Saturday, October 18, 2014

Let your conscience be your guide…

I’ve been working on an Ebola posting and I just keep stumbling on the fact that there are tons of resources out there on every level, from information for the layperson to the health professional.  It seemed redundant to post another. (For links to sites offering up-to-date information on Ebola, see the posting “The latest zoonotic threat.”)  So, I’m going to focus on two things:  our role as a health care professional and what you can do to help.

I’ve been watching all this unfold with the Texas Presbyterian hospital like everyone else.  In total disbelief how it had been handled by those in authoritative positions.  Does this only fall on those in-charge?  My objective is not to point fingers, but to objectively look at what unfolded and make it a learning experience.

This leads into one of my professional pet peeves, and that’s acknowledging what YOU could have done to make things better.  It’s very easy to say “you made me do it” or “this was orchestrated by everyone else,” but how often are you genuinely powerless?  As health professionals we require a little more of something than in other professions…a backbone.  When we do not speak out, it can affect a patient or client’s life, or the health of a community.  I do not understand why health professionals within this hospital did not speak out.  I give the one and only voice I’ve heard so far, a nurse by the name of Briana Aguirre, kudos beyond all belief.  She expressed concern during her interview with the Today Show, she may be fired and even risks future employment with other hospitals in the area by coming forward.  She’s right, she is risking current and future employment.  But it should not be this way.  She deserves a raise if she stay’s where she is at, and if not, to be whisked up and paid well by a future employer.

Aren’t we suppose to speak up for our patient/client?  Should we not be more concerned about the welfare of our patient/client versus rubbing our superiors the wrong way?  As a veterinary professional, I would not want to surround myself with mindless drones.  Instead, I would want people around me that would speak out if I seem to be doing something to the contrary for the betterment of my patient, client and/or community.  So the learning experience…

Don’t let what others may think of you stop you from speaking out.  Although most of us need a paycheck, I hope you came into this profession for something greater than the almighty dollar.  And if you did, keep that in prospective.  For any health professionals reading this, or those that have friends or relatives in a health field (human and veterinary), use this situation to remind us how important it is for us to have a voice.  Keep yelling until someone hears you.

If at any point you have felt compelled to help with this Ebola crisis, I have some news for you on how you can help…check out Fighting Ebola on Open Ideo (https://openideo.com/content/fighting-ebola).  This is a collaborative effort to look at ways to stop Ebola from spreading.  Have you watched news content or read an article online and thought “I have an idea on how to help?”  You can become part of this think-tank, giving ideas and participating with others from around the world.  Registering and creating a profile is simply (I’ve done it).  After the few minutes it takes to get things started, your off and running!  Ideas are currently being sought for the following missions:  strengthening health care capacities, promote care seeking, boost tracking and communication, and “surprise us.”  Maybe you had an idea on improving personal protective equipment (PPE), or a new reporting plan for health care professionals, you can use this tool to submit your ideas!  This platform allows you to actually help, from the safety of your home!

So, the moral to the story, YOU can make a difference.  Everyone has the capacity to help in this crisis.  Let’s not sit back and say “It’s up to someone else.”  Your ideas, your initiative and your capacity for concern can show you the way.

Friday, October 10, 2014

The latest zoonotic threat...

On October 8th the Center for Disease Control and Prevention (CDC) held a live event on Twitter giving people an opportunity to ask questions in regards to Ebola (EVD).  Having done some research online, not to mention the barrage of information being furnished by the news stations, made me excited to be part of getting on-the-spot, up-to-date information right from the horse’s mouth.  Although having this on a website where you are limited to the number of characters you use to ask a question or respond, the CDC and participants did a good job of asking/answering questions.  Here is the rundown of facts learned about EVD from participating in the Twitter event:

·         This EVD is the Zaire strain and this is the largest EVD outbreak in history.

·         Ebola is NOT spread through casual contact.  There is NO evidence that EVD is transmitted via mosquitoes or other insects.  “Though unlikely, if person with Ebola sneezes on someone and saliva/mucus contacts persons eyes, nose, mouth, disease may spread.

·         EVD is spread via blood and bodily fluids (I.e. urine, feces, semen, etc) and can live on fomites (inanimate objects) for up to two hours if surface is dry, longer if surface contained bodily fluids.

·         This outbreak is believed to be from an animal reservoir, most likely a bat. 

·         “When safe alternatives exist, Mothers with Ebola should avoid close contact with their babies, including breast feeding.”

·         Incubation period is two to 21 days, with the typical being eight to 10 days.  Usually the first notable symptom is fever.

·         “Evidence suggests Ebola survivors are immune (to Ebola) for at least 10 years from that particular strain.”

·         There are several treatment modalities and vaccines in development.

·         The current EVD medical processes involve:  finding the disease, isolating the patients, tracing/monitoring disease contacts and stopping exposure.

EVD is a zoonotic disease and should be evaluated from both the veterinary and human health professions.  As stated above, this current EVD outbreak is believed to have started from a bat.  The recent headlines included a dog that was euthanized in Spain because his owners, one of which was a nurse that had treated EVD patients, tested positive for EVD and is currently being treated (Nadeau, October 2014).  Although there a dog has never been documented as having showed clinical signs of Ebola, there was a study in 2005, “Ebola Virus Antibody Prevalence in Dogs and Human Risk” (Allela, Bourry, Pouillot, et al.) that demonstrated dogs may be asymptomatic carriers.  In this study, the researchers note that in various outbreaks in the Republic of Congo, a definitive source could not be identified in connecting to a bat host, however the common denominator was dogs.  When trying to place this information in context, keep in mind these dogs are purpose animals (I.e. used for hunting) and “are not fed and have to scavenge for food” (Allela, Bourry, Pouillot, et al, March 2005).

This information is meant to be a resource for those looking for information.  For the sources listed in this entry, or for more information, please refer to the following:

·         Center for Disease Control and Prevention (CDC).  Has a thorough tutorial on EVD.  http://www.cdc.gov/vhf/ebola/index.html

·         “Ebola Virus Antibody Prevalence in Dogs and Human Risk.”  http://wwwnc.cdc.gov/eid/article/11/3/pdfs/04-0981.pdf

·         World Health Organization (WHO).  Valuable information on EVD.  http://www.who.int/csr/disease/ebola/en/

·         CDC Safety Training Course for Healthcare Workers Going to West Africa in Response to the 2014 Ebola Outbreak.  http://www.cdc.gov/vhf/ebola/hcp/safety-training-course/index.html


·         Facts About Bushmeat and Ebola.  http://www.cdc.gov/vhf/ebola/pdf/bushmeat-and-ebola.pdf

 

Sources:

Allela, Loïs, Bourry, Olivier, Pouillot, Régis, Délicat, André, Yaba, Philippe, Kumulungui, Brice, Rouquet, Pierre, Gonzalez, Jean-Paul, Leroy, Eric M. (March 2005) “Ebola Virus Antibody Prevalence in Dogs and Human Risk.” Emerging Infectious Diseases. Vol 11 No. 3. Retrieved on October 10, 2014. Retrieved from http://wwwnc.cdc.gov/eid/article/11/3/pdfs/04-0981.pdf

Nadeau, Barbie Latza. (October 9, 2014) “The Dog is Dead-And We’ll Never Know if He Had Ebola.” The Daily Beast. Retrieved on October 10, 2014.  Retrieved from http://www.thedailybeast.com/articles/2014/10/09/the-dog-is-dead-and-we-ll-never-know-if-he-had-ebola.html.

Wednesday, October 8, 2014

Fore those seeking information about Ebola...


The Ebola Virus has been on every news source known to man.  Everyone has an opinion on how and who should handle this epidemic.  Let’s start with the basics and gather information on what is Ebola and how, as a medical professional (human or veterinary medicine) we can help.  The Center for Disease Control and Prevention (CDC) is having an online Q & A today giving an opportunity to cutout the middle man.


What's New on the CDC Emergency Preparedness & Response Website

CDC Twitter Chat - Ebola Q&A

Join us today (10/8) at 3PM EDT as CDC experts answer your questions on #Ebola. Use #CDCchat to participate. https://twitter.com/CDCemergency/status/519658049477160962/

Wednesday, September 24, 2014

Thoughts of a Veterinary Professional...

Welcome to the first installment of my podcast Thoughts of a Veterinary Professional.  There are two purpose's of this new enterprise, to spread the knowledge I've attained with the hopes of encouraging others to become part of the animal sciences in addition to encouraging a dialogue among veterinary and human health professionals.  I have been in the animal industry for 19 years in difference capacities...from a Licensed Veterinary Technician and Licensed Wildlife Rehabilitator to Barn Manager and Volunteer Coordinator (for a nature center).  This podcast (http://meresasalisbury.podbean.com) is my conduit to transmit my knowledge to others, to learn from others experiences (I welcome comments) and to create a virtual environment that foster's communication between veterinary and human health professionals. 
 
Installment one is devoted to encouraging others to become part of the animal sciences.  Do you have an interest in animals, but are not sure what direction to go?  Maybe you have a direct or goal, but are not sure where to take your first step.  Or maybe you know someone that wants to get involved and you don't know where to encourage them to start?  This is the installment for you...

Thoughts of a Veterinary Professional › Embed Code — Podbean

Thursday, June 19, 2014

Harms way...


What do you think of when you think of a rabid animal, an animal with the rabies virus?  Do you picture a viciously aggressive animal foaming at the mouth?  If you do, then you would be only able to recognize a small fraction of rabid animals.  Although Hollywood portrays rabies positive animal’s as having floods of foam coming from the mouth, this is not a common sign.

What do you see with a rabid animal and which animals are of concern to contract and/or spread rabies?  In Michigan, the most commonly rabies diagnosed animals are bats.  However, rabies can infect most mammals and those most commonly susceptible includes skunks, raccoons, fox and coyote (in Michigan).  Rabid animals can be abnormally aggressive or abnormally afraid, they seem to be drunk and have a staggered walk, they may simply keep circling, there may be a sensitivity to light (photophobia), the animal will try to drink water and will not be able to (may gag up water or seem thirsty and refuse water, hydrophobia) and lastly may foam at the mouth. 

Rabies is a neurological virus, it affects the brain.  Once rabies infects an animal (or person) it makes its way to the brain and attacks the area of the brain that controls fear and anger.  Rabies is transmitted via salvia so by affecting the area of the brain that controls biting essentially, it makes the animal more likely to bite thereby transmitting the illness.  The foaming at the mouth is caused from the swelling and spasm in the neck, around the jaw and related area’s caused by the virus.  The victim attempts to drink and cannot and may give a sensation of drowning or choking.  Unable to drink, the victim salivates excessively.

In Michigan, if an unvaccinated pet bites another animal, it is supposed to be either quarantined for 10 days or, if this is not possible or the animal is acting ill, euthanized and sent for rabies testing.  If the animal has bitten a person, the quarantine could be up to six months.  Again, if quarantine is not possible, euthanasia and rabies testing.  Rabies can take up to six months (or longer in rare cases) to surface in an infected animal (or human).

Keep in mind rabies attacks the brain, so the brain must be intact to test for rabies.  Otherwise only a necropsy (an animal autopsy) can be performed and may indicate nothing as rabies does not typically affect any other area of the body for virus identification.  Rabies testing, again in Michigan, is performed at Michigan State University and is sent in by the Health Department.  Certain packing measures are taken to keep the animal from decomposing quickly and deteriorating the brain otherwise making it difficult or impossible to test for rabies.  Animal that are tested for rabies should NEVER be frozen as this also causes damage to the brain affecting test results.

One June 12th a woman was bitten by a raccoon in Suttons Bay Township (Northern Michigan).  9 and 10 .com reported the woman was gardening at her home, which is near a wooded area, and a raccoon ran up to her and attacked her.  She attempted to kick it back however was unsuccessful and the raccoon was able to bite her on her right ankle.  Her husband shot and killed the raccoon.  According to the reporter, the local Animal Control Officer (ACO) took the raccoon to a local veterinarian for rabies identification.

Many moons ago (more than 20 years ago) there was reason for concern if you saw a raccoon out during the day.  Raccoons are (use to be more so) nocturnal animals, out during the night.  However they’ve adapted to daytime hours.  If, for instance, you put your trash on the curb during the day or there is another food source available during the daylight hours, you will see them out during the day.  Raccoons are opportunistic scavengers and will not turn down a food source regardless of the time of day.  Therefor the time of day when a raccoon is out is no longer a reliable indicator of disease.  In regards to this woman’s case, raccoons are not typically territorial or so protective of their young that they would ran after someone.  This reported news story of the woman in Suttons Bay Township sounds suspiciously like rabies.  The concern is her husband shooting the animal, hopefully it wasn’t in the head and/or the brain was damaged to the point that it could not be tested for rabies.  Although a veterinarian’s job is to diagnose disease in animals, this is not a case for a veterinarian.  A report needs to be made with the Health Department and then, through the Health Department, the animal is sent for rabies testing to the State of Michigan.  The Health Department also tracks these incidents to determine the rate of incidents of rabies and the species affected.  A helpful tool for those at hospitals and veterinary hospitals when trying to determine if rabies is actively in their area.

So, why am I writing about this?  This is a case where is it imperative for physicians and veterinarians to work hand-in-hand.  The emergency room physician should be recommending for the woman to receive rabies inoculations to help her body identify and kill the virus if she was in fact bitten by a rabid raccoon.  The raccoon was taken to a veterinarian, where he/she would identify a need to send it out for rabies testing and in turn following protocol.  Especially during the warming months, people are out-and-about more often gardening, hiking, camping, walking their dog, etcetera bringing them, potentially, in harm’s way.  Any pets in the vicinity of this raccoon incident should be up-to-date on the rabies vaccines and distemper series vaccines.

Although it is rare in the United States for rabies positive domestic animals, or even rarer yet, rabies positive humans, vaccinations should be taken very seriously.  YouTube has multiple videos showing rabies positive people and it’s frightening.  Once neurological signs show, it is 100% fatal and to watch a loved one go through this, especially since it is 100% preventable through vaccination, would be horrifying.  Dogs and cats should be vaccinated even if your cat is 100% indoors or if your dog only goes outside to use the bathroom and is immediately brought back in.  If a bat was to get into your home, your pets as well as yourself could be potentially exposed.  Read my previous post “The Community Task Force” for an explanation of groups of individuals that should always have their pets up-to-date on the rabies vaccine.

Human medicine professionals should also be recommending individuals that work in industries where animals are handled (example. Kennels, training/grooming facilities, veterinary hospitals, lab’s, etcetera), to have their vaccines as well.  The rabies vaccination for people is painless and has few possible side effects (nothing is without risk).  The Center for Disease Control and Prevention has a wonderful site on the rabies vaccine and can be found at  http://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.html.

This woman bitten by a raccoon in Northern Michigan is another reminder of the need for cohesive actions between ALL medical professionals, veterinary and human medicine.  We all need to be on the same page and that’s community education and protection.  Neither profession has greater responsibility, both are equally responsible and required to act in the best interest of their patient, client and society.

Tuesday, June 10, 2014

The Community Task Force...

You may have read any number of my posts and wondered “What has this got to do with me?”  Well, when doctors and veterinarians are not communicating it creates additional risks to something we see as so benign, and that’s owning a pet.  Many pet owners or relatives of those with pets take for granted the potential health risks with owning a pet.  I’m not trying to come across as Chicken Little yelling “The sky is falling!!!” but these risks should be calculated and not underestimated.

Let me give you a real life scenario…I was talking to a man over the weekend that stated “I don’t believe in taking my cat to the veterinarian.”  My counter was “is your cat up-to-date on her rabies vaccine?”  Now, if you’ve read my bio you may be thinking this is my 15+ years in the veterinary/animal industry speaking…well it is and it isn’t.  Here’s the rest of this man’s circumstances…

This gentlemen is in his 60’s, is primarily homebound and is susceptible to illness due to current health conditions and he lives in a very rural area.  Although it is not common for a bat to get into his home he did admit it wasn’t impossible.  So here’s a few concerns

1.      His cat is not rabies vaccinated and although it does not have access to outside, bats are commonly found in the area.

2.      For the cat to receive the rabies vaccine, it is first examined for illness.  Concerns for disease transmission do not just include rabies, but also cat scratch disease (CSD, bartonellosis) and the transmission of intestinal parasites are some other zoonotic (disease that can be transmitted from animals to people) concerns.  If bats can get into the home, chances are rodents and other small disease carrying critters that are found out in rural areas are able to get into the home as well.

Apparently this gentleman’s physician did not recommend for his cat to have regular veterinary visits.  Yet again, here’s a situation where the two medical professions are not working cohesively.

When I go into an exam room to take the vitals of my four legged patient, acquire information from the client and discuss recommended vaccines and other services I find it imperative to inquire about the health status of all those in the household.  A common question from pet owners is “What vaccines (or tests) do you think my pet needs?”  I explain there are core vaccines that are recommended for pets based on age and socialization (example.  Those that are taking their pets to the groomer or a trainer) however there are additional vaccines that can be recommended if any of these groups of people are in the home, help clean a litter box and/or visit frequently

·         Children (especially children five and under)

·         Elderly

·         Pregnant woman

·         Persons with compromised immune systems

I do not ask the pet owner specifically what their diagnosis or condition is however I explain that recommendations are altered if there is someone in the home with any of those considerations.  Note:  in the veterinary field we do not document or ask specific information about health conditions to protect the personal information of the client.  I could write a book on these concerns, so I’m making an attempt to cut it short however I do want to mention something else…

I’ve mentioned the concerns of a pet with a zoonotic disease sharing with its human caretakers, but there is another reason why keeping our pets healthy is imperative.  There are many diseases pets can carry that do not affect people (example.  Parvovirus, feline leukemia or FeLV, distemper, etcetera), however if they contract an illness, just like us, it weakens their immune system making them more susceptible of picking up other illnesses, including those that are zoonotic.  It’s not uncommon, for example, for a puppy that has successively defeated parvovirus to soon after develop ringworm (or other fungal infection) or mange.  When a pets immune system is worn down or is in a constant state of flux, other ailments or conditions can develop that can place us at risk.  It is crucial for both animal and human medical professions to work unified in keeping patients, clients and the community safe and as free from illness as possible.

Going back to the gentlemen I spoke of early in this entry, here’s a man, in his 60’s, homebound, he has a weakened immune system with an unvaccinated cat with an unknown health status (because it does not see the veterinarian).  This is an accident waiting to happen.  Human health professionals should be recommending to anyone that is elderly, those with weakened immune systems, pregnant women and those with children in the home (or that frequently visit) to take their pets to the veterinarian.  Just as those in the veterinary professional that diagnoses pets with zoonotic disease or parasites should be recommending the pet owner (or family members) to seek medical attention and to recommend vaccinations, service and products that will protect pet owners from developing a transmissible disease.  It may take a village to raise a child, but it takes a task force of doctors, nurses, veterinarians and credentialed veterinary technicians to keep a community healthy.

Tuesday, May 27, 2014

Stepped away, but not forgotten...


I’m looking at this blog and feeling a little embarrassed as I have totally neglected it.  I want to change that….I started writing this when I was doing a capstone project for my BAS on the communication between human medicine and veterinary medicine, especially when relating to zoonotic disease.  The emphasis being the importance of public health.  I’m posting my PowerPoint presentation so that you can get an idea of my conclusion of my project.

My project strengthened within me the importance of a working relationship within the medical professions.  I knew changes were needed to some degree, but let me highlight areas that still stick with me years later…

·       When I go to a doctor’s visit, whether routine or because I’m not quite up-to-par, I’m never asked if I have pets and I can count on one hand the physicians that have asked me my profession.  The importance?  Not only can allergies affect various parts of the body and lower immune system responses, but I am also exposed to potential diseases/illnesses I would not other be exposed to if I did not have pets or did not work in an animal field.

·       I called the American Medical Association (AMA) to inquire about their partnership with the American Veterinary Medical Association (AMVA) on the “One Health Initiative.”  It seemed like the best way to get in touch with a professional (I.e. doctor) through the AMA would be to go through the members direct line, thinking it would be staffed with trained professionals (I.e. nurses that would be able to direct physicians to resources for questions they might have).  Instead, I found out the call center is staffed with on-the-job trained individuals that did not know what “zoonotic” meant, what “One Health” meant (even though it was on the AMA’s website) and they had no clue what to do with me (this included a supervisor as well).  I ended up getting in touch with an AMA board member by looking up the current board members and going down the list and calling their private practices.  One board member called me and his responses are in the PowerPoint presentation I posted.

·       The Infectious Disease Society of America (IDSA) seemed like a good place to turn for questions on how much they encouraged medical professionals to communicate to each other in regards to emerging zoonotic diseases.  After a few transfers, I was sent to the Vice President of Communications, who just as with the AMA call center, was unsure what to do with me or who to send me to and her response?   “Have you tried the American Society for Tropical Medicine and Hygiene?”    Surprising since this is not a tropical medicine issue.  Anyone who has pets, works around livestock, owns a horse, or really, who gardens without wearing gloves when playing in the dirt, is susceptible to zoonotic disease yet the Infectious Disease Society of America isn’t aware?

·       I called the Center for Disease Control and Prevention (CDC), really not sure how willing they will be to talk with a student.  I found out, not very willing.  I was never able to make it past the News Media Department.

·       A call to the Department for Environment, Food and Rural Affairs of the United Kingdom (DEFRA) was pleasantly surprising.  For starters, I had an easier time getting connected with the right individual than through organizations or the government within my own country.  And the communication you might ask?  Well, they encourage and regularly collaborate with veterinarians and human medicine physicians.

So, what does all this mean?  Well, we do not quite acknowledge the link between animals (pets) and disease transmission.  The American medical professionals, whether or not they believe it to be necessary, do not take the initiative to communicate with each other.  And the unexpected, the professional organizations, such as the American Medical Association and Infectious Disease Society of American, do not encourage or recommend the professional to intermingle or exchange ideas.  The World Health Organization (WHO) back in 2005 acknowledged the need for collaboration “By their very nature, the fields of human medicine and veterinary medicine are complementary and synergistic in confronting, controlling and preventing zoonotic diseases from infecting across species.”

So, what’s is my meager little recommendation?  Although it seems daunting, we as professionals need to start pushing the professional organizations to provide materials and the means to get in touch with both medical sides.  Although it would typically be the other way around, it’s not worth waiting and have a negative impact on our patients and clients.  We are in a time when, more than ever, people are traveling to other countries and coming into contact with diseases they otherwise would not be exposes to, pets are being brought into this country and are living in our homes (and sometimes sleeping in our beds) and livestock and other food sources are being imported into the United States.  We have all these additional risks, yet we are not adapting to the additional risks and those that are supposed to keep up informed are dropping the ball.  At this point, we need to take the initiative and make sure the resources are available for those newly graduating or entering the veterinary or medical fields.  Not only do we need to pull our heads out of the sand and protect the public health as physicians, veterinarians, nurses and credential veterinary technicians, but we need to avoid reserving spaces in the sand for newer professionals to implant their heads.