Watch out: the Norovirus is lurking!

So many people are coming down with rather similar symptoms: nausea, vomiting, diarrhea, & cramping and there is a virus that is going around, which spreads quickly, and you could be at risk. I wanted to discuss what the Norovirus is, how to know you have it, treatments, and, most importantly, prevention!


What is the Norovirus?
It is actually the name for a group of viruses that all act similarly, if not the same, on the GI tract and cause nausea/vomiting, diarrhea, abdominal cramping, etc. and are thought of as a gastroenteritis (and infection of the GI tract). They were once referred to as the "Norwalk Like" viruses after an outbreak of these viruses in Norwalk Ohio in the early 1970's. They also gained a lot of press after hundreds (if not thousands) of guests on cruise ships were getting infected, and ships had to go to port due to such high rates of illness (If I ever even ponder taking a cruise, I remember this fun time, and I'm all set- could you imagine how horrible that must have been? Gross!) The tough part of the Norovirus is that they are highly virulent, in that they spread from person to person quickly and easily, and infections from these viruses are usually at the highest during cold winter months. That is a true bummer for all of us living here in New England! Fun fact? Norovirus is the leading cause of food-related gastroenteritis in the United States.

What are the symptoms?
Nausea
Vomiting
Diarrhea
Stomach cramps
Low grade fever, chills
Headache
Muscle cramps
*the symptoms can occur very suddenly 12-24 hours after exposure to the virus, and normally last around 12 hours and people feel better within 48 hours

How is it spread?
Most often it is spread from person to person through contaminated food and/or water, caring for an infected person, or through contact with contaminated surfaces. It can live on hard surfaces that are infected for around 12 hours and has been found in infected carpet fibers for up to 12 days, plus it can withstand pretty high amounts of chlorine before being killed off. The viruses live in the stool and vomit from people with the virus, so when caring for children, elderly, or anyone who needs a lot of assistance with care, there is a high rate of spreading the infection. you are contagious from the moment you are infected (even before you feel ill) until a full three days after your symptoms end!
Which makes this virus so quick to spread especially in places where people live/work closely together.

What is the treatment?
There is no vaccine or antiviral for these viruses, unfortunately. And as we all know antibiotics only treat bacterial infections, so they are useless against the Norovirus. So you are really just trying to treat/prevent the dehydration that can occur after the diarrhea and vomiting; fluids such as gatorade and coconut water will help to replace fluids and nutrients lost, but really any fluids that you can get in and keep down will help to prevent severe dehydration. If your mouth and tongue are severely dry and you cannot make saliva, you feel dizzy when changing positions, you aren't urinating (or it is very dark) you are dehydrated and if you are unable to take in fluids, you may need to go to the Emergency Department for intravenous (IV) fluids. In children, they often will become restless, cry without tears, and have dry oral cavities; they need treatment with IV fluids if they refuse or cannot keep down fluids.


How do I prevent this from happening?
Wash your hands FREQUENTLY!!
Eat food that is thoroughly cooked if you are eating out (or unsure of food quality)
Wash fruits and veggies before eating them
Wash areas that have become contaminated with hot soapy water or bleach
Immediately wash all clothes, bed linens, etc that have become in contact with vomit or stool of an infected person
If you do get infected, avoid contact with others and preparing food until three days after symptoms are gone

Generally, the Norovirus is a nasty couple of days where you feel horrible, but it ends and there are no long term effects, but if you have chronic illnesses or other active diseases, it can be deadly usually because of the effects of dehydration and the electrolyte imbalances that can occur. In children, the elderly, and chronically ill, you need to make sure they are taking in fluids with nutrients (pedialyte, Gatorade, coconut water)and if they cannot, you need to seek medical assistance.

So wash your hands, cook that food, and steer clear of anyone with those symptoms and you will be Norovirus free this winter!

Yours in Good Health
B

If you exercise, you need a VITAband!

Sometimes when I am running early in the morning, when it is still dark out, I worry that something will happen to me and how would I be able to get my medical info and allergies out to the EMT's that might find me?  Plus...It doesn't help that my mother is constantly worried I will be "dead in a gutter" (most likely why I have the irrational fear of getting hurt during a standard morning run) but wouldn't it be cool to have that info stored on you along with some other perks?  Enter: the VITAband, my new favorite athletic accessory!

What is it?
The VITAband is a lightweight plastic bracelet that you can wear while working out, and it can be used to electronically store your pertinent medical information (like allergies to bee stings, medications, foods, etc OR Chronic medical conditions like diabetes, heart conditions, etc).  Each VITAband has a specific VITAnumber that is  specific just to YOU.  You go online and register your information with your VITAnumber into your ERP (Emergency Response Profile) and list your medications, allergies, past medical history, and emergency contacts. Most emergency responders are taught to look for anything that might identify you are give such information (such as allergy or medical bracelets) and they can look up your number and find out the information that you have stored so that they might know what is causing your medical emergency,and how to contact your family/loved ones.  You can put as much or as little information as you want to into the ERP, it is all what you want to put into it!

What's even better?
The VITAband can also be used as a credit card! WHAT??  I know you thought it couldn't get any better, but you can upload a prepaid Visa debit card to your VITAband and you can use it anywhere there is Visa PayWave.  So, you never have to worry if you are on long runs/walks/bike rides if you need to get something to eat or drink, you always have a form of payment on you!

Are there any fees?

The bracelet itself costs $19.95 and there is an annual cost of $14.95 to store your information.  So you just pay a one time fee for the bracelet and then the annual fee, which I totally think is worth it right?  It gives you the sense of knowing that if something happens to you, your health information will be passed along.  Plus, if you are feeling a little parched on a longer than expected outing, you have the cash equivalent right there on your wrist!

I suggest that anyone that exercises for long times/distances alone get a VITAband, it is worth it, and as a medical professional, that information is unbelievably helpful for us to treat you, and can get your loved ones at your side ASAP.  VITAband: go out and get one!

Yours in Good Health

B

The morning after alternative.....

I know that this is a touchy subject for many people, but Plan B is an oral emergency contraceptive that is currently OTC (over the counter) for women over the age of 17, and under 17 they have to get a prescription from an HCP to be able to obtain this emergency contraception.  So, I want to clear up a few misconceptions about Emergency contraception, how it works, and when it is used.   It was recently recommended as an appropriate OTC medication for women of all ages, but the US government is currently trying to block that. I won't try to sway you either way, but I want you to know the facts.

What is Plan B?
Plan B (AKA "The morning after pill") is merely an emergency contraceptive, meant to be taken within 72 hours of having unprotected sex to help prevent the chances of an unwanted pregnancy. It consists of progestin levonorgestrel, and can either be taken in one dose or two (Plan B is two pills taken 12 hours apart versus Plan B One-Step is only one pill).

How Does it work?
Taking Plan B can have a few different actions, based on what stage your body is in your menstrual cycle.  It can either delay or prevent ovulation, or it can interfere with the fertilization/implantation of an egg.  Now, if you are already pregnant, it will NOT TERMINATE a pregnancy.  It is not an abortion pill, it merely affects the lining of your uterus due to the fluctuations in hormones.  This treatment is commonly used in hospitals for woman who have been sexually assaulted.  If you take it within 24 hours of unprotected sex, it is 95% effective in preventing pregnancy and 89% effective if taken within the 72 hour time frame, of course the sooner you take it, the more effective it is.  Remember: Plan B DOES NOT PROTECT YOU AGAINST STDs!!

When should I consider taking it?
If you had unprotected sex
The condom broke or fell off
You missed more than 3 pills of your regular birth control in one month
Your diaphragm moved/fell out
You were sexually assaulted (Please go to the nearest Emergency Room for treatment and call a sexual assault hotline)
Your form of birth control was forgotten or failed

When should I NOT take Plan B?
If you are pregnant
If you have an allergy to the ingredients
If you have any type of abnormal bleeding/ pain that you have not seen your HCP about yet

What are the side effects?
It is considered pretty safe, but there are some side effects, such as:
nausea
vomiting
abdominal cramping
headache
menstrual changes
breast tenderness
diarrhea

I am not going to tell people what to think BUT Plan B is not an abortion pill, and it can be a safety net for people who have made mistakes. Why prevent younger women who are sexually active from having access to Plan B?  I am not a proponent of 13, 14, 15 year olds going around having unprotected sex, but let's face the facts, we have all either seen or heard of Teen Moms, a popular TV show, so it clearly happens, let's take the middle man out of it an allow younger women to obtain the morning after pill, along with pamphlets of information on who to contact (and HOW to contact) an HCP for free/cheap treatment and counseling.

The side effects are minimal, and the $50-$70 price tag might be steep for some people, but allowing someone who made a mistake to have the mental freedom of knowing that their mistake will not haunt them for the rest of their lives is priceless.

Yours in Good Health
B

A healthy start to your day...especially if you are dieting!

You've probably seen these fruits at the grocery store, and never paid them any mind, but  pummelos are great for you and fill of fiber and nutrients to keep you feeling full longer and that means less snacking during the day!  They have a delicious taste that is sweet and can be used to cook with, or just to eat like any other citrus fruit.

What are Pummelos?
They are big citrus fruits that usually have a greenish looking rind, they look like a grapefruit on steroids, and one can weigh around 2 pounds- the largest of all citrus fruits.   And while they look like a grapefruit, their flavor is much sweeter and less acidic than grapefruits. They originally come from Asia, and they have been called Chinese grapefruits, although they are cultivated all over Asia, not just in China.  They have really thick rinds, that can tend to be super bitter, so most people don't eat them, but the inside has usually 11-18 wedges, making these a fruit that you will usually need to share!

Why are they so good for you?
Each pommel has about 30grams of fiber which is about 1/3 of the recommended daily amount of fiber, and as we all know fiber is hard to digest by the body (and usually completely indigestible), and that makes your body feel fuller for longer, which will make you less apt to snack during the day!  Also, like all citrus fruits, its chock full of Vitamin C and has well over 150% of your daily vitamin C needs.  Vitamin C is hugely helpful in building and repairing tissues in the body, and it helps to form protein in the body that builds ligaments, skin, blood vessels, etc. and it also is an antioxidant (fights free radicals and may help prevent cancer).  They have no fat, no cholesterol, and are very low calorie.

You can eat pummels like you would an orange or a grapefruit, use them for marinades (to make spicy/sweet dressings), or make preserves/marmalade.  They are a delicious fruit that have great benefits for your body, and if grapefruits are too intense for you, you should give pummelos a try and see if you like them, especially if you are watching your waistline around the holiday time, they are a great snack or breakfast!

Yours in Good Health
B

Do you wear cotton socks?

Good! There are many reasons to wear breathable fabrics, such as cotton or bamboo, some of which are because you can get infections in the skin of your feet from being too moist. Normal amounts of sweating due to just wearing socks, walking around, running, etc is expected, but when the wetness doesn't go away, you are at risk for fungal and bacterial infections: pitted keratolysis is a skin infection caused by excessive wetness of the feet.



What is Pitted Keratolysis?

It is basically a bacterial infection in one of the outer most layers of the skin (dermis) on your feet (it can rarely occur on your hands too).  The infection causes pits, or craters, in the skin on various areas of the feet, and most frequently  on areas that bear the most weight, such as the heel and forefoot (the pads) of your feet.  The enzymes that the bacteria produce, eat away at the keratin in the skin, and cause those pits/craters in the skin.  When the feet are exposed to excessive warm, moist areas (such as sweaty socks....especially polyester and other synthetic fabrics) the bacteria grows and thrives in that environment and without treatment, it stays around indefinitely.

Who is most at risk?

Diabetics and those with immunosuppression from either chronic disease or due to medications, are at higher risk. Also, those that have chronically sweaty feet, or frequently wet feet, are at high risk.



How do I treat it?
Treatment is usually pretty easy, actually. Once your HCP has diagnosed pitted keratolysis, topical antibiotic creams (such as erythromycin or clindamycin) applied twice daily for 7-10 days usually clears up the infection completely in 3 weeks (all lesions and odors will clear up). In some cases, patients are given oral antibiotics if they do not respond to topical treatments.


How do I prevent it?
Some patients are able to prevent pitted keratylosis simply by switching to natural fibers (cotton or wool) that help wick sweat away from the feet, instead of wearing poly blend socks. Also, wearing appropriately sized shoes that don't overly restrict feet and cause excess sweating can be helpful. Some patients find their symptoms do not return if they apply roll-on antiperspirant to the soles of their feet to prevent excess sweat; if that doesn't work, you can have your feet injected with Botox to prevent the sweat from occurring. Basically keeping dry feet, are keeping pitted keratolysis free feet!

Wear natural fiber socks and keep your tootsies as dry and happy as you can, in shoes that fit, and get them open to the fresh air whenever you have the opportunity (and won't offend people!) But if you have any symptoms even close to these, it is best you see your HCP to get treatment as soon as possible, to prevent the infection from required extended treatment, and just to get your feet fresh ASAP!

Yours in Good Health
B

Those might not just be chapped lips....

With the weather getting colder, and cold and flu season upon us, it is also the time that you find your skin getting dry....and your lips are not immune to that. Sometimes your lips can actually get deep cracks in the corners of your lips, which can make opening your mouth really uncomfortable (painful, even) so eating, drinking, and talking are no fun.  And those happen to be three of my favorite things!  It can really be Angular cheilitis, which has an easy treatment, but many people have no idea what it is...and licking those lips can only make it worse.

What is cheilitis?
It is an inflamed lesion in the corners of your mouth, and it most often occurs on both sides, and they turn into deep cracks in the skin, which can eventually either bleed or crust over. I know, I make it sound so attractive!  It can be caused by a few reasons: a fungal infection (like thrush), a bacterial infection, or from a vitamin deficiency. The most common vitamin deficiencies that cause cheilitis are Vitamin B12, zinc, and iron. It can also be brought on, in very rare cases, by a reaction to toothpaste, mouthwash, lipstick, etc.

Who is at risk?
Really anyone can get this if you are missing vitamins in their diet, but people suffering with anorexia and bulimia are at very high risk, for obvious reasons.  Also people with ill fitting denatured or loss of teeth are at risk because their lips touch more and can become infected in the corners, and those with lowered immunity can be at risk for oral thrush infections which can then infect the corners of the mouth. Also, anyone exposed to the cold elements that licks their lips!  Licking dry, cracked lips, can allow for worsening cracks and allow for bacteria to invade the tissues. Who knew?

It is contagious?
It is really only contagious if you have a decreased immune system from chronic disease or those getting treatment that can effect the immune system (such as chemotherapy for cancer treatment).  Other than that, it really isn't usually contagious AND when most people have cheilitis, they do not feel like kissing or doing any activities that can make it spread.

How do we treat it?
If you have cheilitis from a vitamin deficiency, simply changing your diet OR adding a daily multivitamin can treat the deficiency and the outbreak can clear up.  BUT you should go see your HCP if you think you have cheilitis, because you have no idea what the cause could be.  If it is a bacterial infection, usually 7 days of antibiotic ointment applied twice daily to the area can clear up the infection.  And if it is a fungal infection, the medication used to treat thrush, clotrimazole cream, (which is OTC) can be applied to clear up the infection. And, if it it due to a reaction, obviously ceasing to use the product and taking an antihistamine should help with clearing it up.  With all of the treatments, in a few days it will clear up and in a week it will be completely cleared!

How can I prevent it?
Well, good oral hygiene is always a plus in life, but it also helps to prevent cheilitis, and if you wear dentures, make sure that they fit correctly, and see your dentist with some frequency to prevent any cheilitis outbreaks. Keep your lips moisturized in the cold weather, and eat a healthy diet!

 Cheilitis can be very uncomfortable and not look very good but it is actually a pretty easy thing to treat, you just need to be able to identify it, find out what is that cause, and you will be fixed in no time!  So, make sure to go see your HCP if you think you have cheilitis and find out the cause, and if you get it frequently, you might need to make some diet or lifestyle changes to help and prevent the infections from reoccurring.

Yours in Good Health
B

Can I make my Osteoarthritis symptoms better?

Many people suffer from osteoarthritis, and it can be pretty debilitating, causing lots of pain in discomfort.  But there are ways to diminish your pain and allow you to have more movement, less pain, and really live your life.

What is it?
Osteoarthritis (OA) is a degenerative joint disease that is a breakdown of cartilage in joints (the padding between bones) and is the most common form of arthritis.  It usually occurs in the weight bearing joints, like your hips, knees, and spine, but it can be found in any joint in the body.  When the cartilage that acts as a buffer between two bones starts to wear away from overuse (due to repetitive motions in life, too much strain from weight, injury to the joint, and/or genetics) there is no shock absorption between the bones and it can be extremely painful.  Many people tend to limit their exercise and it can really alter how they function in their every day life.

What's the deal?
It has been long recommended that people with OA should get at least 20 minutes of moderate exercise daily, to help keep the joint moving, and allow for increased mobility.  It can be sore at first, but the joint will loosen and feel better as it warms up.  Unfortunately, a study at Northeastern University, looking at 1,000 people ages 49 to 84 with OA, found that 90% of the subjects get little to no exercise, like less that 10 minutes a day!!!  That is crazy!  Around 40% of men and 60% of women over the age of 60 with OA are basically complete couch potatoes.  That makes you into a self fulfilling prophecy, really. You fear that there will be pain with movements, so you don't move a lot, then when you do, it is extremely painful. Exercise helps to basically "massage" the joint and help extra blood flow to the area and ease pain, when there is OA, there is a lack of blood flow due to diminished cartilage, so exercising the joints helps encourage blood flow, literally warming them up, and making the movements less painful and occur easier.  Also, by exercising the muscles that surround a joint, you are helping to add protection to the joint, stronger surrounding muscles can help to stabilize the joint and decrease the amount of weight and pressure on the joint.  Exercise will not reverse the damage that you have, but will make living with the disease more bearable, and allow you to live your life, and not in fear of pain.

What Exercise is Best?
Really whatever you tolerate!  Start low with weights and go slow in increasing weights, as you feel comfortable. Something that might be a good start and is low weight bearing is water aerobics, also Pilate's and yoga can help you increase muscle strength and stretching without heavy impact on your joints.  Talk to your HCP about what exercises you should do, and get a referral for a physical therapist.  If you don't want to go to physical therapy, working with a personal trainer might be beneficial (but usually physical therapy is covered by insurance, with an HCP referral). And try to get a minimum of 20 minutes a day, if you feel comfortable doing more, and you can tolerate it, then go for it!

Long story short, don't let OA ruin your life. You can still live an active lifestyle, you just might need to put more work into it, than you previously had, but your life is long from over!

Yours in Good Health
B