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Saturday, June 6, 2009

Travel Health

Hi from Peru!

I am in Lima at present and finally have a little time to Blog.

It is the winter time here and it really gets chilly in the evenings. Riding around in a cab is quite an experience, kind of like being on a speeding race track with a cacophony of horns as background music. The price of the taxis is equally amazing, no more than $5 to go all around the city, I must admit the price is right.

This is the time of year when many people travel and I would like to talk about some of the things I advise my patients to do before they embark on international travel. There’s nothing like getting sick to ruin a trip, it will make you wish you had never gone in the first place.

Having a travel consult with your doctor is always a good idea and plan ahead, sooner is better than later. Try and get your consultation done at least 60 days before leaving as some vaccines like hepatitis A are only useful if you get both shots and they cannot be taken closer than 30 days apart.

Believe it or not the leading cause of illness in travelers is Diarrhea not exotic diseases like Yellow Fever or Swine Flu even though shots for these conditions may be useful. Diarrhea mainly occurs because travelers are exposed to bacteria that their systems are not familiar with not because the people are dirty. When foreigners come to the US they get Diarrhea too.

Why is Diarrhea so important? Well, let’s say you get Diarrhea then become dehydrated (especially in a hot country). You would then need to be taken to a medical facility where the first step would be to give you an IV, is the needle clean? Is the fluid sterile? You have no way of knowing how hygienic the facility is and all of a sudden a ‘minor illness’ becomes a big deal. There is a protocol that we give our patients to all but eliminate the likelihood that Diarrhea will spoil their vacation.

When you go to some countries you may need special medications, such as medication to prevent altitude sickness. This may be the case for example if you plan to come to Peru and go to Macchu Pichu.

Remember that allergy season is different in different places, for that reason and the possibility of reacting to different foods take along some Benedryl if you have allergies.

Your doctor can review your medical history and suggest Preventive Health strategies specific to your condition. There is a lot more to staying healthy abroad than just taking shots. As far as shots are concerned there may be many that are helpful ranging from updating your Polio vaccination to Meningitis depending on where you are going but some are 'no brainers' for everyone such as up to date Tetanus and Influenza shots.

If you are going to a mosquito infected area remember to pack some long sleeves and pants to wear after dusk, that’s when they tend to bite. Remember if the mosquitoes don’t bite you, you CANT get Malaria or a whole host of vector borne diseases. Its pretty basic and well worth bearing in mind.
On the subject of insect bites, my favorite insect repellant is Skinsensations by Cutter. It doesn’t smell, is not greasy and easily sprays on without making you feel hot. Most hardware and drug stores have it.

Finally, Don’t forget your Sunblock! It should protect against both UVA and UVB rays.

Hasta Manana!

As always wishing you the best of health .............. wherever you are!

Dr Tuakli




Sunday, May 3, 2009

PANDEMIC , HERE???!!! WHOA, JUST A MINUTE!

As a proud alum of both Harvard and Johns Hopkins Schools of Public Health, I think I have been taught by the best to think information and issues through while not deserting 'common' sense.
The current level of alarm in the general population regarding the Swine Flu colloquially known as H1N1 seems unwarranted at the very least. Why?

A little research into influenza in the United States reveals that there are 200,000 hospitalizations and 36,000 Americans die annually from Influenza related complications. If that is the case and according to the CDC it is, 20 times more people died in the US this flu season than have died in Mexico during this 'epidemic'.
Also the people who have died in Mexico have been a small percentage of the people who actually contracted the virus down there. In fact so many people got the virus that there is increasing immunity there and the numbers of new cases are decreasing.

Initially, as I understand it from a top official from the CDC, it was only the cases that were hospitalized that got tested. As a result it looked as if everyone who had it was dying. whereas in truth it was only the sickest of the sick who were in hospital.

When you add to this, the fact that most people in Mexico do not get vaccinated against any flu viruses and that the nutritional status of the average Mexican is not as good as that of the average American one starts to wonder if the label 'Pandemic' might not have been a little hasty.

And then there's this new nomenclature for Swine Flu: 'H1N1' which sounds more high tech and
sci-fi than Porcine Influenza but actually the predominant Influenza A strain in this country during the 2006 -2007 season was a H1N1 virus just a different strain.

I could continue on with the science but I wont except to point out one more fact and that is that a person who contracts influenza A is most contagious for the first 4 days, lasting at most for a week after they develop symptoms. Do not be afraid of people who were in Mexico at Easter!

A group of 27 high school students in Colorado were apparently asked not to attend their high school graduation because they had been on a senior trip to Mexico. None of them were sick!

The point of this blog is the following:
let's not generate panic and deflect resources where they are not needed.
The strain of Influenza isolated so far is no more virulent than the strain that circulated here this winter. This is good news. We can anticipate far less morbidity and mortality from this Flu than we have in the average Flu season yet we don't close entire schools every time a student comes down with the Flu.

Hand washing and the other preventive measures I mentioned in my prior Blogs should make us all feel a lot safer. Its amazing how often the best solution is a low tech one with all due respect to my esteemed colleagues.
I would be interested to read your comments

As Always Stay Healthy.
Add years to your life and life to your years!

Dr Tuakli

Friday, May 1, 2009

Don't drink from that cup!

The latest (as of this morning) confirmed figure of cases of H1N1 (swine flu) in Maryland is 9, I have no doubt that it will be higher by this evening.

Try not to take young children into crowded places, this is not the best time to go to the ball game with them. Avoid crowded malls and shows.

If you are Catholic you should skip communion, it is not a good idea right now to drink from a common cup!

Remember hand washing is your best defense. Children cannot help touching everything, so keep them safe!

Be healthy

Dr Tuakli

Thursday, April 30, 2009

SWINE FLU UPDATE !

The WHO has now upgraded the threat of the Pandemic to level 5. Which means that a global outbreak of the disease is imminent.

In the meantime there have now been 3000 cases with 168 deaths in Mexico. The number of cases in the US exceeds 100 and there are 19 in Canada. I understand that schools in Texas are closed.

Several patients have called to ask for prescriptions of Tamiflu. That is not a good idea, first of all if everyone started to take Tamiflu daily there may not be sufficient supplies for people who are actually sick. Secondly, we don't want to generate resistance to the medication by indiscriminate use.
The best bet is to wash your hands frequently and avoid obviously sick people. Wear a mask, if necessary, in health facilities and crowded places. Seek medical attention immediately for all fevers and flu-like illnesses.

Don't panic, stay informed and take charge of your health. Avoid risky exposures.

As always wishing you optimal health and happiness

Dr Tuakli

SWINE FLU UPDATE

As of yesterday the WHO had updated the Pandemic Alert level to phase 4. This means that there is actual evidence of person-to-person transmission of the swine influenza.
There were 91 confirmed cases in the US with one death in Texas. No cases have been confirmed in Maryland.

Remember, hand washing is of the utmost importance and keep some alcohol-based hand rubbing solution with you. Use it after being in public places like the bank and post office.

There IS treatment for this condition and it is important that it is started early.

If you have any of the typical symptoms of the flu, particularly if you have a high fever make an appointment with your primary care physician as soon as possible.

In the meantime, dont panic! Remember this is actually a preventable condition if you are diligent.

Its Spring! A wonderful time of renewal and optimism

Choose to be Healthy !!!!

Dr Tuakli

Monday, April 27, 2009

SWINE FLU, A Public Health Care Emergency !!!

Tonight I am going to talk about a potential health problem called the Swine Flu. Although the initial symptoms of Swine Flu are pretty similar to the Flu we are all used to it can rapidly get out of hand because humans don't have any immunity to it. It is called Swine flu because it is usually found in pigs.
Even when a person does not get a Flu shot, because of years of exposure to human Flu strains they have a certain ability to withstand the worst symptoms of the flu but with Swine flu there is no innate protection. This is why the World Health Organization has announced the possibility of a pandemic.
A pandemic is worse than an epidemic in the sense that it involves a much wider area of the globe and many more people and thus can take a lot longer to get under control.
There have been 40 confirmed cases of Swine Flu in the US so far. 7 in California, 2 in Kansas, 28 in New York City, 1 in Ohio and 2 in Texas. As you can see there is no defined geographic distribution of the spread and it is assumed that most cases are from travel or contact with a traveller, in these days where thousands of people fly from A to B daily it could just be a couple of days before we are in the throes of an epidemic. Currently this Swine Flu Outbreak is defined as a Public Health Emergency .
PREVENTION is always better than cure!

Wash your hands frequently, avoid sick people. Try to stay in good health, take vitamin C, get plenty of sleep. Drink plenty of fluids and eat nutritious food.

If you have an 'Flu-like" illness be seen quickly. Symptoms may include high fever, chills, sore throat , sweats, body aches and cough.

If you get sick antiviral medication can make the illness milder so you can feel better faster. They can also prevent the more serious complications. The problem is that if you don't start the medication within 48 hours it may not be effective. Because of this we will most often treat a patient 'empirically' before the culture result is obtained. It is important to avoid all aspirin products including peptobismol when you have the flu especially in children under 18.

The medicines that treat the Swine Flu, Tamiflu and Relenza are 70 to 90 percent effective at preventing the Swine Flu.

A person is contagious for 7 to 10 days with the Swine Flu.

In children, according to the CDC emergency warning signs are:
Fast breathing
Bluish skin color
Not drinking enough fluids
Lethargy
irritability
Fever with a rash
Seeming to get better and then return of fever and worsening cough

In adults, emergency signs requiring urgent medical attention include:
Chest pain
Shortness of breath
Sudden Dizziness
Confusion
Persistent vomiting

I hope this information is helpful. Please feel free to call our office for any further assistance you may need.

Dr Tuakli

Sunday, April 26, 2009

IS IT HOT IN HERE?? You bet!

Wow! Talk about spring fever, from 60 degrees to 92 overnight.
I was doing Soccer Mom duty today and I was burning up.
Yes, it was hot today and it certainly doesn't help those with hot flashes. If you thought you were going crazy at least no one noticed that you were sweating more than everyone else but remember there are ways to relieve the flashes and all the other symptoms of hormone imbalance.
For people who prefer not to use hormone replacement there are many herbal supplements which can be quite effective but far and away the most effective management is hormone balancing with bio-identical hormones.
Hormone replacement is not just for the over 50 crowd anymore it is used for younger women for severe PMS and other imbalance related disorders.
But this is not just about hormone imbalance, Spring is a great time to get your health in general well balanced and on a good path. One of the parents today proudly displayed that he had lost 25 pounds just by stopping sodas.
Just do it! Off with all the winter woolies, get off the couch and get moving! You can no longer use the weather as an excuse for not walking. If you don't already have a pedometer, you need one.
We always over estimate exactly how much we walk, shoot for 10,000 steps a day. It's a lot harder than it sounds. It's amazing how little we walk in this country, I often have a hard time making 6000 steps here and yet when I'm in Europe at the end of the day I realise I have done 12,000 just moving around and boy do I feel it.

The warm weather also ushers in the good fruit and vegetables in the supermarket. The prices of course have sky rocketed which means eating well and reasonably, takes a little more planning than previously but...... you are worth it. Try to drink some pomegranate juice during the week and some sort of salad daily.

Sunblock! What a dilemma. Over 80% of patients in my area are vitamin D deficient this time of the year and the best (for some the only)source of vitamin D is the sun. So weigh the pros and cons, if you can get half an hour of sun exposure a day it would help. Darker skin tones need more but if you are very fair skinned and at higher risk of skin cancer you may just have to break down and rely on the supplements. You are going to need at least 1000 units a day!
Either way keep your sunblock handy for prolonged sun exposures. They say any SPF above 45 is wasted. Dont forget to use your Stop Aging Skin Therapy twice a day, it is fantastic.

A little Heads Up. This summer I will be working at the Clinica Esperanza in Roatan, Honduras
and checking on one of my favorite seniors a former Dean of a Law School in Peru who is now 94!
I will also be in Europe later in the summer so the best time for appointments is before June.

Remember Spring time is about renewal. Get energized, get healthy, its not a dress rehearsal!

Add years to your life and life to your years!

Dr Tuakli
 

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