Ask Emily

28 07 2011

What causes ear wax?

You do! Ear wax comes in two types. One is a thick, yellow wax, known as the “wet” type. The other is a greyish, flaky kind of wax, known as the “dry” type and most common among people of Asian origin and American Indians. Either way, its job is to clean, disinfect, and moisturize your ears, which makes it sound like a beauty product.

In reality, it is a health product that your body makes as a line of defense against things that might harm you, from bacteria to fungi to, yes, insects. For this reason, unless your ear wax is causing a health problem, medical folk recommend that you just leave it alone. It will cycle through and out of your ear, renewing as it goes.

Which type you have—wet or dry—depends on a single mutation in a single gene. Researchers have noted that Asians, especially people from East Asia, have ear wax that is dry and whitish. People whose ancestors are from Europe and Africa almost invariably have ear wax that is sticky and brown or yellow. If a person doesn’t dump cholesterol and other smooth fatty things into their ear wax, then the wax will consist primarily of dead skin flakes, the dry type.

Whether or not you make one or the other traces back to a single change in a single gene. This gene encodes a protein that makes ear wax . . . wet. With the single change in the genetic alphabet, a person doesn’t make wet wax. Researchers have even used this single change to trace the course of human migration throughout the world. Who knew ear wax could be so informative and useful?

I know that a fever is when my body’s temp goes up, but why does it go up? Why is THAT the reaction to whatever is going on in my body?

Let’s start by talking about bedbugs. One of the potential treatments for a bedbug infestation is to turn up the heat in the house to a level that bedbugs can’t survive. Turns out, the little bloodsuckers aren’t too fond of high temperatures. Many things that invade your body are like those bedbugs. They’re pretty comfortable at your normal temperature, but high heat can disable the molecules that keep them functioning. That’s why, when your body’s defense system recognizes an invader, one response may be fever.

Cells that detect these invaders can send out chemical signals with a great name: pyrogens. Pyro, of course, refers to fire or flame, and these chemicals travel to the brain’s thermostat center. There, they signal the brain to readjust the body’s temperature . . . kicking it up a few notches.

To a point, this higher temperature is thought to make things uncomfortable for microbes while not harming you too much. When a strong fever response takes things too far, fever can be harmful, but you might be surprised at exactly how high a fever needs to be to cause harm to you. According to the experts, a fever won’t cause brain damage unless it exceeds a very specific 107.6 F (42 C).

This general defense—it doesn’t target the specific invader; instead, it just relies on wholesale heating—is one of your body’s first responses to infectious invaders like bacteria or viruses. Meanwhile, your body is likely also getting to work on more specific tactics to deal with the unwanted intruders.

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By Emily Willingham

Image courtesy of CuriousGeoff

Raccoons and Roundworms

25 07 2011

Everyone knows raccoons can be troublesome. Their nimble fingers can unlatch garbage cans in order to get to the tasty (?!) treats inside.

If you’ve ever raised chickens, you’ve probably coped with raccoons spending pretty much all their waking hours trying to figure out how to get into the coop.

They find their way into attics and crawl spaces to have their babies—not the type of family that anybody really likes to have living next door.

As if that weren’t bad enough, many raccoons harbor a pretty horrifying parasite. Horrifying to us, anyway. It doesn’t hurt the raccoon, but if the roundworm Baylisascaris procyonis gets into a human being, the outcome can be bad.

After infection with this worm, a person may present with skin lesions or other severe organ or tissue damage. Some young children have died from this infection—primarily due to ingesting lots of eggs.

Now I would never eat a roundworm! Not on purpose, I wouldn’t, and I probably wouldn’t even do it by accident. But a child might. The parasite lives in the raccoon’s intestines, and its eggs end up coming out in the raccoon’s feces. The eggs can stay viable for months or years, so kids who happen to play in the dirt where raccoons have pooped can get the eggs onto their hands and then into their mouths. Then the eggs hatch, and the larvae begin their migration.

If raccoons are making themselves comfortable near your house, you may want to get serious about evicting them (your local animal control agency may trap them for you), and safely remediate any soil they may have contaminated.

Don’t attract them by letting them have access to garbage cans, bird feeders, or other food sources.

Watch their amusing antics on YouTube, not in your yard.

By Ms. Health Department

Image courtesy of MSVG

Fifth Disease? What About Third or Fourth?

21 07 2011

Last summer, PKIDs’ advice nurse, Dr. Mary Beth, explained what fifth disease is: a viral rash that is tricky to contain because by the time you get the rash, you’re already through the contagious stage.

The rash itself is not painful and most children get through it without any problems, although adults may experience joint pain with this infection.

If a pregnant woman catches it, there is a small risk that the unborn baby will have severe anemia and the woman may have a miscarriage.

It’s also worse for people with sickle cell disease. Their red blood cells can get dangerously depleted during a bout with fifth disease.

Why is this condition known by a number instead of a real name? The vernacular term “slapped cheek syndrome” isn’t too endearing; neither is its scientific moniker, “erythema infectiosum,”  nor “parvovirus B19,” the name of the organism that causes it.

Even “variola” has a certain melodic ring to it, and that (smallpox) was the Chuck Norris of infectious disease.

It turns out that, by old tradition, several of the rashy illnesses of childhood were known by numbers:

  • First disease was measles
  • Second disease was scarlet fever, caused by the same bacterium that causes strep throat
  • Third disease was rubella
  • Fourth was Duke’s disease, which is not a defined disease today
  • Fifth, our friend erythema infectiosum
  • Sixth, roseola—which sounds a lot like rubella and rubeola—is actually caused by a couple of strains of herpes viruses

It seems that, just like squirrels are said to be rats with good PR, the names of the other diseases were relatively euphonious compared to “erythema infectiosum,” and so the rather anonymous “fifth disease” was the name that stuck.

Frankly, the whole rubella-rubeola-roseola conglomerate might be easier to keep straight if each of those diseases were still referred to by number. Maybe it’s time fifth disease got the charming name it’s never had. How about . . . slappacheeka? Rosella? Gwendolyn?

By Ms. Health Department

Image courtesy of

GBS and Pregnancy Don’t Mix – Get Tested!

18 07 2011

Pregnant? Do not fail to be tested and TREATED for group B strep infection

The first story I read was heartbreaking. A mother-to-be at 38 weeks, in for a routine prenatal appointment. The heartbeat check turns up nothing. The baby has died, and she must undergo induction for a stillbirth. Weeks later, she learns that her baby tested positive for a Group B Streptococcus (group B strep or GBS) infection of the blood and lungs. The mother had tested positive for GBS in a previous visit, but because her membranes were intact, no one was concerned.

GBS is present in about 25% of pregnant women. According to the Centers for Disease Control and Prevention (CDC), this bacteria is the most common cause of life-threatening infection in newborns. Many women undergoing standard prenatal care also undergo testing for GBS. They can carry the bacteria in the vagina or rectum without having any symptoms, but if the bacteria pass to the womb, the outcome can be devastating.

The disease in infants can be early-onset or late. Early-onset disease afflicts newborns in the first week, most commonly causing a blood infection (sepsis) or lung infection (pneumonia), although meningitis (inflammation of the brain membranes) can also happen. Late-onset disease, in which meningitis is more common, occurs from the second week through the first three months of life. Early-onset GBS infection afflicts about 1200 babies each year in the United States, with outcomes that can vary from permanent deficits such as deafness and developmental disabilities to death. In many cases, detection and treatment can prevent transmission from mother to child.

July is GBS Awareness Month. Pregnant women, parents of newborns, and healthcare providers should be aware of the following to help prevent the possible devastating outcomes of infant GBS infection:

  • The CDC recommends that all pregnant women be screened for GBS in weeks 35 to 37.
  • The standard test is a painless vaginal and rectal swab test.
  • A rapid DNA test is also available in some places.
  • A woman should be tested in each pregnancy.
  • A positive test requires follow-up, awareness, and treatment.
  • Treatment consists of antibiotic administration, often during labor.
  • Transmission usually occurs during passage through the birth canal but can occur before birth.
  • Risk factors for early-onset GBS (during the first newborn week) include early delivery, urine positive for GBS during pregnancy, fever during labor, and a long period between water breaking and delivery.
  • GBS infection in infants occurs at higher rates among African-Americans than other ethnic groups.
  • If an infant has fever, difficulty feeding, irritability or lethargy, difficulty breathing, or a bluish color to the skin, contact a healthcare provider immediately or go to an emergency room.

It’s important to note that GBS is not a sexually transmitted disease. These bacteria are simply often present in the digestive tract or the vagina or rectum of about 25% of women. A healthy adult carrier would likely never even notice their presence. That’s one reason the CDC shifted its guidelines from testing only pregnant women who had risk factors to testing all pregnant women. It’s another quick and straightforward way to prevent infection and death in infants.

For more information about GBS testing or to learn more about promoting July as GBS Awareness Month, visit Group B Strep International, an organization founded by parents of children who were born stillborn, full term, because of GBS infection. And remember…getting tested isn’t the only step in preventing GBS transmission from mother to child.

By Emily Willingham 

Image courtesy of

You and the Shingles Vaccine

14 07 2011

Who should…and shouldn’t…get the shingles vaccine?

The virus that causes chickenpox, varicella zoster, doesn’t confine its activity to childhood. For reasons that remain unclear, it can re-emerge in older age as the rash called herpes zoster, more commonly known as shingles. Just as you can get chickenpox only once, usually you also have shingles only once. But that “once” can translate into chronic, unbearable pain if a complication known as postherpetic neuralgia develops. This pain, a burning nerve pain severe enough to disrupt sleep, can last for years.

That’s why people who are eligible for the shingles vaccine should get one. But who are those people?

The short answer is, almost anyone age 60 and over. The U.S. Food and Drug Administration has approved this vaccine only for this age group because researchers have no evidence yet that it’s effective in younger groups. It makes sense because one of the risk factors for developing shingles is . . . being over 60. Another risk factor is having had chickenpox before age 1.

The shingles vaccine is not, however, a substitute for the childhood vaccines against chickenpox.

Some people in the over-60 age group should not get the shingles vaccine. Avoid this vaccine if any of the following applies to you:

  • You’ve had a life-threatening allergic reaction to gelatin or the antibiotic neomycin. The vaccine contains other ingredients, so if you’re deathly allergic to something, check the ingredients list.
  • You’re taking drugs that suppress the immune system or have a disease that does, such as HIV, because this vaccine is a live-virus vaccine.
  • You have tuberculosis.
  • You are or might become pregnant, an unlikely possibility in the 60+ age group.
  • You are moderately to severely ill, including have a fever over 101.3 F. Wait to get the vaccine until you’re better.

Can you get this vaccine if you’ve already had the shingles? Sure, even though you’re not likely to get shingles again. You can also get this vaccine while receiving the influenza vaccine.

Like any vaccine or other medical intervention, the shingles vaccine can have side effects and carry risk. The most common side effects are pain and swelling at the injection site and headache. One large research study of the safety of the vaccine found no difference in rates of negative events between the vaccinated group and the group that received a placebo (a dummy injection). A substudy within that study, however, found a slightly higher rate of serious adverse events in the real vaccine group compared to placebo (1.9% vs. 1.3%). The data did not indicate that the events were vaccine-related.

The effectiveness of this vaccine depends on the outcome in question. Studies indicate that it reduces your risk of getting shingles by about 50%. If you do get shingles, the vaccine is linked to fewer days of pain during the outbreak and shorter periods of pain for people who go on to develop postherpetic neuralgia.

By Emily Willingham

Dr. Mary Beth Talks Melanoma

11 07 2011

PKIDs’ advice nurse, Dr. Mary Beth, explains the warning signs of melanoma (skin cancer) and tells us how to prevent it.

Listen now!

Right-click here to download podcast (5 mins/2 MB)

Virus Slams Unvaccinated

7 07 2011

A deadly disease is marching its way across the United States and Canada. It’s a disease that infects about 20 million people every year and kills about 200,000. The United States once was a hotbed of infection, seeing almost 900,000 cases of this disease in 1941. But by the 1990s, that number had dropped to fewer than 150 cases annually. Why? Vaccinations.

The disease is measles. It sounds . . . childish, doesn’t it? And people often refer to it as a “childhood disease.” But make no mistake. It’s a virus, one that doesn’t care whom it infects or what tissues it targets, whether brain or lungs. A virus that has a 90% infection rate. A virus that kills children who seem perfectly healthy one day and are dead from lung complications or encephalitis the next. Roald Dahl’s daughter died of measles. Mark Twain almost did. Even though the descriptive “childhood” often accompanies it, there’s nothing remotely childish or casual about this virus. Hospitalization rates are high, and death is not uncommon. In 2005, for example, a total of 311,000 children worldwide died from measles.

And a couple of shots in the arm (or leg) can prevent all of it.

You might think that the outbreak in 2008 would’ve spurred some parents to ensure vaccinations for their children. After all, that year saw more measles cases in the United States than had happened in any year since 1997. Of the people infected, 90% had not been vaccinated or had an unknown vaccination status, according to the Centers for Disease Control and Prevention. Now, this year is well on its way to besting that record and then some.

Some notable facts about this year’s outbreak through May 20, 2011:

  • From 2001 to 2008, a median of 56 measles cases were reported annually to the CDC.
  • During the first 19 weeks of 2011, 118 were reported.
  • 89% of this year’s cases have been linked to import from other countries.
  • About 89% of those who have contracted measles so far have been unvaccinated.
  • 40% of those who have contracted measles in this outbreak have been hospitalized.
  • All but one of the hospitalized patients were unvaccinated (the one vaccinated patient was hospitalized for observation only).
  • Rates of hospitalization have been 52% for children under 5 years and 33% for children over age 5 and for adults.
  • Transmission has occurred in households, childcare centers, shelters, schools, emergency departments, and at a large community event.
  • One outbreak alone in Minnesota has encompassed 21 people so far, including seven infants too young to have been vaccinated.

This virus doesn’t care who you are, how old you are, how healthy you are, whether or not you were breastfed or organically fed or loved beyond all measure. It’s a virus. It kills, with pain and distress. And, it bears repeating, a couple of shots in the arm can stop it.

By Emily Willingham

Image courtesy Wellcome Library, London