of pharmaceutical drugs has been found in the drinking water supply of more than 1 million people in and around D.C..

“In addition to caffeine, the drugs found in water treated by the Washington Aqueduct include the well-known pain medications ibuprofen and naproxen, commonly found in Aleve. But there were also some lesser-known drugs: carbamazepine, an anti-convulsive to reduce epileptic seizures and a mood stabilizer for treating bipolar disorders; sulfamethoxazole, an antibiotic that can be used for humans and animals in treating urinary tract and other infections; and monensin, an antibiotic typically given to cattle. In addition, the study uncovered traces of triclocarban, a disinfectant used in antibacterial soaps.”

Nobody knows what this means to human health yet, with such small amounts it is unlikely to cause any immediate harm, however the additive effects are uncalculable at this point. We are continuing to find more and more potentially harmful chemicals that we are exposing ourselves to at low levels, some of which have similar hormone-disrupting properties, some that have been shown to be carcinogenic or effect thyroid function, and a multitude of others that have unknown human health implications and for which there is no know safety cutoff.

We as a society have to stop allowing ourselves to be preyed upon by the corporate sales machine – the majority of the chemicals and pharmaceuticals in our environment that can potentially effect our health are simply not necessary. I have addressed the antibacterial soap and germiphobe movement in the past, and if you read “The Omnivore’s Dilemma” by Michael Pollan, the horrors of feedlot-grown, grain-fed beef are described, with the cows having chronic liver infections and abscesses from the food requiring antibiotics to survive until slaughter. These practices continue to pressure evolution in bacteria and is generating the “superbugs” that are harder and harder to treat. These are not acceptable or sustainable practices, we are seeing more and more contamination of our food, our water, and our homes with chemicals and toxins now an ubiquitous part of our environment and it will soon catch up with us if we continue to allow it to happen.

via Jack Foreman via AHIP Newsletter via Washington Post

Environmental Toxicology: Unsafe toys, lipstick, water bottles, pesticides and more!

Posted in ethical consumerism, healthcare, politics, sustainability on February 25, 2008 by theseep

This is part of a grant proposal that we are writing through ECOSLO to start an environmental health education program in our community. It truly is frightening what we are being exposed to on a daily basis.

In our modern industrialized society, on a daily basis we are exposed to countless chemicals, toxins, and carcinogens in the form of fumes, preservatives, pesticides, fertilizers, waste runoff, and residues. Some of these substances have been proven to be harmful, some of them are speculated to be harmful, and for many of them, we have no idea as to their potential impact on our health.
Even though we are certain of many of these health effects, the offending chemicals are still in our everyday foods, packaging, toys, household cleaners and many other products. It is of paramount importance that we educate consumers on what is safe, what is dangerous and why, and continue to support research into the effects of other potentially harmful substances. A more difficult subject to tackle is the additive effects of what we are exposed to, combinations of heavy metals, multiple hormone-modulating chemicals, or chronic, long-term exposure to materials that we are told are safe at low levels.
While educating consumers is important, educating healthcare professionals is important as well. The same way we are supposed to educate our patients on the dangers of smoking and obesity, we need to be educating our patients on the myriad of issues involving environmental health, both known and potential. Preventative medicine has been proven to be the least expensive and most effective way to counter many disease processes, and our hope is to prevent a portion of the morbidity and mortality that is occurring and will occur from human exposure to chemicals from our industrialized society.
The more publicized exposures include lead-based paint in children’s toys, lead leeching from dishes, phalates and bisphenols leeching from plastics, organophosphate poisoning from pesticides, and perchlorate contamination in many foods. Lead and other heavy metals are known to cause developmental delay, hyperactivity, and various other neurologic problems and can commonly found in old paints, many lipsticks, and more recently contaminating children’s toys. Phalates are plasticizers found in a wide range of consumer goods including pesticides, perfumes, nail polish adhesives, caulk, baby care products, and medical tubing and has been correlated with hormonal changes linked to decreased sperm counts, changes in genital anatomy in boys, and is possibly linked to resistance to insulin and the development of Type II diabetes. Bisphenols are used in the production of polycarbonate plastic and is found in the lining of canned foods, water bottles (including the commonly used Nalgene bottles with recycling symbol #7), and a large percentage of plastic food containers. They have been found to mimic estrogen and disrupt hormones, causing decreased sperm counts, carcinogenic effects during development, as well as a link to increased risk of breast cancer. Organophosphates are pesticides that block acetylcholinesterase, disrupting nerve conduction and also make up the active ingredients in Sarin and VX nerve gas. Although they degrade fairly quickly in the environment, they are one of the most common causes of poisoning worldwide and can potentially effect brain development even at low levels. Perchlorates are salts that are used in rocket fuel and fertilizers and has been found to contaminate up to 1/3 of American produce and milk. It interferes with iodide uptake in the thyroid gland, thereby causing hypothyroidism (low thyroid functioning).
While more research is necessary to support and confirm some of these correlations, and a significant amount of work has yet to be done to uncover the health effects of other chemicals, what we can do now, on local, regional, and national levels, is to educate consumers of the known and potential problems with exposure to these substances in our homes and daily lives. Through outreach to local hospitals, physicians’ offices, nurses, and other healthcare professionals, we hope to decrease the exposure risk to our community. We hope to integrate environmental health into a comprehensive preventative health system that can save billions of healthcare dollars per year and lead to significantly decreased morbidity and improved lives for our citizens. As a secondary benefit to this education, decreasing the use of toxic pesticides, chemicals, and plastics, will also decrease the amount of toxins released into the environment in the manufacture of these goods, decrease landfill waste, and encourage sustainable and organic farming, which as been recently shown to provide food using 20% less energy and with significantly more vitamins and antioxidants.

Beck From the Dead: A Review of Glenn Beck’s Deathbed Video

Posted in healthcare, politics, Uncategorized on January 21, 2008 by theseep

I watched the video of Glenn Beck, rambling clearly under the influence of some sort of narcotic pain medication, after his hemorrhoid surgery. In the video he indemnifies the entire medical system because he feels that he didn’t get the care he deserved, fingering himself and the CEO of GE as prominent local VIPs deserving of only the upper echelon of medical care.  He compares the unbearable hospital experiences with his slightly less horrific, back alley, miscreant-style Glenn Beck days.  Maybe when he was an unnamed, unimportant “schlub”, like he refers to all of us other lowly peons. “One of the darker experiences of my life”, he said twice, comparing his experience to the horror movie, “saw”. Looking at the video clinically, it appears that he possibly had a mild psychotic break while on the medications, hallucinating and becoming suicidal. Regardless of whatever actually happened, his reaction was certainly not normal.
The video continues, his histrionically derailed trains of thought wander around, lacking any type insight or trace of intelligent analysis, never saying what was so horrific about the hospital stay. Was it the wait time to be seen? Did he feel that he should have had his pain relieved more quickly? Did he have to sit for a few minutes in a dirty waiting room with other sneezing, oozing, bleeding, moaning patients? Was it a busy ER, where he was triaged appropriately and seen as soon as the busy staff could, while they were concurrently coding an elderly cancer patient, getting report on the next ambulance coming in, trying to arrange an emergency cardiac catheterization for a heart attack victim, paging three admitting docs at the same time, all while calling the floor supervisor to stop stalling on admitting the 1 ICU, 2 telemetry, and 2 more med-surg patients that we’ve been boarding overnight so we can put 4 more of the 15 other sick people in the waiting room in beds to be seen?

Maybe he simply has no perspective and should discuss some of the real problems with our health system. Like how insurance companies deny patients the care that they need so they don’t lose profit margins. Or how a growing number of American citizens commit healthcare fraud, lying and faking to feed their prescription narcotic addiction, or driving gas-guzzling Hummers and Expeditions while raking up thousands of dollars in U.S. taxpayer funded healthcare bills per year. Or how the processed, industrially made, pesticide-laden foods that we feed ourselves directly contributes to obesity, diabetes, cardiac disease, and other illnesses, with many dyes, preservatives, or other ingredients causing medically significant side effects, including cancer, birth defects, miscarraiges, and others, even contributing to childhood ADD. Or how frivolous lawsuits cost millions of taxpayer dollars per year, drive good physicians out of business, causing healthcare shortages, and further drive the price of basic medical care through the roof.

I’m sure you had some discomfort, but suck it up, man! I really don’t understand how this issue became “Glenn Beck has a Harrowing Medical Experience: U.S. Healthcare in Shambles” story, as opposed to, “Glenn Beck has Transient Psychotic Break While in Hospital: Narcotic side effects and How Prescription Narcotic Abuse is On The Rise.”

6th Annual Mount Sinai Global Health Conference, “Environmental Crisis and Human Health”, 6pm, Friday, February 29th and 9am Saturday, March 1st.

Posted in clean energy, conservation, global warming, healthcare, sustainability on January 21, 2008 by theseep
I’ve just been informed that the Mount Sinai School of Medicine Global Health Center and the Global Health Education Consortium, along with Physicians for Social Responsibility and the MSSM Masters in Public Health Program have announced the 6th Annual Mount Sinai Global Health Conference, entitled “Environmental Crisis and Human Health” to be held at Mt. Sinai School of Medicine. More info at www.mssm-ghc.org/conference2008SPEAKERS INCLUDE:
Dr. Howie Frumpkin, M.D., MPH, DrPH
Director of the National Center for Environmental Health/ Agency for
Toxic Substances and Disease Registry at the US
Centers for Disease Control and Prevention, and one of
the leaders of the CDC’s response to climate change

Dr. Michael McCally, MD, PHD
The executive director of the Nobel Prize-winning organization
“Physicians for Social Responsibility” and a leading
environmental health expert and advocate

Dr. Joel Cohen, PHD, DRPH
Author of “How Many People Can the Earth Support?”
and Abby Rockefeller Mauze Professor of Populations
at Rockefeller and Columbia Universities

Robin Guenther, FAIA, LEED AP
An architect who won the Center for Health Design’s
Changemaker Award for her efforts to green healthcare,
she co-authored the “Green Guide for Health Care” and
also wrote the new book, “Sustainable Healthcare Architecture”.

Sponsored by the Rosenbluth Foundation at the
Mount Sinai School of Medicine
Goldwurm Auditorium
1425 Madison Ave
NY, NY

This sounds like a fantastic conference but I unfortunately don’t think I’ll be able to make it out. The issue of human health and climate change as well as current exposures to environmental toxins and chemicals is a growing field and we need to be prepared for the forthcoming crises.

via Sigrid Hahn

Glenn Beck’s ER Experience: Much Ado About A Total Lack of Perspective

Posted in healthcare, politics on January 19, 2008 by theseep
So we’ve all been subjected to CNN’s poorly informed pundit’s “harrowing” ER experience. From what I can gather, he had a thrombosed hemorrhoid, waited for 40 minutes to be brought back to a room and around 2 hours for pain medications. He sobbed when recounting the event and how unfair it was that he, Glenn Beck, had to wait for medical care. Somehow, this has become a national news sensation and is being touted as an example of how horrible our medical system is. To top it all off, Beck’s hemorrhoids are now ridiculously being likened to the Edith Rodriguez tragedy, who actually died in a L.A. ER waiting room after waiting for hours to be seen.
I’m an ER doctor and although I do agree that our health care system is in trouble and is riddled with problems, Glenn Beck’s rectal pain does not showcase any of them.

As far as his 40 minute wait time goes, certainly he was in pain and this should be treated as expediently as possible, but I’m sorry to inform the general public that a 40 minute wait is really short! Although our hospitals only have a 15-30 minute wait, most hospitals routinely have 2 hour or longer wait times, sometimes 12 or more hours for less acute issues! It is unfortunate that he had to wait 2 hours for pain medications, but I would assume that in a busy ER, there were likely much more pressing issues from other patients like heart attacks and people trying to die. There are multiple reasons for prolonged wait times in emergency departments. The most common is because of triage protocols. From all of the patients presenting to an ER, we must take the sickest patients back first – strokes, chest pain, active bleeding, respiratory compromise, sepsis (severe infections), etc, come back first. Unfortunately there are many people that present to ERs that do not actually need emergency care and these people must wait for the more acute complaints to be take care of.
Bonus rant: These are patients with coughs, colds, rashes, some chronic conditions, and a plethora of other complaints that should be treated by primary care as an outpatient rather than in an emergency department. Some come because they couldn’t get into their primary care doctor or don’t even have one, some come because they didn’t want to wait for primary care, some just want immediate gratification, and some just have noplace else to go. Regardless of the cause, primary care complaints clog up the department so poorly informed pundits screaming in peroneal agony need to wait until the other patients are cleared out. We are actually mandated by law to give a medical screening exam to any patient that presents to the ER, regardless of their complaint, be it emergent, chronic, or completely ridiculous. All this without requesting any information about ability to pay or insurance status, we must see them all. The most frequent abusers of the emergency system tend to be those on our public assistance programs, MediCal here in California. These are “heavy utilizers”, people that choose to go to the ER for even minor complaints, because they know that they can be seen quickly and they don’t have to pay a copay. Now the taxpayers get a $500 ER bill for what would have been a $75 primary care visit. Unfortunately, since there is no personal accountability built into our public health system, there is no incentive to use the system properly. In the same vein, a surprising number of patients utilizing our public health system are smokers, spending the equivalent of a low-cost heath insurance policy on a pack of cigarettes per day (~$150/month) and incurring billions of dollars collectively in smoking related healthcare costs and lost wages. These patients cost the system and the taxpayers a ridiculous amount of money and often will keep other emergency patients from being seen in a timely fashion.
The problem with our healthcare system today is not with the physicians, nurses, and other staff, we all strive to give our patients the best care we can considering the circumstances at any given time. We’re there to help, and even though we didn’t sign up to be spit on, cursed at, swung at, vomited on, sprayed with blood and other body fluids, plus have ridiculous lawsuits filed against us, we go to work anyway and try to give some help to whomever comes in, regardless or race, creed, disease state, wimpitude factor, or ability to pay. Many of you have seen Sicko, so you know that insurance companies are a big part of the problem. I think two other major contributors to our healthcare crisis are frivolous lawsuits (often from unreasonable expectation of care), and a lack of personal responsibility from a patient perspective. If insurance coverage is made non-profit, medical liability is reformed, and people have to pay the health costs of their lifestyle choices (ie: smokers pay for smoking related illness costs, obese patients contribute extra to care for cardiac disease and diabetes, etc), we’ll see a significant decrease in cost to everyone and more efficient care. Leaving healthcare up to the free market is a recipe for disaster – right now we outspend every other country in the world by far, yet our health system ranks 37th!
How’s that free market working for you?

Lead Poisoning From Your Dishes? You Betcha!

Posted in ethical consumerism, healthcare, sustainability on December 26, 2007 by theseep
 Once again, our runaway train to industrialization and mass-production has turned up more ways that we’re poisoning ourselves. Over the last month or so, a flurry of concern has arisen across Utah after a 16 month old girl was found to have lead poisoning. After extensive testing of their home, it was found that the plates that the mother was eating from contained lead, which was then passed to the child through breast milk. Wow. The original story aired on KUTV from Salt Lake, and their local on-air watchdog, “Get Gephardt“, did some further investigation. The television station was able to get viewers to bring in over 1,500 plates for lead testing and found that more than 30% contained toxic levels of lead (pdf link for the full report and list of manufacturers). It seems that glazings commonly have lead and many plates with colorful paintings or patterns often have higher levels as well. The lead in the glazing and paints leeches out into your food, especially when heating them in microwaves. Although some of these plates were made in China, many were made in Europe, or here in the good old US of A. And it wasn’t just cheapo Walmart brands either, expensive names such as Spode were full of the stuff.

Lead is extraordinarily toxic to the developing nervous systems of young children and can cause permanent developmental delays and retardation. This is just another example of how industrialized production of goods from improperly tested materials can be harmful. We’re finding more and more toxic substances in everyday items, from toys, to food containers, to foods, and more. Imagine how many things we haven’t figured out are harming us at low levels or have an additive effect with others?
If you can, get your dishes tested. If you can’t, consider performing a “tox audit” of your home – we’re transitioning to metal water bottles and glass food containers from petrol-based plastics with phalates, Bisphenol-A, and other toxins (here’s a good quick article on plastics).
As far as the lead-tainted dishes in question go, there have been no recalls, although the HomeTrends/Gibson dishes in question were pulled from WalMart’s shelves. Utah legislators are going to bat and trying to get a law passed to require manufacturers to label products with lead. Nice start, hopefully that will help you choose when you buy new dishes in 5-10 years.

Not-so-shocking Study Shows Childhood Obesity Significantly Increases Risk for Heart Attack

Posted in ethical consumerism, healthcare, sustainability on December 17, 2007 by theseep

In a recent New England Journal of Medicine article, Danish researchers showed significant correlations between childhood obesity and coronary artery disease as adults. Looking at 276,835 children born between 1930 and 1976, a linear correlation was found with increasing BMI (Body Mass Index) directly related to increasing risk of having a heart attack. The example used was that a 13 year old boy who is 11kg (24.2 lbs) overweight will have a 33% higher likelihood of having a coronary event than a similar boy of average weight.

NIH statistics show that 17% 0f American children are obese, triple the number since 1980!

Smoking and obesity have become two of the major causes of morbidity and mortality in our country, both of which are preventable. Obesity is a multifactorial issue that stems primarily from the obvious – poor diet and lack of exercise. Granted, the “American diet” is horrendous overall, with plastic-wrapped, preserved offerings of fried this and that, breaded and cheese-filled whatevers, and heaping portions of processed carbohydrates. One of the problems is that these foods are being marketed to children. Sales and demographics experts run numbers to see how they can most effectively sell horrendously unhealthy foods to more and more children (don’t you feel guilty, you heartless bastards?). Cartoons and plastic gifts are used to entice kids to throw fits until they get the Happy Meal or package of sweets that they saw on TV. Also, there is a trend in the media to say that “It’s OK to be yourself (aka obese).” Yes, it is good to be comfortable with yourself as a person, but it is not OK to be morbidly obese! From a pure healthcare standpoint, once you are more than 10-20 lbs overweight, you should start looking at ways to lose some poundage, not find ways to justify your excess weight in the eyes of society. It’s not insensitive or rude, it’s your health. We have gotten so bad, that last year a physician in New Hampshire actually lost his license because one of his patients was offended that he told her that she was overweight and needed to lose weight for her health. She complained to the board and when he refused to go to sensitivity training, they took his license! This to me is absolutely ridiculous. It’s like an alcoholic suing you because you told them to stop drinking!

It comes down to parents, however, to provide their children with a healthy diet and teach them lifelong lessons of nutrition and regular exercise. To do your child the most good, feed them locally grown, organic foods when possible, avoid prepackaged foods as much as you can, and avoid fast foods entirely. Minimal or no sodas/sport drinks/etc, water down your juices, and no bottled water (that’s more of an environmental concern, though). Once the kids are out of the house, it’s tough to encourage these things, so do it while you have their full attention. Also, don’t forget the exercise! Limit TV/computer/video game time significantly. Go cycling or play ball with your kids, take them surfing or hiking instead of letting them vegetate in front of the television. Don’t buy your child Guitar Hero, buy them an actual guitar! Fiddling with 4 buttons on a plastic guitar teaches them nothing except that it’s OK to sit around on the couch and do nothing to better yourself in any way. Your son won’t thank you for all the dates he DIDN’T get because you encouraged him to be an awesome “Guitar Hero.” He may, on the other hand, thank you for guitar lessons after the plethora of dates he did get from his swoon-worthy real-life guitar melodies.  Oh, and virtual dates don’t count.

Baker JL et al. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 2007 Dec 6; 357:2329.

More Insights Into The Cost of Smoking + bonus rant

Posted in conservation, ethical consumerism, healthcare, politics, sustainability on November 21, 2007 by theseep

Also, see “Some Insights Into The Costs of Smoking.”

Besides the fact that smoking causes more deaths per year than AIDS, homicide, suicide, heroin, cocaine, alcohol, auto accidents, and fire deaths combined, this video shows the amount of tar inhaled into your lungs smoking a pack a day for 20 days 7.2 grams, the volume of about 2 charcoal briquettes.

Imagine the tar/dust from 2-3 briquettes coating your lungs every month for years. Imagine that every pack causes irreversible hardening of all of the arteries of your body, promoting the formation of fibrinous plaques that rupture, sending cascades of clot-activating protein into the small arteries of your heart and brain, causing early heart attacks and stroke. Imagine the inflammation from your immune system trying desperately to remove the tar and inactivate cancer-causing free radicals. Oxygen-exchanging alveoli are broken down, intima is thickened, and smooth muscles spasm, causing COPD and emphysema, which becomes progressively irreversible. While you are breaking down your own lungs, causing your cancer, and contributing to your future stroke and heart attack, the second-hand smoke does the same thing to your friends, your family, and your children.

The average healthcare costs of a smoker are 40% higher than the average person and an additional 40,000-60,000 cardiac deaths per year are due to exposure to environmental tobacco. According to the CDC, smoking accounts for about 87% percent of lung cancer deaths and 30% of all cancer deaths. How is this legal? How do we allow the tobacco corporations to cater and market to the poorest subsection of our population, those who work the hardest and utilize the most tax-funded healthcare dollars? By not holding the companies accountable, we are actually subsidizing the profits of tobacco companies. By not holding the smoker responsible for their lifestyle choices, we allow them to draw far more than their share of healthcare funding, thereby subsidising their tobacco habits as well.

Here’s my proposal, and I realize that this is just rough math leaving out many variables. If there are 44.5 million smokers in America with healthcare costs directly attributable to smoking topping 50 147 billion heathcare dollars per year, with 30 billion packs of cigarettes sold in the U.S. every year, that works out to about $3.08 $6.50 per pack of cigarettes. We simply add this $6.50 as a tax to each pack of cigarettes that will go directly to pay for the projected heathcare costs that smoking that individual pack will incur. Of course, for our healthcare and public assistance programs to work, many more things need to be done, like making healthcare as an industry not-for-profit (single-payer could work as well, but this is easier), initiating tort reform with penalties for frivolous lawsuits (both of the aforementioned mean campaign reform and eliminating lobbyist favors/contributions/bribery), and instituting personal accountability for lifestyle choices. Let’s get some people in Washington that have the integrity and moral fortitude to question and challenge the status quo. Let’s start doing the right things for the right reasons and hold both corporations and individuals accountable for the true costs of their actions, socially and environmentally.

Anyone up for it? Dennis Kucinich? Barack? Stewart and Colbert?

via Gizmodo

The Beginning of the Next Evolution of Humankind Through Technology

Posted in healthcare on November 15, 2007 by theseep

  Humanity has stopped evolving. To be more precise, we have stopped progressing forward in a traditional  evolutionary sense and thanks to medical technology and cultural constructs, we are actually de-evolving in certain ways. The unfortunate but simple truth is that Darwinism has been defeated by modern science. No longer do the strongest and most intelligent survive, we now keep alive the weak and ill and due to both technology and social constructs less desirable genes and traits are passed along more and more. Don’t get me wrong, I’m not saying that we shouldn’t be doing these things, I am simply pointing out how technology has altered natural environmental pressures and we should expect to eventually see physiologic and physical changes in humanity as a result. Besides altering natural evolution, we are also developing our own version of evolution through technology. We have seen a melding of humankind and machine for years in Sci-Fi books, movies, and television shows and are there more and more evidence that this could represent the future direction of the human race. We have already made significant progress in cyborg technology – prosthetic limbs, cochlear implants, eye implants, exoskeletons (and here), and other advancements. One of my favorite tech blogs, Engadget, has had a recent few posts that show some of the newer developments – targeted muscle reinnervation for prosthetic limbs to allow better control, and a brain implant that should allow a patient to speak again through a computer. Both DARPA (Defense Advanced Research Research Project) and Segway inventor, Dean Kamen have developed prosthetic arm prototypes that are revolutionary with incredible dexterity thus far unsurpassed function for a robotic limb. The next 100 years will certainly be interesting for humanity – climate change, peak oil, superbugs, technoevolution, and who knows what else?

Femtosecond Lasers May Save Us From Superbugs

Posted in healthcare on November 14, 2007 by theseep

 On November 1st, the Institute of Physics published an article describing the use of specialized femtosecond laser pulses to destroy viruses and bacteria while leaving human cells unscathed. Using a process called Impulsive Stimulated Raman Scattering (ISRS), lethal vibrations are produced in the protein coat of microbes similar to an opera singer shattering a glass with her voice. Supposedly by modulating wavelengths and frequency, human cells are not damaged by the laser. If this research comes to fruition and can be developed further, we may have our next wave of high-tech “antibiotic” treatment. Since we’re currently manufacturing “superbugs” through overuse of antibiotics, we’re going to have more and more difficulty finding chemical cures for these wee beasties and this type of therapy just might save our skins. This is truly a groundbreaking news and could revolutionize the way we treat infections – imagine getting a 30 minute laser treatment for pneumonia instead of being admitted to the hospital on 10 days of antibiotics!

Via Engadget

Rivera Family Sues After NYC MRSA Death, Why Superbugs Will Take Over

Posted in conservation, ethical consumerism, healthcare, politics, sustainability on October 30, 2007 by theseep

Nobody will argue that the death of 12 year old Omar Rivera was not a tragedy, but why does his name need to be dishonored by suing the hospital and NYC Health and Hospital Corp?  This is not a one-sided argument, however.  This is the type of high-profile case that vilifies everyone, from the parents, to the hospital that treated the child, to the media, to our entire healthcare and judicial systems.  Firstly, this case is already causing a panic in the population because of how it has been handled by the media. This MRSA, or methicillin-resistant Staph Aureus, was first isolated in 1953 and has been a constant battle in hospitals, showing up in the sickest, most stressed and immunocompromised patients.  Along with VRE (vancomycin-resistant enterococcus), healthcare workers have constantly put themselves at risk to treat these “superbugs” that are nothing more than the natural response of bacteria to our use (and often overuse) of antibiotics.  All organisms have the ability to adapt to environmental pressures, and since the advent of antibiotics, humanity has pressured bacteria to evolve in order to survive our chemical assault.  The unfortunate part is, that through irresponsible use of antibiotics, we have hastened this evolution and continue to encourage microbial resistance.  As an ER doctor, since moving from Massachusetts to California just 4 years ago, we have gone from treating skin infections, known as “cellulitis”, usually caused by Staph and/or Strep bacteria (which live on all of our skin and you can’t get rid of, no matter how much antibacterial soap you use), with penicillin or a 1st generation cephalosporin like cephalexin (Keflex), to using entirely different classes or multiple antibiotics due to resistance.  Currently in California, greater than 50% of skin infections are due to MRSA, which is now classified as “community acquired”, since we no longer see it exclusively in very ill or immunocompromised patients.  Because this is such a new phenomenon, I still see primary care doctors and others placing patients on the “old” antibiotics for these newer “superbugs”. It sounds like young Mr. Rivera was placed on amoxicillin for his cellulitis, which just a few years ago, would have been fine.  This issue is so new, however, that studies are just coming out that document these new changes in resistance patterns and the proper antibiotic treatment is still under development.

So what can we do? We as citizens need to question any and all antibiotic use.  Stop demanding antibiotics from your doctors.  Stop using antimicrobial soaps and sanitizers (see this previous rant)- we evolved to live commensualistically with bacteria on our skin, you cannot and should not sterilize yourself.  In today’s high-volume, low-reimbursement healthcare system, it is easier for a doctor to prescribe antibiotics for a viral cold than to explain to a demanding, rude, uninformed patient, that antibiotics are only for bacterial infections like pneumonia, cellulitis, and urinary tract infections and do not treat viruses.  People expect a “magic bullet”, that by going to the doctor there will be come miracle cure for every ailment and sniffle.  Unfortunately this is not the case, but these expectations, along with the corporatization of healthcare, demanding “customer satisfaction” over good medical practice, is indirectly leading to the type of irresponsible antibiotic use that is causing these “superbugs” in the first place.  We as physicians need to take the time to discuss the proper use of antibiotics with our patients and give them only what they need, not what they think they need.

I could continue to rant about how our current legal system and our “sue-happy” nation is one of the major factors contributing to the impending downfall of our healthcare system, and how the Rivera family is disgracing the memory of their child by trying to leverage $25 million dollars from their son’s death, but I will leave it at this:  Everything we do has an impact, from every bit of fuel we burn contributing to global warming, to each mass produced bit of clothing we buy contributing to the oppression of those workers and dispersing toxins into the environment, to every dose of antibiotic we take contributing to antimicrobial resistance.  Most of our problems on a macroscopic scale are being caused by our individual actions on a microscopic scale.  If we each educate ourselves and begin making the right decisions, we will see a slowing of these phenomena, which represent nothing more than the equal and opposite reaction of our personal and collective actions.

Surgeon General’s Message Twisted by Politics

Posted in global warming, healthcare, politics on July 29, 2007 by theseep

Although not surprising in the least, Dr. Richard Carmona, the Surgeon General of the United States of America from 2002-2006, the Nation’s guiding voice for the health and well-being of it’s citizens, has come forth to reveal that his position was tainted by politics. His recommendations were edited or silenced, and his professional opinion was undermined by the interests of the controlling political party. Earlier this month, Dr. Carmona, a former trauma surgeon who served in Vietnam in the Army Special Forces, winning two purple hearts, told a congressional panel that during his 4 year term as Surgeon General he was forbidden to discuss or issue reports on stem cell research, emergency contraception, sex education, prison and mental health or global health issues. Top aides also attempted to block and “water down” reports on the significant dangers of second hand smoke.
Continuing on with the ridiculousness, Dr. Carmona was told to mention Bush three times in every speech, and was discouraged from supporting or attending the Special Olympics because they are supported by an opposing “prominent political family” (read: The Kennedys). Are you kidding? Don’t support the Special Olympics because of your political agenda? What kind of twisted, self-centered, manipulative SOB tells the Surgeon General not to support the handicapped because of their political interests?  Our current regime has stooped lower than any other in history. Once again, the Bush administration’s true colors are revealed, and impeachment hearings should be initiated for Cheney then Bush. Write your congressperson to express your outrage.

via NY Times