Map of Vaccine-Preventable Outbreaks Over Time

Image by Council of Foreign Relations

The council of foreign relations have produced an interactive map the shows the concentration of vaccine-preventable outbreaks throughout the world over time. Such diseases include measles, mumps, rubella, polio, and whooping cough.

The take-home point of the map is that diseases that were once considered "eradicated" due to near-universal vaccinations have now made a tremendous comeback which is felt almost certainly due to the anti-vaccine movement.

Vaccinate!!!

Reference:
Vaccine Preventable Outbreaks. Council of Foreign Relations.

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UFC Boss Dana White Underwent Surgery for Meniere's Disease

Balance is very important in martial arts... So imagine have a condition like Meniere's Disease and being the boss of the Ultimate Fighting Championship organization.

Dana White who is the president of the UFC organization apparently has Meniere's Disease since 2011 causing  symptoms of ringing, ear fullness, fluctuating hearing loss, and spinning attacks that last for hours to days at a time. Usually, one ear is the culprit though it can occur on both sides as well.

Presumably, he already tried conservative measures without improvement and therefore underwent surgery for this condition on January 15, 2013. [link]

What is Meniere's Disease?

It is simplistically hypothesized that Meniere's Disease, also known as endolymphatic hydrops, is due to a fluid overload within the inner ear residing inside the skull (DIFFERENT location from fluid that occurs with ear infections).

When too much fluid accumulates in the inner ear, symptoms of tinnitus, ear fullness, and hearing loss occurs followed by the spinning attack. The spinning vertigo lasts until the fluid overload dissipates.

Treatment

Treatment occurs as follows (there are variations, but these are the steps overall):

Step 1: Diet Changes

Avoid all salt, caffeine, and alcohol. Salt avoidance typically means less than 1000mg of sodium per day. Caffeine avoidance is not just coffee, but also decaffeinated coffee, coke, pepsi, tea, chocolate, etc. Alcohol avoidance is pretty self explanatory.

By avoidance of these substances, it seems to substantially minimize the amount of fluid retention that occurs in the inner preventing fluid overload and the symptoms that go with it.

If symptoms persist with dietary restrictions, than...

Step 2: Diuretic Medications

In addition to dietary avoidance of salt, caffiene, and alcohol, a prescription water pill (diuretic) is added. I typically prescribe maxzide though any diuretic will do. Diuretics force the kidneys to produce more urine to be expelled from the body. If you can believe it, the inner ear also behaves like the kidney and does the same thing preventing fluid overload within the inner ear.

If step 1 and 2 do not work, than...

Step 3: Surgery

Surgical drainage of the inner ear is called endolymphatic shunt decompression (ELS surgery). This operation is what Dana White underwent. Essentially, the mastoid bone located behind the ear is completely removed and once the inner ear structure called the endolymphatic sac is reached, it is opened and a plastic-like tubing (the shunt) is placed. Risks of surgery include permanent hearing loss and facial paralysis.

Essentially, the surgery is trying to physically drain the fluid out of the inner ear rather than medications or diet adjustments which attempts to prevent fluid from building up in the first place.

Step 4: More Surgery

There are other surgical procedures that may be tried beyond step 3, but these are considered destructive procedures and have a high risk of permanent hearing loss (consider it likely to happen) as well as the possibility of making the dizziness worse. In essence, the balance system of the ear is permanently destroyed whether thru injection of a neuro-toxic drug like gentamycin into the ear itself or surgically cutting the balance nerve completely from the brain.

Source:

UFC's White hopes surgery relieves debilitating disease. USA Today 1/14/13

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Actress Kristin Chenoweth Suffers from Meniere's Disease

Kristin Chenoweth is an accomplished actress both on TV and live on Broadway having performed in Wicked as Glinda as well as appearances in TV shows Glee and Pushing Daisies.

She also suffers from Meniere's Disease which was diagnosed in 2007.

As such, she is prone to dizzy attacks which may have contributed to well-known falls during performances over the years.

• 2003: Fell off the stage during rehearsals for Wicked
• 2006: Fell off the stage during Broadway revival of The Apple Tree
• 2011: Fell down the stairs during injuring her back on the set of Glee.

And those are just the falls we know about.

Meniere's disease is a disorder of the inner ear which leads to spinning dizzy attacks without any specific trigger. The dizzy spinning typically lasts several hours and is often preceded by tinnitus, aural pressure, and a hearing decrease on just the affected ear.

Fluctuating hearing loss is not uncommon as well.

Diagnosis is not straightforward and is usually obtained by history alone, but supporting tests include ENG (electronystagmography), VEMP (vestibular evoked myogenic potentials), ECoG (electrocochleography), ABR (auditory brainstem response), MRI scan, etc.

Once diagnosis of Meniere's disease is made, treatment occurs in stages:

Stage 1: Eliminate all salt (less than 1000mg of sodium per day), caffeine (no coffee, tea, decaffeinated, sodas, chocolate, etc), and alcohol from the diet.

Stage 2: If stage 1 does not help, addition of a diuretic pill like maxzide.

Stage 3: Invasive procedures which include endolymphatic shunt operation or vestibulectomy using intratympanic gentamyin injection into the ear or surgical lysis.

Flare-ups are treated symptomatically with phenergan and if needed, steroids whether oral or injection into the ear.

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Natural Remedies for a Sore Throat, Cough, and Viral Infections

Homeopathy and alternative medicine often get a bum rap, but they have come up with some treatments for sore throats and upper respiratory viral illnesses that actually have been proven to work.

Here's a few...

1) Honey

Sore throats (and coughing) can be soothed by swallowing honey straight-up or slightly diluted with warm water with honey to make it easier to swallow. The best time to do this is at bedtime given it will stick around for awhile (eating/drinking will wash away the coating). The purpose of honey is to create a throat barrier to ease the discomfort.

Think of it like chapstick to coat irritated lips, but meant for the throat.

Use of honey is also recommended by the World Health Organization which has also published a monogram on viral colds and the various treatments explained. Pay particular close attention to Annex 3 (Page 11) which gives various recipes to treat pediatric cough including the use of honey.

Reference:
Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.

2) Humidification

Dry cool air increases risk of viral infections as well as giving it to others. As such, add room humidification to a bedroom and keep the door closed (small room humidifiers can't humidify an entire house... so keep door closed!).

Why does this help? Increased humidification inactivates viruses!

Humidification also helps minimize a persistent dry cough worse at night often due to reactive airway disease triggered by breathing in dry air.

However, keep in mind that if you actively have a viral illness, it is too late for humidity to help. It is best used as a preventative measure.

Reference:
Dynamics of airborne influenza A viruses indoors and dependence on humidity. PLoS One. 2011;6(6):e21481. Epub 2011 Jun 24. Influenza virus transmission is dependent on relative humidity and temperature. PLoS Pathog. 2007;3:e151.

Heated, humidified air for the common cold. Cochrane Database Syst Rev. 2011 May 11;(5):CD001728.

3) Gargling and Saline Flushes

Gargle with saline water... or even just tap-water on a daily basis. Why does this help prevent viral infections? It washes away the viral particles before it gets a chance to cause problems.

It's also probably why drinking lots of fluids also helps since the viruses get deactivated in the stomach from the acidic digestion.

Unfortunately, gargling only helps with the throat... saline flushes are required to help with sino-nasal problems.

Reference:
Can we prevent influenza-like illnesses by gargling? Intern Med. 2007;46(18):1623-4. Epub 2007 Sep 14.

4) Xylitol

This naturally-occurring sugar substitute apparently has all sorts of anti-bacterial as well as anti-fungal properties and has been known to doctors and scientists but hardly marketed or promoted in any fashion.

However, the importance of this compound is that it DOES appear to significantly decrease the incidence of ear infections and sinus infections when used regularly. It comes in nasal spray form as well as gum.

Reference:

Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.

A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996 Nov 9;313(7066):1180-4.

Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

Conclusion

Sometimes the BEST medicine are things you can do at home without need for a physician visit... and is based on fact rather than anecdotal evidence.

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The "Morning Person" Gene

German scientists have potentially discovered a genetic reason why some people are morning people whereas others are night-owls.

The gene called ABCC9 dubbed "morning person" gene was identified by analyzing 4251 individuals who reported their sleeping pattern.

The ABCC9 variant type and number of copies significantly affected the number of hours of sleep. To confirm this finding, scientists modified the ABCC9 gene in the fruit fly and obtained similar results.

The gene codes for a protein that senses the energy metabolism of a cell, but how this relates to sleep is unclear. The gene is also associated with other conditions including heart disease and diabetes which probably helps explain why quality of sleep seems to be associated with these disease processes.

In the past, it was thought that poor sleep "caused" cardiovascular problems, but just maybe, sleep problems and heart problems are caused by a common genetic trigger rather than one causing the other.

Reference:
A K(ATP) channel gene effect on sleep duration: from genome-wide association studies to function in Drosophila. Mol Psychiatry. 2011 Nov 22. doi: 10.1038/mp.2011.142. [Epub ahead of print]

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