Posted by: Christopher Maloney, Naturopathic Doctor | October 18, 2014

Dr. Oz From September: Was The Severity of This Ebola Outbreak Predictable?

Before we act surprised about how Ebola has reached the U.S., it’s pretty amazing that we haven’t had more cases.

Here are experts talking back in September, both of whom expected Ebola to reach the U.S. One of them, Dr. Richard Besser, was exposed to Ebola (with protective equipment, but that’s not a certainty anymore). He makes a joke of the fact that he could be infecting Dr. Oz and the rest of the studio audience.

http://www.doctoroz.com/episode/ebola-epidemic-why-experts-say-it-coming-here

In September, the number of cases was outpacing the ability of care. Now we’re long past this point. We’ve basically retreated from West Africa, and now we’re playing a blame game rather than taking necessary action.

Posted by: Christopher Maloney, Naturopathic Doctor | October 17, 2014

Why Is This Ebola Outbreak So Much More Deadly?

If you believe the CDC and the WHO, the Ebola virus is difficult to catch and requires basically cutting yourself open with an infected scalpel. Clearly, this is not the case in this outbreak. But where did they get that idea, and why hasn’t this outbreak fizzled out like every other one of the over thirty plus outbreaks we’ve documented?

First, the CDC and the WHO aren’t making up the “hard to get this virus” story. It’s based on the history of Ebola virus dating back to the 1970’s. If you read the CDC’s history of Ebola outbreaks, it’s one screw-up after another, but in the end the outbreaks burned themselves out. Often in the first and only clumsy lab worker who infected themselves with a dirty scalpel. (Here’s the CDC history).

If you look at that history, which reads like the beginning of several pandemic thrillers, workers who contracted Ebola virus often didn’t get sick. They’d test positive for antibodies, but never have any symptoms.

How is it possible that we’re now seeing people get this illness and die by the thousands? Hint: it’s not because of urban settings. And it’s not because of increased air travel. Back in 1994 a Swiss scientist contracted Ebola from a Chimp corpse. She visited a hospital in Africa and then was flown back to Switzerland for supportive treatment. The whole time she was never placed under strict containment measures. They even let her out by day fifteen, so she was walking around for four more weeks with symptoms and never infected another person. (From a Stanford student’s Honors Thesis on Ebola, here) If that was this virus, the Swiss would be quarantined.

So why is this Ebola outbreak different? It’s because it’s not the same virus. When we say “Ebola” we all think of the same disease. But like the influenza virus, there are different families or clades of Ebola virus. This particular virus is barely in the Zaire family, it’s a genetic outlier. (see this Ebola’s full family tree here) So like SARS, or Avian Flu, or any new influenza virus, this particular version of Ebola is a mutation. Now, that doesn’t mean it’s airborne, but evidently it means that this particular strain is far more contagious.

 

 

 

 

 

 

But wait, should we know more about this particular Ebola strain? Nope. The mapping for this strains genetics includes “158 Ebola strains and 2 Marburg strains.” That’s a lot of different options.

Does the variety of options explain a lot of the confusion the CDC is experiencing about Ebola? Yes. Back in 1995, they could trace an African Ebola outbreak in health workers almost entirely to the unsanitary reuse of needles that had been used first on an Ebola patient. (Stanford thesis). We had horrific outbreaks in monkeys with Ebola shipped all over the world in 1989, and not a single worker got ill even though they got antibodies. So they thought they knew the risks and they weren’t very high.

So the experts are not prepared for the virulence of this particular strain. It’s far more infectious and deadly than previous strains of the same virus. While their mistakes are understandable, it’s time to get serious about Ebola. Even though no one is talking about airborne, patients need to be treated “as if.”

And if anyone cares, these are the New York Times (CDC data) graphs of the outbreak in Liberia. Maybe it’s time to really have a shift before we lose a generation of Liberians.

What you’re looking at are best and worst case scenarios. The best case is losing 27,000 people. The worst case is losing half a million to one and a half million. The population of Liberia is around four million, and the lives lost in two recent civil wars was about 250 thousand.

 

Posted by: Christopher Maloney, Naturopathic Doctor | October 16, 2014

Dr. Oz updates on Ebola and Air Travel.

Dr. Oz answered questions about Ebola again today. If you listen to what he’s saying, it’s pretty harsh. Basically he doesn’t consider us ready to deal with Ebola. At the end of the interview, he says he wouldn’t be ready to deal with the proper gowning techniques, even though he’s trained to gown as a surgeon to protect patients.

http://fox8.com/2014/10/16/dr-oz-answers-your-ebola-questions/

Some direct quotes from his responses:

“We are woefully unprepared to manage Ebola. We are doing a live experiment…when you start showing a fever you’re contagious…It takes weeks to train these nurses…we shouldn’t be concerned for our personal health but for our country…I’m not well trained to take care of people with Ebola…”

Posted by: Christopher Maloney, Naturopathic Doctor | October 15, 2014

What Is The Best Treatment For Ebola?

The best current treatment for Ebola that we currently have is a blood transfusion from someone who has gotten better from the disease.

Dr. Kent Bradley, the first person to be flown back to the U.S. and a survivor, has donated blood to both Dr. Richard Sakra and cameraman Ashoka Mukpo. Both of them are being treated at Nebraska Medical Center.

Dr. Bradley has plans to donate to the infected nurses in Dallas as well.

Of the  thirty-four outbreaks of Ebola-like virus since 1967, most have been very poorly studied. Our current lack of knowledge about how to treat Ebola is a direct result of our largely ignoring previous outbreaks. Very little follow-up has been done with patients.

What we do have is some very good results for blood transfusion: “Transfusion of blood from convalescent patients was highlighted as potentially useful in Kikwit, Zaire when only one of eight patients receiving a transfusion died.” That’s a really good number compared to our current death rate worldwide of 50-70%.

In comparison, only two of five patients receiving heparin (an anticoagulant) survived. I wonder at this treatment, as the Ebola virus itself seems to act as an anti-coagulant. (here) I would argue that Vitamin K (which aids coagulation) would have a better outcome, but we have no data on whether it would or not.

On autopsy, what actually causes death in a person with Ebola is unclear. But patients exhibit signs that ” resemble that of severe sepsis and septic shock.” So what causes death may be a breakdown of the gut or lungs, allowing bacterial entrance into the blood stream.

In the 2012 review article, Daniel Clark et al. argue for the use of septic shock prevention and supportive measures as a starting point for supportive treatment. (here)

As researchers note, we simply have not bothered to follow-up on Ebola cases in West Africa. So now we have the tragedy of needing to do the research on our own citizens.

Posted by: Christopher Maloney, Naturopathic Doctor | October 15, 2014

Is the CDC Monitoring Nebraska Ebola Cases?

As we now have a second Ebola infection in Dallas, this one a nurse who had a fever on a commercial air flight, the CDC is rethinking how they’re dealing with Ebola.

With all the attention on Dallas, I’ve been wondering about the NBC newsman recovering from Ebola in Nebraska. Yep, not Dallas, Nebraska. Is the CDC monitoring those health care workers in the same way it’s handling Dallas?

Since he didn’t get the virus here, we don’t hear as much about Ashoka Mukpo, who’s being treated at the Nebraska Medical Center (story here). By all accounts, Mr. Mukpo is recovering and should be on is way back to full health. But by all accounts, Dallas was as safe as safe could be, until suddenly it wasn’t. So, is Nebraska being monitored?

 

Posted by: Christopher Maloney, Naturopathic Doctor | October 14, 2014

Will Probiotics Protect Against Enterovirus 68?

In a really nice study, researchers confirmed what every parent already knows: that your preschooler is a teeming virus-catching wonder.

When studying the nasal secretions of preschoolers (which had to be the easiest study ever, just collect the trash bin at the end of an average day), researchers found a veritable cornucopia of viruses. “Rhinovirus was identified in 28.6% of 315 swab samples, followed by respiratory syncytial virus (12.4%), parainfluenza virus 1 (12.1%), enterovirus (8.9%), influenza A(H1N1)pdm09 (7.9%), human bocavirus 1 (3.8%), parainfluenza virus 2 (3.2%), adenovirus (2.9%), and influenza A(H3N2) (0.6%).” (study here)

In other words, a preschooler’s nose is one-stop-shopping for a CDC list of pandemic viruses. Notice there was not one, but two different influenza viruses present among our mix.

But the key finding was that, while their noses were chock full of viruses, these children weren’t dying. They had symptoms, but their bodies were handling it. And those children who took probiotics had statistically fewer days out sick than those who did not.

The probiotics did not make a bit of difference in how many viruses the children carried. The “probiotic intervention was not effective in reducing the amount of viral findings” while giving children fewer days of illness.

So what’s happening here? It’s the terrain. The children taking the probiotic had less area in their guts available to the virus for growing, so they had fewer days of symptoms.

Should your preschooler be on probiotics? Yes, but it won’t make that much difference. And don’t think that because you’re slathering them with alcohol sanitizer that they’re noses are virus-free. But do feed them, get them enough sleep, and thank your genetics that your child is able to survive an amazing barrage of viruses and still just have a sniffle.

Posted by: Christopher Maloney, Naturopathic Doctor | October 11, 2014

Dr. Oz Talks About Spreading Ebola In the U.S.

When Sierra Leone has given up on Ebola and is turning patients away to die at home, it’s time to seriously reconsider our priorities as a nation.

If Sierra Leone had a massive Tsunami, or if they had an earthquake or a flood, we’d be pouring resources into the country to help them recover. But because Ebola is contagious, we’re not sending in rescue workers. And because we aren’t committing to containing Ebola now, we’re setting ourselves up for outbreaks in other countries.

Ebola is easier to get than we’ve been told. It isn’t airborne (see previous post) but it is passed by any contact to the eyes or mouth from dried blood. That means if you are caring for a person with Ebola, and touch your eyes, you can become infected.

We cannot expect that those with the resources to leave West Africa will stay there. They will leave and go somewhere safe, even as far as Oklahoma city. Here’s Dr. Oz talking about the risks:

http://www.koco.com/news/dr-oz-ebola-cases-possible-in-oklahoma-city/28988424

and the raw interview here: http://www.koco.com/news/raw-interview-about-ebola-with-dr-oz/28995412

“Imagine if the virus smolders for generations.”

He’s right, we need to do more to make sure that the virus dies out in West Africa. We can’t continue to play catch up and defense.

I’ve written previously about preliminary studies of Ebola and the possibility of green tea helping discourage viral growth. There’s a lotion out now that may do the same thing: http://www.wjbf.com/story/26741468/gru-professor-green-tea-lotion-can-kill-spread-of-ebola-virus-likely

In my same post, I talked about the fact that adding vitamin C in a patient’s arm didn’t save them. But what about avoiding vitamin C deficiency to begin with? There are no studies on vitamin C status and Ebola patients. But a study on the disease progression in monkeys shows that the virus breaks down the coagulation cascade. In other words, patients with Ebola don’t bleed because of connective tissue breakdown, they bleed because the Ebola virus acts like uncontrolled coumadin in the system.

Which leads to the thought, what if the patients were injected with Vitamin K, not Vitamin C? We have Vitamin K available. It’s used nationwide for newborns. There’s no shortage.

Maybe it would work, maybe it wouldn’t. But right now, we’re waiting for pharmaceutical companies to upregulate production on experimental drugs while the possibility of cheap, supportive measures are being ignored.

Posted by: Christopher Maloney, Naturopathic Doctor | October 11, 2014

Confessions of a Naturopathic Doctor: Junk Food Hangover

When the rest of the world sees Naturopathic Doctors, they see chirpy, yoga-obsessed do-gooders who never saw the inside of a McDonald’s bag. So it’s natural for a large portion of the population to want to feed us torn up strips of our own yoga mats with a little no-carb dressing.

But the reality is that I live the lifestyle I do because it hurts too much to do anything else. Periodically I forget this, like last night, and I pay heavily for my transgressions.

Anyone old enough to drink, and a disturbing number of those not legally able to drink, is familiar with the idea of a hangover. Too much alcohol, and the next day you get to stumble around, feeling like the roof of your mouth is a bit hairy and that your brain is still a little pickled from the night before. Now imagine that same wondrous feeling from eating the wrong foods.

That’s right, I had most of a cinnamon loaf last night, drenched in cinnamon and sugar. Only it wasn’t sugar because that’s too expensive for that store bakery. Instead it was high fructose corn syrup and all those little, long-worded chemicals that mean: “you’re now a lab experiment. What will this do to you?”

In my defense, I was watching a Manga movie with my eight-year-old, making his night special. But I topped off my cinnamon loaf with not one but two bags of microwave popcorn. It was the Cub Scouts’ new, healthier popcorn, complete with canola oil, but it still contained those darn artificial and natural flavorings which again include pretty much any chemical under the sun they want to put in there.

Like alcohol, it took about two hours to start feeling pretty poorly. I was irritable, out-of-sorts, and pretty nauseous.  Regret is always twenty-twenty. Did I really need to eat most of a loaf? A second bag of popcorn? But I made it to bed early, convinced I could sleep this one off.

No such luck. Today my mouth feels numb, my tongue too thick. I’m constantly thirsty. My fingers have swelled up so the ring that normally fits on three fingers only fits on one. Instead of dropping overnight, my weight went up a pound, and I expect to gain two or three more pounds today from water weight.

But I also don’t feel comfortable in my own skin. It isn’t itchy, it’s just not right. I’m constantly looking for faults in myself or others. At 2:30 this morning I woke up briefly from a minor panic attack. I calmed myself down, but I normally sleep like a log.

My body aches, not really bad, just like I’ve been lifting trees all day. That kind of tired ache, only yesterday I just sat on my butt. So this ache isn’t from muscle fatigue. It’s from chemical buildup.

Oh, and I’ve got my eye blisters or blebs. Nothing like a partial loss of sight to make you feel really smart about last night’s choices.  See, other people have sensitive skin. That I could just get a steroid cream for. But I have sensitive sclera (the whites of my eyes). They bubble and blister when my body isn’t happy. I lose peripheral vision, and it’s pretty scary, even though I’ve had them before and they go away when I’m good.

So I think I’m swearing off store-bought junk food again, at least for a while. For those of you who’ve read this with disbelief while swigging your morning-after drink, just be happy you’re a rapid acylator (can process  the chemicals and alcohol more rapidly).  I won’t be joining you for any kind of binge drinking or binge eating anytime soon.

I practice what I preach to patients not from a pulpit, but from having walked the paths my patients have walked too long myself.  It’s not a moral imperative for me to eat healthy, home-made, locally grown foods. It’s a physical necessity with immediate consequences for me. And I fall down, but I can’t stay down here. It’s horrible and it hurts. But I know the way out of the valley of darkness, and the path is paved with salad.

Posted by: Christopher Maloney, Naturopathic Doctor | October 8, 2014

What Really Makes Us Fat?

It’s so rare to have someone really tackle obesity, so I have to give full credit to the Scishow for doing a weird but comprehensive overview of probable contributors.

My favorite part comes about 9:40 minutes in, when he mentions that gut bacteria may play a significant role. But the whole video is worth watching, particularly if you’ve just purchased a diet book or had yet another doctor tell you that calories in=calories out.

Posted by: Christopher Maloney, Naturopathic Doctor | October 7, 2014

Is Ebola Virus Transmitted Through the Air?

The most recent case of confirmed Ebola in Spain raises the possibility that the rules for Ebola transmission are not accurate.

According to the World Health Organization, Ebola is transmitted: “via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people.”

In other words, Ebola is like H.I.V. or Hepatitis B. You basically have to get a persons’ blood or other fluids on your own broken skin to be infected. The important thing is that you can’t get Ebola by having a person in the same room or airplane with you.

But anyone who has been following the Ebola outbreak must have wondered at the number of health care workers who have contracted the illness. The numbers just keep going up and up. Under guidelines, infection requires “close contact with patients when infection control precautions are not strictly practiced”. So we must assume that 348 health care workers, 186 of them who have died, simply didn’t understand that they shouldn’t let patients’ blood into open wounds in their own bodies?

The most recent Spanish case of Ebola makes this scenario impossible. The person infected had two brief contacts with the Ebola patient, a priest who had been in West Africa. She was a sanitary technician who changed his diaper once, and who later had contact with his belongings after he died.

Now, she wore full protection both times. Yes, there’s some question about using tape on the contact point between the wrists and the gloves. Yes, she lacked the ability to breathe different air. But remember, the current definition of contact requires direct contact of fluids through broken skin or mucous membranes. It is highly unlikely that occurred.

The worker finished treating the patient and went on vacation in Madrid. She clearly wasn’t worried about some kind of transfer. So we must assume that she was infected in some way not currently covered by the World Health Organization protocols.

What no one is saying openly is that the most likely source of infection was through the air. An aerosolized form of the blood could be inhaled and transmit the virus. In biological warfare circles, aerosolized Ebola does transmit the disease. (study here) We’ve known this for decades. (study here)

But another, less contagious route would be orally or conjunctivally (through the eye). Small studies on monkeys show that both oral and conjunctival infection from Ebola virus results in death. (study here) Another study confirmed that control monkeys, who had no direct contact with any fluids of infected monkeys, still became infected with Ebola virus. The only exposure was that the monkeys were held in the same room that had previously been occupied by the ill monkeys. The researchers again presumed that: ” (t)he most likely route of infection of the control monkeys was aerosol, oral or conjunctival exposure” (study here).

What is startling is not that these studies exist, it’s that no studies confirm the claims that the only route of transmission is through direct contact only. The monkey studies were done in 1996 and 1995, and can be accessed by simply by searching medline for keywords: “Ebola transmission aerosol.”

So workers using protective gear need to be aware that any speck of blood, picked up and stuck in a mouth or rubbed in an eye, is a potential infectious agent long after the patient has died and been buried. That requires a much greater level of quarantine and completely dedicated hospitals where sanitary measures are absolute. Think “boy in a bubble” absolute. No taped wrists, no common elevators. And full hazmat showers after any contact, because even a speck is contagious.

The other problem is that the most recent case went for vacation in Madrid. According to the World Health Organization: “People remain infectious as long as their blood and body fluids…contain the virus. Men who have recovered from the disease can still transmit the virus … up to 7 weeks after recovery from illness.” That means the Spanish nurse was infectious and wandering around Madrid. Her saliva, etc., was contagious. We can just hope that the person who washed her dishes didn’t wipe his or her eyes.

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