There is a story that is told in medical history about a milk delivery maid who was dubbed 'Typhoid Mary' because she single handed contributed to the biggest typhoid epidemic in England. An interesting story often told to very green medical students as an introduction to the term "carrier".
A patient of mine came in recently with the Swine Flu H1N1) he was very sick and was still wearing his Fedex uniform. I advised him that the type of work he was doing and his exposure to the elements would only make him sicker, needless to say I put him out of work for a week.
As I looked at this poor person with bloodshot eyes, sweating and coughing up a storm, I had cause to rethink our (the Health Establishment's) definition of 'High Risk' patients i.e those who are eligible to recieve the H1N1 vaccine. Surely the delivery man innocently delivering packages from one establishment to the next and potentially picking up infection at one and depositing it at the next, is at high risk. Not only that, he (or she) presents a risk to the community at large as he proffers his pen with a grin and the instruction to 'sign your name!' before darting off to the next densely populated building.
In my office we have been lucky enough to have had the H1N1 shot throughout the 'shortage' and we have religiously followed the Health departments instructions to limit its use to high risk individuals; children ages 6 months to 24 years, healthcare workers and pregnant women. As of this week I have opened it up to many more people that I consider high risk such as teachers and metro workers.
I have been struggling with the idea from the beginning that students need to be vaccinated but not those who teach them. Maybe I am more sypathetic because my husband is a professor or just because I have NEVER seen my 17 year old son as sick as he was with the Swine Flu. He rarely gets sick but this bug made him as sick as a dog! (He came down with it 3 days before I recieved my supply of vaccines ...........).
Anyway to cut a long story short, come on and get your H1N1 vaccine, lets curb this epidemic. It takes 2 weeks to develop a good immunity so hurry in, next week is Thanksgiving and yes, if you drive a UPS truck ................ you are welcome too!
Wednesday, November 18, 2009
Thursday, October 29, 2009
It really IS an epidemic this time!
Yes, we have H1N1 shots in our office and Yes, I recommend them!
We have been inundated with people who have flu-like symptoms as well as people coming in for the vaccine. It really qualifies as an epidemic this time around. The local school board is posting the percentages of absenteeism for every school that has at least 10% of the kids out sick and there are no schools that are NOT on the list! One school was recorded twice with almost 20% of the students out sick.
One of my patients came in today with a red eye, body aches, fever, headache and generally feeling yucky and mentioned that at her elementary school (she is a kindergarten teacher) 10 teachers were out sick on the same day which resulted in general chaos as they tried to move the teachers and volunteers around to fill in the gaps.
One anecdotal observation: I haven't seen a single patient who has tested positive for Swine flu on culture who doesnt have a cough and a fever. Interesting since with regular flu you dont always have a cough. Body aches and sore throat are also extremely prevalent symptoms.
What to do? Well, first of all if you have any of these symptoms Stay Home! Spray your door knobs and counter tops with Lysol or the equivalent. Cough into your elbow and put hand sanitizer on your hands frequently. Get treated early.
We treat all our patients aggressively with homeopathic remedies, vitamins and supplements along with prescription anti-virals. Almost all are better within 3 days ............... except for that cough! If you start treatment late that cough can drag on for weeks. Inhale steam as much as possible and avoid cold drinks.
Prevention: Always the best option.
Get your Flu shots, both regular and the H1N1 (call the office if you need one). Stop by and pick up your "Well Being" and Vitamin C and Cod Liver Oil take them thru the winter, its going to be a rough one.
Stay out of crowds.
Warning:
Beware The Flu is usually worse after Thanksgiving ( after all the hugs and kisses). This year it started really early and with a vengeance, and if it is going to get worse after Thanksgiving we all need to be pro-active!
We have been inundated with people who have flu-like symptoms as well as people coming in for the vaccine. It really qualifies as an epidemic this time around. The local school board is posting the percentages of absenteeism for every school that has at least 10% of the kids out sick and there are no schools that are NOT on the list! One school was recorded twice with almost 20% of the students out sick.
One of my patients came in today with a red eye, body aches, fever, headache and generally feeling yucky and mentioned that at her elementary school (she is a kindergarten teacher) 10 teachers were out sick on the same day which resulted in general chaos as they tried to move the teachers and volunteers around to fill in the gaps.
One anecdotal observation: I haven't seen a single patient who has tested positive for Swine flu on culture who doesnt have a cough and a fever. Interesting since with regular flu you dont always have a cough. Body aches and sore throat are also extremely prevalent symptoms.
What to do? Well, first of all if you have any of these symptoms Stay Home! Spray your door knobs and counter tops with Lysol or the equivalent. Cough into your elbow and put hand sanitizer on your hands frequently. Get treated early.
We treat all our patients aggressively with homeopathic remedies, vitamins and supplements along with prescription anti-virals. Almost all are better within 3 days ............... except for that cough! If you start treatment late that cough can drag on for weeks. Inhale steam as much as possible and avoid cold drinks.
Prevention: Always the best option.
Get your Flu shots, both regular and the H1N1 (call the office if you need one). Stop by and pick up your "Well Being" and Vitamin C and Cod Liver Oil take them thru the winter, its going to be a rough one.
Stay out of crowds.
Warning:
Beware The Flu is usually worse after Thanksgiving ( after all the hugs and kisses). This year it started really early and with a vengeance, and if it is going to get worse after Thanksgiving we all need to be pro-active!
Sunday, August 16, 2009
Peri-menopause is a tough one!
It has been my experience in the last 20 years that the Peri-menopausal period is actually harder than menopause itself.
I want to discuss some of my theories as to why this is so, but first what is Peri-menopause?
Peri-menopause is defined as the time during which a woman's body transitions into menopause, it can be from 6 to 10 years and ends 1 year after a woman has had her last period. It usually starts to occur in the 40's.
Many women are taken by surprise when they begin to experience peri-menopausal symptoms as they are unfamiliar with this phenomenon. Often they expect the cessation of their periods to be the first sign. Whereas period irregularities are often an early sign, they are more likely to become erratic and varied, longer or shorter in length and different each month.
Peri-menopause is a time when hormone levels are fluctuating wildly, and the changing symptoms demonstrate this. Moodiness and depression may set in because of unaccustomed feelings, people who have never had headaches before can develop migraines. The memory declines but not consistently and women may begin to feel a little 'fuzzy' and very vulnerable. The latter occurs particularly in professional women who are used to being able to make split decisions. And then there's the weight gain ! Almost invariably across the board there is more deposition of truncal fat in spite of regular exercise and weight control methods.
Inconsistent sleep and night sweats cause a lack of rest and this adds to the irritability and depression, women find themselves anxious for no specific reason and may lose their motivation.
Changes in the sexual arena can also be expected and once again may fluctuate with hormone levels.
Remember that this is also a transition for families who are suddenly surprised at the changes in a woman's persona but often are too tactful to mention it. The people around you are a good barometer they tend to notice a whole lot more than you give them credit for!
So why is it so tough?
Well, first of all because it is unexpected, it seems so sudden there is no time to adjust. It often occurs at a time when the woman has a lot of responsibilities, having achieved a certain professional level with a completed family to take care of. Stress is a huge aggravating factor in Peri-menopause and the sudden overwhelming sense of not being able to handle things is very common. For many women this is the first time they have ever had 'anything wrong' with them.
Secondly, it is not often discussed so women don't know where to seek help, they may not even be aware that there is help and so this generates a feeling of isolation. A reluctance to discuss the symptoms while attempting to handle it by themselves. They are not alone! Millions of women have the same problem they just dont talk about it. Whereas the syndrome of Menopause is well known the precursor is not.
Lastly, there maybe a sense of loss, women know something is changing and it may not be a state they are ready for. they know intuitively things will never be the same again. Skin changes, memory changes, lots of gas, dizziness and joint pains may also accompany this condition. One thing is for sure these are physical and physiological changes, its not all in your head!
In my next blog I will discuss ways to deal with these symptoms and how to improve the quality of life as you proceed to menopause.
Be well, lively and healthy until next time.........................
Dr Tuakli
I want to discuss some of my theories as to why this is so, but first what is Peri-menopause?
Peri-menopause is defined as the time during which a woman's body transitions into menopause, it can be from 6 to 10 years and ends 1 year after a woman has had her last period. It usually starts to occur in the 40's.
Many women are taken by surprise when they begin to experience peri-menopausal symptoms as they are unfamiliar with this phenomenon. Often they expect the cessation of their periods to be the first sign. Whereas period irregularities are often an early sign, they are more likely to become erratic and varied, longer or shorter in length and different each month.
Peri-menopause is a time when hormone levels are fluctuating wildly, and the changing symptoms demonstrate this. Moodiness and depression may set in because of unaccustomed feelings, people who have never had headaches before can develop migraines. The memory declines but not consistently and women may begin to feel a little 'fuzzy' and very vulnerable. The latter occurs particularly in professional women who are used to being able to make split decisions. And then there's the weight gain ! Almost invariably across the board there is more deposition of truncal fat in spite of regular exercise and weight control methods.
Inconsistent sleep and night sweats cause a lack of rest and this adds to the irritability and depression, women find themselves anxious for no specific reason and may lose their motivation.
Changes in the sexual arena can also be expected and once again may fluctuate with hormone levels.
Remember that this is also a transition for families who are suddenly surprised at the changes in a woman's persona but often are too tactful to mention it. The people around you are a good barometer they tend to notice a whole lot more than you give them credit for!
So why is it so tough?
Well, first of all because it is unexpected, it seems so sudden there is no time to adjust. It often occurs at a time when the woman has a lot of responsibilities, having achieved a certain professional level with a completed family to take care of. Stress is a huge aggravating factor in Peri-menopause and the sudden overwhelming sense of not being able to handle things is very common. For many women this is the first time they have ever had 'anything wrong' with them.
Secondly, it is not often discussed so women don't know where to seek help, they may not even be aware that there is help and so this generates a feeling of isolation. A reluctance to discuss the symptoms while attempting to handle it by themselves. They are not alone! Millions of women have the same problem they just dont talk about it. Whereas the syndrome of Menopause is well known the precursor is not.
Lastly, there maybe a sense of loss, women know something is changing and it may not be a state they are ready for. they know intuitively things will never be the same again. Skin changes, memory changes, lots of gas, dizziness and joint pains may also accompany this condition. One thing is for sure these are physical and physiological changes, its not all in your head!
In my next blog I will discuss ways to deal with these symptoms and how to improve the quality of life as you proceed to menopause.
Be well, lively and healthy until next time.........................
Dr Tuakli
Wednesday, July 1, 2009
Hi from Honduras
Last week our blog came from the Andes in the southern hemisphere and now we are coming to you from Central America. What a difference in weather, time, and culture---In Peru it was winter time and it was cold and drizzly, and in Honduras it was hot & humid.
My family and I were on the island of Roatan, which is part of the Bay Islands located north of mainland Honduras. It is known for its stunning beaches, pirate history, and a wonderful mix of natural and ethnic diversity. In all my travels I truly believe that Paya Bay in Roatan is one of the most tranquil and idyllic places on this planet. The Paya Bay Resort exudes a special energy that calms the soul and gives new meaning to relaxation and regeneration. Next summer, I plan to organize a weeklong retreat with free seminars on anti-aging and bio-identical hormone replacement at this resort. I would be happy to supply details to anyone who is interested.
One of Roatan's main attractions is its barrier reef (the second largest in the world) which attracts divers from all over the world. In addition, there is a host of other activities including yoga, kayaking, meditation, hiking, and just watching the sunset from your hammock on the beach. Paya Bay is a very secluded and private spot of the island, and it gives one the sensation of being at peace & harmony with yourself and nature.
I have been volunteering to work in Honduras for several years now, and three years ago went to Roatan to work at the Clinica Esperanza, a clinic established by a nurse from Ohio, Ms. Peggy Stranges, to provide basic health care to islanders regardless of their status. I came upon Paya Bay quite by happenstance, after working in the clinic for a week I decided to take a weekend on a part of the island more remote and less populated. What a discovery! I cannot wait to go back and hope that I can encourage others to experience this small slice of paradise known as Paya Bay, Roatan, Honduras.
All good things must come to an end---as we departed a military coup d'etat was taking place and we learned upon arriving in Washington, D.C. that the president of Honduras was exiled to Costa Rica and an interim government was established. Notwithstanding this unfortunate turn of events, the Bay Islands (Roatan, Guanaja, and Utila) are not a center of political unrest and they are culturally and geographically distinct from the mainland. Fortunately Paradise remains untouched!
Remember to find time to relax and to stay emotionally and physically healthy. Until we meet again, Dr. Tuakli
My family and I were on the island of Roatan, which is part of the Bay Islands located north of mainland Honduras. It is known for its stunning beaches, pirate history, and a wonderful mix of natural and ethnic diversity. In all my travels I truly believe that Paya Bay in Roatan is one of the most tranquil and idyllic places on this planet. The Paya Bay Resort exudes a special energy that calms the soul and gives new meaning to relaxation and regeneration. Next summer, I plan to organize a weeklong retreat with free seminars on anti-aging and bio-identical hormone replacement at this resort. I would be happy to supply details to anyone who is interested.
One of Roatan's main attractions is its barrier reef (the second largest in the world) which attracts divers from all over the world. In addition, there is a host of other activities including yoga, kayaking, meditation, hiking, and just watching the sunset from your hammock on the beach. Paya Bay is a very secluded and private spot of the island, and it gives one the sensation of being at peace & harmony with yourself and nature.
I have been volunteering to work in Honduras for several years now, and three years ago went to Roatan to work at the Clinica Esperanza, a clinic established by a nurse from Ohio, Ms. Peggy Stranges, to provide basic health care to islanders regardless of their status. I came upon Paya Bay quite by happenstance, after working in the clinic for a week I decided to take a weekend on a part of the island more remote and less populated. What a discovery! I cannot wait to go back and hope that I can encourage others to experience this small slice of paradise known as Paya Bay, Roatan, Honduras.
All good things must come to an end---as we departed a military coup d'etat was taking place and we learned upon arriving in Washington, D.C. that the president of Honduras was exiled to Costa Rica and an interim government was established. Notwithstanding this unfortunate turn of events, the Bay Islands (Roatan, Guanaja, and Utila) are not a center of political unrest and they are culturally and geographically distinct from the mainland. Fortunately Paradise remains untouched!
Remember to find time to relax and to stay emotionally and physically healthy. Until we meet again, Dr. Tuakli
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.
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
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
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
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