Thursday Mishmash

I love aliens.  Little green men.

Like this guy:

It all started with a little television show called The X-Files. I was obsessed.  Of course aliens are real and have been visiting our planet for decades! Of course the American government covered up the events in Roswell, New Mexico.  Now, before my fellow physician colleagues out there call for a psych consult, let me be clear that I don’t really believe any of that.  Sure, sometimes it’s nice to think that we, humans, are not alone in this vast universe, but I certainly don’t believe that we are being visited on a regular basis by other intelligent creatures from far away galaxies. Nor are select individuals being abducted from their homes and experimented on in spaceships.  (Though, as an aside, have you ever been in an MRI machine?  The bangs and clicks those machines make are startling similar to the sounds that abductees often describe. I’m just saying.) The concept of “We are not alone” is an intriguing one.  One pervasive human trait is our fear of being alone.  I think we pair bond for that reason (and of course to reproduce, but really I think, to avoid being alone).  How can we be the only intelligent life in the universe? What makes us special? Was it happenstance? Divine intervention? A fluke?

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Speaking of mish mash.  On a trip to Montreal about 8 years ago, husband did some research on where to eat and what to do in the city.  He found a little greasy spoon outside the city that had a wonderful reputation for something called the mish mash. Apparently this was the place to go to for a hangover breakfast. And that’s exactly what we did.  The restaurant was called Cosmos. Run by a Greek family, the house specialty was the mish mash – fried mashed potatoes, bacon, sausage, eggs and anything else you wanted, all mashed up together.  Seriously, it was one of the best breakfasts I’ve ever had.

Shockingly, we found out a few years ago that Tony (top) was killed in his home, his son a suspect in the murder. So sad and tragic.

tonycosmo

cosmo

mishmash

 

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I started this blog in September, 2011.  I was a month away from starting back to work after my second maternity leave.  I felt like I had learned so much from experiencing pregnancy, childbirth, and postpartum depression that I realized how much it helped make me a better doctor and wanted to share some of that experience.  Little did I know that three and a half years later, I’d still be writing and would have close to 350 followers!  It’s been fun being able to see where all my visitors are from. Some of you are thousands of miles away, others are just hop, skip and a jump from my back door, and some are from cities I’ve never heard of! Some of you are active contributors, others merely quiet observers.
Thank you all again for visiting.

 

Doctor Only Me Time.

Day 12 – National Blog Posting Month.

Later today I am leaving the city for a big conference.  Getting on a jet plane, folks. Don’t know when I’ll be back again.

Just kidding…

I feel a bit weird leaving my husband and kids.  I know they’ll be fine but it’s a lot of work, three kids and a household.  Two days ago I told husband I felt guilty for leaving him with the kids.  He said not too, that I deserved a break.  I couldn’t help but think, “I need a break?! I get to go to work everyday! He needs the break!” I love him for saying it though. I know if he were in my shoes, he’d be excited to go away for a few days.  I’m sure I will be excited once I’m at the airport but right now I worry about how the grade one parent-teacher interview will go on Thursday and I worry that the baby still isn’t quite over his stomach flu because nor am I.

Last night husband made sure he knew where my life insurance policies were.  You know, just in case.  Oh God, that reminds me that I still haven’t done my will.

I really do need this conference though.  Since having the baby I haven’t really done much in the way of organized course work/self-learning.  I’ve done some online reading around patient issues but not much else.  I really need some time to focus on medicine and what’s new. I am meeting my friends from residency and we’ll be doing some guided self-learning workshops in between the conference sessions.  We’ve booked some restaurants and I pray my stomach is better.  My appetite is returning, very slowly, so I know I shouldn’t overdo it in the eating (or drinking) department.  Le sigh.

I plan on bringing my winter running clothes as the temperatures are about to drop and I’m headed a bit northeast of my current location.  I haven’t run in almost a week because of this stomach virus, so I really really hope I can get a 3-5 km run done.  I really miss it.

I have a morning clinic to work and a few errands to run before the car picks me up for the airport. I’m sure the excitement will set it in at some point but for now I just wish this stupid stomach virus would end.

Life Imitates Art.

I have always been a sucker for disaster movies.  If I’m laid up on the couch sick with the flu, or just need a go-to movie to watch, my husband always knows which film to put on.  Hollywood doesn’t disappoint – there are many to choose from, be it in the form of natural disasters like comets and asteroids threatening the Earth, or solar flares, or climate change causing another ice age – I have my pick of movies that I can watch over and over and over again.

There’s a certain suspension of reality from the movies I’ve listed below – how likely is it that we will see another ice age? I mean, really.  How likely is it that a comet or asteroid is suddenly going to be discovered that will hit us in just the right way to cause an extinction level event?  I always joked that if such a thing were to ever happen, I would want a front seat to watch it.  A giant asteroid hurtles towards the Earth and will destroy the planet?  Yes! Sign me up for a front row seat to watch it enter the atmosphere!

 

 

 

 

 

 

 

 

 

 

 

But then there’s the other kind of disaster movie.  The movie about a virus, spreading throughout a population.  There’s only been a few that I can think of, probably because it hits a little too close to home for most people.  You know the movies.  You’ve seen them.

These movies are a little harder to watch, especially Contagion.  Why?  I think that’s pretty much self-explanatory.  The likelihood of a virus causing illness and spreading quickly, infecting and potentially killing people, is well documented in human history.

The Black Death (aka the Second Plague) killed an estimated 75-200 million people in the 14th century.  It was caused by a bacterium called Yersinia pestis and was carried by rats.  Also known as the Plague, it ravaged most of Europe, and took almost 150 years for Europe’s population to recover.  The Plague recurred on and off for the next 500 years, causing smaller outbreaks in Spain, France, Sweden and Russia.

 

Smaller pandemics of cholera, typhus, measles and smallpox have been reported throughout the past 1,000 years:

  • The Italian Plague killed 280,000 people in the 1600s
  • In Southern New England, 30-90% of the population of the Wampanoag people died of leptospirosis
  • In the 17th century, the Great Plague of London killed an estimated 100,000 people
  • In Asia/Europe, in the early 1800s – the first cholera pandemic killed over 100,000 people
  • The second cholera pandemic, in the mid 1800s, killed another 100,000+ people in Asia, North America and Europe
  • In 1838, over 100,000 people died in the smallpox epidemic of the Great Plains
  • The third cholera pandemic affected Russia killed 1,000,000 people in the span of 8 years, between 1852-1860
  • 20,000+ people died of a typhus epidemic in Canada, in 1 year in 1848
  • In 1875, 40,000 people died of measles in Fiji
  • Worldwide, in 1889, 1,000,000 people died of a flu pandemic

The 20th century alone saw some of the world’s worst pandemics.

  • The Spanish flu decimated the world’s population after WWI, killing an estimated 75,000,000 (75 millon) people, in 2 years!
  • In 1957, the Asian flu killed  2,000,000 people worldwide.
  • 1 million people died in 1968 of the Hong Kong flu.
  • 15,000 people died in India, in 1974, of cholera
  • More than 30,000,000 people have died of HIV/AIDS since 1981

The 21st century is almost a decade and a half old.  We have seen our fair share of outbreaks. Nothing as devastating as in the past, thanks mostly to sanitation, vaccination, antibiotic and antiviral medication, but outbreaks nonetheless.  One might argue that the world is due for one.

  • In 2003, SARS killed 775 people, mostly from China, Hong Kong and Canada; it spread to 37 countries from China
  • The 2009 flu pandemic (H1N1) killed about 15,000 people worldwide.

And this brings me to the real reason for this post.

For months now, news of the Ebola epidemic in West Africa has filtered through my Twitter and Facebook feeds.  The numbers of infected are astounding. I’ve seen estimates that by January 2015, over 1 million people will be infected, half of whom will die.  Ebola, historically, has had 90% death rate.  During this recent epidemic, about half of people infected are dying.  But that is still 50% case fatality rate.

So, what is Ebola? And why is it so deadly? Well, Ebola is a virus.  It’s actually quite pretty, I think.

My knowledge of virology is limited to a few hours of lectures on viruses from medical school.  It has an RNA-genome and it is kind of long for a virus.  Like most viruses, Ebola enters a cell by attached to that cell’s protein coat and fusing with it.  Once fusion of the two occurs, the virus empties it’s contents in the cell and the RNA attaches to the host cell’s RNA and takes over. Instead of the cell making its own proteins, it now has instructions from the viral RNA and starts making copies of the virus.  Once those copies are made the virus attaches to the cell’s outer coat, buds with it and leaves the cell.  By this time, the cell usually cannot function anymore, and so it dies.  The new virus copies get into the bloodstream where they are free to infect other cells and the cycle starts again.  The host immune system cannot keep up with this invader.  The virus makes special proteins that interfere with the hosts’ defenses and leaves the host vulnerable.

The Ebola virus especially likes the cells that line the blood vessels, as well as certain cells of the immune system and the liver.   After infecting these cells, it damages the integrity of the vessels, leaves the immune system’s defenders weakened, and damages the liver’s ability to form clotting factors.  The host then starts to bleed internally, hence the reason Ebola virus infection is also known as hemorrhagic fever.  The host bleeds internally, eventually causing death.

By the grace of God, if you so believe, Ebola virus is not airborne.  This means that it’s not present in the air and cannot be transmitted from being coughed on, sneezed on, or breathed upon.  Infection with Ebola occurs when bodily fluids (blood, feces, urine, emesis) from an infected host are mixed with a healthy host.  Most of the people who have gotten sick in Africa were family members and health care workers caring for the sick, and sadly, the dead.  The WHO recommends avoiding contact with the sick whenever possible, regular hand washing with soap and hot water, and discourages traditional funeral rites of washing and embalming the bodies of the dead.  The virus can be killed with heat (heating for 30 to 60 minutes at 60°C or boiling for 5 minutes).  Quarantine remains an effective method of controlling the disease.

I’ve often joked with friends and family that the world is due for a pandemic.  It’s been almost a hundred years since the Spanish flu pandemic.  The seasonal flu is nothing to joke about – the very young and the very old, still die every year from regular, joe-schmoe influenza.  There is a vaccine developed every year against the strains that most likely will be in circulation.  Since 2009, the vaccine now protects again H1N1 as well. Our office is getting ready for our annual fall classic – the Flu shots are arriving tomorrow and we are starting “flu shot” clinics next week.

But something in the news recently has me a bit worried. Earlier this week, it was reported that a traveller from West Africa boarded a plane in Liberia and landed in Dallas, Texas.  Asymptomatic at the time, he passed through whatever checkpoints were in place and entered U.S. soil.  A few days later, he started getting sick and presented himself to the local ER.  He told the triage desk his travel history, was seen by a doctor, given a script for antibiotics and was sent home.  He returned to the hospital 4 days later, very ill, and was diagnosed with Ebola virus.

Yes, folks. Ebola virus is now in North America.

I have one question.

How the FUCK did this happen?!?!?

Why are planes from West Africa being allowed to land?  If such a plane does land, why aren’t those travellers being immediately quarantined and monitored for symptoms?  Have we learned nothing from SARS and H1N1?

I wouldn’t want to be that triage nurse in Texas who took the travel history information from the Ebola patient and failed to forward it along to the attending physician.  I’d like to think that physician, had he known his patient had recently been in Liberia where there is an Ebola outbreak occurring, would have immediately notified the Centers for Disease Control and Prevention (CDC), and locked down his hospital. But no, that physician apparently didn’t know of the travel history, the patient didn’t bother to mention it again, and he was sent along his merry way to infect his family and God-knows who else.

Apparently, the man went back to the apartment complex where his family lived, started getting progressively more sick, was actually seen vomiting outside the building before being taken back to the ER where he was eventually diagnosed.  Does this not alarm anyone?  When I read the news report to my husband, he made an interesting observation. One that actually is a bit frightening.

Who cleaned up the vomit which likely was teeming with Ebola virus?

Did a dog come by and lick the vomit? Did that dog go back to his owners?  Is the dog sick? What will Ebola do in a new host species? Has the virus mutated? Can it become airborne?

According to that report yesterday, 18 people have been identified as being in contact with this individual.

Today? The Texas health departmentt said there were 100 potential contacts.  “Dallas County officials said more than 80 had direct or indirect contact with the patient.”

Well, which is it?  Indirect contact shouldn’t be a concern with Ebola, right?  Only direct contact, like family members cleaning up vomit or feces, or wiping the face of their sickened family member; or the maintenance worker of the apartment complex told by his bosses to clean up the vomit outside the building?

Today it’s 100.  Tomorrow it could be 1000.

Is this the beginning of next pandemic I joked earlier I thought we are due for?

In those two movies I love to watch, Outbreak and Contagion, the CDC takes control of local health departments and gets the epidemic under control.  Is life about to imitate art?

For all of our sakes, I certainly hope not.

 

 

 

 

 

 

 

 

 

JJ – The Animal Rescuer

Day 9 – January Daily Blog Posting Month

A few months ago, a good friend of ours packed up her life in the city and together with her partner moved to Costa Rica to manage the Nosara Animal rescue shelter. Before they left the country, we had them over for dinner to wish them well. I can honestly say both my husband and I were a little jealous at their freedom in life to be able to do so.

Our friend had always worked with animals. For as long as I’ve known her, she was worked in veterinary clinics as a technician and has loved animals. A few years ago she rescued a feral pregnant cat and took care of her during the pregnancy. She was there when the cat delivered her litter and actually kept the kittens that survived. She has traveled to Bali as well as Costa Rica to volunteer at animal shelters.

Two years ago, she held a wine and cheese fundraising event for the shelter in Bali. She is also a photographer and was selling her work. I bought one of her photographs and put it up in my exam room. It is a stunning photograph. It gave me a sense of calmness and peace and I felt it was perfect for patients to look at while in the exam room.  I can’t count the number of compliments I’ve received about this photograph.

She is chronicling her adventure in Costa Rica in the form of a blog and the entire reason I am writing about her today is to showcase her blog and her photography.  She plans to donate 50% of her commission to the animal rescue, I am proudly going to plug it here. If you love animals, please visit her blog and her photography website.  You can also follow her on Twitter @TravelRescuer.

Thank you!

The Journey and Adventures of Animal Rescue in Costa Rica

JJ’s Online Photography Gallery

Sleepy Thoughts.

I felt the need to write, despite being utterly exhausted today.  I wish I could blame it on my 1 month old son, but not this time.

Last night we had friends over for dinner.  A few bottles of wine and a bottle of Port later, I’m going to bed at midnight, only to be woken up at least 3 times to nurse.  (And just for the record, I helped with the wine consumption just a little bit, stopping myself at two glasses of wine and a half glass of port, not so much because of nursing but mostly because I wished to avoid the hangover.)  I did manage to avoid the hangover, but have barely been able to keep my eyes open all day.

The things we do to maintain our social lives.

The friends who joined us for dinner are moving out of the country next month, so it was important to us that we see them before they leave.  They are moving to Costa Rica for at least a year to work in an animal rescue clinic.  It’s a huge move for this couple but one I have no doubt they will make work. It’s an incredible adventure and I am a little bit jealous of the freedom they have to make such a move.  Don’t get me wrong, I wouldn’t change my life at all, I love my family and my work, but the thought of just picking up, putting my stuff in storage, hopping on a plane and living the expatriate life is for a while is really, really intriguing.

In all this “free time” I have now that I’m on maternity leave, I have been reading a lot of blogs on various subjects and find myself drawn time and time again to the MSF blogs. Reading about the work these doctors do abroad is fascinating.  When I told my husband about it, he said he would love to pack up the kids, rent out the house and have all of us go to Africa for a year.  He imagines I would work for MSF while he and the kids help build a house or something.  Obviously we’d have to wait until the kids were older, but what an incredible experience that would be.  To be able to leave the safety and comfort of my home and experience life in a developing country, to bring much-needed medicine and education – the thought of it just leaves me breathless.  Could I really do something like that? Could I leave my practice, my home, my comfort zone?  I’m really not sure, but I’d like to think I could.

Could you?

Dreaming of the Beach …

My FB feed today is full of comments about the weather.  It’s a snowy, slushy mess today.  It’s February, for heaven’s sake, what do people expect??

Hubby said this would be the perfect week to have gone south.  I reminded him that indeed, 5 years ago this week, we were in Negril, Jamaica on our honeymoon.

Ah… Negril.

We stayed at CoCo La Palm on the seven-mile beach.

Heaven.  It was pure heaven.

I have been wanting to go back ever since we left.  The locals were incredibly friendly, we loved how everyone was on “Jamaica time”.  We’d order a Red Stripe and maybe it would arrive a half-hour later.  So we quickly learned to order several at a time (ha!) so we were well stocked.

As I look out my office window today, the snow and slush make me want to get on a plane right now with the family and hit that beautiful beach again.

I think I am ready for winter to be over.  We’ve had our fair share of snow and sleet.  I want to see my tulips sprouting.  I’d like to put my boots away.  It’s time.