Posted in Health, news

Death by Protein Supplements: What is Urea Cycle Disorder?

In 2017, a 25-year-old mother of two died after over consuming protein supplements in preparation for a body building competition, and her mother is speaking out on the potential dangers that many athletes face.

Meegan Hefford was found unconscious in her West Australia apartment and was declared brain-dead, passing two days later.

Unbeknownst to her, she suffered from Urea Cycle Disorder (UCD), such that when she consumed protein shakes and supplements she overproduced a toxic byproduct.

 

What is Urea Cycle Disorder?

People with Urea Cycle Disorder (UCD) have a mutation that causes them to lack an enzyme that helps break down ammonia.  The urea cycle is responsible for removing ammonia from the blood stream. Ammonia is made by cells, when they breakdown the nitrogen in proteins.  Ammonia needs to be eliminated, and through this cycle turns in to urea which can be excreted in the urine.  If a step is missing, ammonia and nitrogen products build up causing hyperammonemia.  This can cause liver and brain damage and eventually death.

What are symptoms of Urea Cycle Disorder?

If one suffers from hyperammonemia, a result of UCD, the following symptoms may manifest:

  • Fatigue
  • Lethargy
  • Vomiting
  • Respiratory issues
  • Seizures
  • Behavior issues
  • Gait abnormalities
  • Cognitive issues
  • Headaches

UCD cases are rare with 1 UCD patient per 35,000 births.

According to the National Urea Cycle Disorders Foundation, “Because many cases of urea cycle disorders remain undiagnosed and/or infants born with the disorders die without a definitive diagnosis, the exact incidence of these cases is unknown and underestimated. It is believed that up to 20% of Sudden Infant Death Syndrome (SIDS) cases may be attributed to an undiagnosed inborn error of metabolism such a urea cycle disorder. Some children with autism spectrum and behavioral disorders may have undiagnosed urea cycle disorders.”

Treatment includes stopping the excess protein/nitrogen intake, fluids, medications, dialysis and at times, liver transplantation.

 

So do we need to fear protein supplements?

No.  But what we need to remember is if we are increasing our protein, and many times accurately, for body building we need to realize that our bodies, including our kidneys, may not be on the same page.  When this happens, protein supplements can be dangerous so competitive athletes, or others using protein supplements, should be supervised by their health provider.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio, KDWN, and is a Board Certified Family Physician

Advertisements
Posted in Health, news, weather

This Year’s Hurricane Season: Predictions

This year the NOAA (National Oceanic and Atmospheric Association) predicts a “near-normal” hurricane season.

According to the National Oceanic Atmospheric Administration, this season may have 9 to 15 named storms (winds of 39 mph or higher), of which 4 to 8 could become hurricanes (winds of 74 mph or higher), including 2 to 4 major hurricanes (category 3, 4 or 5; with winds of 111 mph or higher).

2019 Hurricane Numbers.png

 

June 1st marks the official start of Hurricane season and it runs until November 30th.  September is usually the most active month.  Hurricanes are categorized by their wind speed as designated as the following using the Saffir-Simpson Hurricane Wind Scale:

  • Category I have sustained winds of 74 to 95 mph
  • Category II have sustained winds of 96 to 110 mph
  • Category III have sustained winds of 111 to 129 mph
  • Category IV have sustained winds of 130 to 156 mph
  • Category V have sustained  winds of over 157 mph

Category III storms have known to cause “devastating” damage and Categories IV and V have been associated with “catastrophic” damage.

In a given year, the Atlantic Ocean averages 12 named storms with 6 becoming “hurricanes” and 3 becoming “major” meaning a Category III or greater.

Hurricane Katrina in 2005 was at one point a Category V but when it hit landfall it was a Category 3, tragically killing over 1800 people and causing $108 billion in damage.  The deadliest hurricane to ever hit US soil, however, was the Great Galveston Hurricane of 1900 in which over 10,000 people died.

Our current hurricane season may be dependent on “El Nino” and water temperatures.

El Nino is refers to a ocean-atmospheric interaction where sea surface temperatures rise near the equatorial Pacific, causing increase wind shear in the Atlantic equatorial region and has been linked to lower than active hurricane seasons.  However warmer water temperatures in the Atlantic and Caribbean as well as monsoon activity in Africa could increase hurricane activity.

So an El Nino hurricane season may offer some protection but can be easily offset by ocean water temperatures.

This year’s names for the 2019 Hurricane Season are the following

Atlantic

Andrea
Barry
Chantal
Dorian
Erin
Fernand
Gabrielle
Humberto
Imelda
Jerry
Karen
Lorenzo
Melissa
Nestor
Olga
Pablo
Rebekah
Sebastian
Tanya
Van
Wendy

 

Pacific

Alvin
Barbara
Cosme
Dalila
Erick
Flossie
Gil
Henriette
Ivo
Juliette
Kiko
Lorena
Mario
Narda
Octave
Priscilla
Raymond
Sonia
Tico
Velma
Wallis
Xina
York
Zelda

 

Hurricane Kate 300px.jpg

How to prepare for the hurricane season

Preparation means starting early.

Make sure you keep informed of the latest alerts and official recommendations.

Evacuate when told to do so by city officials.

Many people will try to tough it out and unfortunately get walled up in their homes.  So make sure you have adequate water (1 gallon per day/person for at least three days) and 1/4 – 1/2 gallon/water/ per pet, except the fish obviously.

Canned foods, flashlights, medical supply kit, batteries, blankets, cash, medications in water proof containers should be set aside for disasters, and put important papers in waterproof/fireproof casings.

According to ready.gov, they recommend the following:

 

Prepare NOW
  • Know your area’s risk of hurricanes.
  • Sign up for your community’s warning system. The Emergency Alert System (EAS) and National Oceanic and Atmospheric Administration (NOAA) Weather Radio also provide emergency alerts.
  • If you are at risk for flash flooding, watch for warning signs such as heavy rain.
  • Practice going to a safe shelter for high winds, such as a FEMA safe room or ICC 500 storm shelter. The next best protection is a small, interior, windowless room in a sturdy building on the lowest level that is not subject to flooding.
  • Based on your location and community plans, make your own plans for evacuation or sheltering in place.
  • Become familiar with your evacuation zone, the evacuation route, and shelter locations.
  • Gather needed supplies for at least three days. Keep in mind each person’s specific needs, including medication. Don’t forget the needs of pets.
  • Keep important documents in a safe place or create password-protected digital copies.
  • Protect your property. Declutter drains and gutters. Install check valves in plumbing to prevent backups. Consider hurricane shutters. Review insurance policies.
When a hurricane is 36 hours from arriving
  • Turn on your TV or radio in order to get the latest weather updates and emergency instructions.
  • Restock your emergency preparedness kit. Include food and water sufficient for at least three days, medications, a flashlight, batteries, cash, and first aid supplies.
  • Plan how to communicate with family members if you lose power. For example, you can call, text, email or use social media. Remember that during disasters, sending text messages is usually reliable and faster than making phone calls because phone lines are often overloaded.
  • Review your evacuation zone, evacuation route and shelter locations. Plan with your family. You may have to leave quickly so plan ahead.
  • Keep your car in good working condition, and keep the gas tank full; stock your vehicle with emergency supplies and a change of clothes.
  • If you have NFIP flood insurance, your policy may cover up to $1000 in loss avoidance measures, like sandbags and water pumps, to protect your insured property. You should keep copies of all receipts and a record of the time spent performing the work. They should be submitted to your insurance adjuster when you file a claim to be reimbursed. Visit www.fema.gov/media-library/assets/documents/137860 to learn more.
When a hurricane is 18-36 hours from arriving
  • Bookmark your city or county website for quick access to storm updates and emergency instructions.
  • Bring loose, lightweight objects inside that could become projectiles in high winds (e.g., patio furniture, garbage cans); anchor objects that would be unsafe to bring inside (e.g., propane tanks); and trim or remove trees close enough to fall on the building.
  • Cover all of your home’s windows. Permanent storm shutters offer the best protection for windows. A second option is to board up windows with 5/8” exterior grade or marine plywood, cut to fit and ready to install.
When a hurricane is 6-18 hours from arriving
  • Turn on your TV/radio, or check your city/county website every 30 minutes in order to get the latest weather updates and emergency instructions.
  • Charge your cell phone now so you will have a full battery in case you lose power.
When a hurricane is 6 hours from arriving
  • If you’re not in an area that is recommended for evacuation, plan to stay at home or where you are and let friends and family know where you are.
  • Close storm shutters, and stay away from windows. Flying glass from broken windows could injure you.
  • Turn your refrigerator or freezer to the coldest setting and open only when necessary. If you lose power, food will last longer. Keep a thermometer in the refrigerator to be able to check the food temperature when the power is restored.
  • Turn on your TV/radio, or check your city/county website every 30 minutes in order to get the latest weather updates and emergency instructions.
Survive DURING
  • If told to evacuate, do so immediately. Do not drive around barricades.
  • If sheltering during high winds, go to a FEMA safe room, ICC 500 storm shelter, or a small, interior, windowless room or hallway on the lowest floor that is not subject to flooding.
  • If trapped in a building by flooding, go to the highest level of the building. Do not climb into a closed attic. You may become trapped by rising flood water.
  • Listen for current emergency information and instructions.
  • Use a generator or other gasoline-powered machinery outdoors ONLY and away from windows.
  • Do not walk, swim, or drive through flood waters. Turn Around. Don’t Drown! Just six inches of fast-moving water can knock you down, and one foot of moving water can sweep your vehicle away.
  • Stay off of bridges over fast-moving water.
Be Safe AFTER
  • Listen to authorities for information and special instructions.
  • Be careful during clean-up. Wear protective clothing and work with someone else.
  • Do not touch electrical equipment if it is wet or if you are standing in water. If it is safe to do so, turn off electricity at the main breaker or fuse box to prevent electric shock.
  • Avoid wading in flood water, which can contain dangerous debris. Underground or downed power lines can also electrically charge the water.
  • Save phone calls for emergencies. Phone systems are often down or busy after a disaster. Use text messages or social media to communicate with family and friends.
  • Document any property damage with photographs. Contact your insurance company for assistance.

Always have an emergency plan, practice it with family members, discuss with distantly located relatives how you will notify each other of your safety, and stay tuned to your radio, TV, wireless emergency alerts encase evacuations are ordered.

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in children, Health, news

US Braces for New Wave of Polio-Like Illness

As August approaches, the CDC is asking health care professionals to be on the lookout and report any suspected cases of AFM (Acute Flaccid Myelitis), a paralyzing illness resembling polio, as cases may peak during this time.

Last year a total of 233 cases were confirmed in 41 states.  This year 11 have been reported and an additional 57 cases are being investigated.  Cases have been reported in California, Maryland, Nebraska, North Carolina, Pennsylvania, Texas, Utah and West Virginia this year.

 

afm-state-map.png

Image above from CDC

Last year, California, Colorado and Texas appeared to be the worst hit with 15, 16 and 31  cases respectively.  Experts are urging states to report any cases of suspected AFM as the above map could be an under-representation of true numbers.

On their website, the CDC reports the following:

  • Most of the patients with AFM (more than 90%) had a mild respiratory illness or fever consistent with a viral infection before they developed AFM.
    • Viral infections such as from enteroviruses are common, especially in children, and most people recover. We don’t know why a small number of people develop AFM, while most others recover. We are continuing to investigate this.
  • These AFM cases are not caused by poliovirus; all the stool specimens from AFM patients that we received tested negative for poliovirus.
  • We detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four of 570 confirmed cases of AFM since 2014, which points to the cause of those patients’ AFM. For all other patients, no pathogen (germ) has been detected in their spinal fluid to confirm a cause.
  • Most patients had onset of AFM between August and October, with increases in AFM cases every two years since 2014. At this same time of year, many viruses commonly circulate, including enteroviruses, and will be temporally associated with AFM.
  • Most AFM cases are children (over 90%) and have occurred in 48 states and DC.

 

The “48 states” refers to cases since 2014.   90% of the cases occurred in children under the age of 4.

The age range of children affected appear to be 3-14.  A 6-year-old boy in Washington State died in 2016 and was the first death to be linked to this mysterious illness.  His parents reported he had felt ill, became dizzy and within hours suffered swelling in the brain and paralysis.  Despite medical efforts, he passed.

In 2018 parents of two children who died from AFM accused the CDC of hiding their deaths.

Although the exact cause of AFM is unknown, health experts are considering a variety of possibilities. They have actually been investigating this since 2014 when reports of AFM began to surface across the United States.

What is AFM?

AFM stands for Acute Flaccid Myelitis.  It’s a condition that occurs suddenly, causing inflammation of the brain and spinal cord, causing loss of muscle tone and reflexes.  Although limb weakness is the primary symptom, patients could also exhibit slurred speech, facial drooping, and in serious cases inability to breath due to paralysis of the respiratory muscles.  Mild cases appear to resolve but serious cases can cause residual paralysis or death. Children appear to be more affected than adults.

What causes AFM?

Although health officials do not know for certain, due to its rapid onset, a pathogen such as a virus seems highly likely.  With the 2013-2014 outbreak, some of the cases tested positive for enterovirus (EV-D68), but it is not conclusive whether this was the exact cause or just coincidentally found in the patients tested.

Some postulate a combination of viruses may be a factor or an autoimmune disease.  Although Guillain-Barre syndrome causes acute limb weakness and paralysis when the immune system begins attacking the nervous system, the report that many individuals feel feverish or ill prior, seem to point to a pathogen as the primary cause although the latter is not being ruled out.  Virus families such as enterovirus (including polio and nonpolio enterovirus), adenovirus (causing respiratory and GI illness) cocksackieviruses and flaviviruses (including West Nile) have been suspected.

How common is AFM?

Per the CDC, acute flaccid myelitis is rare (less than 1 in a million cases) however currently they report 570 cases have been confirmed since the outbreak began in August 2014.

How is it diagnosed?

Medical professionals look at a variety of factors.

History: how the paralysis/loss of muscle tone began and which limbs did it affect first

Laboratory tests and CSF (cerebrospinal fluid) testing: to look for signs of infection

MRI of the brain: which may show gray matter involvement in a case of AFM.

Is there a treatment?

There is no standard treatment that has been proven effective, however depending on the severity of the symptoms, health professionals can consider a variety of options including steroids, IVIG, interferon, antivirals and supportive measures.  Some physicians are using “nerve transfers”, similar to a transplant, to help children regain control of their limbs.

Is there a vaccine?

No.  Until they can identify the exact cause, or causes, health officials cannot create a vaccine.

How does one avoid getting AFM?

If we assume it’s a pathogen causing the illness, avoiding contact with sick individuals, being up-to-date on one’s vaccines and good hand-washing are imperative.  Although we do not know if AFM is caused by a mosquito-born illness, avoiding mosquitoes would be wise as well.   More therefore needs to be researched to determine why and how those individuals with AFM were infected.

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in earthquake, Health, news, weather

Earthquake Preparedness And Safety

Image above from WorldAtlas.com

As multiple earthquakes and aftershocks rattle the Southwestern US, seismologists predict more to come and people fear the “big one” could follow.

Here’s how to prepare:

Have An Emergency/Earthquake/Fire Readiness Plan

Assuming cell phones will not work in the event of a natural disaster, map out with family and friends where possible meeting sites will be.

Know your emergency exits and plan what to do in case of an earthquake/fire (explained below).

Have food, water and supplies stored in plastic garbage bags that can be easily grabbed and taken with you in case of an emergency.

Have an “emergency kit” with phone numbers, medications, money and other important documents in water-proof/fire-proof casing.

Include tools, whistles, flash lights and batteries in your emergency kit as well.

Ensure Your House is Safe

Loose foundations, awnings, book shelves, chandeliers and knickknacks to name a few could cause serious injury in the event of an earthquake.  Anchor down any loose fixtures.  Family members should know how to shut off gas/electric/water supplies and appliances should have flexible, break away connections. Avoid hanging anything heavy such as pictures or chandeliers above the bed.

whitetail-deer-15-antler-chandelier_255x255.jpg

Image above from cabinplace

Consult professionals if unsure if your house is able to withstand shifts in its foundation.

During a Quake

If indoors, take cover under a table, desk, or doorway.  Be careful of swinging doors, and keep hands and arms close to your body, covering your head if possible.

Earthquake-Safety-Tips.jpg

Avoid running outside during an earthquake. Find a room in the house with few  wall/ceiling hangings and stay in the center to avoid windows, bookshelves or other furniture shifting and falling onto you.

If you’re in bed, and no time to run to a safe room, you can cover your head with a pillow.

If you are outside when the shaking starts, find an open area and drop to the ground, staying low.  Avoid power lines, trees, overpasses and buildings.

If in a vehicle when the shaking starts, pull over to a safe open area. Again avoid power lines, trees, buildings and overpasses.

After a Quake

Exit any damaged buildings, move away from them and go to an open area, and refrain from going into another building that may appear damaged.

If you live in an area near water, go to higher land in case a tsunami follows.

If trapped inside, use a whistle or nearby object to alert first responders of where you may be.

For more information on earthquake preparedness, visit here.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

Posted in Health, news

Tips to Prevent Childhood Drowning

The leading cause of death in children are “unintentional injuries” including drownings.  According to the CDC, 20% of drowning victims are under the age of 14.  And non-fatal drowning victims could sustain brain damage and long term disability.

Pools, bathtubs and any body of water pose risks, however this time of year is especially dangerous, because activities surrounding pools, such as BBQs and alcohol use, become distractions to the adults supervising.

When it comes to drowning prevention, the following is necessary:

All pools should be enclosed

Fence height should be at least 4-5 feet high and the entry gate should self-close and self-latch.

Even if your pool has a fence, be aware that the house who’s hosting the BBQ, play date, or sleep-over may not.

And any kiddy pools or ice buckets used for drinks should be dumped out after use and flipped over so they do not become a future threat.

All young children should be within arm’s reach of an adult when swimming

The farther you are away from the child you’re supervising, the longer it takes to rescue. With distance between you and the victim, other children may swim in your path and you may lose sight of where the victim submerged.  And seconds count.  A panicked child under water may also aspirate water into the lungs becoming hypoxic quicker.  Moreover they could be at risk of “secondary drowning” in which water in the larynx triggers a spasm closing up the airway, or water falling into the lungs causes pulmonary edema and respiratory failure days after the water incident.

Do not get distracted

Put the phones away.  Adults supervising kids in a pool should not be answering a phone call or on social media.  Moreover, adults should not be drinking alcohol while supervising a child. Reaction time is key, and a drunk adult could become a drowning victim as well.

Remember that drowning is silent

Many drownings occur while others are feet away from the victim. Why? Because a submerged victim makes little sound and nearby splashing visually and auditorily obscures the victim’s splashes.

Parents have long learned that when children get quiet during playtime, something could be going wrong.  Use that same Spidey-sense when they are in the pool.

swimming-pools

Learn CPR and water rescue skills

Most CPR classes teach adult, child, and infant CPR.  Having this knowledge and becoming certified could save a life one day.

If swimming in open waters, know the weather and sea conditions prior to jumping in.  Life jackets/vests, appropriate for the child’s size, should be worn, even if the child is out of the water, such as in a boat.

 

What is “Dry Drowning” and “Secondary Drowning”?

Dry Drowning occurs when water touches the first pass of the respiratory tree, one’s vocal cords, larynx.  When water touches this area a reflex is triggered, causing a spasm (laryngospasm) such that the vocal cords constrict and close up the airway.  It’s a defense mechanism designed to prevent water from falling into the lungs. However, laryngospasm causes immediate hypoxia, lack of oxygen, and if not reversed, the victim will die.  In dry drowning, water never officially reaches the lungs.

 

bronchi_lungs.jpg

IMAGE FROM SEER TRAINING

 

In Secondary Drowning, water gets inhaled and sits in the respiratory tree and if uncleared through coughing, will sit and prevent proper oxygenation.  Moreover the water will irritate the lung linings causing more fluid and inflammation, resulting in pulmonary edema.  This could occur hours to days after the water activity.

According to Florida Hospital Tampa pediatrician, Dr. James Orlowski, these events are very rare, comprising only 1-2% of drowning incidents.

What are the symptoms?

The symptoms for both “Dry” and “Secondary Drowning” are similar in which the victim could have any of the following:

  • Cough
  • Chest Pain
  • Difficulty Breathing
  • Shoulder Pain
  • Neck Pain
  • Confusion
  • Irritability
  • Behavior Changes
  • Fatigue
  • Difficulty speaking
  • to name a few…

Prevention

Horse play in water should be avoided. This includes bathtubs, plastic pools, hot tubs, pools, lakes, ocean, etc.

Never swim alone.

Swim in areas staffed with lifeguards and/or appropriate supervision.

If water does get inhaled watch the child or adult to look for any of the above symptoms. If concerned seek medical help immediately.

Have a safe and healthy summer!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in cell phones, Health, news, smart devices

Skulls May Change Due to Cell Phone Use

Image above from Science Alert

 

Reports of “horns” growing on the heads of cell phone users is an over-dramatization. However, skull bone growths have been documented on those with “text” or “surf” neck.

A study published in the journal, Scientific Reports, found benign bone growths, known as exostosis, on the skulls of cell phone users.

Study authors looked at 1200 skull xrays (lateral view) and found more prominent bone spurs in younger cell phone users.  Researchers postulate that the growths are adaptive as a result of frequent neck bending when viewing cell phones.

Thus, enthesophyte development may be an adaptive mechanism to further increase the surface area at the tendon/bone interface at sites enduring frequent tensile stress, with bone growth progression taking place in the direction of tensile stress acting on the bone at the point of insertion.

Neck discomfort frequently follows avid cell phone use and many people complain of muscle strain. This study demonstrates how the body tried to adjust for the increase strain on our neck.

These bone spurs should not be confused with “cutaneous horns” which are growths on the face and scalp.

cutaneous-horn-forehead

 

Doctors recommend avoiding excessive time on a cell phone or position it to avoid excessive flexion of one’s neck.

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Health, news

Hepatitis A Outbreak Declared in Clark County

A Hepatitis A outbreak has now been declared in Clark County Nevada.

According to the Southern Nevada Health District, 37 cases have been reported since the start of this year.

Drugs and homelessness have contributed to the outbreak but it can be spread by eating contaminated food.

Per the CDC, 20,133 cases, with 11,595 hospitalizations have been reported in multiple states including Ohio, Tennessee, West Virginia, Kentucky, Indiana, Florida and Arizona to name a few. According to the CDC, California and Utah have declared their outbreaks’ over.  191 deaths have been reported since the outbreak began in 216.

 

What is Hepatitis A?

Hepatitis A is a disease that affects the liver.  Its caused by a virus (Hepatitis A virus) that is most commonly ingested. Poor hand washing and/or contaminated food are likely culprits.  It’s transmitted by the fecal-oral route, where food or drink contaminated by fecal matter enters another person’s GI tract.  Sexual transmission of Hepatitis A has been reported during activities involving oral-anal sex.

Hepatitis A can live outside the body for months, so unclean dining areas can be contaminated and transfer to food.

Those who are immunosuppressed run the risk of dying from the infection.

 

What are the symptoms of Hepatitis A?

Symptoms of Hepatitis A include:

  • Jaundice – yellowing of the skin and eyes
  • Fever
  • Abdominal Pain
  • Fatigue
  • Dark Urine
  • Joint Pain
  • Clay – looking stools
  • Diarrhea
  • Nausea
  • Vomiting
  • Loss of appetite

Hepatitis-A.jpg

 

What is the treatment for Hepatitis A?

There is no specific treatment for hepatitis A.  Most hepatitis A infections resolve on their own.

We usually recommend rest, fluids, and offer medications to help with nausea and vomiting.

For liver injury we avoid medications and alcohol that can worsen liver damage. The liver will usually recover within months after hepatitis A infection.

There are vaccines for Hepatitis A included in the childhood vaccination schedule.  Those older who weren’t vaccinated as a child can get the vaccine from their local provider or health department.  Many states require all health care and food workers to be vaccinated.

The best form of prevention however is good hand washing, dining area hygiene, and cooking food thoroughly.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and Board Certified Family Physician