Medical Articles by Dr. Ray

Jun

2003

Genetic Link Found For Bipolar Disorder

By Ray Schilling | Diabetes, Mental Health, Prevention, Women’s Diseases

A staff psychiatrist at the Dalhousie Medical School in Halifax (Novia Scotia, Canada) has gathered 1100 DNA samples and psychiatric histories from patients with bipolar disorder and family members who do not have this psychiatric disease. Dr. Martin Alda, The Medical Post reports on page 46 of the May 20, 2003 edition, and his medical team were able to identify 4 areas of interest on chromosomes 15, 7, 6 and 21 where molecular markers for bipolar disease were located.

Two additional tools, namely responders to lithium (common bipolar disease stabilizer) and certain ethnic group differences, are being utilized as well. Dr. Alda has already found that unstable genes can be stabilized in the presence of lithium. By studying the genes involved in the expression of bipolar disorder and defining what triggers a depressive response and what triggers a manic episode, the researchers hope to unravel the mysteries that still surround this intriguing disease. Dr. Alda is also studying the connection of diabetes and biploar disease. Patients with biploar disease are 3 times more prone to diabetes than the general population. As these patients (bipolar patients with diabetes) are poor responders to lithium, there is a suggestion that perhaps the newly defined genetic loci are blocked in some way by the hormone changes in diabetics. Further investigations in this direction are planned by the research group.

Genetic Link Found For Bipolar Disorder

Link to bipolar disorder: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/bipolar-disorder/

Link to diabetes:

http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Last edited October 26, 2014

Jun

2003

Effect Of Smallpox Vaccination Lasts Much Longer

By Ray Schilling | Infectious Disease, Prevention, Skin Disorders

Introduction

A study found that the effect of smallpox vaccination lasts much longer than previously thought. In the age of bioterrorism Americans worry about what would happen in the case of an attack with smallpox. Due to concentrated efforts worldwide through the WHO for many years, smallpox could be declared eradicated in the US in 1949 and worldwide in 1972. American children since then did not receive a smallpox vaccination. However, 95% of Americans over the age of 35 have been vaccinated and according to a recent study have been shown to still have a very good immune response that likely would make them immune to a bioterrorism attack with smallpox virus.

Review article in the British Medical Journal

A review article in the British Medical Journal (BMJ 2003;326:1164) on May 31, 2003 reports about a study by Oregon researchers from the Departments of Molecular Microbiology and Immunology in Portland. Dr. Mark Slifka and Dr. Erika Hammarlund (Oregon Health Sciences University) collected blood samples from 306 previously smallpox vaccinated volunteers to check for antibody levels as well as T cell responses against smallpox antigens. The volunteers were of different ages and included people who were vaccinated against smallpox as recently as last year and as long as 75 years ago. All of them showed a very good response due to high antibody levels and their serum was able to neutralize the smallpox vaccinia virus in Petri dishes.

Good T cell responses after 35 years of smallpox vaccination

The T cell mediated cellular immune response showed some slowing down in the older age group. However, another study done by a North Carolina research group and also presented at a meeting from the American Society for Microbiology in Washington, DC. and published recently (New England Journal of Medicine 2002;347:689-90) found that T cell responses lasted a very long time. A group of people vaccinated 35 years earlier, so the North Carolina group reported, had perfect T cell responses to the smallpox vaccinia virus. The conclusion of these studies is that the effect of smallpox vaccination lasts much longer.

Effect Of Smallpox Vaccination Lasts Much Longer

Conclusion

There is no point of vaccinating more often than two times in a lifetime. Even one-time vaccinated people often have good immunity against smallpox. People born after 1972 and never vaccinated against smallpox should consider vaccination and discuss this with their doctors. There are, however, some known complications of the vaccine such as a myopericarditis (a heart condition). Next, generalized vaccinia can occur, a skin condition common in people with skin problems like acne or psoriasis. 1 in 10,000 immunizations will get viral encephalitis, which often leads to brain damage. There is presently a campaign to vaccinate 500,000 frontline healthcare workers in the US against smallpox. This is a government plan to prepare for a smallpox bioterrorism attack. Due to the possible complications so far only 35 000 healthcare workers have volunteered for vaccinations. Link to overview regarding history of smallpox from the CDC.

Jun

2003

Hormones After Menopause (HRT) Not For Everybody

By Ray Schilling | Hormones, Prevention, Women’s Diseases

Lately there have been several review articles published in the medical literature about hormone replacement therapy (HRT) after menopause for women. A number of longterm follow-up studies have shown that HRT with a combination of estrogen and progesterone hormones is associated with a higher risk of stroke, heart attacks, blood clots and pulmonary embolism. The WAVE trial has recently shown that estrogen replacement does not lead to protection from heart disease or strokes, however exercise and weight loss (from calorie restriction) does.

Two more recent studies add to the story: the one is a study showing that urinary incontinence (=bladder leakage) is much worse on estrogen replacement (HRT) than without it. The other study showed that estrogen replacement leads to dementia of the Alzheimers type.

Here are the details: Dr. Jodi Steinauer (University of California at San Francisco) reported about the findings during the American College of Obstetrics and Gynecology meeting at New Orleans. The study was designed to see whether estrogen/progestin hormone replacement would improve bladder function with aging. Episodes of urine loss when coughing, sneezing or running (urinary incontinence) were observed by the 1208 women from the HERS trial (Heart and Estrogen/Progestin Replacement Study) who were followed along for 4 years. The women were either given a hormone tablet (estrogen/progestin) or a “fake” pill with no hormones (placebo pill). To the surprise of the investigators the opposite of what was expected happened: The HRT group did much worse than the placebo group.

Hormones After Menopause (HRT) Not For Everybody

After one year urinary incontinence was up 2 to 3-fold in the HRT group and after 4 years this number was up 3 to 5-fold. Of the women who did not have stress incontinence in the beginning, only 38% of the placebo group developed it over 4 years, whereas in the HRT group 54% developed it. The authors concluded that HRT replacement therapy in menopause should be avoided (reported in The Medical Post, page 1 and 86, May 13, 2003).

Recently a new study (JAMA 2203;289:2651-62) showed that dementia was double the rate in older postmenopausal women on HRT than in the placebo group. 4532 postmenopausal women aged 65 years or older from the Women’s Health Initiative’s memory study (“WHIMS”) were followed by researchers for 4 years. The HRT therapy consisted of Prempro (Premarin and Provera). None of the women had dementia in the beginning of the study. After 4 years 21 of the placebo group had developed it (age related), the Prempro group developed 40 dementia cases. It is unclear why the HRT group had developed dementia, but the authors of the study theorize that perhaps a series of mini-strokes would be responsible for this.

In summary, it appears now with more evidence from the literature that HRT should only be given to postmenopausal women in a few selected patients under close medical supervision, but that the majority of women likely should not take it. Osteoporosis can be prevented by regular brisk walks, dietary changes with fat reduction and avoidance of refined sugar etc. as another powerful tool to achieve longevity. Keep in mind that these “hormone” replacement trials were regarding Premarine and Provera, both products of the drug industry. The body reads these hormone-like susbstances as estrogen-like substances and gets an overdose with the regular dosaging. Only bio-identical hormones in the right mix will be heart and brain protective and will work against osteoporosis. In short, the study described above was done with the wrong “hormones” and should have been done with bio-identical hormones. In menopause there are all kinds of reasons why a woman should use bioidentical hormones to return to her previous hormone balance, but it needs to be supervised by a knowledgeable physician with experience in this.

Read the truth about bio-identical hormone replacement under the “menopause” link below.

Here is a link to “menopause”: http://www.nethealthbook.com/articles/menopause.php

Last edited December 9, 2012

Jun

2003

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

By Ray Schilling | Heart Disease, Nutrition, Prevention, Vitamins and supplements

The May 2003 issue of the medical journal “Clinical Practice” contains an article by the dietician Andrea Miller (pages 46 to 49) about supplementation with these vitamins in relation to hardening of the arteries from too much of the amino acid homocysteine.

Homocysteine is an amino acid that contains sulfur, which is formed from the metabolism of methionine, an essential amino acid that we depend on in our food for maintaining a normal metabolism. There are complex metabolic pathways that involve several enzymes to function normally, which involve the three vitamins B-6, B-12 and folic acid (folate) to balance everything.

If one of these vitamins or any of the enzymes involved malfunction, a surplus of homocysteine results with an accelerated hardening of the arteries throughout the body. A certain percentage of the population does not have the full concentration of one or more of the metabolic enzymes in their system. If the food we eat is also relatively deficient in the above named vitamins, the body runs out of alternative metabolic options and produces dangerous levels of homocysteine. A normal blood level of homocysteine is between about 5 and 10 micro-mol per liter. This is not routinely measured by screening tests unless the doctor suspects a genetic trait in the family where family members tend to get heart attacks at an early age (mid 30’s to early 40’s). When the level of homocysteine is elevated to 12 micro-mols per liter, a supplement with folic acid of 1 mg per day would reduce this by 25% to safe levels of 9 micro-mols per liter. This results in a 15% decrease of the death rate from heart attacks.

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

Vitamin B-12 is found in animal products such as meat, poultry and dairy products. Vegetarians may not get enough Vit. B-12 and should supplement as should persons above the age of 50. A lack of B-12 vitamin leads to pernicious anemia.

Vitamin B-6 is found widely distributed in meat, fortified grains and poultry and usually is in our food supply to a satisfactory degree.

Folate (folic acid) is contained in orange fruits, beans, lentils and green vegetables. However, not everybody eats well banced meals and the food supply could be marginally deficient in folate.

Recommendation: The take home message is that a good multivitamin tablet containing about 400 to 600 micrograms (=0.4 to 0.6 mg) of folate (folic acid), 5 mg of vitamin B-6 and 20 micrograms of vitamin B-12 would be providing an adequate amount of these vitamins and reduce homocysteine levels in most people to safe levels. It is not recommended to take single vitamin supplements of these vitamins as this could lead to toxicity. Also, there is no point in taking higher doses of the vitamins as this also would lead to toxic reactions.

Link to information about balanced nutrition: http://www.nethealthbook.com/articles/nutrition.php

Last edited December 9, 2012

Jun

2003

Exercise Saves Lives In Women Over 65

By Ray Schilling | Cancer, Fitness, Health, Heart Disease, Prevention, Stroke, Women’s Diseases

A recent study released in the Journal of the American Medical Association (JAMA Vol. 289 No. 18, May 14, 2003) has found a profound effect of exercise on the survivial of elderly women. Dr. Gregg et al. have followed 9518 women aged 65 or older for a total of 12.5 years with a follow-up visit in between at about the 6 year point. They found that women who exercised (walking, aerobics etc.) and who were compared with a control group who was sedentary (no form of exercise), had the following improved survival rates.

These findings were independent of other factors up to an age of 75 years. In other words, age, smoking, weight and a number of pre-existing diseases did not influence these improved survival figures from the effect of exercise. However, when a woman had a significant chronic disease or was older than 75 years of age, the survival improval from exercise was not as strong as indicated in the table above. Also, the follow-up visits showed that those women who exercised continually, had the highest survival advantage.

Exercise Saves Lives In Women Over 65

The bottom line: increasing and maintaining a physical exercise program will likely lead to a longer life. At the same time the exercise program needs to be started early enough to be of benefit to those who are older than 75 years of age.

Disease and death rate reduction from exercise in women aged 65 and over
Reduction of:	Effect of risk reduction:
overall death rates	48%
cardiovascular disease	36%
cancer	51%

Some of the Associations that were contributing to this important study were: The National Center for Chronic Disease Prevention and Health Promotion (Atlanta, Ga), the Graduate School of Public Health, University of Pittsburgh (Pittsburgh, Pa), the Prevention Sciences Group, Departments of Medicine and Epidemiology and Biostatistics, University of California (San Francisco) and the University of Minnesota and Section of General Internal Medicine, Veterans Affairs Medical Center, Minneapolis.

Here is a fitness link: http://www.nethealthbook.com/articles/fitness.php

Last edited December 9, 2012

May

2003

Allergies, Asthma And Diabetes All Helped By Fish Oil

By Ray Schilling | Allergies, Arthritis, Diabetes, Heart Disease

Cod liver oil was what your grandmother told you to take. It turns out she was right as two studies from Manchester/England and Boston/US have shown. The common denominator are omega-3-fatty acids, which are found in fish oil, cod liver oil, mackerel, salmon and other fish, generally speaking all sea food that feasts on plankton.

1. A prospective study with a cohort of 1100 children from before their birth until their 5th birthday, which will be next year, is being conducted in Manchester/England.

A smaller pilot study with 37 children (4-year-olds from this cohort) was recently analyzed as reported in Denver by Dr. Clare Murray, a pediatric lung specialist from the University of Manchester. The investigators have done detailed diet analyses with the help of the parents. They found that children with severe asthma were taking in a lot less omega-3-fatty acids than a healthy control group. Further analysis showed that the asthmatic group took in a lot of the inflammation provoking omega-6-fatty acids, whereas the control group had a much better balance between these two unsaturated fatty acids. Apparently it is the ratio between omega-6 to omega-3 fatty acids that determines whether the prostaglandin metabolism is switched versus pro-inflammatory (ratio more than 3 to 1) or versus anti-inflammatory (ratio 3 to1 or less). This article can be found in the Medical Post, Vol39, No.17 (page 19), April 29, 2003.

2. Another study is mentioned on the same page of the Medical Post: Dr. Frank Hu from the Harvard School of Public Health is the lead author of a study published in Circulation: Journal of the American Heart Association. 5103 female nurses with established type 2 diabetes have been followed for about 18 years and their medical histories, life styles and eating habits were updated every two years.

Allergies, Asthma And Diabetes All Helped By Fish Oil

In the beginning of the study every patient was free of heart disease and cancer. The big surprise was that eating fish 5 times per week diminished the risk for developing heart disease by 65%. Even the women in the study who ate fish once or twice per week had 40% less heart disease than those who did not eat fish. In addition, fish eaters survived those who were not fish eaters much better (lower mortality). Controls of women without diabetes who ate fish five times per week had also a reduction of heart disease by 35% compared to non fish eating controls. Dr. Hu stated that it is the omega-3 fatty acids in fish that are the active ingredient. They are known to reduce irregular heart beats (arrhythmias) that can lead to sudden death. Omega-3 fatty acids also reduce blood fat levels (triglycerides), clot formation and improve blood vessel function. He also noted that both genders have the same benefit (no difference between male and female), just that the study was done on female nurses.

Comments: For your information the table below shows what foods contain omega-3 and omega-6 fatty acids.

Omega-3 and omega-6 fatty acids in our food
Type of unsaturated fatty acid:	Foods that contain this type of unsaturated fatty acid:
omega-3 fatty acid	flaxseed oil, walnuts, macadamia nuts, fishoil, canola oil, mackerel, salmon, sardines, tuna and most cold water fish
omega-6-fatty acid	corn oil, cotton seed oil, grape seed oil, safflower oil, soybean oil and sunflower oil

In the past 50 years the food industry has changed the ratio of omega-6 to omega-3 fatty acids in many common foods to the point that the ratios are now 12 to 1 and up to 25 to 1. It is cheaper to produce these foods in that manner as they often have a longer shelve life. Read food labels. Inform yourself about omega-3 fatty acids. Take 2 capsules of a high strength, molecularly distilled (to remove PCB’s, mercury and other heavy metals) fish oil once per day and include more fish in your meals. Avoid deep fried foods, as they contain omega-6 fatty acids.

Here are some links explaining this more:

Link about balanced nutrition.

More details about fat and fatty acids.

Last edited October 26, 2014

May

2003

Early SARS Treatment In Hong Kong Reduces Death Rate Dramatically

By Ray Schilling | Infectious Disease, Lung Disease

Dr. Loletta Kit-Ying So from the Pamela Youde Nethersole Eastern Hospital in Hongkong reported on May 10, 2003 in the medical journal The Lancet (Lancet 2003;361:1615-1617) about their experience with early SARS treatment. Key to the success of this group is early recognition and early treatment of SARS. They found that high doses of corticosteroids to control the inflammatory reaction of the airways coupled with the antiviral antibiotic ribavirin has meant a breakthrough in the treatment of SARS. They have treated 50 patients with the new combination protocol.

Medication protocol:

Initially the patient is started on the fluoroquinolone antibiotic levofloxacine 500 mg once per day. This has an immunomodulating effect and keeps the virus at bay. Methylprednisolone at 1 mg per kg of body weight given three times per day is the corticosteroid used for 5 days, the gradually tapered to nothing over 16 days. The virus itself is treated with the antiviral drug ribavirin 400mg three times daily intravenously for three days or until the patient becomes stable, followed by tablets (1200mg twice per day) by mouth.

Outcome:

The good news with this protocol is that 70% of patients have left the hospital and are recovered; 27% are treated and are stable; three patients are mechanically ventilated (on a respirator), but stable. One patient who was an elderly diabetic patient has died of a heart attack.

Early SARS Treatment In Hong Kong Reduces Death Rate Dramatically

There are no major side-effects of the treatment protocol. Some modifications are made with patients who have tuberculosis and with patients who are pregnant.

Here is an overview of SARS with links to the CDC.

Last edited October 26, 2014

May

2003

Blood Clot Dissolving Therapy Saves Lives

By Ray Schilling | Heart Disease, Prevention, Stroke

Clot dissolving therapy (fibrinolytic therapy) has saved many lives when it is applied fast enough with patients who have a heart attack. In younger patients up to age of 65 to 70 years this method was applied without questioning by the treating physicians.

Several studies have shown that elderly patients have more complications such as strokes, where there can be a brain hemorrhage causing another disaster, namely a stroke from a hemorrhage as a side-effect of the clot dissolving medicine. It’s a case of too much of a good thing overthinning the blood. A new study from Sweden, which was published in the Archives of Internal Medicine on April 29, 2003 (Arch Intern Med 2003;163:965-971) showed that elderly patients with a heart attack can also benefit from this clot dissolving therapy. The main investigators, Drs. Ulf Stenestrand and Lars Wallentin, have followed 6,891 patients who have sustained their heart attacks between 1995 and 1999. They were at least 75 years of age and older, but not older than 85 years. Of these patients 3,897 received fibrinolytic therapy and 2,994 did not. Combined survival statistics and statistics of whether or not the patients suffered a stroke as a result of the clot dissolving therapy were recorded over the next year.

There was a drop of 13% of deaths and of strokes in the treatment group when compared to the controls. There were some other ways that the investigators analyzed the data statistically, but the treatment group was always better off.

Blood Clot Dissolving Therapy Saves Lives

The investigators concluded that there is no reason to withhold this clot dissolving treatment from elderly patients as the practice had been up to then. Until randomized studies with more details can be done, they stated, one should treat elderly patients who have acute heart attacks until the age of 85 with clot dissolving treatments.

Here are some links that may be of interest:

This link explains what a heart attack is.

Last edited December 9, 2012

May

2003

Bipolar Disorder In Children And Teens Different From Adults

By Ray Schilling | Mental Health, Prevention

Bipolar disorder used to be called “manic-depressive illness” in the past, now it is termed “bipolar disorder”. It is a multifaceted mental illness where subtle changes in the mix of brain hormones can lead to periods when the patient is euphoric, manic or even psychotic (manic episode), but at other times it seems that someone “pulled the plug”, so to speak, and the patient is depressed, lethargic and perhaps even suicidal.

To complicate matters even further,and this was the subject of a recent seminar at the Child and Health Resource Institute in London/Ontario, symptoms in children and teens are often completely different from symptoms in adults. This can be very misleading to the healthcare workers and the immediate family members. It can also delay the diagnosis and appropriate treatment of bipolar disorder. The Medical Post in its April 1, 2003 edition (page 54) published a review of this topic, based on a presentation by Dr. Margaret Steele at this seminar in London/Ont. Dr. Steele is a child psychiatrist of the University of Western Ontario.

Dr. Steele explained that bipolar disorder is relatively rare in children and adolescents. About 0.5% or less of children in pre-puberty and about 1% of adolescents are affected. But these children/adolescents usually have a family history of either bipolar disorder or depression. 20% of adults with bipolar disease experienced their first episodes of the disease during the teen years.

Bipolar Disorder In Children And Teens Different From Adults

Below is a summary of her findings with regard to depressive symptoms in children/teens when compared to adults in tabular form.

Comparison Of Symptoms Of Depression In Bipolar Disorder Patients Depending On Age
Adult Symptoms:	Symptom Presentation In Children/Teens:
depressed mood	irritability is more common; normally easy-going, but suddenly being oppositional and grouchy
anhedonia (difficulty to think positive and enjoy living)	“I am bored” may be the only comment, retreating into a shell
sleep disturbance, mostly insomnia (problems sleeping)	they may have the opposite, namely hypersomnia (sleeping too much and too long); this may cause problems when they sleep in during the week or they fall asleep in school
appetite disturbance (usually associated with weight loss)	young children fail to grow and gain weight; adolescence may crave junk foods (sugar and starch) and overeat
lethargy	in children a decrease in concentration may only become evident as a decrease in school performance (slipping marks)
psychomotor agitation or retardation	these symptoms are similar in both adults and children, may be evident as pacing, fighting (agitation) and as “laziness”, moving slowly (retardation)
Suicidal thoughts or behavior	similar in adults and children, but could be more concealed at a younger age (see below)
hopelessness	when asked “what do you see in the future?” an answer like “I see nothing at all, I have no goals” could indicate hidden suicidal thoughts
masked depressive symptoms	younger children may have temper tantrums, which would be out of character from their normal behavior; adolescents may “act out”
somatic complaints	adolescents present with headaches and other physical symptoms (e.g. abdominal pain etc.) meaning a “screen of mood” should be done

The other part of the equation of bipolar disorder is mania. Different names are used for this hyperactive state of the mind depending on how severe it is: ‘hypomania’ for the lower end, ‘mania’ for an abnormally elevated and expansive mood lasting for at least 1 week. The most severe form of mania is a ‘manic psychosis’ where the person is “completely out of it” and needs to be hospitalized. Again there are some differences of how a manic episode is expressed in children/teens when compared to adults. Dr. Steele covered this in the seminar mentioned above as well and I have summarized the findings in tabular form again as follows.

Child psychiatrists are most familiar with assessing whether a child or adolescent has bipolar disorder. Apart from symptoms being quite variable as mentioned above, there are also lower-key versions of bipolar disorder.

A milder, scaled down version of a manic episode is called ‘hypomania’ as explained above and when expressed in bipolar disease this can lead to ‘bipolar II disorder’. In 60% of adolescents with bipolar disease a ‘mixed bipolar episode’ can be diagnosed. Typically, in these cases the teenager would have depressive symptoms in the morning (feeling low energy, feeling terrible etc.), but later in the day after school would get revved up having problems winding down at night. Often such behavior is very stressful for the parents, particularly as bipolar disorder is running in families and one of the parents may have established bipolar disorder that is being treated.

The reason for including this overview here is that many parents may recognize some symptoms in their offspring that warrant a closer look by a child psychiatrist. By diagnosing this condition early and treating it, these children and teens can have a normal life and prevent a lot of needless suffering and danger.

Click for links about bipolar disorder , depression and watch for suicide.

Manic symptoms in bipolar disorder patients depending on age
Manic symptoms in adults:	Manic symptoms in children/teens:
inflated self-esteem	elevated, irritable mood; it is beyond being giddy and silly, which many teens normally display; children may say that they are ‘Spiderman’, it can be difficult to separate from normal play, but on further questioning manic children have racing thoughts and hear voices (delusions), which normal children do not have
racing thoughts, often detected in conversation as ‘flight of ideas’	racing thoughts express themselves more as ‘distractibility’; a child might pick up a toy, drop it after a short time and suddely play with something else
pressured speech	increased chattiness
excessive pursuit of activities that are potentially harmful (speeding in car, excessive drinking or drugs, risk taking in the stock market, etc.)	risk taking expressed differently: kids might steal despite never having done this before; manic children may exhibit sexual behavior such as flirtatious behavior, etc.
medical conditions may mimic symptoms of mania (e.g. diabetes out of control)	side-effect of oral corticosteroid therapy for asthma can lead to a psychosis and mimic a manic episode

Click for links about bipolar disorder , depression and suicide prevention.

Last edited October 25, 2014

May

2003

How Dangerous Is West Nile Virus…

By Ray Schilling | Infectious Disease, Prevention

West Nile Virus (WNV) is a flavivirus. Related flaviviruses cause Dengue fever and Yellow fever. The reason WNV has been on the news is that until 1990 the virus has not been observed in North America.

Up to that point it was only known to be present in Africa, India, the Middle East, southern France, the former Soviet Union and Indonesia. But since 1999 WNV has been spotted in dead crows in New York and recently also in Toronto/Ont. It is predicted that in 2003 the virus likely will reach the western parts of Canada. It has been spotted already in Washington late in 2002. It is mainly transmitted between birds and mosquitoes. Humans only get infected with WNV through infected mosquito bites. Only about 1% of all mosquitoes are infected with the WNV in endemic areas. The incubation time is 2 to 15 days after a mosquito bite.

Symptoms:

About 80% of people who get infected with West Nile Virus are without symptoms. About 19% will develop mild flu-like symptoms with muscle aches, a fever and a headache.

There may also be a skin rash and swollen lymph glands. After a week or less the symptoms disappear and the patient has recovered. In 1% of patients the infection can be severe with a high fever, a headache and a stiff neck due to meningitis.

How Dangerous Is West Nile Virus…

Meningitis in this case is from an infection and inflammation of the lining of the spinal cord and brain with the WNV. In some more severe cases the virus can enter the brain tissue and cause a viral encephalitis with a high death rate. People over 50 years of age are particularly susceptible for developing the more severe forms, which often lead to death. Extreme muscle weakness and headaches are usually the presenting symptoms along with a high fever. They may turn unconscious, particularly with encephalitis, may stop breathing and may need to be intubated and put on a ventilator.

Diagnostic tests:

After clinicial suspicion the physician likely will either do a blood test or do a spinal puncture to remove a sample of spinal fluid for specific anti-WNV antibody testing.

Prevention:

The risk is very small as stated above as only 1% of mosquitoes are infected. Prevention consists in steps to prevent mosqitoes from breeding and to prevent them from stinging you. Instal screens on doors and windows.

Stay indoors at dawn, dusk and in the ealry evening. Avoid forested areas during the course of the day. Wear light colored, baggy clothes ( mosquitoes like dark clothes) with long sleeves and long pants. Your lawn should be mowed short to cut down on places for mosquitoes to hide. Still waters such as in clogged gutters, in saucers under plant pots, puddles of water under tarps or in old tires need to be eliminated. Bird feeders need to be flushed out with a garden hose every two to three days to interrupt the mosquito breeding cycle. Use a mosquito repellant with DEET in it (should not contain more than 30% for adults or 10% for children to avoid toxicity). Do not use DEET on children younger than 6 months old.

Treatment:

At the present time there is no treatment other than supportive therapy in hospital for sick patients. Remember that the main breeding cycle in nature for WNV is between birds and mosquitoes. As humans we need to watch that we stay “out of the loop” by following the above preventative measures.

Here are a few useful links regarding West Nile Virus:

Health Canada site on West Nile Virus

CDC site on West Nile Virus (question and answer style)

Last edited December 9, 2012

Introduction

Review article in the British Medical Journal

Good T cell responses after 35 years of smallpox vaccination

Conclusion

A Survivor’s Guide to Successful Aging

Prostate Cancer Unmasked

Healing Gone Wrong – Healing Done Right

Medical Question Answered

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Prostate Cancer Unmasked

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