26 April 2019 Blog Post: On Measles

26 April 2019 Blog Post: On Measles

Nearly 300 students and staff from two local universities are now under measles quarantine. Of the 38 cases of measles in California this year, more than three-quarters of California’s known measles patients were either not vaccinated or did not receive the recommended two doses of vaccine.
 
Some patients may not know whether or not they have received the two doses of vaccine due to lost or inaccessible pediatric records. So what are your options in that case?
 
You have two options. You can test for immunity (which is a blood test we perform Santa Monica Primary Care) or we can just give 2 doses of Measles/Mumps/Rubella (MMR) vaccine at least 4 weeks apart. There is no harm in giving MMR vaccine to a person who may already be immune to one or more of the vaccine viruses. If you opt for testing, and the tests indicate that you are not immune to one or more of the vaccine components, then we give 2 doses of MMR at least 4 weeks apart. If any test results are indeterminate or equivocal, we consider you non-immune.
 
Measles is highly infectious. I repeat – highly infectious. It is primarily transmitted from person to person via large respiratory droplets. Airborne transmission via aerosolized droplets has been documented in closed areas (such as an office examination room) for up to 2 hours after a person with measles occupied the area. Following exposure, more than 90% of susceptible people develop measles. The virus can be transmitted from 4 days before the typical measles rash becomes visible to 4 days after the rash appears.
Measles outbreak: Nearly 300 students quarantined at 2 California universities

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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22 April 2019 Blog Post: My thoughts on Senator Maureen Walsh’s Statement

22 April 2019 Blog Post: My thoughts on Senator Maureen Walsh's Statement

It took me the almost two days to formulate a response to Washington State Senator Maureen Walsh’s statement that nurses “probably play cards for a considerable amount of the day.” So here it is…
 
I have spent the better part of the last two decades working in a hospital settings ranging from County facilities to large private hospitals and community hospitals. I have worked days, weekends, holidays and overnights. I’ve worked 30 hour shifts and at 2 in the morning. I’ve watched more sunrises over ambulance bays that I care to recall. But in all of that, I can assure you that I was never, ever even close to being the hardest working person in the hospital. That distinction goes to the nurses. Imagine 12 hours on your feet, multiple patients, dressing changes, wound checks, family members, medication reconciliation, interpreting vital signs, laboratory data and (worst of all..) – interacting with doctors! Then coming in the next day and doing it all over again.
 
When I think of nurses I often think of the Bob Thaves’ quote about Ginger Rogers. He said, “Sure he [Fred Astaire] was great but don’t forget that Ginger Rogers did everything he did, …backwards and in high heels.”
 
Hospital nurses never stop moving. I’ve seen them cross picket lines to check on patients and come in on days off to help discharge a patient who they cared for during a lengthy stay. As a testament to their professionalism, I have no doubt whatsoever that a nursing staff would care for Senator Walsh in exactly the same professional manner that they would any other patient – even if made aware of her above statement.
 
And, Senator, I’ve seen nurses do many extraordinary things but I have never even once seen them play cards.
 
If they did, however, they’d probably be pretty damn good at it.
Washington state senator slammed for saying nurses 'play cards' for 'considerable amount of the day'

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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20 April 2019 Blog Post: “Any opinions on the science behind this food allergy test or others like it?”

20 April 2019 Blog Post: "Any opinions on the science behind this food allergy test or others like it?"

A patient direct messaged me the following: “Any opinions on the science behind this food allergy test or others like it?”
 
Food Sensitivity Test

My answer: Who needs an opinion when there are data! A fast click on the link reveals the method used in this testing protocol – namely “IgG Reactivity to 96 Foods.” Turning to the evidence… There are several validated, standardized, and accepted tests for the evaluation of food allergy and intolerance. However, there are also a large number of other tests for these conditions that are promoted by various laboratories and practitioners who are not allergy specialists [Kelso JM, 2018]. The clinical utility of food-specific IgG tests has not been established, a fact that even some laboratories performing these assays acknowledge. A position statement from the European Academy of Allergy and Clinical Immunology (EAACI) concludes “food-specific IgG4 does not indicate (imminent) food allergy or intolerance, but rather a physiological response of the immune system after exposition to food components. Therefore, testing of IgG4 to foods is considered as irrelevant for the laboratory work-up of food allergy or intolerance and should not be performed in case of food-related complaints” [Stapel SO et al, 2008]. So… the $159 is probably better spent elsewhere.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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