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Medical Mistakes

Tuesday, June 1st, 2010

Estimates vary, but according to several sources, in the U.S., medical errors are roughly estimated to cause from 44,000 to 195,000 deaths and 1,000,000 injuries each year. It’s also estimated that in hospitals in the U.S. adults receive only 55% of recommended care, that 30% of care might be unnecessary, that 14% of patient’s cases involve substandard decision making, and that 1% of hospital patients have adverse effects because of negligence. (Preventable Medical Errors: Nature and Extent – Wikipedia)

Contradicting a commonly held myth, one thing that does not appear to be a major source of error is incompetent health care providers. Instead the core problem seems to be that medical care has become very complicated. For example, it takes from 80 to 100 correctly executed steps to administer one dose of a single medication to a critically ill patient in an ICU. Another misunderstanding is that every adverse event means a mistake occurred. Patients need to be aware of the fact that an adverse event doesn’t necessarily mean an error happened, since some level of unavoidable risk is often involved with many health practices and procedures. (1) I think that focusing on the human factors issues involved in providing medical care could be one of the most useful ways of significantly reducing the rate of mistakes. Factors that can increase the odds of an error include: an inexperienced medical staff, the use of new procedures; prolonged, intensive, complex or urgent care; caregiver sleep deprivation (which can as much as triple the risk of mistakes), the emotional impact of past mistakes which can thereby cause future mistakes, the patient being either very young or old, poor communication (2), failure of follow-up, failure of informed consent, failure to follow advance directives, over-reliance on automated systems, caregiver depression and burnout, an unwillingness to share information (sometimes for fear of liability and loss of reputation) which impedes system improvement, cost cutting measures, poorly designed facilities and buildings, and caregivers being in denial about the very problem of medical errors itself. In underdeveloped countries infrastructure failure (such as inadequate training and broken equipment) also frequently leads to substandard care. One general cause of mistakes that encapsulates a number of the more specific causes just listed is likely to be the assembly line nature of much of modern medical practice. Doctors see many patients for a brief time, and don’t have the luxury of spending time to get to know the patient, which increases the likelihood of oversights. As a reaction to a system that both doctors and patients frequently hate, some doctors have been experimenting with alternative models. (See, for example, Dr. Pamela Wible’s website: Community Ideal Medical Clinic and Create Your Own Clinic (3) (Patient Safety: Causes of Healthcare Error - Wikipedia, Medical Error: Risk Factors – Wikipedia, Preventable Medical Errors: Most Common Causes – Wikipedia)

Some examples of medical errors include: misdiagnosis (4), giving the wrong medication (type, dose, route, combination, or at the wrong time), hospitalcaused infections, an incorrect laboratory result, equipment malfunction, transplanting organs of the wrong blood type, wrong site surgery, wrong patient surgery, surgical materials left in the patient, wrong blood type transfusion, anesthesia (too much, too little, or complications resulting from the failure to check the patient’s history), and manufacturing errors. Birth injuries are often caused by oxygen deprivation and mechanical trauma. At home, patients can fail to take their medications, and/or can implement their treatment regime improperly. (5) (Patient Safety: Health Literacy – Wikipedia, Medical Error: Examples of Errors – Wikipedia, Preventable Medical Error - Wikipedia, Types of Medical Mistakes – Wrong Diagnosis.com)

There are a number of precautions a patient can take to reduce the risk of being the victim of a medical mistake: The most important consideration is that you should be an active member of your health care team. To find a good doctor try asking the head ER or ICU nurse at a large local - ideally teaching - hospital for a recommendation. Find out who other doctors recommend. Your pharmacist is also an excellent source of free advice, since he/she has a from-the-trenches view of how patients respond to different medications. Schedule appointments as far ahead as possible. Make a prioritized list of all the issues you want to discuss with him/her. Get copies of all medical records, current medications, and test and procedure results. Bring them with you when you see any doctor, give all of them copies, and keep a copy with you. Be honest with your doctor(s) and tell them about any of your unhealthy habits. Bring your spouse with you when you describe your history and/or problems. Two memories are better, and you won’t be as inclined to bend the truth. (That is, unless you are hiding something from your spouse.) Make sure your doctor(s) know every medicine, herb, and supplement you’re taking. Let them know about any allergies or adverse reactions to medicines you have had. If your allergies are severe get a Med Alert bracelet. Also, be sure allergy information is on your chart, and your pharmacy’s computer. Ask questions: Learn everything you can about your condition. What advocacy organizations can your doctor recommend? What is your prognosis? How accurate is the test you are about to do? How long will it take you to recover? Have your doctor explain your treatment options, his/her whole treatment plan, his/her reasoning, and then get a second opinion. More treatment isn’t always better, so you need to justify everything you do. What would happen if you had no treatment? How soon do you need to make a decision? Is there a research trial out there that would be right for me? Will my health insurance cover this? And just to be morose, in case things don’t go well you will want to have a living will on file. (20 Tips to Prevent Medical Errors: Patient Fact Sheet – U.S. Department of Health and Human Services, 8 Crucial Tips for Keeping the Elderly Safe from Medical Errors – Aging Parents Authority, How to Avoid Medical Mistakes with Doctors and Hospitals - eHow, How to Avoid Medical Mistakes – eHow, Medical Errors: Tips to Prevent Them – FamilyDoctor.org., 20 Tips to Help Prevent Medical Errors: Patient Fact Sheet - AHRQ, 6 Secrets of Getting Better Doctor Care by Michael F. Roizen and Mehmet C. Oz – Shine)

Understand your medications: Get in writing the name and purpose of any new medication you are prescribed. (For that matter always get everything in writing.) Make sure you can read and understand your doctor’s prescription. Whenever you are prescribed a new drug, if you have an allergy remind your doctor. Know what each of your medications are for. Does this medicine replace anything else you are taking? How do you take them? When do you take them? For how long? What are their side effects? How do you handle them? Do any of your drugs interact with each other or anything else? Are there any foods or drinks you should avoid while taking them? If you have trouble swallowing a medication ask if it comes in a liquid, and if you do have a liquid medicine make sure you know what to measure it in, and how to do so. For example, teaspoons often don’t hold a unit teaspoon. Don’t crush, chew, break, or mix your medicine in a liquid unless you are told this is OK. Take medications with water unless directed otherwise. Know what to do if you miss a dose. How should you store your medicines? What are their expiration dates?

When you pick up your medicine, check to make sure it’s what you expected, the instructions are clear, and the dose is right. If you take a large number of medications, put them all in a bag and schedule a brown bag appointment with your doctor and/or pharmacy, and go over all of them. Know both the brand and generic names of all your medications so you don’t accidentally take duplicate ones. If you use only one pharmacy the pharmacist will be more likely they will catch interactions, if you don’t then bring a complete list of what you take to all of them. Have your doctor’s name and number, and provide them to the pharmacist so they/you can call if there are any questions. (How to Prevent Medication Errors – ISMP)

Don’t save medications. Don’t share medications. Don’t throw your medications in the garbage since children can get into them, and also the drugs can get into the soil. Don’t flush them down the toilet because they can get into the water supply. See if your pharmacy has a drug recycling program. If not, perhaps your hazardous waste facility will take them. Lastly, there are organizations that donate expired medicines, those which are still good, to third world countries. (How do I Dispose of Expired Medicine? – WiseGeek)

In the hospital: If possible chose a hospital that handles many cases of your type. Find out how a hospital compares to others in general. (How Safe is Your Hospital? by Kathy Mitchell – The Austin Bulldog,) While in the hospital verify everything that is to be done for any procedure. For surgery you should put your initials on the site to be cut. One of the most important things you can do to prevent an infection is when you deal with caregivers ask them if they have washed their hands. Don’t let anyone give you medication without checking your patient identification bracelet first. Ask your nurse to keep your medications in their original package, and open them at your bedside right before giving them to you. If a medication doesn’t look like what you have been taking ask why. When you leave the hospital go over all your medications, and when you get home update your current medication list. If you aren’t able to be your own advocate have a family member or friend present doing all the above and double checking everything. When they can afford it some people even go so far as to hire their own private nurse who stays with them in the hospital and double checks all of their treatments. (When Hospital Staff isn’t Enough by Abigail Trafford - Kaiser Papers) Be sure to specify those who will need to have access to your medical records. Here is one service I ran across which is an electronic personal health record system that provides online access to your records anytime you are involved in a medical emergency or disaster. (MyCrisisRecords.com)

Looking at medial errors from the provider’s point of view:

There are parallels between the aviation and medical industries that suggest some common approaches to safety might be productive. (Patient Safety: Safety Programs in Industry – Wikipedia) Some methods that have been adapted from aviation include: mandatory and non-punitive reporting of mistakes, systematic data collection and analysis, teamwork training and feedback, and near miss reporting. What all of these measures have in common is that they involve a systems improvement approach, which aims to identify and eliminate the underlying system defects that lead to mistakes rather than focus on finding fault regarding a particular caregiver. One example which many people will be familiar with is the Deming Model of Total Quality Management. Anesthesia happens to be the area of medicine which has most thoroughly implemented the systems improvement philosophy. Some of the safety measures that have been adopted here include the standardization of IV medications to 1 ml doses, uniform color coding standards, uniform equipment controls, and back up safety mechanisms for ventilators. Several other such system safety practices more broadly adopted throughout the health care industry include: centralized sterile admixture services, the use of pharmacy computers to screen patient’s medications for interactions (5), requiring a patient’s informed consent, recommended second opinions and reviews of treatment regimens by specialists, unit dose packaging, and the Formulary System (which specifies the safest and most effective drugs for medical practice). (Risk Factors and Prevention of Medication Errors in Critical Care - Medical News Today) The limitation of a systems approach is that there are tradeoffs for the changes involved in increasing system safety. For example, there is an increase in workload when you add additional checks, and you get increased numbers of false warnings. Both of these problems might themselves cause additional errors. Another example of such a tradeoff would be the blood shortages that were created when the medical establishment limited blood donations to only very low risk donors to protect the nation’s blood supply.

Similar to the systems approach is the evidence-based medicine one. (Patient Safety: Evidence-based Medicine – Wikipedia) The aim here is to combine a doctor’s judgment regarding a particular case with the best evidence from medical research. In theory the advantages of this approach are that it should reduce problems arising from the use of outmoded medical practices, provide a common framework for communication, help consumers make better choices, and keep providers up to date with the newest practices. Problems with evidence based medicine might include providers using it to cut costs by unnecessarily limiting services, costing time and resources through implementing guidelines, disrupting the traditional relationship between providers and patients, increasing the risk of liability for those who fail to follow the guidelines in exceptional cases where they don’t apply, and limiting treatment options in harmful ways to the current consensus within the medical community. (7)

Several approaches to improving medical safety are based on changing the incentives facing caregivers. The problem with this approach is that the healthcare providers are also often the victims of the medical mistakes they make. Such mistakes can have a large emotional impact on them, so they are already highly motivated to avoid them. We seem to have reached the point of diminishing returns regarding using incentives to change outcomes, and programs based on changing incentives don’t seem to have been very successful. Pay-for-performance has been tried, but some studies have shown it has only slight incremental value. (Patient Safety: Pay-for-Performance – Wikipedia) There is also some evidence of unintended consequences, since it creates incentives for care givers to avoid high risk patients, one category of which is the poor and uneducated. It also can create incentives to meet the demands of an overly simplistic performance measure, with patient care adversely affected. Another incentive based approach is to reduce payments for medical errors. One program reduced payments for eight categories of error: blood transfusion reactions, air embolisms, falls, objects left in a patient during surgery, urinary tract infections from catheters, mediastinitis, sepsis from catheters, and pressure ulcers. A problem here is that in such a system there is a risk of creating a culture of silence and driving reporting underground. On the other hand, if reports are made confidentialto alleviate this particular problem then consumer groups complain that this denies the public the information it needs to make informed choices. Another problem with reducing payments is that patients often deal with many care providers, and assigning responsibility for mistakes is often difficult. Finally, still another incentive based reform which has been implemented has been the laws protecting whistle-blowers.

An assessment of the current situation by the Agency for Healthcare Research and Quality (AHRQ) concluded that: In spite of the fact that most of the measures of healthcare quality were improving, some were still deteriorating. The rate of change is modest. Improvement varies by phase of care and setting, and, overall, variation in care is high.

For further reading here are a few books I found on-line that looked interesting: Medication Errors by Michael Richard Cohen, The Consumer’s Guide to Medical Mistakes by Robert A. Peraino, Never Go to the Hospital Alone by Steve Harden; all found at Medical Mistakes – Google Books.

(1) One tradeoff regarding the risk of mistakes is that for at least some physicians this is likely to be part of what makes being a doctor rewarding. So without the risk the psychological rewards of medical practice would be reduced for many doctors.

(2) Some causes of poor communication are: the use of a foreign language, poor handwriting, improper documentation, a high patient to nurse ratio, patient dishonesty, numerous hand-offs of patients, unclear lines of authority, incorrectly thinking that someone else is addressing the problem, and similarly named medications.

(3) Her site lists the following alternative models: Benefactor Model: A New Model of Charitable Care: The Robin Hood Practice; Ideal Micropractice: Going Solo: Making the Leap, Going Solo: One Doc, One Room, One Year Later, What’s a Micropractice?; Cash Model: Cash and Carry Healthcare; Community-Designed Practice: The Community-Focused Family Medicine Clinic; House Call Model:
House Calls Bring Relief to Physicians, Patients; Free Clinic: Common Ground Health Clinic Video, USCD Student-Run Free Clinic Audio; Retainer Model: Dr. Knope’s Concierge Medicine Blog Video)

(4) Misdiagnosis errors often occur because a particular disease isn’t considered, incorrect information is supplied to the doctor, too much weight is given to one factor, or the symptoms of the condition aren’t sufficiently salient. Also, misdiagnosis is especially likely to occur with several types of mental illness: dissociative identity disorder, bipolar disorder, and schizophrenia. (Medical Diagnosis: Errors in Diagnosis – Wikipedia)

(5) A study of 2,600 patients found that between 26-60% of patients could not understand medication directions, informed consent, or basic health care information. M. V. Williams, et al. (1995). “Inadequate functional health literacy among patients at two public hospitals” ”low health literacy levels negatively affects healthcare outcomes. In particular, these patients have a higher risk of hospitalization and longer hospital stays, are less likely to comply with treatment, are more likely to make errors with medication, and are more ill when they seek medical care.” (See also: SES Status, Health, and the IQ Connection - Lost Wanderer)

(6) A RAND study estimated that the U.S. healthcareindustry could reduce mistakes if health information technology were widely adopted. This includes such things as electronic patient records, electronic medication ordering (including a standardized bar code system), automated drug-drug/drug-food interaction checks, allergy checks, patient education, tracking referrals and test results. Potential problems with such reforms include: default selections can potentially override non-standard medication regimens, computer system backup might lead to a false sense of security, irrelevant or frequent warnings could interrupt work flow, and mistakes due to staff inexperience with this sort of new system. (Patient Safety: Technology in Healthcare – Wikipedia)

(7) I have a very strongly held disagreement with the U.S. healthcare industry’s attitude towards risk. For a critical view of the U.S. healthcare industry’s attitude towards risk and medical practice I recommend the book, “Risk Watch: The Odds of Life“ by John Urquhart and Klaus Heilmann. The authors argue that the news creates a false understanding of the dangers in life, they discusses the risks involved in medical treatment and daily life, and argue that life is safer today than in the past. It seems to me that the health care industry is so obsessed with not making mistakes (partially for fear of liability) that overall by omission of treatment it causes many more injuries and deaths than would otherwise be the case. In other words, if you give a person a drug and it injuries them you are potentially liable. But if you don’t give ten thousand people a drug that would have saved them, because it hasn’t yet been approved, no liability applies, and this isn’t counted as a mistake. For what is overwhelmingly likely to eventually prove to be an example of this, see: Hookworms are our Little Friends – Lost Wanderer. In my opinion this asymmetry needs to be corrected by reforming liability law. Part of that reform would involve the idea that reasonable risks (and the tragedies these will inevitably create) need to be allowed and accepted to reap the huge benefits that are currently being forfeited. In many circumstances patients should have the right to take personal responsibility, and assume the risks of unproven treatments.

(Oops, Wrong Patient: Journal Takes on Medical Mistakes by Denise Grady – New York Times, Root Cause Analysis – Wikipedia, Medical Errors and Patient Safety – U.S. Department of Health and Human Services, Medical Errors by Rebecca Frey - Encyclopedia of Surgery, Dead by Mistake by Cathleen F. Crowley and Eric Nalder – Hearst Newspapers, An Epidemic of Medical Errors: The Scope of the Problem – Bear Market News)

Tags: Anesthesia, Benefactor Model, Bipolar Disorder, Cash Model, Communication, Community Ideal Medical Clinic, Community-Designed Practice, Concierge Medicine, Dissociative Identity Disorder, Dr. Knope, Dr. Pamela Wible, Evidence Based Medicine, Free Clinic, Health Information Technology, Hospitals, House Call Model, Ideal Medical Practice, Ideal Micropractice, Incentives, Medical Accidents, Medical Errors, Medications, Misdiagnosis, My Crisis Records, Retainer Model, Risk, Risk Watch: The Odds of Life, Schizophrenia, Tradeoffs
Posted in Accident Prevention, Health | No Comments »

Food Poisoning

Tuesday, December 22nd, 2009

Each year food poisoning causes about 76 million Americans to get sick, over 300,000 to be hospitalized, and 5,000 people to die. It’s estimated that only five pathogens account for more than 90 percent of food-related deaths: Salmonella (31%), Listeria (28%), Toxoplasma (21%), Norwalk-like viruses (7%), Campylobacter (5%) and E. coli O157:H7 (3%). (Food Poisoning Information Center) The typical fatality involves a child, an elderly person, a chronically ill person, or a person with an impaired immune system.

One problem people have is determining whether they have food poisoning or if they have the flue. Food poisoning tends to start and end much more quickly than the flu, and usually lasts from 12 to 24 hours. Flu symptoms generally develop slowly over a day or so and a person typically develops a headache, fever, weakness, and a sore throat. In addition to the speed of onset the three main clues suggesting you don’t have the flu and do have food poisoning are frequent vomiting, repeated diarrhea, and (sometimes) if others who ate the same food are sick in the same way.

If someone is poisoned the advice varies depending on how severe it is and how vulnerable the patient is. If the victim is a member of an especially vulnerable population, such as an infant, you should go to a doctor. If you are a healthy adult, and any of the following symptoms occur, the advice also is to get to a doctor:

See medical attention if you have a fever over 101 F, you have been vomiting for more than 12 hours, you haven’t been able to keep fluids down for at least 12 hours, you have serious muscle cramping, you have bloody diarrhea, or suspect you have botulism.

The big concern with food poisoning, except if you have botulism, is dehydration. Dehydration is indicated by any of the following symptoms: having a dry mouth or sticky saliva, have little urine or dark urine, being dizzy, lightheaded, confused, having an increased heart rate, having problems with breathing, having a fast rate of breathing, having no tears, or having sunken eyes.

In very serious cases of food poisoning medications may be prescribed to stop the cramping and vomiting, and a doctor might also prescribe antibiotics. However, you should never stop diarrhea because its purpose is to clear the toxins from the body.

Botulism is a much more serious matter, and you should get to a hospital if you think you have it. Its symptoms include a headache, double vision, dizziness, weakness, droopy eyelids, constipation, dry mouth, paralysis, or the loss of reflex to light. The antitoxin for it must be given in the first 72 hours after symptoms first appear, and cannot be used on infants.

If you choose not to go to a doctor you should rest in bed, avoid activity (especially after eating), take plenty of fluids (ideally containing electrolytes - but not lots of sugars), and have someone monitor you. You can get electrolyte drinks sold in drugstores. Unless the condition is extreme (and if it is you should be in the hospital) you shouldn’t take medicines to prevent the vomiting and diarrhea because, as mentioned above, these are the mechanisms by which your body gets rid of food toxins. If you can, temporarily discontinue all oral medications. Avoid dairy products (because of temporary lactose intolerance), and caffeinated drinks. Don’t eat solid foods until you stop vomiting, when you began to do this limit them, and only eat light, soft, bland foods (such as saltine crackers or plain bread). One option is to try the BRAT diet, which gets its name from the four foods it includes: banana, rice, applesauce, and toast. Eat and drink slowly, and don’t mix hot and cold foods. Avoid brushing your teeth after eating since this can make you nauseous.

Alternative medicine sites sometimes recommend taking charcoal tablets that soak up toxins. Others recommend treatments with two bacteria found in milk products, Lactobacillus acidophilus, Lactobacillus bulgaricus, along with citrus seed extract. A fluid to replace water and electrolytes can be made by adding one teaspoon of salt and four teaspoons of sugar to one quart of water. Two herbs that are sometimes recommended for treating forms of food poisoning other than botulism are Arsenicum album and Nux vomica. You might consider calling your doctor and asking about any other foods or liquids, and off the shelf medicines, you should take.

From my prior posts regarding symbiotes (We Need Our Symbiotes – Lost Wanderer , We Need Our Symbiotes II – Lost Wanderer, and Umami Hypothesis – Lost Wanderer) readers will know that I have mixed feelings about going all out to avoid germs, (For a lighthearted spoof of this issue see: Germs – Weird Al Yankovic) but with that in mind here’s the advice I’ve been able to find on-line regarding trying to prevent food poisoning:

Prevention:

Foods from animal sources (FFAS) include such things as meat, milk, poultry, seafood (such as fish and shellfish), and eggs. Check the expiration dates on FFAS before buying or preparing them. Keep FFAS cold, and do not allow them to sit at room temperature. Cover and refrigerate these foods within a few hours. Be careful to keep juices from animal sources from contaminating other foods, such as by dripping down in the refrigerator. Don’t thaw FFAS at room temperature. Thaw meat in the refrigerator allowing 1 day for every 5lbs. Alternatively immerse FFAS in a cold water bath and change the water every 30 minutes (a 20 lb turkey will take 12 hours to thaw in cold water.) Don’t refreeze foods that have been thawed (especially poultry), and don’t partially cook a FFAS one day and then finish cooking it the next. FFAS should be cooked thoroughly to the appropriate internal temperature for the type of meat it is, (See the chart at: Safe Food Handling – USDA) and you should be sure of the temperature by using a good instant-read, digital, probe meat thermometer that is sensitive at the tip. (Of course, some FFAS are safe because they have been pasteurized.) Don’t cook stuffing inside the turkey, and remove it from the turkey before refrigerating leftover meat. Gravy and broth should be stored separately, too. The general rule is keep hot foods hot and cold foods cold.

Don’t drink unpasteurized milk (or foods made from it), juice, or cider. (Commercial juices sold at room temperature are safe because they have been pasteurized.) (Buying food that has been sterilized by using gamma radiation is another option. (Food irradiation – Wikipedia)) Breast-feeding is safest for infants and might prevent many food borne illnesses as well as other health problems. Don’t eat shellfish that has been exposed to red tides or are from contaminated waters. Don’t give honey to children under 1 year of age. Don’t store food in containers that previously held poisons or are made of metals. Don’t eat wild mushrooms unless you are certain they are safe.

Wash your hands, cutting boards, work surfaces, and utensils with soap and hot water both before and after handling raw FFAS. Wash raw fruits and vegetables thoroughly before eating them, out of concern for E.coli, Salmonella, and pesticides. (Some people recommend avoiding alfalfa, bean, clover, or radish sprouts altogether since they are difficult to clean.) Wash your hands with soap after handling reptiles, birds, or feces. If you are ill (especially with diarrhea or vomiting) do not prepare food for others. Cover any sore on your hands before preparing food

If you do home-caning, of course, use the proper procedures, while remembering that undercooking is the main problem in home canning. Rotate dry and canned food products. Put a “Use by” date on your canned products, and if a store bought product does not have a “Use by” date take a black ink marker and write the purchase date somewhere on the label. High-acid canned food such as grapefruit, tomatoes, and pineapple can be stored for 12 to 18 months. Low-acid canned foods such as poultry, fish, meat, and most vegetables will keep from two to five years if stored in a cool dry place. Avoid containers that are swollen with bulging lids, are rusted or leaking, are dented, have an unusual odor, or have an odd color. The rule is when in doubt, throw it out. (See: Safe Home Canning of Fruits, Vegetables and Meats - University of Minnesota Extension and USDA Complete Guide to Home Canning, 2009 revision)

Those at high risk, such as people with weakened immune systems, infants, the elderly, and pregnant women should avoid soft cheeses (such as feta, Brie, Camerbert, blue, Mexican style) and foods from deli counters. (Hard cheeses, processed cheeses, cottage cheese, cream cheese, and yogurt are considered safe.)

If you need to move anything from its original package to a new container, take a marking pen and write on the new container in large letters the common name of the product. This is especially important for products that are not easily identifiable, because while what it is might be obvious to you it might not be obvious to someone else. To help prevent cross contamination have separate color-coded plastic cutting boards or cutting plastic surfaces for different foods. An example would be red for red meats, yellow for poultry, tan for seafoods, green for fruits and vegetables, blue for ready-to-eat foods, and white for dairy. Store baking utensils together and keep them separate from cooking utensils. The same goes for the pots and pans and so forth.

Things you should have in your kitchen include:

You should have a liquid soap in a dispenser for hand-washing at your kitchen sink. (Antibacterial soaps aren’t an improvement, but what is important is to thoroughly scrub under running water for at least 20 seconds.)

You should also have an easily readable thermometer for your refrigerator placed in front for easy reading. (This is also the warmest part of the refrigerator.) Keep your refrigerator set so it reads 40° F, and your freezer at or below 0 F.

You should have a paper towel dispenser instead of using kitchen sponges or cloth towels, since they are excellent breeding grounds for bacteria.

You need shallow pans or containers to store foods in the refrigerator. Shallow pans allow more surface area for more rapid cooling.

Restaurant Eating:

You should order foods or dishes that are mostly made-to-order. This means most of the cooking of the main part of the dish (the meat, chicken or seafood part) is done after it is ordered. If this is not clear from the menu then ask. Temperature abuses are more likely to occur with foods that the cook is keeping warm with a steam table or a warmer rather than keeping cold in a refrigerator.

Stick with ordering foods that you are familiar with, either because you have had it before or you know how it’s prepared. You will be more likely to notice if something is wrong.

Know the minimum cooking temperatures of the meat and seafood products you order and make a request that the food be cooked to this temperature. For example, when ordering a hamburger, ask for it to be cooked to an internal temperature of at least 160 F.

If you are served an undercooked meat or egg product in a restaurant, send it back for further cooking. You should also ask for a new plate. If the problem is more than it simply being undercooked, but the sight, smell, or taste suggests some other concern don’t eat it and don’t re-order the same food again. The server might possibly re-serve you what you just returned, or perhaps all the servings of that food might be unsafe. This is especially likely to be the case if it came from a batch processed food. Avoid raw or rarely cooked meats, eggs, and seafoods; this includes such dishes as sushi, sashimi, raw oysters, rare hamburgers, or raw egg sauces (such as hollandaise, béarnaise, etc.).

If you are going all out you should regularly review a restaurant’s inspection and violation history. This is part of the public record. Familiarize yourself with the structure of the food inspection report used by your local program. Look at previous inspections for temperature violations and food-borne illness investigations. Investigate the training that your restaurant chef received by looking for food safety certificates, degrees, etc. Many local public health programs now publicize the inspection results on the Internet as well as require food facilities to post inspection grades, and will make them available for review by the public upon request. (For more information regarding preventing restaurant food poisoning see: Food Poisoning Information Center)

(Food Poisoning – Medline Plus, What medicine is there to treat food poisoning? – Go ask Alice!, Food Poisoning – Treatment, Food poisoning prevention – University of Iowa, Food Safety – Prevention – NOAH, Food Poisoning, Food Poisoning Prevention, Food poisoning prevention – MedlinePlus)

Tags: Arsenicum Album, Botulism, BRAT Diet, Campylobacter, Cheese, Dehydration, Diarrhea, Diet, E. Coli, Electrolytes, Flu, Food Irradiation, Food Poisoning, Home-Canning, Hygiene, Lactobacillus Acidophilus, Lactobacillus Bulgaricus, Listeria, Norwalk-like Viruses, Nux Vomica, Restaurants, Salmonella, Toxoplasma, Vomiting, Weird Al Yankovic
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Radon Gas

Wednesday, December 16th, 2009

Radon is an invisible, odorless, radioactive gas that is created when naturally occurring uranium in rock and soil decays. People breathe this gas in and while it is in a person’s lungs it decays into radioactive particles, which are trapped there while they, in turn, undergo further decay. It accounts for about 56% of all the radiation the typical person receives in a year, and can eventually lead to lung cancer. (1) (Your radiation exposure - Radiological Protection Institute of Ireland)

Even though radon has always been with us, until homes and buildings became well insulated it didn’t present much of a problem since the average concentration of radon in outside air is a low 0.4 picocuries per liter (pCi/L). (2) The real concern is that radon can accumulate to much higher concentrations in indoor air because over the years construction standards have improved resulting in better sealed homes. In such situations radon can seep into buildings through cracks in their foundations, through well water, or come in around water or sewer pipes, and increase in concentration. (3) The result is that the EPA estimates that the average indoor level of radon is 1.3 pCi/L and at this level over a lifespan it will cause between 3 and 13 lung cancer deaths per 1,000 people. (The Health Risk of Radon Gas – VSI Environmental) A level of 1 pCi/L is the risk equivalent of 20 chest x-rays per year, and a level of 4pCi/L is the risk equivalent of 200 chest x-rays per year. (Radon Myths and Facts – Radon Doctor) It’s estimated that radon causes about 21,000 additional lung-cancer deaths every year in the United States. By comparison drunk driving kills about 17,400 people a year, falls in the home 6,000 a year, and home fires about 2,800 a year.

Given this situation standards were necessary, and the EPA eventually determined that a reasonable action level was 4 pCi/L. Even at this moderate concentration it’s estimated that one in fifteen homes are above it, and over a lifespan there will be between an additional 13 and 50 people in 1,000 who will die from lung cancer. For those who smoke the issue is even more pressing since it is known that smoking synergistically interacts with radon, multiplying the risk of lung cancer for any given level of exposure. Because of these facts the U.S. Congress has set a goal that indoor radon levels should eventually be reduced to the same as outdoor levels, but the problem is that this can’t be done with the current technology and available resources. For now people can generally afford to reduce radon to around 2 pCi/L.

Radon levels do vary greatly within buildings, with the highest concentrations in the lowest areas, and above the first floor the problem largely disappears in many homes. To determine the level of radon in a building there are do-it-yourself kits as well as professional testing. The kits are of two types, short term (less than 90 days) and long term (greater than 90 days). The advantage of the short term kits is that they provide a quick understanding of the situation, while the long term ones give a better understanding of the average indoor radon level throughout the year. This is important since the concentration of indoor radon can vary greatly depending on such factors as how often windows are left open. Frequently both methods are used since they are both fairly inexpensive. However when selling a home these methods often aren’t sufficient and professional testing is necessary since independent documentation is frequently required.

If the levels are above 4pCi/L, there are several common methods available to address the problem. The simplest approach is to seal the cracks in the building’s foundations. Then the next step is a vent pipe system, which involves using a pipe and fan to suck radon from beneath the building’s foundation and vent it to the outside air. These methods aren’t excessively costly, and typically run about $1,200 for repairing a home if a contractor is used.

(1) Although the literature is generally of the opinion that lung cancer is the only health risk from radon, some people speculate that radon might also be a risk factor for Alzheimer’s. (Alzheimer’s – Lost Wanderer)

(2) It should be noted that, since the risk from radon is continuous, no level is safe. Even at the 0.4 level over a lifetime such exposure will lead to about 1-3 people in 1,000 to die from lung cancer.

(3) Radon levels in homes can get very high. In 1984 Stanley Watras was a construction engineer working on the Limerick Nuclear Power Generating Station in Pottstown, Pa. Before the plant had gone into operation he found himself setting off the radiation alarms when he was entering the plant. The problem was eventually traced to high levels of radon in his home, which had 4,400 pCi/L in the cellar, 3,200 pCi/L in the living room, and about 1,800 pCi/L in the bedrooms. (Radon – A Short History) This level presented an equivalent risk to him of smoking 135 packs of cigarettes a day, or 49,275 packs a year. (Stanley Watras – Wikipedia)

(A Citizen’s Guide to Radon: The Guide to Protecting Yourself and Your Family From Radon – EPA, Radon – EPA)

Tags: Alzheimer's, Cancer, Lung Cancer, Radiation, Radon
Posted in Health | 2 Comments »

We Need Our Symbiotes II

Tuesday, December 15th, 2009

For a short follow-up to my prior blog post, (We Need Our Symbiotes – Lost Wanderer) Gut Buddies reports the following:

The Bifidobaterium lactis strain may be partly responsible for breast-fed infant’s enhanced immune systems.
Bifidobacterium infantis may reduce symptoms associated with inflammatory bowel disease and irritable bowel syndrome (bloating, cramps, gas, diarrhea).
Lactobacillus bulgaricus and Streptococcus thermophilus are used in yogurt and help decrease lactose intolerance and may prevent diarrhea. Be sure the label on the yogurt says it contains live and active cultures.
Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii may help treat diarrhea associated with antibiotic treatment. Antibiotics sometimes destroy healthy bacteria while trying to kill unhealthy bacteria and sometimes diarrhea will result.
Lactobacillus acidophilus may help decrease yeast infections.
Lactobacillus casei may help reduce the incidence of cancer, specifically bladder cancer.

Tags: Bifidobacterium Infantis, Biofidobacterium Lactis, Gut Buddies, Lactobacillus Acidophilus, Lactobacillus Bulgaricus, Lactobacillus Casei, Lactobacillus Rhamnosus GG (LGG), Saccharomyces Boulardii, Streptococcus Thermophilus, Symbiotes
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We Need Our Symbiotes

Monday, December 14th, 2009

My next post will be on avoiding food poisoning, but before I post on that issue I need to point out that there obviously exists a balance between living in disease causing filth and being obsessively hygienic. A lot of research suggests that we need various probiotics in order to be healthy, and that a large number of health problems occur because we have cleaned up our environment so thoroughly that we don’t have the necessary symbiotes in our bodies any more.

The hygiene hypothesis seems to be gradually being refined into what has been called the Old Friends Hypothesis. The shift is from one of believing that we benefit from infections with various organisms in general sort of way, to saying that bad organisms are bad for us, and good organisms (symbiotes) are good for us. So, obviously we should try to avoid the bad ones and seek out the good ones. Here are two previous blog posts of mine that touch on this issue The Umami Hypothesis – Lost Wanderer and Apitherapy & Biotherapy – Lost Wanderer.

Here is a general survey of some of this material by Gut Buddies: ‘Friendly’ bacteria: side-lined healers - Gut Buddies (Some of the friendly bacteria (and products) referred to by Gut Buddies in this post are: segmented filamentous bacterium, Lactobacillus acidophilus and Bifidobacterium animalis, Bifidobacterium infantis 35624, Puritan’s Pride, Lactobacillus reuteri, B. infantis 35624, Lactobacillus F19, L. acidophilus NCFB 1748 and B. lactis Bb12, Advanced Oral Hygiene with S. salivarius and B. coagulans, PerioBalance with Lactobacillus reuteri Prodentis, Halofuginone, and Bacillus polyfermenticus).

Helminths (hookworms and whipworms, etc.) have been apparently very effective in helping with numerous allergic and autoimmune conditions, including allergies, asthma, autism, Crohn’s Disease, Eczema, Irritable Bowel Syndrome, Multiple Sclerosis, Psoriasis, Sjögren’s Syndrome, and Ulcerative Colitis. (AutoimmuneTherapies) (Hookworms are our Little Friends - Lost Wanderer)

Similar immune-modifying symbiote-based therapies might help with many other diseases and conditions:

Alzheimer’s (Alzheimer’s Inflammation May Trigger Alzheimer’s Disease via Autoimmune & biotherapy news 2009/7/9 – Gut Buddies) (See also: Alzheimer’s – Lost Wanderer)

Aortic dissection (Inflammation Critical in Aortic Dissection, Researchers Find via The worm’s next success? – Gut Buddies)

Autism (Autism May Be Linked to Mom’s Autoimmune Disease (type 1 diabetes, rheumatoid arthritis and celiac disease) via Autoimmune & biotherapy news 2009/7/9 – Gut Buddies) (See also: The Vitamin D Theory of Autism – Lost Wanderer)

Dental Issues (Probiotic lozenges promote oral health - Gut Buddies (GUM PerioBalance (Lactobacillus reuteri Prodentis) and Advanced Oral Hygiene lozenges (S. salivarius and B. coagulans)

Depression (Is Dirt the New Prozac? by Josie Glausiusz (concerning the common soil bacterium, Mycobacterium vaccae)

Diabetes (Diabetes- Lost Wanderer)

Diarrhea (Kefir benefits the sickest young children on antibiotics - Gut Buddies)

Flatulence Odor (You Can be a God/Goddess – Lost Wanderer (Odafree/Whiff withYucca Shidgera from desert Yucca, Fructo-oligosacharides from Jerusalem artichokes, and Copper Chlorophyllin from alfalfa. Local inventor clearing the air on pill that helps you breathe)

Gastric reflux (Reflux Esophagitis Due to Immune Reaction, Not Acute Acid Burn via The worm’s next success? – Gut Buddies)

Migraine Headaches (Migraine Headaches - Lost Wanderer)

Narcolepsy (Narcolepsy Is An Autoimmune Disorder, Stanford Researcher Says via Autoimmune & biotherapy news 2009/7/9 – Gut Buddies)

Obesity (Study Confirms: Your Hidden Food Allergies Are Making You Fat via Give microbes to mum for less-allergic young - Gut Buddies)

(Probiotics may reduce belly fat in women (Lactobacillus and Bifidobacterium) via Obesity As An Immune Disorder – Matt Metzgar)

(Early differences in fecal microbiota composition in children may predict overweight (Staphylococcus aureus) via Obesity As An Immune Disorder II – Matt Metzgar)

(Childhood: Food Allergies May Be Linked to Obesity by Nicholas Bakalar and The Effect of The ALCAT Test Diet Therapy for Food Sensitivity in Patient’s With Obesity via Obesity As An Immune Disorder III – Matt Metzgar)

(Obesity – extending the hygiene hypothesis via Microflora - Matt Metzgar)

Obsessive-compulsive disorder (Link Discovered Between Antibodies To Strep Throat Bacteria And Obsessive Compulsive Disorder (and Tourette syndrome) In Mice (Group A beta-hemolytic streptoccoccus (GABHS)) via The worm’s next success? – Gut Buddies)

Schizophrenia (Schizophrenia - Lost Wanderer) (Immune System Activated in Schizophrenia via The worm’s next success? – Gut Buddies)

Vaginosis (Bacterial vaginosis treatments: Probiotics can increase effectiveness of some antibiotic therapies via Autoimmune & biotherapy news 2009/7/9 - Gut Buddies)

Recently, Matt Metzgar has been posting a lot on the topics of probiotics (1) and prebiotics. Matt began by pointing out the site Paleobiotics, which discusses how the ancient diet influenced people’s gut flora. The diets of hunter gatherers would have had a lot of indigestible fibers in them, which were instead consumed by our gut bacteria. Since we no long eat this sort of diet we harbor somewhat different colonies of bacteria, to the likely detriment of our health. Matt points out that in one study (Can vegetables help you resist infection?) that men who took prebiotics massively increased their good gut bacteria, but the group only taking a probiotic didn’t benefit very much. (See also: Eat Bugs. Not Too Much. Mainly With Plants via Prebiotics versus Probiotics - Matt Metzgar)

Conditions that Matt talks about that might be influenced by the types of bacteria we harbor include:

Allergies (The role of Probiotics in allergic diseases, Maternal breast-milk and intestinal bifidobacteria guide the compositional development of the Bifidobacterium microbiota in infants at risk of allergic disease, (bifidobacteria) Babies, Bacteria and Breast Milk: Genome Sequence Reveals Evolutionary Alliance (Bifidobacterium longum supsp. infantis) via Balancing Bacteria - Matt Metzgar and Babies and Bacteria – Matt Metzgar)

Anxiety, in patients with chronic fatigue (A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome (Lactobacillus and Bifidobacteria) via Probiotics and Mood – Matt Metzgar)

Chronic diarrhea (Don’t poo-poo technique: Fecal transplant can cure superbug, doctors say via Transplanting Good Bacteria - Matt Metzgar)

Cold and flu symptoms in children (Probiotic effects on cold and influenza-like symptom incidence and duration in children, (Lactobacillus acidophilus or L acidophilus NCFM in combination with Bifidobacterium animalis) and HOWARU (Bifidobacteria and Lactobacilli) via Probiotics for Children – Matt Metzgar)

Dental Issues (EvoraPlus via Probiotics and Oral Health - Matt Metzgar)

(The effects of manuka honey on plaque and gingivitis: a pilot study, Streptococcus mutans in saliva of normal subjects and neck and head irradiated cancer subjects after consumption of honey via Honey and Oral Health - Matt Metzgar)

(Peelu, Comparative effect of chewing sticks and toothbrushing on plaque removal and gingival health, Subgingival plaque microbiota in Saudi Arabians after use of miswak chewing stick and toothbrush, Chewing sticks versus toothbrushes via Chewing on Fiber II - Matt Metzgar)

(Toothbrushing with vegetable oil: a clinical and laboratorial analysis via Brushing with Vegetables - Matt Metzgar)

(Dietary fiber intake and dental health status in urban-marginal, and rural communities in central Mexico and A longitudinal study of the relationship between diet intake and dental caries and periodontal disease in elderly Japanese subjects via Chewing on Fiber - Matt Metzgar)

Hypertension (The Improvement of Hypertension by Probiotics: Effects on Cholesterol, Diabetes, Renin, and Phytoestrogens via Hypertension and Probiotics – Matt Metzgar)

(1) In addition to the conditions mentioned in this post, probiotics might also help with such things as lactose intolerance, colon cancer, cholesterol, improving immune function and preventing infections, improving mineral absorption, preventing harmful bacterial growth under stress, and managing urogenital health. (Probiotic – Wikipedia)

Tags: Advanced Oral Hygiene, Allergies, Alternative Therapies, Alzheimer's, Anxiety, Aortic Dissection, Apitherapy, Asthma, Autism, Autoimmune Diseases, B. Coagulans, Bifidobacterium Animalis, Bifidobacterium Bb12, Bifidobacterium Infantis 35624, Bifidobacterium Longum Infantis, Biotherapy, Celiac Disease, Chewing Stick, Cholesterol, Colds, Colon Cancer, Copper Chlorophyllin, Crohn's, Dental, Dental Health, Depression, Diabetes, Diarrhea, Diet, Discordance Hypothesis, Eczema, EvoraPlus, Flatulence, Flue, Food Poisoning, Fructo-oligosacharides, Gastric Reflux, Gingivitis, Group A Beta-Hemolytic Streptococcus (GABHS), Gut Buddies, Helminths, Honey, Hookworms, Hygiene, Hygiene Hypothesis, Hypertension, IBS, Inflammation, Irritable Bowel Syndrome, Kefir, L. Acidophilus, L. Acidophilus NCFB 1748, Lactobacillus Acidophilus, Lactobacillus F19, Lactobacillus Reuteri, Lactobacillus Reuteri Prodentis, Lactose Intolerance, Matt Metzgar, Migraine Headaches, Migraines, Mismatch Theory, Miswak Chewing Stick, MS, Multiple Sclerosis, Mycobacterium Vaccae, Narcolepsy, Natural Living, Necator Americanus, Obesity, Obsessive Compulsive, Odafree, Old Friends Hypothesis, Paleobiotics, Peelu, PerioBalance, Plaque, Prebiotics, Pregnancy, Primitivism, Probiotics, Psoriasis, Rheumatoid Arthritis, S. Salivarius, Schizophrenia, Segmented Filamentous Bacterium, Sjogren's, Staphylococcus Aureus, Streptococcus Mutans, UC, Ulcerative Colitis, Umami Hypothesis, Vaginosis, Whiff, Yucca Shidgera
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Safe and Green Cleaning

Saturday, December 12th, 2009

In one of my earlier blog posts I discussed the miracle cleaner electrolyzed water, but for now we will have to get by with other products. Matt Metzgar has discussed using Green Works and Ecover products. (Green Works – Matt Metzgar and Going Green – Matt Metzgar) (Although, for a critical review of Green Works products you can read, “The Four Biggest Enviro-Scams: Green claims that make us see red” By Amy Tennery, who recommends Seventh Generation products as superior. (But be sure to also read the rebuttal to this.)) Another such product line is EnviroRite’s. And online, Greenhome.com sells a number of such products.

For those who want to go a step further, and live as safe and green as possible, you can make your own products. I won’t try to reproduce the vast lists of specific formulas people recommend for doing home chores, but only try to hit a few of the highlights. If you wish to pursue this, the links provided below should more than get you going. (Also, for a whimsical perspective on replacing products with substitutes – which aren’t necessarily green – you can take a look at Joey Green’s Wacky’s Uses for Brand Name Products site.)

There are a few ingredients common to many of the recommendations people make. (From Non-Toxic Home Cleaning - Eartheasy):

Baking Soda – cleans, deodorizes, softens water, scours.

Soap – will clean most things. (unscented, phosphate free, and doesn’t contain petroleum distillates)

Lemon (juice) – a strong acid that is effective against most bacteria.

White Vinegar – cuts grease, removes mildew, odors, some stains and wax build-up.

Washing Soda – is sodium carbonate decahydrate. It will cut grease, remove stains, soften water, clean walls, tiles, sinks and tubs. Do not use on aluminum.

Ethanol Alcohol – is an excellent disinfectant.

Corn Starch – can be used to clean windows, polish furniture, and shampoo carpets and rugs.

Hydrogen Peroxide - used as a disinfectant.

You can find suggestions for just about every conceivable purpose: air fresheners and deodorizers, fabric softeners, furniture polish, stain removers, pesticides (ants, fleas, flies, mice, mites, mosquitoes, moths, roaches, wasps, etc. ), windshield washer fluid, shoe polish, rust removers, disinfectants, cleaners for glass, your hands, the oven, vinyl, wood, drains, mildew, toilets, paintbrushes, floors, tub and tile, aluminum, copper, brass, silver, porcelain, etc.

On a related issue, there are sites online that focus on cosmetics safety. The Campaign for Safe Cosmetics. Here is an article that discusses this issue: Safe Cosmetics by Christina Hartje-Dunn,

Here is a somewhat random selection of books on safe and green cleaning: Clean Your House Safely and Effectively without Harmful Chemicals by Randy Dunford, Green Clean: The Environmentally Sound Guide to Cleaning Your Home (Paperback) by Linda Mason Hunter, Green Clean by Linda Mason Hunter, Better Basics for the Home: Simple Solutions for Less Toxic Living (Paperback) by Annie Berthold-Bond, and Easy Green Living: The Ultimate Guide to Simple, Eco-Friendly Choices for You and Your Home (Paperback) by Renee Loux.

Here are a number of online articles dealing with green living and safe cleaning: Safer Alternatives To Common Household Products - Barlow Scientific, Hazardous products and healthy alternatives – King County, A Consumer Guide To Safer Alternatives To Hazardous Household Products, Part 2; The only 18 things you need for a clean house by Valerie Rains, Shine staff, Cleaning the House Safely by Elizabeth Hughes, Alternative Cleaners - Howare County Recycling District, Natural Insect Pest Control – Eartheasy, Non-Toxic Home Cleaning – Eartheasy, Alternative Cleaning Recipes – Ecology Center, Non-Toxic Household Cleaners by Kendra Cecil, Less Toxic Alternatives – Clean Community System, Hazardous Household Substances: Alternatives That Are Relatively Free of Toxic Effects by Marie Hammer, Tips on finding the safest household products – King County, Safer Alternatives to Hazardous Household Products – State of Nevada Bureau of Water Pollution Control, Home and Garden Tips – Natural Resources Conservation Service: U.S. Department of Agriculture, Safe Alternatives to Household Hazardous Products – Sierra Club of Canada, Safe Alternatives to Hazardous Household Products – King County Kid’s Page, Household Hazardous Products - Univ. of Missouri Extension, Green-Clean Your Home By Amy Roffman New, From Natural Health, September/October, 1994; and How to Make a Non-Toxic Cleaning Kit by Annie B. Bond,

Tags: Cosmetics, Ecover, Electrolyzed Water, EnviroRite, Green Cleaning, Green Works, Greenhome, Hygiene, Joey Green, Matt Metzgar, Natural Living, Seventh Generation, Toxins
Posted in Accident Prevention, Health, Lifestyle | No Comments »

Lead Poisoning

Friday, December 11th, 2009

Lead has no known function in the human body. It’s an insidious toxin with a very broad range of symptoms, and even people who appear healthy can have dangerous levels of it in their blood. The problem of lead contamination is entirely a result of civilization, since levels in pre-industrial people (in the range of 0.01 micrograms/deciliter (mcg/dl)) were around 100 to 1,000 times lower than blood levels typically found in people today. (Lead Toxicity, A Review of the Literature. Part I: Exposure, Evaluation, and Treatment Lyn Patrick, ND)

One of the major players in this disaster was the Ethyl Corporation. In its pursuit of profits it criminally exposed workers to lead in its factories, and lied about it while they were dying. Its lead-based-no-nock-gasoline-additive eventually put about seven million tons of lead out through the tailpipes of cars into the atmosphere. (1) (The Ethyl-Poisoned Earth by Alan Bellows)

The main cause of lead’s toxicity is its ability to interfere with many enzymes by binding to their sulfhydryl groups. Short term measurable effects of lead poisoning begin at 25 mcg/dl. Obvious symptoms begin to occur at levels above 40mcg/dl in adults, and above 60 mcg/dl in children.

The list of potential health problems related to lead is a very long one: Lead can damage hearing, vision, muscle coordination, the blood, kidneys, heart, and reproductive system. Symptoms can include abdominal pain, anemia, loss of appetite, constipation, delayed growth, depression, diarrhea, fatigue, headaches, irritability, decreased libido, memory loss, muscle pain, nausea, personality changes, problems with sleep, an unusual taste in the mouth, weakness, tingling in the extremities, vomiting, and weight loss. In one recent study those people with blood lead levels in the top 20% (over 2.11 mcg/dl) of the subjects had 2.3 times the odds of suffering from a major depressive disorder, and almost 5 times to odds of having a panic disorder as those in the lowest 20% (under 0.7 mcg/dl). (The average blood lead level of the group was 1.61 mcg/dl.) (Young Adults’ Blood Lead Levels Linked to Depression, Panic Disorder)

Exposure to even low levels might cause irreversible learning difficulties and mental retardation in children. One study found that the IQ scores of children dropped about 7 points across the sample as children’s blood lead levels varied from 1 mcg/dl to 10 mcg/dl. (2) (Very Low Lead Levels Linked With IQ Deficits)

The current consensus is that there is no safe level of lead exposure. Lead accumulates in the blood, soft tissues and bone; and its half-life is weeks in blood, months in soft tissues, and years in bone.

In the past lead was used commonly in house paint, as an additive to gasoline, and as a pesticide. One piece of good news in all this is that the Clean Air Act has helped reduce air emissions of lead nearly 90 percent during the last 20 years.

If you have a problem with lead contamination there are a number of things you can do to deal with it:

Make sure your child’s blood is tested for lead before age 2, and regularly to age 6, if there is the possibility of lead in the child’s environment. The major treatments are removal of the source of lead and possibly chelation therapy (administration of agents that bind lead so it can be excreted). (Chelation therapy – Wikipedia)

Around the home anything that has paint or a finish made before 1978 in the U.S. could be a source of lead. (It was banned in France and many other countries before 1920.) So you shouldn’t use cribs, bassinets, highchairs, painted toys, or toy chests made before that date. Lead paint is still sometimes found in toys and toy jewelry made today, so you should keep up on toy recalls by checking the lead recall lists. (Toy Hazard Recalls – CPSC) Unfortunately, 75% of the nation’s housing has lead paint. Broken down by time period, 90% of pre-1940 buildings have it, 80% of pre-1960 ones have it, and 62% of pre-1978 buildings have it.

Keep children away from paint chips (which they might eat) by closing and locking doors. You should create barriers between living and play areas, and the sources of lead. Apply temporary barriers such as contact paper or duct tape to cover lead sources.

Lead contaminated dust can be created by the friction of opening windows and doors, it might be blown in - coming from distant contaminated soils, or it can be generated during home renovation on a pre-1978 house. Lead dust is invisible and will pass through most masks and filters, so, if you have to sand or strip old paint that may contain lead, be sure to use a high quality mask to prevent inhalation of lead particles. Regularly wash children’s hands, pacifiers, toys, and any other items that might go in the mouth. Feed children nutritious low-fat meals high in calcium and iron, since this will reduce the amount of lead absorbed into the body. Wet-mop and wipe floors, window components, and other horizontal surfaces (counters, tables or floors) frequently. If possible, windows should be kept shut to prevent abrasion of painted surfaces, or only opened from the top sash. Don’t vacuum with a regular vacuum because it just lets lead dust fly around, but instead use a vacuum cleaner that utilizes a HEPA (High-Efficiency Particulate Air) filter. Pregnant women and children shouldn’t be present during a pre-1978 house renovation.

Lead was often in exterior oil-based paint prior to 1950, and as it ages it often contaminates soil about a house where children play. Stop children from playing in bare soil and close to the sides of the house. Instead, provide them with a sandbox more than 3 feet away from it. (If your do have a sandbox, parents should cover the box when it’s not in use to prevent cats from using it as a litter box.) Plant grass on areas of bare soil, or cover the soil with mulch or wood chips. Take off your shoes when you go inside, and, if you walk barefoot outside, wash your feet when you go indoors. Also, give your pet’s feet, legs, and undersides a rubdown with a towel after taking them outdoors.

Lead solder can contaminate house pipes, so, unless you know your pipes are uncontaminated, you should only use cold water from the tap for drinking or cooking. Also, if water sits in a pipe for several hours flush it from the tap for two minutes before drinking. You can also use a water filter to reduce the lead in the water you cook and drink with. For example, a simple Brita water filter will remove around 9o% of the lead found in tap water.

Replace inexpensive, horizontal, plastic blinds that have been made in Asia or Mexico, since these types of blinds often contain lead. Pregnant women and children should not be exposed to burning candles that could contain lead in their wicks. Don’t drink out of crystal glass. Soft vinyl lunch boxes can have dangerous levels of lead. Avoid using any personal care products that contain significant amounts of lead.

Hobbies that often involve working with lead are making stained glass windows, working with pewter and other collectible figurines, the glazing and firing of pottery and ceramics, making lead weights, reloading and making ammunition, making lead shot, target practice, making lead fishing weights or lures, refinishing furniture, and remolding. You should never sand, burn, or scrape paint unless you either know it doesn’t contain lead, or take the proper precautions. You should shower and change clothes after finishing a task that involves working with lead-based products.

Sites where lead might be a problem are hazardous waste sites, an area where cars are abandoned or repaired, ballast on a ship, a heavily traveled major highway or roadway, and an older house with peeling exterior paint. Also artificial turf playing fields have recently been found to produce a potentially hazardous amount of lead dust.

Other sources of lead are kohl (a South Asian cosmetic), sindoor (a cosmetic used by traditional Hindu and Sikh married women), herbal remedies (Ayurvedic preparations (Ghasard, Bala Goli, and Kandu), surma, and those of Chinese origin), and folk remedies (azarcon (also called Maria Luisa, Liga, Alarzon, Alkohl, Greta, Coral and Rueda), farouk, bint al zahab, and pay-loo-ah). Additional sources are solder which was used in the past to seal cans of food, ceramic glazes, lead curtain weights, lead bullets from hunted animals, bullets lodged in a person’s joints (since they deteriorate over time), imported candies that contain tamarind or chili, contaminated pottery, containers, cookware, or tableware. Older Christmas tree ornaments might be decorated with lead paint, and lead is in some tree light wires. Old newspapers, paper bags, magazines, and comic books could have been made with lead based inks. You should never burn treated lumber, since there will be heavy metals in the smoke. Industrial facilities, urban runoff, and atmospheric deposition are all sources of lead in the aquatic environment. Even your keys can often contain small amounts of lead.

Types of work that is typically associated with the risk of lead contamination include house construction and repair, shipbuilding, painting (especially marine related painting), iron processing, brass or copper foundry valve and pipe fitting, bronze work, welding, resurfacing, bridge, tunnel, and elevated highway construction; the demolition of bridges, towers, and other steel structures; lead battery manufacturing and recycling, radiator manufacturing and repair, scrap metal recycling, the electronics industry, the manufacture of some plastics, automotive repair, fishing weight production, leaded glass manufacturing, lead ore production, milling, and smelting; and municipal solid waste incinerators.

If your workplace poses a risk of lead contamination there are a number of safety precautions you should take: You should work with your employer to reduce lead and lead exposure in the workplace, perhaps by providing special ventilation equipment and/or fitted respirators. Wash your hands and face before eating, drinking, or smoking. Eat, drink, and smoke only in areas free of lead dust and fumes. Wet clean and HEPA vacuum lead-contaminated dust. Use separate work clothes and shoes while at work, and keep your street clothes in a clean place. Shower at work before going home, and launder your work clothes at work. If you take your work clothes home, wash and dry them separately.

For more information there are a number of sources you can contact. Here are some numbers:

EPA’s Safe Drinking Water Hotline 1-800-426-4791.

National Lead Information Center 1-800-LEAD-FYI, or 1-800-424-LEAD (5323).

Lead Surveillance and Reporting, Office of Epidemiology, 1-360-236-4252.

For information about lead in the workplace call the Department of Labor and Industries, 1-360-902-5663.

For a list of qualified testing laboratories for analysis of lead in paint, soil, or dust call 1-800-424-LEAD. Please specify that you are requesting the NLLAP/ELPAT list of laboratories.

HUD’s Lead Reduction Office, see: http://www.hud.gov/lea/leahome

For a home test, see: http://leadtestkit.com/kits1.html

You can also talk to your state or local health department about testing paint and dust from your home for lead.

To permanently remove lead hazards, you have to hire a lead “abatement” contractor. Call your local paint stores to find out if the contractor you’re considering has a good history with the store. Find a contractor who has been in business for several years, and can offer references. The longer they’ve been in business, the more they will likely know about lead. Find a contractor with whom you feel comfortable, and who can answer your questions and explain their work.

(1) Only one of the many consequences of this might have been a nationwide crime wave. A number of recent studies have shown a strong correlation between atmospheric lead levels and crime rates. The sharp decline in US crime rates, which began in the early 1990s, correlates perfectly with the reduction of leaded gasoline in the early 1970s. Other countries have seen similar declines, also delayed by twenty years. (The Ethyl-Poisoned Earth by Alan Bellows)

(2) Throughout this entire discussion there exists the common problem of inferring causation from correlation. Since direct experiments with humans would be unethical, many results require an assumption that lead is actually the cause of a health problem. At higher levels of contamination this assumption is unproblematic, but at lower levels this can be a source of uncertainty. Looking at the national lead standards for blood toxicity through the years, in the space of about 50 years, they have changed six-fold from 60 mcg/dl to 10mcg/dl. One reason to be skeptical of a 7 point IQ drop because of such low lead levels is that this suggests that people who grew up in the 1950’s and 1960’s would have had greatly reduced IQ’s, and this doesn’t seem to have been the case.

In 1960, 60 mcg/dl
In 1970, 40 mcg/dl
In 1975, 35 mcg/dl
In 1985, 25 mcg/dl
In 1991, 10 mcg/dl

It is certainly possible that raising a child’s blood lead level from 1 mcg/dl to 10 mcg/dl directly causes an average 7 point drop in IQ. The problem here is that there are potentially hundreds of confounding variables that could be creating the observed correlation. It’s possible that children with lower IQ’s have a greater tendency to chew on paint chips, be less well-nourished, or attend poorer schools. Also, parents with lower IQ’s might have a greater likelihood of living in lower quality housing and in more contaminated neighborhoods, be less aware of the dangers of lead poisoning, or be less competent when taking precautions, etc. So, the connection between lead at low levels and IQ could be one of children inheriting genes from relatively lower IQ parents, which predispose them to also have lower IQ’s.

In short, while it is entirely reasonable to take no unnecessary chances with lead poisoning (personally I would prefer my blood level to be literally zero), it’s only careful to remember that researchers haven’t actually established an airtight connection between the low blood lead levels and the observed health effects they are currently concerned about. (From: Toxic Lead Levels by Valerie)

(Lead – CDC) (Lead – Prevention Tips – CDC) (Lead – Sources of Lead – CDC) (Lead Poisoning Fact Sheet) (The Basics about Lead Paint – Home Safe Environment) (Lead Poisoning – Wikipedia) (How to Lower The Risk of Your Child Getting Lead Poisoning – eHow) (Simple ways to help prevent childhood lead poisoning - iVillage) (Helping Parents Prevent Lead Poisoning. ERIC Digest. by Binns, Helen J. – Ricks, Omar Benton) (Lead Poisoning: Prevention – MayoClinic) (Ways To Prevent Lead Poisoning by Dr. Ben Kim) (How to Prevent Lead Poisoning) (Prevention of Lead Poisoning – Cure Research) (Campaign for Lead Safety Awareness – Angie’s List) (Lead Poisoning Prevention – KeepKidsHealthy)

Tags: Causation Versus Correlation, Chelation, Clean Air Act, Crime, Ethyl Corporation, IQ, Lead, Lead Poisoning, Mental Health, Pregnancy, Toxins
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Preventing Falls

Saturday, November 28th, 2009

Falls are the second leading cause of accidental death in the United States each year. According to the home safety council they cause about 5.1 million injuries and nearly 6,000 deaths yearly. (Falls Prevention - Home Safety Council) Many seniors who fall never go home again, and are placed in care facilities or end up in a wheelchair for the remainder of their life. The average cost of health care resulting from a fall is $19,440, not including doctor’s fees. Falls also result in five times more hospitalizations for seniors than the next leading cause. Roughly 25% of such falls are listed as the main cause of death through complications in those over 65 years of age. (Cost of Falls Among Older Adults – CDC) (Hip Fractures Among Older Adults - CDC)

Here are some ways to prevent them:

The stairs are where many serious falls occur, and a large number of them occur when someone is carrying something. So, don’t try to carry too many things at once, and give yourself at least one free hand to grab the handrail. You should have secure handrails on both sides of your steps and stairs, and make sure they run from the top to the bottom extending 12 inches beyond both. They should be rounded and no more than 1 & 1/2 inches in circumference. Their ends should also be shaped to indicate when you have reached the top or bottom. Obviously, keep all litter off stairs. The entire stair length should be well lit, and you should be able to turn on the lights from both ends. Preferably stairs should have no carpet, but instead anti-slip strips or anti-slip paint on them. If there is carpet on the stairs it must be firmly attached and be tightly woven with a low pile. Your stairs should not have noses or open risers. If there are children in the home the stairs should have safety gates. Stair treads should be deep enough for a whole foot, 11 inches or more. Stair rises should be no higher than 7 inches. If you have eye problems you should paint a line at the edge of stairs so you can see it better. The ultimate stairs solutions would be either to live in a house with only one level, or to install an elevator. If you have only a short rise to deal with consider having a ramp instead of steps.

The bathroom is another common place where falls occur. You should have non-slip strips or a mat in the tub or shower. You should also have a non-slip bath mat outside of them. Have grab bars in them, and handle bars on the toilet that makes it easier to stand up. (1) All grab bars must be mounted properly, so they can not only carry a person’s full weight, but also the greater momentary force generated when a person is falling. Replace a sliding glass door with a shower curtain. A shower seat will allow people to wash without having to bend over. A liquid soap dispenser will prevent having to fish around for a dropped bar. And a storage unit attached to the shower or tub will reduce a person’s need to turn around to reach things. You can convert your regular shower head to a hand held shower spray, which will allow you to reach farther. If you buy a tub transfer bench you can remain seated at all times when getting in and out. You also might consider converting over to a walk-in shower. Fix any leaks which might make the floor unnecessarily wet and slippery. Remove soap build-up in tub or shower on a regular basis. Use hard water, since soft-water can make things very slippery. If you need to go to the bathroom often at night, consider using a bedside commode.

In the kitchen you should install cabinets, sliding shelve, and lazy Susans so that you don’t have to reach up to get things. Commonly used items should be stored between waist and shoulder level. To reach higher items have a solid step stool with nonskid steps and feet and a bracing bar to hold on to. Wipe up spills as soon as they happen. The oven and refrigerator should open easily. You should have an area where you can sit down to prepare food. Use non-skid wax on the kitchen floor, and put a non-skid mat by the kitchen sink.

Around the home make sure that cords are not underfoot, and don’t run them under rugs directly where you walk. You should have a straight path through every room. Floors should be smooth and level, but not slippery. Preferably doorways should be wide, 36 inches is a good size. All doors and windows should open and close easily. Living room chairs should be sturdy, not swivel chairs, chairs on casters, or lightweight chairs. All the other furniture should also be sturdy enough for you to lean on. Carry things in your pockets so your hands are free to grab and stop a fall. Don’t walk in the dark, but have night lights in the bedroom, hall, and bathroom. Glowing light switches can help. Make sure your lighting doesn’t produce hazardous shadows or glare, and light cords should be long enough so you don’t have to reach up. Provide good lighting for the closet. Carry a small flashlight on your keychain. Ideally get rid of small rugs, or, if not, at least securely tape them to the floor with double sided carpet tape all around. Repair or replace frayed corners or rolled up edges on carpets and floor coverings. In general you want to minimize bending or climbing. A long-handled grasper can be used to reach objects that are on high shelves or on the floor. Lower the closet shelves. You should get up from chairs or your bed slowly, and take advantage of the fact that higher chairs and couches are easier to ease into and out of. Keep track of where your pets are, and put them in another room before carrying heavy things into the house. Close cabinets and drawers when done. Have a phone close to the floor so you won’t have to get up in case you fall, and keep emergency numbers near each phone. Furniture should have rounded or padded corners in case you fall. (Safety › Edge & Corner Guards)

In the bedroom your bed should be low enough such that you do not have to climb into it, and high enough so that you can sit with your feet on the ground. Have the light switch and your eyeglasses within arm’s reach of where you sleep, and a phone close to the bed so you can answer it from there.

Don’t wear trailing clothes, and if your clothes have long cords shorten them. Avoid bare socks, smooth soled shoes, shoes with shoelaces, and slippers. Instead wear low heeled shoes with good grip, or go barefoot. If you are barefoot you will feel the ground better, and this feedback should help you walk better. (See also: Barefoot Walking and Running – Lost Wanderer) Matt Metzgar reports on a high tech approach that works along these lines. Researchers are doing vibration research that involves providing sensory feedback to people’s feet. Scientists at Harvard are working on vibrating insoles, and one group has shown that such subsensory vibrations do improve the elderly’s gait. (Vibration Roundup – Matt Metzgar, Statipro (a French company), US Patent 6024093 – Proprioceptive sole or pedal device containing crystals for treatment of statural disorders, Vibrating Insoles – Wyss Institute, and Subsensory vibrations to the feet reduce gait variability in elderly fallers)

Outside you need a roof or awning to keep snow off of your home’s entrance-way. Have a place near your door where you can put packages while you close it and get ready to put things away. Sidewalks and walkways should be well lit and clear of debris, clutter, and weeds. You should keep your steps and sidewalks in good condition by fixing broken or uneven steps. Holes and cracks are trip hazards, as are bumps and ridges. Put abrasive strips on outdoor steps, and have a non-stick surface area inside all of your outside entrances. Install motion sensitive lights on your outdoor paths. Have someone shovel immediately after a snow storm, and then apply salt or sand. All entrance areas should have an outside space large enough such that you are not crowded by your swinging door.

To prevent child falls consider installing window guards on windows ground floor and up, unless designated as emergency fire exits. Make sure they have easy release mechanisms. When a child can pull to a standing position, the crib mattress should be adjusted to its lowest position; there should be at least 26 inches between the top rails of the crib drop side and the mattress. Toys, bumper pads, and other objects that can be used as steps to climb out should be removed from the crib. Never leave babies alone on beds, changing tables, or sofas. Strap children into high chairs and strollers. Keep furniture away from windows. Keep windows and doors locked. For bunk beds you should never allow a child younger than age 6 to sleep on the top bunk. For older children, if the upper bunk is not up against a wall, use guardrails on both sides. No matter how old a child is, keep the guardrails in place on the top bunk since children might roll out during sleep. Don’t allow any horseplay on bunks. You should keep dresser drawers pushed all the way in to lessen the risk of a child climbing up the dresser. Make it a habit to push kitchen and dining room chairs in under the table to take away an attractive climbing gym for children. Don’t store desserts or other treats in high locations, particularly over stoves, to decrease climbing temptations. Outside, ladders should be put away and hung on their sides when not in use. Playgrounds should have 12 inches of padding.

Certain situations increase the risk of falling. You should be careful when you are on a stool or ladder in reaching your arms out or overextending your reach. Are there situations where you have to rush, such as getting to the front door, or answering the telephone? Think of ways to eliminate these situations. Slow down, take your time. Also, be careful about consuming alcohol.

One major risk factor to keep in mind is that vitamin D deficiency is very common and can lead to abnormal gait, muscle weakness, osteomalacia, and osteoporosis. (Vitamin D Deficiency in Modern Society – Lost Wanderer)

Other things that increase your risk of include having a history of falls, age, living alone, and being Caucasian.

Medications that can increase the risk include benzodazepine digoxin, diuretics, sedative psychotropics, taking four or more medications, and class 1a anti-arrhythmic medications.

Medical conditions that increase your risk of falling include circulatory disease, poor nutrition or malnutrition, poor postural performance, impaired cognition such as with dementia or memory problems, visual impairments, muscle weakness (indicated in particular by having a slower walk and poor hand strength), a history of stroke, a low body mass index, poor self-rated health and decreased quality of life, chronic obstructive pulmonary disease, depression, arthritis, thyroid problems, incontinence (which leads to frequent bathroom trips at night), impaired mobility, drowsiness, dizziness, poor balance, low blood pressure, Parkinson’s disease, Meniere’s disease (affects the middle ear and causes vertigo), poorly controlled epilepsy, joint stiffness, limited neck movement, any lower extremity disability (loss of strength, orthopaedic abnormality, foot problems, or poor sensation), and difficulty in rising from a chair. Fear of falling can also lead to falling because people who are afraid of falling will restrict their physical activities and become sedentary.

There are many health related preventive steps you can take to help prevent falling. Get your vitamin D level checked. You should regularly get your eyes and hearing tested. If you have foot problems get them treated. You should exercise, for example take Tai Chi Lessons, and perhaps even learn better how to fall. Work on increasing your balance, strength, cardiovascular capacity, and flexibility. Review your medications (including supplements and other products you take over-the-counter) with your doctor.

Assistive devices can be very helpful in preventing and coping with falls. If your doctor recommends a walker or cane for stability, learn how to use it properly from a health care professional, and then do use it. Some people use hip protectors, or get an alarm device they wear in case they fall. There are a number of other assistive devices, mobility aids, and other helpful gadgets available. (Arthritis Aids – Gadgets – Products – Tools – Adaptive Equipment) Keep all such devices in good repair. (replace worn rubber tips, etc.) During winter cleats for your shoes and boots can be helpful for dealing with ice. (Polar Cleats) (Get-A-Grip Advanced – Snow & Ice Traction Cleats)

If you do fall you should try to fall on your side or buttocks, rolling over naturally turning your head in the direction of the fall, and keep your arms bent. Don’t necessarily try to get up right away, but assess the situation, and then, if the situation suggests it, crawl to find something to raise yourself up with.

(1) A raised toilet seat will also make it easier to get up. But, on this issue there is a trade-off, since using a squat toilet is the natural and healthier way for you to do your business. (The Squat Toilet – Lost Wanderer) For someone who has a condition such as arthritis, I have read that in Asia they make a squat toilet that starts out in sitting position and then mechanically lowers you into position.

(Practical Guide to Universal Home Design: Convenience, Ease, and Livability – Remodeling, Building, and Buying a Home) (Preventing Slips and Falls) (Prevention of Slips, Trips and Falls) (The Fall Prevention Project) (Preventing Falls in the Home – NAMIC Online) (A Home Fall Prevention Checklist for Older Adults – MetLife) (Minnesota SeniorSafe – Minnesota Safety Council) (Fall Prevention Home Safety Checklist What YOU Can Do To Prevent Falls – Minnesota Safety Council) (Preventing Falls at Home)(Home Fall Prevention Guidelines) (Preventing Injuries from Slips, Trips and Falls) (Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults - CDC) (What Causes Falls in the Elderly? How Can I Prevent a Fall?) (Preventing Falls in the Elderly by K.R. Tremblay Jr., and C.E. Barber¹ (12/05) (What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? - World Health Organization – Europe) (Aging well: Making your home fall-proof – CIGNA) (Handicap Shower Safety – 10 Money Saving Keys to Fall Proof Your Shower Area – No Tools Required! – Ezine Articles) (How to Fall-Proof a Bathroom for Seniors – Denise Wang) (Fall-proof your home – Humana) (Tumble-Proof Your Home to Prevent Falls – Common sense precautions for all ages By Sandra Wendel) (Fall Prevention Center of Excellence) (Preventing Slip-and-Fall Accidents) (Fall Prevention Center) (CDC – Falls – Older Adults) (What you can do) (Preventing Falls) (Preventing Injuries from Slips Trips and Falls – NASD) (Public Enemy Number One: Slips, Trips and Falls) (Falls – Older Adults – Home & Recreational Safety - CDC) (Falls Among Older Adults: An Overview – Home & Recreational Safety – CDC) (Falls in Nursing Homes – CDC)(Fall Prevention Activities – CDC) (Preventing Falls: What Works – CDC) (Help Older Adults Live Better, Longer: Prevent Falls and Traumatic Brain Injuries - Public Health Grand Rounds) (Podcasts — Unintentional Injury Prevention – CDC) (Causes of Falls – Wrong Diagnosis) (Causes of Falls – Osteoporosis-INFO.com) (Preventing Falls Among Older Adults – Patricia M. Burbank) (Pets cause falling injuries – Wellsphere) (Creating a Fall Proof Environment in Your Home - National Safety Council) (Safety First: Fall Risks and Fall Prevention Tips – parentgiving) (Be Safe at Home – Minnesota Falls Prevention) (Falls – Older Adults - CDC)

Tags: Barefoot, Bathroom, Fall Prevention, Falls, Kitchen, Squat Toilet, Stairs, Vibration Research, Vitamin D
Posted in Accident Prevention, Health | No Comments »

Carbon Monoxide

Friday, November 20th, 2009

Carbon monoxide (CO) is the leading cause of poisoning worldwide, with it killing and injuring more people than all other poisons combined. (Carbon Monoxide Protection) It is colorless and odorless, becomes toxic at 25 ppm (parts per million), and deadly at 400 ppm. The early symptoms of CO poisoning often mimic the flu, causing headaches, nausea, unclear thinking, shortness of breath, weakness, and loss of muscle control. CO accounts for about 40,000 known cases of poisoning in the U.S. each year, and in about 500 of these cases the person dies. Some experts estimate that about 11,000 undetected cases occur each year, and because of this have recommended routine emergency room screening for CO poisoning. (Routine Screenings Uncover Hidden Carbon Monoxide Poisoning)

In about half of the most serious cases where people do survive they will later develop permanent brain damage. Now researchers know part of the reason why; in about half of the cases of permanent brain damage (so for a total of a quarter of the most serious cases where the people survive) it’s an autoimmune reaction. CO alters some of the brain’s myelin in such a way that a person’s immune system attacks it, then doesn’t know when to stop, and goes after much of the rest of the brain’s myelin. (Long-term Effects Of Carbon Monoxide Poisoning Are An Autoimmune Reaction) (GAS ATTACK: Carbon Monoxide Poisoning)

If that wasn’t bad enough, CO harms people in a number of other ways. It can permanently damage a person’s heart, independently of its role in oxygen deprivation. (Carbon Monoxide May Cause Long-lasting Heart Damage) The fetus is particularly vulnerable to it, down to levels as low as 25 ppm. (Tiny Levels Of Carbon Monoxide Damage Fetal Brain) Children and infants might suffer hearing damage at these same levels. (How chronic exposure to tiny levels of carbon monoxide damages hearing in young ears) Also the probability of hearing damage goes up if noise and carbon monoxide are combined. (Noise And Carbon Monoxide Exposure Increases Hearing Loss In Workers According To Université De Montréal Study)

Here is a laundry list of things to do to avoid killing yourself with CO:

Have at least one CO detector in your home outside each sleeping area, and in your workplace. Make sure they’re working. If one goes off get out and call 911. (Know About CO - Alarm Education) (The Silent Killer: Selecting an Effective Carbon Monoxide Detector that can Save Lives) (AlarmSuperStore.com)

Have your gas or oil furnace, wood stove, fireplace, gasoline powered generator, gas water heater, gas oven, gas dryer, kerosene and gas space heaters, stove and any other gas, oil, wood, or coal burning appliances serviced by a qualified technician every year.

All gas appliances must be vented, with a pipe that is somewhat vertical and not perfectly horizontal. Always properly patch a vent pipe. Only buy gas equipment that is certified by the AGA or UL.

Your gas oven should have an exhaust fan, and also never heat your house with your oven.

Don’t use a generator, camp stove, kerosene heater, charcoal or gas grill, portable flameless chemical heater (catalytic) in your home, garage, or even outside near a window. You should never burn charcoal indoors. (Portable Heater and Generator Safety) (Unvented Portable Kerosene Heaters – Safety Considerations)

Don’t run a car inside a garage, especially if it is attached to your house. Have your car’s exhaust system checked every year. If you have a vehicle with a tailgate, if you open it you must open the vents and windows to move air through your car or truck. Be very careful about letting people ride in the back of an enclosed pickup truck.

Don’t use any gasoline powered engines such as mowers, snow blowers, chain saws, weed trimmers, generators, or small engines in enclosed spaces. A propane or charcoal barbecue should only be used outdoors away from any buildings.

If your refrigerator’s cooling unit gives off an odor have it checked, it could be giving off CO.

Spray paint, solvents, degreasers, paint removers, and cigarette smoke are all sources of CO.

It can be dangerous to swim near a boat’s stern when the engine is running. You shouldn’t moor next to a boat that is running its engine or a generator. Your boat should also have a CO detector. (Carbon Monoxide Poisoning Causes) (Boating and Boat Safety: Reduce the Odds of Carbon Monoxide Poisoning)

When you are traveling you should remember that there is no federal law that requires CO detectors in hotels, and about 50 people a year are poisoned in them. (Hotel Guests At Risk From Carbon Monoxide Poisoning, According To Study) Some people recommend traveling with a portable CO detector, and one such model is the Costar P-1. (How to Ensure your Safety against Carbon Monoxide Poisoning in Hotels)

CO poisonings sometimes occur after a disaster when people are using emergency generators. (CDC – Carbon Monoxide Poisoning After a Disaster)

Doctors recommend that you seek prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.

One positive step is that researchers have developed a new method for clearing carbon monoxide from a person. Instead of using 100% oxygen they used a mixture of oxygen and carbon dioxide, which cleared CO three times faster. (Simple New Method Holds Great Promise For Treating Carbon Monoxide Poisoning Quickly And Easily)

Another interesting wrinkle in the CO story is “that paranormal experiences track quite closely with symptoms of carbon monoxide poisoning.” (From a reader’s comment on Haunted Houses Possibly Explained – Lost Wanderer) (Carbon monoxide as an explanation for perceived hauntings – Haunted house – Wikipedia)

Having said all this, doctors are finding that CO can be useful in some circumstances. It turns out that a little CO can be beneficial in treating pre-eclampsia. (When Preventing Pre-eclampsia, A Little Carbon Monoxide Goes A Long Way) (However, I think a safer and more natural alternative might be vitamin D supplementation. (Vitamin D for the Prevention of Preeclampsia? A Hypothesis.)) And CO is an anti-inflammatory that could be useful in treating certain lung diseases, multiple sclerosis, and other inflammatory conditions. (Carbon monoxide could fight disease and Carbon monoxide may protect against MS symptoms)

Finally, here are some general overviews of CO related information and CO poisoning. (Carbon monoxide poisoning – Wikipedia) (An Introduction to Indoor Air Quality – Carbon Monoxide (CO))

Tags: Autoimmune Diseases, Brain Damage, Carbon Monoxide, CO, Hearing Loss, Poison, Poisoning, Pre-eclampsia, Toxin, Toxins, Vitamin D
Posted in Health | 4 Comments »

Dental Related Information

Thursday, October 29th, 2009

My short list of advice for maintaining your dental health is: Brush and floss after every snack and meal. Water-pick also whenever you can. Get your teeth checked and cleaned every 6 months. Get that tool to identify plaque at home (see below). Don’t suck on citrus fruits. Don’t chew on ice. Don’t hold metal nails in your mouth when hammering. Try to avoid Epstein-Barr. Don’t drink energy drinks, sports drinks, fitness water, and cola. For now, drink fluoridated water. Use xylitol and take vitamin K2. If you want to use an electric toothbrush, get the oscillating kind. Get your teeth sealed. Get amalgam fillings for now, but keep an eye on new materials as they come along. Drink lemonade or ice tea through a straw, and rinse immediately afterwards, then brush as soon as possible.

Defenders of amalgam fillings point out the following facts: A person with 7 amalgam fillings (the average) absorbs about 1 microgram of mercury daily. You get about 6 micrograms a day from food, water, and air. You would need to get around 45 micrograms a day to have the slightest risk of the being able to detect any blood changes signaling the beginnings of mercury’s effects. A study of Portuguese children showed no evidence of neurological problems from dental fillings. The findings showed no detectable loss of intelligence, memory, coordination, concentration, nerve conduction, or kidney function during the 5-7 years the children were followed. (Dental Tooth Fillings Containing Mercury Don’t Affect Children’s Brain Development, Study Suggests, Studies Evaluate Health Effects of Dental Amalgam Fillings in Children) (But, for a contrary view see: Root Canals, Extractions and Mercury Amalgam Fillings)

As far as filling baby teeth, according to a recent literature review there isn’t enough evidence to be able to say which filling materials is best among the various types used. (No Clear Winner Among Fillings For Childhood Cavities, Types of Fillings, and Dental Filling Options – American Dental Association)

Also, dental mercury accounts for less than a quarter of a percent of all environmental mercury pollution. Currently available composite fillings cause more secondary cavities, sometimes slowly release bisphenol A, may contribute to plaque formation, don’t last nearly as long, cost more, and are often not covered by insurance. (Amalgam Fillings Are Safe, But Skeptics Still Claim Controversy, Researcher Says)

However, people are still concerned about amalgam, and in the quest to improve dental materials scientists have developed a replacement for it that is made from bile acids. These are acids that are produced by your liver and stored in your gallbladder. They claim it is hard, durable, and strongly resistant to cracking. (Stronger Material For Filling Dental Cavities Has Ingredients From Human Body, and Scientists develop dental filling using bile acids) And researchers have found that braided polyethylene fibers can be added to non-amalgam composite fillings that will increase their toughness by up to 433%. (Fibers Used In Bullet-proof Vests Quadruple Toughness Of Dental Composites)

Dentists have been using dental sealants with success for years, (Dental Sealants) although some people have questioned their safety. (Dental sealant safety reconsidered – new research fails to find environmental hormone risk) Sealants work by preventing decay from starting in the nooks and crannies of your teeth.

Following similar reasoning, researchers have adopted technology from the semiconductor industry that enable them to polish teeth to the nanoscale smooth level. The idea is that they become too smooth for bacteria to cling to, and then they can be removed easily through brushing. (New Tooth Cavity Protection: Nanoparticles Make Surface Too Slippery For Bacteria To Adhere)

It turns out that manual toothbrushes work just about as well as electric ones at reducing plaque and gum disease. Researchers looked at 40 years of research, including 29 high-quality trials, and found that the only electric toothbrushes better than manual ones (by 11% with plaque and by 6% with gingivitis in three-month trial) were those where the head of the toothbrush rotates back and forth in an oscillating motion. (Manual toothbrushes work just as well)

I will mention several topics here I have blogged about before. Xylitol is a naturally occurring sugar in many fruits and vegetables, prevents cavities, and has a very low glycemic index. (Food from Finland, and Xylitol - Lost Wanderer) Vitamin K2 plays a vital role in the development of facial bones, as well as providing possible protection against cavities. It normally enters the diet through eating the meat of grass fed – not grain fed - animals. (Vitamin K2 – Lost Wanderer, On the Trail of the Elusive X-Factor: A Sixty-Two-Year-Old Mystery Finally Solved By Chris Masterjohn) Periogen is a product that is purported to dissolve tartar. (Dissolve Tartar with Periogen – Lost Wanderer)

I haven’t investigated the issue of fluoridation enough to have an informed opinion. All I can say is that one side of this debate is either delusional or lying. Here are some sites that discuss it: (Fluoride Action Network, Water fluoridation - Wikipedia, Safety – Fluoride Information Network, Community Water Fluoridation – CDC, Is Fluoride Safe? By Charles Wilson, DDS, and 150+ Fluoride Facts, horror stories and cover-ups by Floyd Maxwell, BASc)

Scientists have developed a device that is used to identify plaque build-up, and has been designed for use in the home. It is the size of a toothbrush, and has a blue light that is shone in the mouth. The viewer looks through yellow glasses with a red filter, and they see any plaque as a red glow. (New Tool To Improve Oral Hygiene Developed)

Researchers have developed a test that tells the likelihood a child will get cavities. The test works by looking at the relative proportions in saliva of different types of sugar chains, known as oligosaccharides. (USC Dental Researchers Develop First Test For Predicting Cavities In Children)

Researchers have found that they can repair damaged tooth enamel, in the early stages of decay, by soaking teeth in a solution of calcium, phosphate and fluoride, the three substances that make up tooth enamel. They found that for the mixture to work the ingredients must be combined with the protein casein phosphopeptide at a pH of 5.5. It’s applied using a custom fit mouth tray, along with a saliva-proof sealing gel. They expect it to be available for patients in 5 years. (New treatment could banish dental fillings)

Dental erosion is when the enamel is stripped from your teeth, causing them to become brittle and painful. It’s caused by acids from such things as soft drinks, sports drinks, herbal teas, some fruit juices, beer salts, Lucas candy, aspirin, acid reflux, and bulimia. (More U.S. Teeth Susceptible To Silent Enamel-eating Syndrome) In one study it turned out that, from worst to least damaging drinks, the order was: lemonade, energy drinks, sports drinks, fitness water, ice tea, and cola. (New Study Indicates That Popular Sports Beverages Cause More Irreversible Damage To Teeth Than Soda) I would have thought lemonade and other citrus products were healthy, but apparently not totally, and until more is known people are recommending drinking lemonade through a straw, and rinsing or brushing right after drinking it. (Does consuming too much lemon juice cause harm to tooth enamel?)

I ran across this video (Cure Tooth Pain) that claims you can stop tooth pain with a mixture of mashed garlic, lemon juice, and salt. One critic was naturally concerned that the lemon acid would destroy the tooth enamel, and recommended oil of cloves instead. Another person recommended a hot salt water rinse.

Some dentists are especially concerned about Mountain Dew. They argue that this drink is worse than others because of its especially high levels of caffeine and sugar. They have dubbed the blown out mouths they see, “Mountain Dew Mouth.” (Watch what you Dew! Dentists sounding the alarm about heavy soft-drink consumption among teens)

It turns out that alkaline substances used in industry can also damage tooth enamel. (Exposure To Alkaline Substances Can Result In Damaged Teeth) And you are never supposed to hold tacks or nails in your mouth when you are working.

More than three dozen studies show that dental cavities are not caused by breastfeeding. It turns out that infant’s cavities are actually caused by a recently discovered type of bacteria, which is called Early Childhood Caries (ECC). Furthermore, breastfed children are actually less likely to develop this disease than bottle fed children. ECC correlates with (but is not necessarily caused or caused by): pregnancy complications, traumatic birth, cesarean sections, kidney disease, maternal diabetes, and viral or bacterial infection. For the neonate, risk factors seem to be premature birth, sugary foods, Rh incompatibility, a salty diet, allergies, iron deficiency, gastroenteritis, pacifier use, malnutrition, prenatal exposure to lead, infectious diseases, and chronic diarrhea. (Big Bad Cavities: Breastfeeding Is Not the Cause by Lisa Reagan of The Natural Child Project)

There seems to be no strong research that supports routinely removing disease-free impacted wisdom teeth. The reasons for this are the difficulty of following a population over 10 to 20 years, and the small number of adults with impacted wisdom teeth, since they are routinely removed. Of course, this does not mean they shouldn’t be removed, we just don’t know. (No Wisdom In Routinely Pulling Wisdom Teeth, Study Says)

Chewing on ice is bad for your teeth because you are subjecting your teeth to a thermal shock when the enamel contracts. Heat has the opposite thermal shock effect, so drinking hot drinks isn’t ideal either. And if you have fillings the effect is even worse, since the dental materials will contract or expand differently than the tooth. It can make for painful teeth, and in the worst case the tooth can fracture.

If your teeth are sensitive to heat or cold this could also be because you might have a small fracture in a tooth. Your dentist can test for this possibility. (Is chewing ICE bad for your teeth?)

People who have a general sensory sensitivity with their hearing, sight, taste, smell, and touch also very often have sensitive teeth. Such people avoid loud noises, bright lights, perfumes, itchy clothing, and hot and cold foods. (Wear Sunglasses? You May Have Sensitive Teeth)

It turns out that a desire to chew ice is one symptom of iron deficiency. Seith Roberts suggests that one of the few crunchy things in the hunter gatherer days were bones, bone marrow has lots of iron, so this desire evolved because it was adaptive. (Pagophagia and the Umami Hypothesis)

For those who are hoping for a perfect solution to many dental problems, Japanese scientists have been able to grow a new tooth in a mouse. They did this by taking two types of cells, mesenchymal and epithelial, separately growing large numbers of them, putting them together into a drop of collagen, growing a tiny tooth, and then inserting it into the mouse’s mouth. The transplant grew into a perfect new tooth. (Toothless mice can eat again) Researchers have also been able to regrow mouse teeth from tooth buds extracted from mouse embryos, although in this case the teeth were simpler and with fewer facets. (Teeth regrown for the first time) Inventors claim that they have developed a device that massages gums with pulsed ultrasonic waves that can grow a toot from a tooth root. They also say that it can also be used to stimulate bone growth. (Smile! A new Canadian tool can re-grow teeth say inventors, and How to regrow or repair bad teeth naturally)

They’ve found mutant chickens with teeth, alligator teeth that is. The discovery led researchers to speculate that chickens might still have most of the genetic machinery necessary to grow teeth, and they have found that they can induce teeth to grow in normal chickens by changing the expression of certain molecules. The hope is that this research could one day lead to re-growing teeth in people. (Mutant Chicken Grows Alligatorlike Teeth)

Since bone loss often causes tooth loss, it seems relevant to mention that scientists have developed an injectable toothpaste-like solution that hardens in the body, and provides a porous biodegradable scaffolding for the formation of new bone. It works by using a combination of stem cells and growth factors. (Injectable artificial bone developed)

A research team has developed software that can detect osteoporosis using routine dental x-rays. The method does this by measuring the thickness of part of the lower jaw. (Dentists Could Detect Osteoporosis, Automatically)

It’s probably best to avoid getting the Epstein-Barr virus since it has been found to be associated with inflammatory diseases of the mouth. (Epstein-Barr Virus Associated With Inflammatory Diseases Of The Mouth)

Another oral problem people often have is Halitosis, or bad breath. (Bad Breath (Halitosis) – ADA) It can be caused by certain foods, poor dental hygiene, dry mouth, and tobacco products. It can also be caused by various medical conditions, such as an infection in the respiratory tract, chronic sinusitis, tonsil stones, trimethylaminuria, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, or a liver or kidney ailment. If you are on a low carb diet, or fasting, you could develop ketone breath, which happens when ketones build up in your body and are released in the mouth.

One common piece of advice for managing bad breath is to use a tongue scraper, since bacteria on the back of the tongue is often the source of the problem. (Using a tongue scraper or brush can cure bad breath.) Other advice is to use a water pick, drink more water, chew gum that is cinnamon flavored and contains xylitol, and to floss.

Scientists have found that the more oral bacteria you have the higher the risk you have of having a heart attack. (The More Oral Bacteria, The Higher The Risk Of Heart Attack, Study Shows)

Besides heart disease there are a number of other conditions associated with poor oral health. (It’s important to remember that the nature of the relationship in each case might be only correlational, or it might be causal in one direction or the other. Or it could even be reciprocal. So, the relationship of each comorbid condition to oral bacteria must be considered separately, although in many of these cases the nature of the relationship is reasonably clear.) These conditions include Alzheimer’s, premature birth, diabetes, HIV/AIDS, osteoporosis, Sjogren’s syndrome, certain cancers, eating disorders, syphilis, gonorrhea and substance abuse. (Oral health: A window to your overall health, Diabetes and Oral Health Problems, Dental Health May Influence Alzheimer’s, Gum Disease, Heart Disease, Premature Births, and Vitamin K2 - Lost Wanderer)

One form of chronic fatigue syndrome (CFS) might be triggered by a rare reaction to dental metals. In one Swedish study, 76% of CFS patients who tested positive for metal allergy, on the MELISA blood test, and then had their metal fillings replaced, achieved some or full health improvement. (Further arguing for some sort of allergic like connection with CFS, it might also be caused by gluten intolerance, celiac disease, and chronic sinusitis.) (Encyclopedia – Chronic fatigue syndrome, and Chronic Fatigue Syndrome or Chronic Mercury Poisoning?)

From GutBuddies – Safe dental anesthesia for helminth hosts, there is a new type of dental anesthesia available for drug sensitive patients that doesn’t involve any needles or medications, because it works by using cold to numb your teeth. The gumEase G100 is filled with a chilled saline solution, and fitted around your teeth to cool them to -7 degrees C. Several of the devices used in sequence will work for almost all normal procedures, its 100% pain relief lasts for up to twenty minutes, and it can also be used post-operatively at home. The device is FDA approved, currently available for dentists to try, and is probably less expensive than regular anesthesia. (I wonder about any problems this product might create for patients who have cold sensitive teeth.)

GumEase is also being tested for relief from tension and migraine headaches (Migraine Headaches - Lost Wanderer), and patients who have tried it report it works for these conditions also. (Study to Determine Efficacy of gumEase cryoanesthesia Mouthpiece in Treating Migraine and Tension-type Headache Pain without Drugs to Begin)

Your can purchase the gumEase G100 from CryoDevices, or Olympic Dental and Medical Devices. For dental application it’s about $110 for a box of 10, and for migraines a 3 pack costs about $36. In the UK you can contact George Harrell at gharrell@cryodevices.com.

Researchers have developed a dental device that will automatically deliver a patient’s drugs. It fits inside two fake molars, and contains the drug, a release valve, sensors, and actuators. (Molar medication)

A new medical device, called PediSedate, has been developed to deliver nitrous oxide for dental or medical anesthesia. It is a toy-like headset that connects to a game such as Nintendo or a CD player, and while the child is playing or listening to music s/he gradually drifts off to sleep. (PediSedate)

A 2004 study claims that women who have dental x-rays during pregnancy are three times more likely to have a low birth weight baby. (Dental X-rays Of Pregnant Women Associated With Low-weight Babies) However, a number of researchers are very skeptical of this result. (Dental experts fault study linking X-rays to term low birth weight, and Dental x-rays and low birth weight J. Radiol. Prot. 24 (2004) 321–325)

Researchers are testing a natural hormone called relaxin that might make it possible to straighten teeth more quickly, with less pain, and which would prevent relapse. (Teeth On The Move by Kate Melville)

Just for fun, Grand Illusions sells strips of plastic that talk to you when you hold one end in your teeth and run your thumb nail down the tape. (Talking Tapes – Grand Illusions)

Tags: Amalgam, Artificial Bone, Bad Breath, Breastfeeding, CFS, Chronic Fatigue Syndrome (CFS), Dental Erosion, Dental Fillings, Dental Health, Dental Sealants, Early Childhood Caries (ECC), Epstein-Barr, Flossing, Fluoridation, Grand Illusions, GumEase G100, Halitosis, Ice, Mercury, Migraines, Mountain Dew, Natural Child Project, Nitrous Oxide, Osteoporosis, PediSedate, Periogen, Plaque, Relaxin, Teeth, Tongue Scraper, Toothbrush, Vitamin K2, Water Pick, Wisdom Teeth, X-rays, Xylitol
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