KaiMD

The Aftermath of a Hurricane

November 1st, 2012

Hurricane Sandy might have passed, but the devastation has only just begun.  In my practice, I have already seen some potential health problems caused by the storm.  Here are some points for staying safe.

  • Don’t eat anything in the fridge that could remotely be spoiled.  Even if you put ice in the refrigerator and it is still solid, without air circulation your food may still be at a temperature that can hasten bacterial growth.  Getting diarrhea can be devastating and likely require hospitalization if dehydration occurs.
  • Drink only bottled or boiled water, even if the health officials say it is safe in your area.  The main source of water may be fine, but you can’t be sure that the individual supply to your building has not been contaminated.  It’s better to err on the safer side than to contract diarrhea.
  • Be wary of restaurants in your neighborhood that have reopened in areas that could have lost power.  Can you trust that their food was refrigerated properly or that they have clean running water to wash their hands before preparing your food?  Again, it is better to be hungry than to eat contaminated food, even if it’s cheap and convenient.
  • If you do develop diarrhea, you need to hydrate with an electrolye-containing fluid.  Water is not enough, as you lose significant amounts of sodium, chloride, and potassium each time you have watery stools.  A sports drink like Gatorade or Powerade is ideal, but coconut water also works.  If you do not have these, you can add a teaspoon of salt to a glass of water.
  • Don’t step into water that may contain raw sewage.  Contaminated water is a breeding ground for bacteria like E. coli and tetanus.  Any small cuts or openings in the skin can get infected very quickly.
  • Take care of your wounds, be sure your cuts and scrapes are properly cleaned and apply antibiotic ointment (bacitracin or Neosporin) to the areas.
  • Get your flu and tetanus shots.  If you have not gotten these vaccines, get them now.  With the stress of the storm, our immune systems weaken and are vulnerable to diseases.  In addition, with large groups of people gathering in shelters and sharing bathrooms, any viruses or bacteria can spread very quickly.  As the weather is also getting colder, viruses are going to affect entire communities, especially those without electricity.  Again, if you have been in contact with water that could be contaminated with sewage, a tetanus shot is a must!
  • If you are on medications for chronic diseases, you may find it difficult to get refills from pharmacies.  Some pharmacies are unable to process payments through insurance companies and are requiring people to pay cash for prescriptions upfront.  Consider getting a week’s supply even if you have enough right now.  There may be shortages of medications in the coming weeks and you don’t want to run out.
  • Be careful of candles in the home.  Have fire extinguishers available nearby at all times.
  • Do not leave the car running in the garage to charge your phone.  Carbon monoxide could build up very quickly.
  • If you do not have power, make sure you clear the hallways of furniture as you could easily trip over objects in the dark.
  • Do not walk barefoot in your house.  There may be glass shards on the floors or debris that are not easily seen.
  • Do not use the gas stove to heat your house.  Carbon monoxide can accumulate in the air causing dizziness, nausea, headache, and death.  If you start to feel light headed, go outside immediately and leave the door/windows open.
  • Be wary of walking down streets with trees.  Some branches may have been weakened from the storm, and could still fall with a slight breeze.
  • The hospitals in New York have been especially hit hard with the closing of major area health care centers.  If you have a minor injury, try to avoid going to the emergency room as they are overwhelmed with very sick people.  Instead, go to an Urgent Care facility.  These are usually staffed by ER physicians and you will be seen much quicker.
  • Be careful of exhaustion.  This is a very stressful time for everyone.  Do not overextend yourself, as your immune system will be weakened.  Make sure you get adequate sleep, eat regularly, and go out into the sunlight if possible.  After a few days indoors, our vitamin D (which requires sunlight to become active) levels are likely to be low.

These are tough times for everyone affected by the storm.  Be sure to reach out and help your neighbors in need.  New Yorkers have a false reputation for being rude.  As a lifelong New Yorker, I have seen only kindness and bonding during the worst of times.  We pull together as a family, and we rebuild.  Stay safe and be healthy!

Being Prepared for Natural Disasters

October 28th, 2012

We are currently bracing for Hurricane Sandy here in New York City.  Hopefully everyone is prepared by now, but I wanted to provide some tips for you and your family to stay safe.

  • Make sure you have enough medications for you and your family’s chronic conditions (e.g. insulin for diabetics) to last for the the next 7 days
  • If a medication requires cold storage, make sure to freeze some ice packs that you can place in a cooler
  • Collect clean tap water in pots and pans that you can use for drinking should the municipal water system be contaminated by the storm surge/runoff. Continue to drink only boiled water after the storm if needed.
  • Make a list of your medical conditions, names of all medications and doses.  If you need to evacuate or need to go to a hospital for an injury, this information is important.  If you have a heart condition, you should have a copy of your latest EKG (electrocardiogram).  Keep these papers in a plastic waterproof sealable bag.
  • Print out a list of phone numbers of family and friends.  If you lose power, you may not be able to recharge your phone and access those numbers.  This is especially important if you need to evacuate.
  • Create a small bag filled with water, food (granola bars, nuts, etc), some cash and clean clothes should you need to evacuate.  (remember, you may not  be able to use ATM’s if the power goes out)
  • Check on elderly relatives and neighbors.  Elderly people are most vulnerable to dehydration.  Make sure they have plenty of bottled water available.
  • First aid kit.  Have it accessible at all times.  Fallen trees and flying debris can cause wounds that need immediate attention.
  • Clear any clutter on the floors.  If there is no electricity and it is dark, you have a chance of tripping on objects.
  • Stock up on food that does not require refrigeration, such as soy milk, cereal, and bottled juices.
  • Avoid going outside, even if you think the storm has passed.  Be careful, downed power lines and falling tree branches can very dangerous.

 

Caffeine and Your Health

October 25th, 2012

There has been a lot of buzz in the media recently regarding caffeinated drinks and so-called “energy” drinks and safety.  Caffeine is a stimulant drug and causes our bodies to release hormones such as epinephrine, known as the “fight or flight hormone” in our bodies.  On one hand, it can be used to fight fatigue due to a lack of sleep or jet lag and can be used to treat migraines.  However, in high doses or people whom are more sensitive to the drug, it can cause the heart to beat faster (tachycardia), anxiety, hand tremors, nausea, esophageal reflux (GERD) and insomnia.  At very high doses, caffeine can lead to fatal arrythmias (abnormal heart beats). 

While the occasional cup of coffee does not have deleterious effects, we must make sure we are not taking in extra caffeine for the wrong reasons.  For example, people who have daytime sleepiness from chronic sleep deprivation could be using caffeine to mask underlying medical problems.  They should have a complete work-up with their physician for sleep apnea or thyroid disorders.   I always address caffeine intake with all my patients, and if I hear someone is drinking 5 vente coffees from Starbuck’s each day that is certainly a red flag for me to inquire more about the person’s overall health.

Another issue is the effect of caffeine on sleep.  Caffeine will certainly affect the quality of sleep and the ability to fall asleep.  This can lead to a vicious cycle where one night of insomnia, leads to an energy drink to stay awake in the morning, which again causes restless sleep, and more caffeinated beverages the following day.  Over time, caffeine dependence can develop and along those lines, caffeine withdrawal.  

I once had a patient who complained of severe headaches and fatigue that started abruptly two weeks prior.  It turned out that the local coffee place where he would normally go for his twice daily espresso drinks went out of business around that time, and he wasn’t able to walk to the coffee place a few blocks away.  After he started back on coffee and a short course of tylenol, his headaches went away.   

Coffee and tea used to be the only sources of caffeine.  However, the typical market is now full of all types of caffeinated foods.  Energy drinks, sodas, and guarana juice are aggressively marketed to teenagers with brightly colored packaging.  The trend towards bitter or dark chocolate is another hidden source of caffeine.  I recall a patient who said he couldn’t sleep and denied any caffeine use, “I don’t touch coffee or tea because I know it will keep me up at night.”  However, when I questioned him further, he talked about how he recently got into the habit of having 2 pieces of dark chocolate before bedtime.  The 30 milligrams of caffeine per piece (about the same as a cup of coffee) was certainly the cause of his sleeplessness.  After he stopped his nightly sweet ritual, his sleep immediately improved.  

I would urge anyone with a history of heart condition, irregular heartbeat (such as atrial fibrillation), and teenagers from consuming caffeine.  With the multitude of hormones stimulated by caffeine, it is also uncertain whether any of these imbalance can have an effect on a teenager’s growth and development.  People react differently to caffeine and can have varying degrees of tolerance, so it is hard to say how much is too much.  However, if it is affecting your life or how you feel in the day, it is best to cut back.  As with all things moderation is the key.

Fish Oil Supplements Are No Substitute for the Real Thing!

September 13th, 2012

The Journal of the American Medical Association recently reported a meta-analysis that showed Omega-3 Fatty Acid Supplementation has no effect on death from cardiac causes, stroke, or sudden death.  To many people who are currently taking Fish Oils because they heard it was good for their heart, this may come as a disappointment.  The recent finding comes as no surprise to me, given the recent controversy over the protective value of a high HDL (aka “Good”) cholesterol.  In fact, one of the main effects of fish oils on the cholesterol profile is to raise the HDL.

There are many confounding variables with many of the fish oil studies.  For example, some people who participated in the studies may think that the fish oils would “cancel out” the cholesterol in their diet, and instead of eating fish for dinner may opt for a large steak.  Obviously this is an exaggeration, but it does illustrate how supplementation instead of obtaining the food from the natural source can provide a false sense of security.

The original idea that a diet high in Omega-3 fish oils originated from observations of diets eaten in the Mediterranean Sea region and Japan.  People in those areas of the world were noted to have longer lifespans and fewer deaths from heart disease.  Obviously, there is more to those diets than Omega-3 and I think we should learn to adopt other aspects of their diets, such as consuming less red meat, having 3 or more fish meals per week, eating more fresh fruits and vegetables, and most importantly, reasonable portions of food.  For vegetarians and people who don’t like fish, Omega-3 can be found in flax seeds, soybeans, chia seeds and walnuts.

Currently, we are all trying to find that “magic pill” and we are repeatedly finding there really isn’t one.  I think the best advice is prevention by living a healthy lifestyle through proper nutrition and exercise.

 

West Nile Virus

August 23rd, 2012

This summer across the U.S. we are seeing the largest number of people infected with the West Nile Virus.  This illness, which is spread by mosquitoes, is cause for great concern.  While in most people, the disease is limited to rashes (usually reddish on the trunk), joint pains, fever, fatigue, swollen lymph nodes and nervous system disorders like numbness and tingling in the hands, it can prove fatal in elderly people or those with compromised immune systems.  These fatalities comprise about 1% of all people who are infected.  Because there is no vaccine against West Nile currently, you need to protect yourself from getting bitten by mosquitoes. 

This summer, it is especially important to keep mosquitoes from breeding around your home.  Mosquito larva hatch in pools of water, even as little as a soda cap.  Be sure to drain any small puddles of water in your yard.  This includes birdbaths, small fountains, buckets for collecting rainwater, clogged gutters or drains.  In addition, be sure to use a mosquito repellent containing the chemical DEET on exposed skin if you plan to be outdoors.  Wear long sleeves and pants if possible.  Avoid the dawn and dusk hours as mosquitoes feed during those times. 

If you do develop any of the above symptoms, be sure to see your physician for an evaluation.