March 19, 2012 – What's Going Around ???

Case Cluster #1: Nonspecific viral illness

Presentation: Several cases of an unidentified nonspecific viral illness presented to our office. Primarily affecting adults the severity of each was determined by overall wellness and physiologic reserve of the patient. Patients complained of total exhaustion as if “someone had left their energy tank valve open” and drained out all their energy. They reported no leg strength, profound fatigue, hypersomnia, and anorexia. No patients reported any GI symptoms or any respiratory symptoms.

Course and treatment: All cases responded spontaneously without medical intervention.

Epidemiology: Viruses are evolutionarily selected to replicate during times of climactic instability. Thats fancy for “the bugs come out when the weather changes”. Palm Springs has two main sick seasons- when we go from hot to cold and cold to hot.

Prevention: Use the 8 foot rule for any contacts. If someone is coughing, sneezing or hacking, maintain 8 feet from them if possible. If closer mask up if able. Continuous discipline for hand washing after touching public surfaces or communal home surfaces. Keep your immune system online by staying hydrated, eating nutritious foods, getting plenty of sleep, lowering stress levels, regular exercise, daily vitamin, avoiding cold air, not smoking or being around second hand smoke, and limiting booze intake.



Case Cluster#2: Gout

Presentation: Several cases of gout have come through the office and are common this time of year. As Palm Springs starts to warm up many people are still on winter fluid replacement regimens creating a milieu of dehydration in which gout frequents. In addition with BBQ on the upswing and beer and cocktails flowing, its a perfect environment for gout. Patients present with pain in a joint or joints often red, warm and exquisitely tender. While the most frequent site has traditionally been the first metatarsophalangeal joint, ie the base of the big toe, gout can present in many joints including the knee, elbow, wrist, and ankle among others.

Course and treatment: Diagnosis usually follows a familiar clinical pattern but laboratory studies are helpful in confirming the presence of a high uric acid level. Treatment is targeted at aborting the attack usually with a medication called colchicine taken one per hour until diarrhea ensues or the attack aborts along with indomethacin for inflammation and pain control. There are additional prophylactic medications that can be considered by your physician to prevent further attacks.

Epidemiology: A family history of gout is very common, along the lines of about 70% of patients. Patients breakdown into 2 groups; the over producers and the underexcreters. What gout actually is is precipitation of uric acid crystals in the joints creating a sensation of ground glass shards in joints. Traditionally gout was a disease of nobility and seen in those who drink fine aged red wines, eat aged cheeses, eat certain fish like anchovie or mackerel and the like. Patients with gout need to decrease intake of alcohol, red meats, organ meats, aged wines and cheeses, and decrease shellfish. In addition they should be drinking 16 eight ounce glasses of water per day if no other medical conditions preclude this.

Prevention: Following a gout diet as above, taking allopurinol or uloric, and drinking copious amounts of water can reduce or even eliminate gout attacks.



Case Cluster #3: MRSA

Presentation: We continue to see pus filled lesions and ulcers surrounded by a deeply red area that are reported as spider bites by patients though no inciting insect or arachnid having been seen.

Course and treatment: Unroofing of the pus filled lesion or culture of the ulcer reveals methicillin resistant Staphylococcus aureus. This resistant form of Staph can be troublesome and is resistant to several of our mainstay Staphylococcal antibiotics. Treatment with Bactrim, a common sulfa drug is usually effective as the bug is often sensitive, though not always. Contaminated operative hardware or indwelling catheters can present special concerns and should be carefully discussed with your doctor probably in consultation with an infectious disease doctor.

Epidemiology: Once rare, MRSA is now common spread all through our school systems, hospitals etc. It is common in the HIV positive population as well as in nursing homes, jails and prisons, intravenous drug users, and healthcare facilities.

Prevention: MRSA is spread by contact. Keep your lesions covered and your hands copiously washed. Practice impeccable linen hygiene and clean all common surfaces both in the home, workplace and school. Keep your immune system online by staying hydrated, eating nutritious foods, getting plenty of sleep, lowering stress levels, regular exercise, daily vitamin, avoiding cold air, not smoking or being around second hand smoke, and limiting booze intake.

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I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

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