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AUGUSTA

MEDICAL EXAMINER

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DOCTORS HOSPITAL • EISENHOWER ARMY MEDICAL CENTER • EAST CENTRAL REGIONAL • GRACEWOOD • MCGHEALTH • MEDICAL COLLEGE OF GEORGIA • PRIVATE PRACTICE • SELECT SPECIALTY HOSPITAL • TRINITY HOSPITAL • UNIVERSITY HOSPITAL • VA HOSPITALS • WALTON REHABILITATION HOSPITAL

JUNE 6, 2008

NEWS • PEOPLE • EVENTS • TRAINING & EDUCATION • EMPLOYMENT

Why?

Portrait of a serial killer Say the words serial killer and any number of mental images come to mind, all human: Charles Manson, Ted Bundy, John Wayne Gacy, and Jeffery Dahmer are a few of the more infamous names in the category. That rogue’s gallery is headed by John Wayne Gacy’s 33 victims. Including those, the death toll wreaked by just those four men is 92 victims. That’s one horrific total until you consider the following one sentence about mosquitos. According to Wikipedia, the online encyclopedia, mosquitoes are “the most deadly disease vector known to man, killing millions of people over thousands of years and continuing to kill millions per year by the spread of diseases.” Do not adjust your Medical Examiner. Yes, mosquitos kill millions of people per year, and have been doing so for thousands of years. Those figures are not exaggerations. The best guess is that mosquitos infect about 700 million people with disease every year. Malaria alone accounts for more than 5 million deaths each year. According to The New York Times Magazine, mosquitos will eventually be responsible for the deaths of 1 in every 17 people currently alive today. By comparison, even a fiend like Adolf Hitler was a rank amateur. While it may be true that many deaths that are mosquito-related happen in places far away from Augusta and even the United States, we’re far from immune. Lola Russell, a press officer at the Centers for Disease Control in Atlanta, called the attention of the Medical Examiner to the neighborhood stats for West Nile Fever, a mosquito-borne illness that is potentially serious. In 2007, there were West Nile cases in Columbia, Richmond and Aiken Counties. In fact, the total for Georgia in 2007 was 50 cases compared to only 8 during 2006. South Carolina had just five cases last year, but that compares to only one case in 2006. (Statistics are maintained by the US Geological Survey. The Georgia state and county maps and statistics may be found at http://diseasemaps.usgs. gov/2007/wnv_ga_human.html Surprisingly enough, West Nile virus, originally identified in 1937, Please see MOSQUITOS page 4

Her M.O.

Yes, this is that rarest of all criminals, the female serial killer. As most of us know, it’s the female mosquito who does all the damage. Entomologists say mosquitos are ingeniously designed to do their dirty work. For starters, they can identify their prey from afar courtesy of sophisticated heat and chemical sensors. Using these they can identify warm-blooded animals (like us) by their thermal profile as well as by carbon dioxide and lactic acids that are exhaled with every breath. Chemicals released through perspiration also seem to be effective attractants. Once a likely victim has been identified, it’s time for dinner, catered by you and me. You’d think that any bug trying to stick its long, sharp nose into our skin would prompt a definite reaction, but mosquito saliva has been described as a “pharmacological cocktail” that may include a mild anesthetic. The barb that is the mosquito’s proboscis can enter the skin effortlessly and undetected. Skeeter saliva also includes vasodilators, anticoagulants to prevent clotting while she’s draining us of blood, agents to suppress the immune response of the victim, and various sugars, proteins and enzymes. After taking her fill, she flies off to her next stop. By the time the bite site become itchy and a little swollen, she’s long gone. The itch and skin bump are the result of our body’s immune reaction, delayed though it might be, to the saliva left behind in the puncture wound. To treat mosquito bites, wash the site with mild soap and water. Try to avoid scratching the bite area, even though it itches. Some anti-itch medicines such as Calamine lotion or over-the-counter cortisone creams may relieve the itching. +

Inside this issue is a new feature that will be part of each First Friday issue of the Medical Examiner. The Business Examiner is a collaborative effort of Neil “Buzz on Biz” Gordon and The Business Exchange, a local commercial real estate brokerage firm that focuses on businesses and franchises. The Business Examiner is envisioned as a resource for all kinds of information that will help all kinds of people: high-roller investors and entrepreneurs and the Average Joes that make up most of us. You might be wondering how this information fits within the scope of a newspaper like the Medical Examiner. As it says on page two of every issue, the Medical Examiner’s mission includes providing “information on topics of health and wellness of interest to general readers.” At first glance it might seem like we’ve gone off track, but in truth, the distance between physical health and fiscal health is quite short. Poverty and poor health are practically kissing cousins, embracing a whole family of ills like poor diet, having no health insurance, and limited access to healthcare. Family therapists say money is at the very top of the list of the biggest contributors to marital discord and family strife. Everyone knows money isn’t the solution to most problems, and having an abundance of money can cause its own set of headaches. Still, financial health is certainly not a bad thing, and usually has a significant beneficial effect on physical health. Benjamin Franklin, in his Poor Richard’s Almanac, put things in perspective: “When wealth is lost, nothing is lost; when health is lost, something is lost; when character is lost, all is lost.” Well, building character might be beyond the scope of the Medical Examiner, but we’ll do our best elsewhere. Two out of three’s not bad. +

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MOSQUITOS… from page 1 was unheard of in the United States until 1999, when an outbreak occurred in and

JUNE 6, 2008

AUGUSTA MEDiCAL EXAMINER

around New York City. But within four years, the disease had been documented in

nearly 10,000 people in 46 states — and in every case, the transmission is caused by a mosquito bite. “Severe symptoms,” says the CDC, “can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.” The Non-West Nile Story There’s a lot more to mosquitos than West Nile, however. You might have noticed earlier, in the quote from Wikipedia, the term “disease vector” used to describe mosquitos. Epidemiologists use vector to describe an organism which does not in and of itself cause disease, but which transmits disease by delivering pathogens from one host to another. Mosquitos are expert carriers. While these little pests do most of their damage in tropical zones of Africa, Asia, South and Central America, and Mexico, temperate zones like Europe and the United States are largely immune to the baddest bites mosquitos bring. What not to wear. (photo: Florida Medical Entomology Laboratory)

General considerations for using bug repellents safely * Always follow the instructions on the product label. * Apply repellents only to exposed skin and/or clothing (as directed on the product label.) Do not use repellents under clothing. * Never use repellents over cuts, wounds or irritated skin. * Do not apply to eyes or mouth, and apply sparingly around ears. When using sprays, do not spray directly on face—spray on hands first and then apply to face. * Do not allow children to handle the product. When using on children, apply to your own hands first and then put it on the child. You may not want to apply to children’s hands. * Use just enough repellent to cover exposed skin and/or clothing. Heavy application and saturation are generally unnecessary for effectiveness. If biting insects do not respond to a thin film of repellent, then apply a bit more.

* After returning indoors, wash treated skin with soap and water or bathe. This is particularly important when repellents are used repeatedly in a day or on consecutive days. Also, wash treated clothing before wearing it again. (This precaution may vary with different repellents—check the product label.) * If you or your child get a rash or other bad reaction from an insect repellent, stop using the repellent, wash the repellent off with mild soap and water, and call a local poison control center for further guidance. If you go to a doctor because of the repellent, take the repellent with you to show the doctor. Note that the label for products containing oil of lemon eucalyptus specifies that they should not to be used on children under the age of three years. + — Centers for Disease Control

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Tracking Down Your Mosquito Problems Mosquitoes are opportunistic, and will find and breed in a wide variety of places around the home. Any water-holding location can become a breeding site for mosquitoes. A half-cup of water can breed enough mosquitoes to cause a problem. You can get rid of your mosquito problems simply and without using pesticides by eliminating breeding locations around the home and yard. Common breeding areas around the home include: LOCATION Potted plants with pans Drainage ditches Low spots that hold water Plugged roof gutters Pet dishes Trash piles Old tires Water holding containers Poorly maintained pools Bromeliads Tree holes Debris on roofs Ponds Boats Bird baths

SOLUTION Don’t over-water, remove pan if possible Remove vegetation and obstructions to water flow Fill and regrade Keep gutters clean Change water frequently Remove or cover Remove or cover Remove or cover Follow recommended maintenance Flush to remove larvae Fill with sand or concrete Remove debris Keep clean, stock with minnows Cover or turn upside down Flush at least once per week.

Source: Florida Medical Entomology Laboratory But that’s no reason to be casual about being bitten. After all, less than ten years ago, no one had ever heard of West Nile in this part of the world. Who knows what mosquitoborne illness may be making headlines in our vicinity ten years from now? The best defense is to apply (according to package directions) a mosquito repellent containing DEET. According to the American College of Physicians, “DEET is the most effective, and best studied, insect repellent currently on the market. This substance has a remarkable safety profile after 40 years of worldwide use, but toxic reactions can occur (usually when the product is misused). When DEET-based repellents are applied in combination with permethrintreated clothing, protection against bites of nearly 100% can be achieved. Plant-based repellents are generally less effective than DEET-based products. Ultrasonic devices, outdoor bug “zappers,” and bat houses are not effective against

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mosquitoes.” Of course, it’s crazy to keep bailing out the boat when you could simply fix the leak. Similarly, the best strategy for mosquito control is getting rid of them in the first place, with repellents as the second line of defense. (See box: Tracking Down your Mosquito Problems) For all their faults, mosquitos do provide a handy free service: letting people know when their insect repellents aren’t working, or when effective repellents need to be reapplied. Simply put, if you’re getting bitten, do something about it. There’s no need for alarmism about the dangers mosquitos pose in this part of the world, but as the CDC’s website points out, it only takes one bite from the wrong mosquito to cause trouble. Their recommendation: if you’re going to be outdoors for even ten minutes during peak time for mosquitos (mainly evening hours) go ahead and apply repellent (See box, next page). +

Can you get AIDS from skeeters? “Mosquitoes cannot transmit HIV because the virus neither survives nor replicates in mosquitoes and the blood from the last bitten person is not flushed into the next person during subsequent feeds. In addition, the circulating viral load of most HIV-infected persons is so low that the theoretical risk that a mosquito bite would transmit HIV is estimated to be less than 1 in 10,000,000.” — American College of Physicians


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