theLiteraryExaminer BY TERRI SCHLICHENMEYER
Virus Hunt: The Search for the Origin of HIV
Death, American Style by Lawrence R. Samuel; c.2013, Rowman & Littlefield; $40.00 / $44.50 Canada, 189 pages
by Dorothy H. Crawford; c.2013, Oxford University Press; $27.95 U.S. and Canada, 244 pages In the new book Virus Hunt by Dorothy H. Crawford, you’ll see how scientists discovered the roots of HIV. In 1981, doctors in California began noticing “rare infections… and an unusually aggressive tumor” in certain patients. Soon, the same was reported in New York , Florida , and elsewhere around the country. By 1982, the disease was called AIDS. The risk of catching AIDS seemed at first to be limited to sexually-active gay men, particularly those with multiple partners. Within weeks, heroin users and hemophiliacs were added to the at-risk group, then doctors discovered that infected mothers could pass it to their children. “Fear of AIDS” became “a disease in its own right.” By 1984, the “causative virus was identified [as human immunodeficiency virus]… and shortly thereafter the genome was sequenced…” But where did HIV come from? Soon after the first description of AIDS was released in 1981, Boston researchers noticed that their captive macaque population was affected with something that sounded similar. Four years later, scientists at that research facility isolated a simian immunodeficiency virus (SIV) which had spread and mutated as animals were “unwittingly” shipped around to other facilities. That led to the discovery that some SIVs are “closely related” to certain strains of HIV and share “between 62 and 87 percent” of their genetic sequences. It didn’t take much to see how the virus mutated, or how it leaped from animal to human, possibly via Africa’s sooty mangabey monkeys (a “natural host of the virus”), which were sometimes hunted for food. But the question of where HIV came from needs to go back even further than 1981. A man from Memphis was reported with what doctors would consider to be typical AIDS symptoms in 1952. SIVs were discovered in Icelandic sheep in 1949. Scientists, in fact, believe that SIVs are “ancient parasites” and that HIV has been “circulating in the African population since near the start of the 20th century.” At the beginning of this book, author Dorothy H. Crawford indicates that the search for the beginnings of HIV is somewhat like a mystery. She’s absolutely correct. It is, but you need a Sherlockian PhD to understand it all. That’s not to say that Virus Hunt is a bad book – that’s not the case at all. What readers will want to know, however, is that it’s very academic and heavily steeped in genetics, epidemiology, and laboratory-level research. That’s great for anyone employed in those fields. For the layperson, this mystery’s not unreadable but it’s as far from relaxing entertainment as you’ll ever get.
Does your death frighten you, or are you intrigued? Curious or repelled? Your attitude may come from the outlook surrounding you, as you’ll see in Death, American Style by Lawrence R. Samuel. In the years immediately following World War I, Americans were reeling. Not only was there a “sheer volume of people” dead from battle, but the 1918 influenza epidemic also claimed many victims. Americans thought hard about death and reached for spiritualists, who purported to communicate with the newly deceased. By the 1930s, researchers had an inkling that maybe death wasn’t “necessary.” Alas, according to one nurse of the era, people continued to expire and they all “died the same, more or less…” In the years prior to World War II, although there were marked increases in death by automobile and by home accidents, dying was “a relatively normal, even innocent affair.” During the war, however, parents suddenly realized that they’d “better be prepared to explain death to their children.” Death on “such a massive scale… was itself frightening and potentially scarring to children.” Post-war modern medicine benefitted by the increasing acceptance of autopsies, the advancement of medical procedures and medicines, and the growing notion that death could be reversed. The timing was fortuitous, at least for research studies: more people died in hospitals than at home in the 1950s. For some, though, being surrounded by machines didn’t sound like a good way to go, so the notion of natural death began to take hold in the mid-1960s. And yet, we just can’t get over our squeamishness: death has been, alternately through the past four decades, a taboo subject, a class subject, reason for “deeply philosophical examination,” and “a principal theme in American pop culture.” Today, we’re able to cautiously discuss death, though many “continue to resist their mortality.” In his introduction, author Lawrence R. Samuel indicates that his intention with this book was not to look at the death industry, but rather at the attitude Americans have towards death itself. He accomplishes that in Death, American Style… just not all that well. Perhaps it’s the length of this book: the “cultural history of dying” is a vast subject; much bigger than the small page count allows here, which leads to an irritating lack of depth. It doesn’t help that Samuel’s first chapter sometimes reads like an overgeneralized synopsis of a dime-store novel, or that some subjects seemed to be brushed aside or are totally missing in the narrative. To the good, there are nuggets of fascination in this book, but they’re pretty scattered and might not be enough to satisfy a truly curious mind. Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.
easttnmedicalnews
.com
Dysphagia By Clarisa E. CuEvas, MD
Dysphagia is defined as difficulty in swallowing. It is a symptom that can be due to a defect in the mouth, oropharynx, or esophagus. It can also be the result of a motor disorder or mechanical obstruction. To determine the area of defect, we must evaluate all stages of swallowing. It all begins with suckling. The lips must be able to form a tight seal as the tongue is displaced posteriorly. The glottis closes to guard the airway, and the soft palate rises to close the nasopharynx as the cricopharyngeal muscles relax. The food then passes to the back of the pharynx. Solids require coordinated actions requiring appropriate jaw movements and teeth alignment. Salivary secretions lubricate the food as it passes through the mouth into the pharynx and then the esophagus. Abnormalities in any phase can interrupt successful swallowing. It is abnormalities of the muscles involved in the ingestion process, their innervations, strength or coordination causing intermittent dysphagia in infants and children. Cerebral palsy, Arnold-Chiari malformation, myelomeningocele, congenial myotonic dystrophy, and other myopathies, as well as cricopharyngeal achalasis, can present as dysphagia. Esophageal disease is a common cause of swallow dysfunction. Sudden dysphagia in the younger child should be evaluated immediately and a foreign body should be ruled out. Eosinophilic esophagitis often presents as a swallow dysfunction and feeding refusal with or without chocking. Candida pharyngitis or esophagitis can cause difficulty in swallowing. Gastroesophagel reflux with esophagitis or ulcerations can result in chocking and difficulty with both liquid and solid bolus. Idiopathic achalasia often presents with difficulty in swallowing liquids and solids. A history of tacheoesophageal atresia or fistulae suggests stricture formation and a motility problem. The clinical presentation varies. In the younger child, it often presents with respiratory signs and symptoms combined with feeding refusal. The older child can have fits of coughing, nighttime drooling, and refusal of their favorite foods. A chocking
episode with food bezoar impaction is the most common presentation in the adolescent patient. Careful examination of oral, pharyngeal, laryngeal, and esophageal anatomy and function are important during the evaluation of children with dysphagia. Three basic approaches are utilized: Radiographic studies: (a) upper gastrointestinal series will help identify anatomic or structural abnormalities such as strictures, vascular anomalies of the esophagus, fistulae and masses. Images of the coordination of movement of bolus through the oropharynx and esophagus can help identify motility dysfunction, chalasia or achalasia; (b) modified barium swallow with a speech or occupational therapist can identify oropharyngeal dysfunction. Direct visualization with a fiberoptic endoscope will help in both the identification of the problem and in removal of a bezoar, foreign body, or therapeutics with botulin toxin or pneumatic dilation for achalasia. Motility studies are indicated for the evaluation of esophageal peristalsis. A 24- hour study can help when GERD is suspected. The therapeutic modalities vary depending on the cause for the dysphagia. At our GI for Kids clinic, we coordinate care with speech therapy and occupational therapy in the case of oropharyngeal problems. Recommendations for treatment of both achalasia (Botox/dilatations) and chalasia (H2 antagonist/PPIs) are given. Treatment and follow-up are provided so as to prevent recurrence of the problem particularly in the case of Eosinophilic esophagitis. Inhalers, PPIs, and esophageal dilation are needed throughout the year. While dysphagia requires a complex evaluation, in most cases we have complete resolution of the medical problem. GiforKids, PLLC is a pediatric gastroenterology specialty clinic located at East Tennessee Children’s Hospital staffed with dedicated providers offering comprehensive care to patients and their families. Clarisa E. Cuevas, MD, is a boardcertified pediatric gastroenterologist with GI for Kids, PLLC, in Knoxville, Tenn.
GI for Kids, PLLC www.giforkids.com
(865) 546-3998
PAID ADVERTISEMENT
JANUARY 2013
>
9