It’s The End of the World As We Know It…

It’s The End of the World As We Know It…

When I was in medical school, my training focused first on learning what a healthy body is like. The anatomy, the physiology, what our tissues look like under the microscope, genetics, biochemistry. I learned how to do physical exam, mostly on my classmates, which meant again that I was focusing mainly on healthy subjects. One of my wise professors once said, “you need to hear a healthy heart 1,000 times before you will understand what an abnormal heart sounds like.” As my training progressed, we started to focus more on disease states. Once we had mastered (sort of) what things were supposed to look like in our body, we got to learn how things are not supposed to look or act. We learned about diseases of the cardiovascular system, nervous system, digestive system. One of my favorite topics was learning about infectious diseases. In fact at one time I thought I would go on to specialize in that field. These are illnesses caused by those pathogens that we largely cannot see, bacteria, viruses, parasites, and fungi. These are external sources of disease, unlike some other diseases that are caused by internal factors like genetics. The array of infectious diseases is vast, and depending upon what part of the world you live in, you are susceptible to different categories. Because my medical training took place in the United States, we tended to focus upon those infectious diseases that we would most likely come across in practice here, things like pneumonia, colds, sexually transmitted diseases, skin infections, etc. We touched on tropical medicine, but since none of us was planning to practice medicine in the jungle, it was more of a brief introduction so that we had some general knowledge of tropical diseases like Malaria.

Fast forward to my current practice in general Internal Medicine, which means I am a primary care doctor for adults. Certainly I see lots of the routine stuff, colds, pneumonia, diabetes, high blood pressure, urinary problems, arthritis. However, in the past couple of years, I have had to dust off that knowledge of some of those tropical diseases. Remember back to the 2014 Ebola outbreak? We had a protocol in my office asking all patients who came in about any recent travel to affected countries. We had a plan about what to do with any patient who had traveled to one of those countries and who had worrisome symptoms. Then, there was worry about a respiratory problem called MERS, which was prevalent in some Middle Eastern countries. Again more questions to my patients about travel. And now, we have Zika Virus. I have not been able to turn on my radio (I am an avid NPR listener) to listen to the news for the past week without hearing about the Zika virus outbreak in South and Central America. The WHO this week declared the Zika Virus an International Emergency, which means that they can focus a lot of attention and resources on containment, treatment, and prevention.
So what’s up with all of these disease outbreaks? Religious fanatics have proposed that this is part of the end of the world, plagues written about in the book of Revelation, along with all of the natural disasters and strange weather that seem to have afflicted our world in recent years. Me, I think there is likely a simpler explanation. The reality is that our world population travels exponentially more than we did even 40 years ago. It’s so easy these days to circumnavigate the globe by airplane in a matter of hours. Moreover, we have cargo and goods that are shipped internationally at an increasing rate. Many diseases that have been exported to new regions did so via the large ocean vessels that carry goods, produce, animals, and other products globally. So continue to dust off my knowledge of obscure diseases I will!
Back to the Zika virus. I have had a number of questions from patients so far, who are worried about contracting this disease. Should they cancel travel plans? Should they invest in mosquito repellant? Is the fever that they just developed the Zika virus? I was getting many of the same questions during the Ebola outbreak incidentally. It’s in times like this that I always remind myself, and my patients, to take a deep breath. With the prevalence of all forms of media in our country from TV, to radio, to internet, to social media, we are constantly bombarded with images and information. Who wouldn’t get caught up in the frenzy? So, here are the facts. The Zika virus is not new, it’s been identified as a pathogen since the 1940’s, which means that it was probably around for a lot longer, we just hadn’t noticed it. In any case, there have been cases of Zika for many years, mostly in Africa, Southeast Asia, and other tropical areas. In the past couple of years, the incidence has gone up in South America dramatically, so it has garnered international attention. It’s theorized that the virus may have changed itself somewhat, so that it is now more infectious.  For the majority of people who get the virus, it is asymptomatic.  If it does cause symptoms, generally those include fever, body aches, rash, and fatigue. It’s self-limited, as most viral infections are, meaning it will just run its course in 1-2 weeks and the infected person will then go back to their normal healthy life. The problem with this particular virus, is that it seems to cause a birth defect if a pregnant woman has become infected. I would like to point out that this has not been proven, but is strongly suspected based on the evidence so far. The virus is transmitted by a mosquito, which is native to most tropical and subtropical areas, which means that eventually it will likely spread to the southern part of the United States. This week there has also been a report of possible sexual transmission, but that has not been completely verified.
So, what to do? 1. Take a deep breath. Don’t freak out. 2. Stop listening to the media. They have a vested interest in ratings, not in educating the public. 3. If you have travel plans to an affected area, make sure to bring (and wear) mosquito repellant containing DEET, and plan to wear longer shirts/pants if you will be out in the jungle or forested areas. Most major cities and resorts spray for mosquitos, as there are many different diseases that are transmitted by those lovely little insects. 4. If you are pregnant, and are planning travel to an affected area, don’t cancel your plans yet, but talk to your OBGYN, and understand your risks.  The CDC is currently advising caution for pregnant women who are traveling to an affected area.
In closing, I thought I would share the top 10 reasons for death currently in the United States. Just so that we all can understand what our real risks are. They are: Heart disease/heart attack, Alzheimer’s disease, Lung Cancer, Stroke, COPD, Pneumonia, Diabetes, Breast/Prostate Cancer, Kidney failure, and Colon Cancer. Because, the patients who usually come to my office panicking about something like Zika virus are usually those patients who just finished a cigarette after eating a Big Mac Lunch and are not practicing safe sex. It’s all about perspective.
So, off I go to my vacation in Puerto Rico in a few weeks, Deep Woods Off in hand! And I am certain that I will enjoy the sun, sand, and relaxation! No end of the world in sight! Cheers!

End of world Meme

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