Posted in Health, news

Hepatitis A Outbreak Declared in Clark County

A Hepatitis A outbreak continues to expand in Clark County, Nevada.

According to the Southern Nevada Health District, 83 cases (up from 37 reported in June) 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, 23,978 cases, with 14,300 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.  236 deaths have been reported since the outbreak began in 2016.

 

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

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Posted in Health, New Year's, New Year's Eve, news

How to Avoid Alcohol Poisoning

The most exciting evening of the year is coming and we start celebrating hours, even days before.  Champagne, beer, vodka, rum…you won’t find a venue without it.  Unfortunately the pace at which alcohol is consumed can be just as deadly as the quantity.  What you read below may be difficult to swallow, but it’s necessary to know to stay healthy.

What is acute alcohol intoxication?

Simply put, it’s alcohol poisoning.  Alcohol consumed in high quantities and at too fast a pace will disrupt metabolic processes in the body.  A healthy human body will break down alcohol at a rate of 1 oz per hour.  So if the average shot glass contains 0.6 – 1.5 oz of alcohol and if one takes in 4 shots in one sitting, math dictates that the body will not be able to keep up.

Whatever the liver does not metabolize will continue to circulate in the body.  As a defense mechanism, your gut may try to throw it up, which is why vomiting is a red flag of acute alcohol intoxication.

Alcohol is additionally a sedative so respiratory rate can drop to the point of causing the drinker to become unconscious.  Slow respiration coupled with high alcohol blood content will cause drinkers to have impaired brain function (loss of memory, acting confused) and dilation of blood vessels.  This can hypoperfuse certain organs as your body tries to preserve blood flow to the heart and brain, thus giving the drinker a pale, clammy look.

Chronic alcohol intoxication could cause scarring of the liver called cirrhosis.

liver.jpg

How much alcohol is safe to drink?

The CDC website defines quantities of alcohol as the following:

A standard drink is equal to 14.0 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in

  • 12-ounces of beer (5% alcohol content).
  • 8-ounces of malt liquor (7% alcohol content).
  • 5-ounces of wine (12% alcohol content).
  • 1.5-ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).

  Women metabolize alcohol differently from men, so they are encouraged to drink less.

According to the National Institute on Alcohol Abuse and Alcoholism, a man should drink no more than 2 standard drinks a day and for women, no more than 1.

Binge Drinking” is defined as 4 or more drinks (woman) or 5 or more drinks (man) in a 2 hour period.

 

According to their website they state:

Moderate alcohol consumption:
According to the “Dietary Guidelines for Americans 2015-2020,” U.S. Department of Health and Human Services and U.S. Department of Agriculture, moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for men.
Binge Drinking:
  • NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking as 5 or more alcoholic drinks for males or 4 or more alcoholic drinks for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past month.
Heavy Alcohol Use:
SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past month.

 

What if I’m taking medication? Can I still drink?

There is no official list of what medications can be swigged with alcohol.  Some sources will incorrectly say “Tylenol” however one’s liver may not agree as both acetaminophen (its key ingredient) and alcohol may cause liver disease.  We suggest speaking with your medical provider first before drinking.

The National Institute for Alcohol Abuse and Alcoholism provides a list of medications that could produce serious side effects when mixed with alcohol (even during the same night).  For example NSAIDS, (non steroidal antiinflammatories, such as ibuprofen), could increase risk of GI Bleed.

How much alcohol is toxic to the body?

Any amount of alcohol may be toxic to the body depending on one’s baseline health and how his/her body metabolizes alcohol.  One drink has even been linked to cancer such as those of the throat and/or GI tract.  So we don’t have an official “safe level” of alcohol to consistently promote.  How we determine ranges of toxicity depends on one’s Blood Alcohol Content (BAC) which can be measured.

The following tables come from the University of Notre Dame, Student Well-Being McDonald Center…….

BAC-Specific Effects

BAC Level Generalized Dose Specific Effects
0.020-0.039% No loss of coordination, slight euphoria, and loss of shyness. Relaxation, but depressant effects are not apparent.
0.040-0.059% Feeling of well-being, relaxation, lower inhibitions, and sensation of warmth. Euphoria. Some minor impairment of judgment and memory, lowering of caution.
0.06-0.099% Slight impairment of balance, speech, vision, reaction time, and hearing. Euphoria. Reduced judgment and self-control. Impaired reasoning and memory.
0.100-0.129% Significant impairment of motor coordination and loss of good judgment. Speech may be slurred; balance, peripheral vision, reaction time, and hearing will be impaired.
0.130-0.159% Gross motor impairment and lack of physical control. Blurred vision and major loss of balance. Euphoria is reducing and beginning dysphoria (a state of feeling unwell)
0.160-0.199% Dysphoria predominates, nausea may appear. The drinker has the appearance of a sloppy drunk.
0.200-0.249% Needs assistance in walking; total mental confusion. Dysphoria with nausea and vomiting; possible blackout.
0.250-0.399% Alcohol poisoning. Loss of consciousness.
0.40% + Onset of coma, possible death due to respiratory arrest.

Estimating Blood Alcohol Level (Based on Weight) – Males

Weight 1 drink 2 drinks 3 drinks 4 drinks 5 drinks 6 drinks 7 drinks 8 drinks 9 drinks 10 drinks
100 lbs .043 .087 .130 .174 .217 .261 .304 .348 .391 .435
125 lbs .034 .069 .103 .139 .173 .209 .242 .278 .312 .346
150 lbs .029 .058 .087 .116 .145 .174 .203 .232 .261 .290
175 lbs .025 .050 .075 .100 .125 .150 .175 .200 .225 .250
200 lbs .022 .043 .065 .087 .108 .130 .152 .174 .195 .217
225 lbs .019 .039 .058 .078 .097 .117 .136 .156 .175 .195
250 lbs .017 .035 .052 .070 .087 .105 .122 .139 .156 .173

Estimating Blood Alcohol Level (Based on Weight) – Females

Weight 1 drink 2 drinks 3 drinks 4 drinks 5 drinks 6 drinks 7 drinks 8 drinks 9 drinks 10 drinks
100 lbs .050 .101 .152 .203 .253 .304 .355 .406 .456 .507
125 lbs .040 .080 .120 .162 .202 .244 .282 .324 .364 .404
150 lbs .034 .068 .101 .135 .169 .203 .237 .271 .304 .338
175 lbs .029 .058 .087 .117 .146 .175 .204 .233 .262 .292
200 lbs .026 .050 .076 .101 .126 .152 .177 .203 .227 .253
225 lbs .022 .045 .068 .091 .113 .136 .159 .182 .204 .227
250 lbs .020 .041 .061 .082 .101 .122 .142 .162 .182 .202

Time Factor Table

Time is the only factor to lower one’s Blood Alcohol Content. Coffee, cold showers, etc… are all myths.

Hours since first drink 1 2 3 4 5 6
Subtract from blood alcohol level .015 .030 .045 .060 .075 .090

 

A Happy New Year should also be a Healthy New Year.  So be warm, dry, safe and have fun!!

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

Posted in Health, Hepatitis, news

Ohio Joins Multiple States in Declaring Hepatitis A Outbreak

Since 2017 multiple states have declared outbreaks of the Hepatitis A Virus and now the Department of Heath in Ohio (ODH) has declared one as well.

Since the start of 2018, cases in Ohio have risen to 79, double the total number recorded for 2017 in the Buckeye state.

hepatitis A

Image from Cleveland.com

 

WTOL reports: Ohio’s hepatitis A outbreak cases appear to be primarily among people who use illegal drugs, those who have been incarcerated, people who have had contact with known cases, those also infected with hepatitis C, men who have sex with men, and people experiencing homelessness.

Per the CDC, the below states have reported the following number of cases:

  • California 704  (as of April 11, 2018)
  • Indiana 148  (as of June 21, 2018)
  • Kentucky 760
  • Michigan 846
  • Missouri 125
  • Utah 109 (2018) and 147 (2017)
  • West Virginia  248
  • Arkansas 40 since February, 2018

Last year Colorado reported a doubling of Hepatitis A cases since the previous year.

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, iHeart Radio and Board Certified Family Physician

Posted in Entertainment, Health, news

David Cassidy is in Multi-Organ Failure

“Partridge Family” and 70’s teen heart-throb, David Cassidy, has been admitted to a Florida hospital in multi-organ failure.

The 67-year-old is reportedly in an induced coma and is awaiting a transplant.  Multiple reports have suggested he’s waiting for a kidney and some state a liver transplant.

david-cassidy-partridge-family

Earlier this year, Cassidy had fallen off the stage during a performance in California and revealed to People Magazine he was suffering dementia.

He had multiple drunk driving offenses and in 2015 was charged with a hit-and-run while intoxicated.  In the latter case, he was given two years probation and his licence was suspended until 2021.

Cassidy has been very open about his battle with drug and alcohol addiction, both of which have been linked with liver and kidney failure.  Its been unclear what treatment the actor has had after his arrests and probation.

What causes multiple organ failure?

Multiple organ failure, or multi-organ failure, or Multiple Organ Dysfunction Syndrome (MODS), can be caused by a variety of factors.  Sepsis, or blood infection, is the most common cause.  Yet trauma, inflammation, or lack of blood flow to the organs can cause them to fail as well.

Mortality rate ranges anywhere from 30-100%.

SIRS (Systemic Inflammatory Response Syndrome), without a definitive cause, can cause hypoperfusion and hypotension causing lack of blood flow to the organs inducing failure.

So infection, ischemia (lack of blood flow), inflammation can all trigger an organ or multiple organs to malfunction.

To treat MODS, critical care needs to be instituted immediately to maintain blood flow and oxygen to the organs while the cause is being determined.  If the liver and kidneys cannot recover, organ transplant may be considered.

This is a developing story.

 

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

Posted in food, Health, news

Hepatitis A Kills 14 in San Diego

A southern California city is reporting the “deadliest outbreak” of Hepatitis A that the US has seen in decades.

264 people have been hospitalized and 14 dead since the outbreak of the virus began in November of 2016.

70% of the cases were homeless individuals, lacking good sanitation and immunocompromised due to their lack of nutrition and possible drug/alcohol use.  9 people have died within the last 6 weeks.

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.  Its 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, iHeart Radio and Board Certified Family Physician