Hepatitis, easy as ABC

Most people only know of Hepatitis from their travel vaccinations stamp collection, but you probably also knew that Hepatitis affects the liver. Well done. But Hepatitis is so much more. It is such an interesting disease. If it was a Popstar I would sing all her songs. Let’s look at some nice things about this fascinating disease.

1. Inflammation of your liver

The latin name for liver is Hepar, and -itis is something we glue after everything to indicate it’s inflammated (colitis = inflammation of intestines, conjunctivitis = inflammation of eye, wapitis = two or more North American deer with large much-branched antlers). Hepatitis means you have an inflammation of your liver. This can be due to a virus (a viral hepatitis) but also by alcohol. If you want to be left alone the morning after the GT-mayhem don’t say you are hungover, no, you’ve got something “far more serious”: you’ve got a starting alcoholic hepatitis.

2. There are 5 viruses that cause viral hepatitis

There is A, B, C, D and E. They all cause the inflammation of your liver, but all in different ways. It’s not like when you learn how to swim that you get your A diploma first, then B, etc. These viruses can sneak up on you when you least expect it and all at the same time.

Hepatitis A: is transmitted fecal orally
Or in plain language from poop to mouth. Hence the true meaning of “being shitfaced”. If you don’t wash your hands after doing number two on the toilet or if a chef in a restaurant doesn’t do it, this virus can enter your mouth via the food that you eat. It gives you symptoms almost always and for about one month, some people get severely sick though. Sad thing is, we can’t really treat it, you just have to lie in bed and wait while turning yellow (you turn back to your normal color in the end). We do have good vaccinations though!

Hepatitis B: transmitted sexually or via blood.
It can also be transmitted from mother to child during pregnancy. Very sad for the child so we need to avert this. This is actually what I’m currently researching. A lot of times the infection becomes chronic and gives no symptoms for years. It does lead to liver failure and can cause liver cancer. We have medication to suppress the virus but most of the times the patients need to take medication their entire life. Better to prevent with some vaccinations! In most vaccination programs, Hepatitis B is part of the immunization of all children. All medical personnel are already obligated to get vaccinated, because there have been numerous outbreaks in history where an infected surgeon transmitted the virus to patients and vice versa.

Hepatitis C: transmitted via blood.
Mostly intravenous drug users are prone to infection, but also men who have sex with men are at increased risk if they do stuff with their anus or put stuff in their anus. Luckily, we recently got really nice medications to treat this infection! Keep stuffing your anus, we’ve got your back! Well, figuratively…

Hepatitis D: transmitted through contact with blood or other body fluids…
However only in patients that are infected with hepatitis B virus. Without B, no D. 

Hepatitis E: transmitted via consumption of contaminated water or food.
Experts are still unsure of the real impact of this virus in a person. It appears as if more people are infected without having symptoms. There are vaccines available, but until we know the exact burden of this disease, we probably won’t regularly distribute them.

3. Beware: an inflamed liver can stop functioning. The dangers of having Hepatitis

I still trap many medical students with asking them what the functions of the liver actually are. Here we go, the main functions:

  • detoxification of your blood. Yep, that alcohol you have been drinking is being processed by your liver. If you’re shitfaced regularly (aka alcoholism), your liver has to work so hard detoxifying you blood that it affects the function to do so. This makes you confused or worse.
  • production of clotting factors. Without your liver making these, you would bleed through all your pores and in your brain and everywhere.
  • production of glucose. Without your liver, you have no back up storage of glucose which is our main fuel. You would have to eat all the time, best excuse for Secret Eaters: I have an infection, I must eat. 
  • bile production. Your blood cells get renewed every so often and their dead bodies are taken from your blood by your liver and made into bile. This stuff makes your poop brown. Without your liver this will stay in your blood turning you yellow as big bird and your urine brown.
  • breaking down of hormones. Without a functioning liver, hormones like estrogen will not be broken down. This will result in men having boobs. And men shouldn’t have boobs… fact.

There you go, easy as ABC. Just remember to get all your vaccinations and limit your visits to poop-eating/fisting/vampire parties. You should be alright on the viral hepatitis issue.

For me, I’ll try to find a way to reduce mother to child transmission here on the Myanmar-Thai border in order to get rid of Hepatitis B for once and for all!

Syphilis, a social disease

Napoleon Bonaparte, Al Capone, Adolf Hitler, Friedrich Nietzsche and Vincent van Gogh. All well-known men that seem to be unrelated in every way. But on closer look we understand that they all changed the world as we know it. And no, not always for the best. I am indeed talking about Nietzsche with his endless nagging about the apparent relationship between the Apollonian and Dionysian juxtapositions in one’s endless struggle trying to create order in one’s chaotic life, … , you know what I mean. But what these men also had in common, they all suffered from Syphilis. Probably not a big shock, looking at the title of this blog. Can we maybe state that, to change the world, you might need a nice little psychosis due to neurosyphilis?

Syphilis is a disease that has been amongst us for many years now and used to be referred to as a “social disease”. Now don’t be afraid, you can still like a Facebook post, play Monopoly with friend or even go to a birthday party. Just wear a condom when you are doing it! You know why? Because unlike what my patients try to convince me of, you don’t get Syphilis from a toilet seat. Syphilis is an STD.
We now know that the bacterium Treponema pallidum thrives through intense relationships of mucous membranes from different persons, or to state it in plain language: penises, vaginas and anuses having fun with each other. The bacteria end up in the blood leading to rashes on your skin, festers on the already mentioned penises, vaginas and anuses and could lead to severe neurological problems… now take a look at the list of names again…

Back in the Middle Ages they didn’t know what the cause was. To investigate the disease and see if it maybe was blood transmittable, some clever men (always those guys) started a “very ethical” study amongst prostitutes, by far the most social people in that time. The researchers found some ladies with syphilis and took their blood. This blood was then given to another group of prostitutes, let’s call them the “I am really not volunteering for this” ladies. All the IARNVFT-ladies got injected with the infected blood and became ill. Voilà: the clever men knew Syphilis was blood transmittable. That’s what you call empirical research.

Unfortunately for them, there was no cure. One of the treatments that was practiced from the 11 century onwards was using Mercury. It wasn’t a cure, merely treating some symptoms if any. The Mercury was rubbed on skin, patients swallowed it, it was vaporized or applied in a plaster. For your reference, using Mercury as a medicine is probably comparable to taking 13 XTC pills, swallowing them away with detergent and smashing yourself on the toe with a hammer. Not something to look forward to. Another idea was to induce high fever in neurosyphilis patients using a Malaria parasite. This led to some patients death but also for the Nobelprize in 1927. Imagine you are paralyzed and psychotic and then getting Malaria, I wouldn’t be the biggest fan.

So, what did they know: Syphilis was blood transmittable, it gave you severe neurological problems … and there was no cure from getting sick after a social event! And if there’s no safe cure, people try crazy stuff to think of ways to prevent it. Flashback to 1717. An English doctor Daniel Turner was sitting in a bar, had some drinks and saw some beautiful ladies. He felt his manhood swelling and he knew he couldn’t resist the action. As a doctor he knew that the last thing on his wish list was getting Syphilis, so with his almost exploding man parts he jumped out of the bar, ran into a greenfield, saw a sweet little lamb … and butchered it. He immediately wrapped the sheep’s intestines around his penis, ran back to the bar and started a social intercourse event with one of the remaining lovely ladies. And guess what? He didn’t get Syphilis. In fact, he didn’t catch any STD. Daniel Turner, through his act of explosive desperation changed our lives drastically, the Condum (old English for hide) was born! To his great disappointment however, not everyone was enthusiastic at the time. We get that now because there probably wasn’t an ultrathin condum or one that glows in the dark or had funky flavours (unless you really like intestine flavour of course… not judging).

Luckily, in 1928 Alexander Flemming opened his window to start the discovery of Penicillin and a cure for Syphilis and many other diseases was finally there. But don’t think you can live like the Prince of Bel-Air. Syphilis is back in the game. After the start of the HIV pandemic, people became more scared about free sex with everyone they met and started either using condoms or having less contacts. This resulted in a huge drop of all STD’s, hooray! But HIV is not so terrifying anymore. That’s of course good news but people are getting back to their old habits, thus increasing STD rates and also Syphilis rates. That’s crazy, almost like … already have … some severe neurological problems … because of Syphi… probably not.
Ok, you can have sex with as many people as you’d like, even at the same time for all I care, but please take care of yourself and wear protection, it’s not a sheep intestine anymore!

My personal takeaway: I do want to change the world, but I’ll try to do this without Syphilis… I’ll try.

What everybody should know about vaccinations

Vaccinations, most of us are confronted with them at least once in our lives. Whether it is because of a child vaccination program or because you’re planning a trip to a far away country. Questions about vaccinations: most of us should ask them, but we rarely do. And those who want to find some answers often find the wrong information. They base their views and decisions on serious misconceptions and some decide, as a result, not to vaccinate their children. And meanwhile people in many countries all over the world are very glad that they can prevent their children from dying or getting really sick. Quite a contrast.
This blog is dedicated to all people that need some serious, truthful answers about vaccines.

1. What exactly is a vaccine?

A vaccine is simply said a way to train your immune system to get familiar with a disease (virus, bacteria or parasite) and to train your immune system to kill that disease. Familiarize with killing it? You don’t mean? … Hold on? … Are they…? … Indeed, vaccines contain material of the infectious disease you don’t want. But before you start shaking and get a panic attack: this vaccine is designed not to cause you harm. It is like a boxer standing before you who is unable to punch back. Let’s say the material inside the vaccine is this Boxer. In most cases this Boxer is injected in your system, sometimes it’s oral.

With some diseases you just need to show your immune system the Boxer once (for example Meningitis). With other diseases the immune system needs to see the Boxer a couple of times (Hepatitis A or B). And sometimes you need to repeat the vaccination every so often to keep your immune system on their toes (DTP).

2. Do you get sick after vaccination?

It is possible, yes, to feel sick for a while. Most vaccines use dead material of the infectious disease. Some vaccines, like yellow fever, use a living virus that has been disabled from multiplying or making you sick. After getting the vaccination, your immune system starts to work, potentially causing some flu like symptoms. This happens more with “living” vaccines than dead vaccines. Other risks of vaccination are a local skin infection where the needle entered the skin and a rash.

Remember: the vaccine is designed not to cause harm. It is your fist that hurts after hitting the Boxer, the Boxer still didn’t hit you back.

3. Is there toxic material in vaccinations? Is a vaccine “poison”?

Do you eat bananas? Did you have a body when you were a child? Are you worried about this? If not, don’t worry about vaccines.
In vaccines they use chemical stuff like thimerosal (a form of mercury but not as toxic as mercury, only used in a few vaccines), formaldehyde and aluminum. Fruits, vegetables, grains and cheese also contain amounts of these toxic agents and actually contain higher dosages of it. A banana contains approximately 16.3 mg/kg formaldehyde, a two-year old child makes formaldehyde in its own body in a dosage of 1.1 mg and a vaccine uses less than 0.1mg in total.

Conclusion: yes, there are toxic ingredients in vaccines necessary to make them effective. But they are non-harmful for your body and the dosage of these toxins is lower than all other stuff you are already confronted with. But, ok, when your not convinced, you should stop eating bananas and you definitely need to get rid of your body.

4. If everyone is getting vaccinated, why should I give it to my children?

Well, for starters, the whole idea of vaccination is a so-called herd immunization. This means that in a group of 100, if 99 people are vaccinated, the one that isn’t (because he couldn’t get the vaccine for different reasons) is protected  through the others. This is the case for many diseases that need a human to transmit the infection. This could mean you don’t have to vaccinate your children, but there is a downfall. More and more people are choosing not to vaccinate, dropping the “herd immunization” and thus increasing the risk of a new epidemic. My advice: if you have a young baby, don’t let them near unvaccinated kids!
There are also infections that you get from, for instance, a simple bicycle accident (Tetanus). Without the vaccinations against it (you need more than one), you’re in trouble, and I’m talking about serious youmightdie-trouble.
Another argument is that maybe your child is at one stage to old to get sick from a virus, say Measles, but they can carry the virus and infect other children that did not get the vaccine yet, thus endangering them.
Lastly, the world is getting smaller and smaller, you/your children are likely to go traveling and trust me, those diseases that you don’t take seriously? They kill people in some of the countries you/they plan to visit.

5. Can I reduce the pain of vaccination by giving my child something?

Yes, after the vaccination you give your child a very pretty bandage from Frozen or whatever other favorite character (my husband still buys Harry Potter bandages for me). Then you give them, depending on their age, a nice little snack and tell him/her how brave they were and how proud you are. Done.

6. Does vaccinating increase the risk of autism or other neurological diseases?

No.

There has been a study in the 1998 by Andrew Wakefield in 12 patients (yes, just two more than the total of your fingers, at least I hope so, if not, it wasn’t my intention to offend you, what happened? you shouldn’t play with fireworks or chainsaws or … boomerangs… we need to move on) that claimed that the MMR (Mumps, Measles, Rubella) vaccine was linked to autism. That’s what everyone remembers. What we don’t remember is that this particular researcher had in fact made up the entire study. Wakefield had been funded by lawyers who were engaged with parents in lawsuits against vaccine-producing companies. The journal (Lancet, big medical journal) exonerated Wakefield and his colleagues on charges of ethical violations, deliberate fraud and scientific misconduct. The study was formally retracted from publication, the man was fired and can never conduct research again. Many follow up studies have been conducted and none ever found this negative effect of vaccinations. In short, boomerang, we need to move on.

7. Finally, what diseases are vaccine preventable?

Well that’s a lot. Are you ready? Sit back, read or skip and trust the advice your government provides…

To date we have effective vaccines against:
Diphtheria (a severe throat infection, especially children die), Haemophilis influenzae B (can cause meningitis in young children, deadly), Hepatitis A (severe infection), Hepatitis B (can cause chronic infection and cancer), Human Papiloma virus (HPV, can give cervical cancer to women), Influenza virus (flu, prevents severe infection, yearly update, see previous blog), Japanese encephalitis (deadly), Measles (deadly), Meningococcal disease (meningitis, deadly), Mumps (deadly and boys can get infertile), Pertussis (whooping cough, for young children deadly), Pneumococcal disease (pneumonia, deadly for young children and fragile patients), Polio (paralyses or death), Rotavirus (deadly for young children in developing countries), Rubella (deadly), Tetanus (pretty common bacteria, causes spasms and eventually death), Smallpox (deadly but eliminated, see first blog), Yellow fever (deadly, no treatment)

Vaccinations we have that are not 100% effective:
Rabies (deadly, after a bite need booster vaccinations), Tuberculosis (prevents severe infection but does not prevent infection itself), Typhoid fever (severe infection, 70% effectiveness).

And luckily, more and more vaccines are coming.

Don’t be afraid of vaccines. Please don’t, it saves not only your own live, but also those of people surrounding you. Should you ever be in doubt however, look into a mirror and understand: you are beating Mohammed Ali, you are beating Mike Tyson, you are a Boxing Champion!

Mythbusting Urinary tract infections

A urinary tract infection (UTI), it’s like trying to pee small needles. Most ladies have experienced it at least once in their life and are in fear it will return. Be afraid, be very afraid, because for many it will return.
I count myself lucky that I have only had the unpleasant experience twice in my life and only in a short period of two months. But oh my! Tears were running over my face and that was only because I just sat down and feared what would come. When the terror started it was excruciating to remain seated for five whole seconds. It took me to a new level of respect for the ladies with a recurrent UTI-experience.
What is it with this awful infection? Time for some facts and myths about UTI’s.

1. Fact: Women get infected more often than men

The whole mechanism behind the infection is a Tale of Two Holes. You get UTI’s mostly from bacteria that normally live and belong in your intestines. The most common cause is E. Coli, but there are many more that can make your pee burn. What they do is tiger-crawling from your anus to your bladder. Take a moment to imagine that please, and try not to move! Indeed, that’s quite a distance to cover from a bacterium point of view. And that’s a good thing. Pee before one of the bacteria reaches your bladder, and you wash him away. Yes him, I call this fucker a guy. For women this popular road is shorter than for men. As most of you know, men have a penis that adds about 10 cm to the tract (well, not all of them …) making the odds greater to be washed away. In this case: size does matter!

2. Myth: you can get UTI by sitting on a dirty toilet seat

Nope. Not true. Better yet, the ladies that squad to pee above a “contaminated” seat tend to not empty their bladder fully. Some of the pee stays inside, sometimes with a UTI bacterium that hung in there. Happy with his new fancy jacuzzi, called your bladder, it gladly multiplies, and you end up crying on the toilet seat once more. So please lovely ladies, sit down. Your thighs can hold the germs. Just don’t rub your vaginas on the whole seat, ok? And no, men, don’t go toilet slapping (either), because … well, it ain’t right.

3. Nobody knows for sure: Cranberries can prevent UTI

The idea behind the cranberries is that you change the sourness, the pH, of your urine making it more acidotic. In this acid the “legs” of the bacteria dissolve, making it impossible for them to keep crawling. It’s weird to imagine that something you eat can have an influence on the pH of your pee. A sour cranberry comes in contact with bile first and that is made to neutralize any acid that comes out of the stomach (pretty acid environment going on in your stomach). So this makes you wonder if you can change it enough to have an effect on bacteria. There are others who suggest cranberries work because of anti-oxidants. I tell patients that they can try it, if it doesn’t help, it’s still tasty.

4. Nobody knows for sure continues: peeing after sex, wiping method, drinking

Some things just make sense. If you have sex, all sorts of bacteria get moved from both your and your partners flora and fauna. Peeing afterwards could be a good idea. Wiping from back to front, is like giving the psychotic hitchhiking bacteria a free ride. I don’t know, why would anybody even consider that? And if you drink a lot of water, you pee more often, flushing away bacteria on the road. Don’t think about these thing, just do them.

5. Myth: you can get a UTI by wearing short skirts

My mother was wrong. Yet again. Had I only known sooner that most of the things parents tell their kids are not evidence based. No, a short skirt does not give you a UTI. However, a short skirt might lead to sex causing a UTI, might get you to a place where you refuse to sit down and pee properly … or might make you wipe from back to … nah, forget this last one.

6. Fact: you can die from a UTI

If the bacteria crawl all the way up to your kidneys, it can cause a kidney infection, Pyelonephritis. From here it can enter your bloodstream and make you septic. Sepsis can lead to death. But rest assured, before you die you will probably go to the doctor with fever, pain on your sides and pain while peeing. This will make the doctor give you antibiotics and voila, you don’t die any more. And if you didn’t go to the doctor, well then you are a masochist. I am not judging,… but you will die.

7. Myth: you always need antibiotics to cure from a UTI

For uncomplicated bladder infections, like the one I had, antibiotics are not needed. Even when I was peeing blood as an additional setting to the torture, I knew that all I needed to do was drink lots of fluids and hang – not literally, see 2. – in there. 
If you do want to get antibiotics make sure that your urine is cultured to test for susceptibilities. You might regret not doing it if the antibiotics don’t work and you get the fever and flank pain from your kidney’s.

Ladies – and men, I am still not judging – let’s promise ourselves to wear short skirts, wipe properly, drink a lot of water and have sex as long as we pee afterwards while sitting on the seat.

 

 

Picture:

Source Flood plain toilet
Author Jacob Levine

Malaria: the search for a vaccine

After my previous blog, we all understand the basics of malaria. It is the parasite that kills, not the bad air from swamps or your armpits. And although we have some medicine to cure Malaria, humanity still didn’t find a vaccine to prevent catching one of the biggest infectious diseases out there. And that isn’t because nobody is looking for it or nobody is investing money in the research. On the contrary, finding a Malaria vaccine is like finding a needle in a haystack and then try to learn that needle to do a trapeze act. In short, it’s hard work.

Why and who needs a vaccine?

Well, a vaccine is not primarily for the people with a bit of money that want to see the Big Five. As nice as it seems that you can travel without taking these often expensive, sometime hallucinating medications, we need to take a wider perspective. A vaccine is needed to prevent children deaths. That’s what counts in these countries. Especially now that more and more Malaria parasites turn out to be resistant to our anti malaria pills.

How to train your dragon… uh, no, how to train your immune system step 1

In Nijmegen, the Netherlands, years ago, a research group found a couple of students to participate in their “can we train our immune system to recognize Malaria” study. They treated them with anti malaria pills and deliberately infected them with Malaria a couple of times. Then they stopped the medication. Now the real challenge began, without any prophylactic therapy all subjects were exposed to the Malaria once again. Just to see if the immune system had actually seen the parasite previously under treatment. Turns out: your immune system rocks! Even with the anti malaria pills it was able to get a good look at Malaria and remember what it looked like. The unfortunate thing was that this memory didn’t last very long. But it was a promising start.

How to train your immune system step 2

Now that we knew the immune system could be trained, researchers wanted to train it with a vaccine, a RTS,S vaccine. It took about 30 years to develop, but eventually they could test this vaccine in African children. They had really nice results, preventing serious Malaria in about 30% of the children. In a world where previously all malaria infected person died, this was good news! But, just like the Nijmegen group, they found that the immune systems memory weaned and the immune system needed to be exposed to the vaccine, and thus to malaria, in order to keep it working. Better than nothing, but not the holy grail humanity was looking for.

How to train your immune system step 3

Now the Dutch are hitting the news again. A new vaccine is made and is being tested in, amongst other countries, the Netherlands. The problem with the other vaccines appears to be that in the vaccine only some of the Malaria particles are used to train the immune system. But this is not good enough. The immune system needs more to ensure a long-lasting recognition. The new vaccine is supposed to be made from an inactivated whole parasite. Yes, you read it correctly, a whole Malaria parasite that has been modified to not go into hiding in your liver and not invade your blood cells. Pretty impressive right? Could work. Hopefully this vaccine wont take 30 years to get past all the safety and effectiveness tests!

So there you have it, the long long long search for a Malaria vaccine and the training of an immune system. Remaining questions that we want to get the answer to these coming years are: 1. Will this new vaccine give long lasting protection for the people that need it the most? 2. Will it help for all types of Malaria?

For now, don’t wait for this vaccine and do travel to Africa and see the animals, I can highly recommend it. Just take your prophylactic malaria pills.

Mal’aria? I don’t smell anything.

Some researchers state that humanity is on the verge to invent a vaccine against malaria. That would be great news, because Malaria is a notorious disease. In 2015 it infected roughly 121 million people with an estimated 429.000 death, most of which were children.

Time to shine a light on this disease in my blog. First some history and basics, next time we’ll learn about the search for that vaccine in a particular study in the Netherlands.

Although Malaria is a well-known disease, most Western people are only confronted with it when they travel to far away countries around the equator and they are going through their usual list of questions: 1. Do I need a special adapter to charge my phone? 2. Do I need a visa and by the way where is my passport? 3. Do I need to take a precautionary medicine for malaria or not?

But actually, not too long ago, this disease was also endemic (read my previous blog if you don’t know what that means) in Europe and in the USA. During World War II for example, approximately 500,000 men became infected with Malaria in Europe. Bet you didn’t know that.

Swamps and Miasma

Our very own granddad of medicine, Hippocrates, has described a disease with fever that would come after draining swamps and lakes. He was a believer of the “Miasma” theory, most people believed that you actually could get sick from bad air. In this case that the fumes from the swamps were the cause of the illness. Malaria even has its name derived from this Miasma theory; Mal Aria means Bad Air in Italian.

You might say: oh, stupid people, what were you thinking in 400 BC? Understand however that the Miasma theory has had an impact on the profession of medicine well into the 19th century.
But rest assured, you don’t need to shower, Malaria really has nothing to do with (your) bad air. It is all about the water where the mosquitos live. Without the mosquito: no Malaria! To be even more precise: malaria is caused by a parasite, Plasmodium, that specific mosquitos carry and inject humans with. At this moment there are 5 different Malaria species known of which P. Falciparum is the most famous one, but please don’t ask him for his signature.

Hide and Sick

Malaria can give you a lot of symptoms, but fever is for sure the numbero uno give-away. Unfortunately, the parasite can be a practical joker. It lives in different stages. Some of these stages are in your blood which are easily targeted by treatment, in other stages the parasite looks for a quiet place in the liver and can actually hide there for years before you get sick, resulting in a different treatment strategy.

Sometimes, natural medicine rocks

Now as a medical doctor, I’m not the biggest fan of traditional medicine. I’ve seen many times how the “traditional doctor” did not know the actual cause of the symptoms and just did some vague Magician Act. However, this does not mean that I don’t believe that nature has most of the answers to our problems. We’ve seen this for example with the discovery of Penicillin from a fungus, and yes, also in the treatment of Malaria, nature saved our asses again: the two most effective treatments for Malaria are both nature based.
The first effective treatment for malaria came from the bark of the cinchona tree, which contains quinine. The second drug is Artimisinine, which is a Chinese herb. It was used in China for many years to treat fever and hemorrhoids (love that combination).
Both of these drugs are used to make new variations to treat Malaria. But we need to go the extra mile. There is an actual danger for Resistance against these medicines. Here we go again. 

In summary: Bad air is difficult to breathe in, but does not actually cause Malaria … or hemorrhoids.

Next week: vaccination time

Endemic, Epidemic, Pandemic: Semantic

Doctors have this habit of using a different vocabulary, making easy things sound very complicated. An example: ‘melena can be an indication of peptic ulceration’ actually means ‘blood out of your ass can be caused by stomach ulcers’. Why use difficult words: a. the doctor wants to sound very important and smart or b. they just don’t know the subject well enough to explain it in normal words. Or, as it said on one of the tiles on the wall at grandma’s house: ‘It takes an assbleeder to talk about assbleeders’.
Even in this blog we go over so many infections and sometimes I can get lost in the semantics. So, this time no specific infection, it’s just about how you can sound smart whilst taking about them.

Endemic

Endemic refers to a disease or condition that takes place in a specific region. For instance, Malaria is endemic in sub Saharan Africa but is not endemic in Europe. At least, not any more. Some diseases become endemic in new places all the time, the flu for example or the common cold. Other endemic conditions don’t move unfortunately: like the scraping throats and spitting on the floor at 5AM at our neighbor’s place in Thailand. Endemic as such is in short not something to be really scared about, especially when you take precautions (anti-malaria pills, flu-shot, earplugs)

Epidemic/Outbreak

Turning it up a notch. Epidemic means that in a period of time, more cases than expected in a community/area/season are suffering from the same condition or are infected with a specific disease. Scary stuff right. For instance, the epidemic of Ebola in 2014. Or obesity in America. By the way, a different word for epidemic is ‘Outbreak’. Remember that movie with Dustin Hoffman? That sweet little monkey – a real one, not mr. Hoffman – that turned out to be a real badass decease carrier? Outbreak = epidemic. Choose whatever sounds more spectacular.

Pandemic

Now the real trouble is when an Epidemic becomes a Pandemic, in which case the infection has spread worldwide. We’ve seen this, for instance, in the H1N1 time. More notorious examples are the Black Death pandemic (1346-1353: up to 200 Million deaths), the (Spanish) Flu pandemic (1918 – up to 50 Million deaths) and the HIV/AIDS Pandemic (peak 2005-2012 – 36 Million deaths)

Another movie example, watch ‘Contagion’ and you’ll understand what I’m talking about (really nice movie actually with Matt Damon and Jude Law… need I say more?). Storyline summary: ‘As the contagion spreads to millions of people worldwide, societal order begins to break down as people panic.’ Panic! If you do, you know you’re experiencing a Pandemic… Other movie must sees in this genre are Twelve monkeys (not about twelve monkeys) and World War Z.

Epidemiology

All these terms are very important for people that study diseases, epidemiologists. You might need some practice to master that word. I followed a masters in epidemiology and my husband still can’t pronounce it different than “epidedemology”, or something like that. Anyway, an epidemiologist studies how a disease behaves, spreads, etc. It is not that I am wearing a T-Shirt that says “I Love Pandemics”, … but that is only because I didn’t find it yet…

There you have it, some new words to drop in any conversation when you’re ordering beers at a bar and try to impress someone. Choose your words wisely though, nobody wants to know about the Endemics in your pants, the Epidemic fail you had at work or the Pandemic boxes you want to open… 

When sex becomes more than just fun

Sex is fun, well, it should be, at least most of the time. That first moment when everything is new and exciting. You get caught in the moment and before you know it: a) you’re back on the street at 01.00 at night and the hangover just started b) you wake up at 7.30, smelling the others breath and think Why o Why? Or c) you fall in love and 15 years later have two children and write a blog on infectious diseases…

But although the sex was fun (most of the time), sometimes you’re reminded that you forgot something. Maybe it was the last thing on your mind, maybe you trusted the person you were with. What did you “forget”: a Condom. What is the name of that kind reminder: Sexual Transmitted Diseases, in short STD. 
Most of us are lucky we didn’t attract them, some are still thinking they were lucky and others, well they were less fortunate and got infected.

Let’s look at the STD’s/infectious diseases you don’t want to get after your fun night of sex and what the risk of getting it is. And for your benefit: I ranked it from most to least common.

1. Genital Human Papilloma Virus (HPV)

In first place, winner of the golden medal during the Ugliest STD-Olympics, leading the charts of the most common STD has to be: Genital Warts. Dreaded by all of us (if not, you have a rare fetish). But most of us are actually already infected with this without having any symptoms. Worse yet, this is a virus that can cause cervical cancer in women and anal cancer in men (who got the infection by having sex with another man, the virus doesn’t travel from your penis to your anus). Bad news: once you have it, you never lose it. Good news: we have a vaccine nowadays so we can protect our children from getting these cancers through this virus. Vaccines save our day!

2. Chlamydia

A very contagious runner up which most of us will know. It gives you discharge (for women different than normal, for man: you will know it is not semen). Women are the unlucky ones, because they can become infertile without ever having had symptoms. So, men and women: if you find out you have this, please let each other (or when you had a “busy” month: all of them) know. Easily cured with antibiotics, one pill and you’re done!

3. Trichomoniasis

The bronze medal goes to…Tri…Trichomo… Trichomonisch… sorry what? Trichomoniasis. This STD is unkown by many, but good chance you or someone you know has had it without even knowing it. Not deadly, no infertility, bad itchings and smell, but most don’t need medication. So boring, NEXT!

4. Gonorrhea

Good old Gonorrhea, just missed the top 3 but that doesn’t ruin the fun for this fella. Men come with a nice discharge from the penis or pus – big surprise coming up – in their knee, I know, their knee…. This doesn’t mean they did something like “Kneeing” somebody, but the bacteria likes to travel to a joint. We can treat this with antibiotics, for now at least.

5. Genital Herpes

Ouch. Just so painful to even look at this. Really contagious, just think of the cold sore a lot of people suffer from, it’s the same virus. The thing with Herpes is that if the lesions are located on a different spot than what the condom covers, you can get infected. But the infected person will know he has lesions – crusted spots – so if he/she is really as nice as you say, they will tell you… Maybe check it while you’re down there… Cause you can never get rid of it, it will go away for a while, … until it’s back again.

6. Syphilis

The great mimicker who actually is getting back in the race now that people aren’t scared of attracting HIV any more. Classically, you get sick in 3 stages. First stage is an ulcer that doesn’t hurt and goes away eventually. Some will not even notice this first stage. Second stage is a skin rash that also involves your palms and footpad, will also go away in time. If that doesn’t lure you to a doctor yet, stage 3 is neurosyphilis: when it hits your brain. Yep, this little guy deserves a blog of his own. For now, let’s just say that if you have it (tested in blood), antibiotics will cure you.

7. Hepatitis B

Depending on where you live this virus can be anywhere in the top 10. For example, most developed countries won’t have a lot of patients. There is a high chance of getting this, especially when there’s blood involved, easy peasy anal sex will do. Why? As you may know, the anus is not made to be stretched that way. Micro tears will turn up and they bleed. Blood contact with someone who is infected with hepatitis B gives you about 30% chance of getting it. This virus infects your liver and turns you yellow. Difficult to treat if you get the chronic version of the infection. So maybe at least wear a condom when doing anal sex or when your partner is menstruating? (or maybe without the question mark).

8. Human Immunodeficiency Virus

And last but certainly not least. HIV. Most famous, but actually you have a very small chance of getting. And with modern medicine it is even less. Why is it still so nasty: it is incurable. Not a death sentence anymore – especially in the Western countries – like it was in the 80’s, more like a very nasty chronic illness that requires you to take medication. For some easy with one pill once a day, every day, for the rest of your life, for others more troublesome.

There you have it, the 8 most common Sexual Transmitted Diseases. Some are easily attracted, but also easily cured. Others are more complicated in every way. The bottom line is that you have to know you have it.
Let’s not judge each other, none of us are saints. If you had an “accident”, just go see your doctor and get tested. Nobody will think you’re a slut or stupid, trust me, we’ve seen it all many times (and far worse). Let’s make sex just about fun!

8 Things you thought you knew about the flu

Flu season is upon us. Many will stay at home with their runny noses, sore throats and sad little coughs. Others will push through the misery, but will subsequently infect all their co-workers. And for sure many will have some grandmothers’ wisdom, or some google results telling them how to prevent or cure the flu. Well, look no further. Time to dive into 8 things you thought you knew about flu, but guess what: you are probably wrong…

1. You can cure the flu with antibiotics

Really? We’re not getting back in to this right? Read the previous blogs! Nope, not doing it again. … Ok, just this time, the summary: the flu is a virus (influenzavirus), antibiotics kill bacteria, not viruses. There. Done. Can we drop this now please?

2. You can’t get immune for the flu

Hmm, difficult fact. Because basically you can. For your immune system to recognize a virus, picture that they need to recognize a 100 digit code (think of ten back-to-back phone numbers). If all 100 digits are recognized, you don’t get sick. If your immune system has seen the virus before, it will remember all those digits easily and rapidly. But there is a difficulty with the flu, the virus changes a lot every season. As if you are still wearing soft denims and velvet dresses. Hello? Soooo 2016. When only one digit is different, the puzzle is solved rather quickly, you get a runny nose for one day and that’s it. But what if ten digits (one phone number) are different? Then it takes time. You can get immune for the flu that you had, but you might encounter a different one this year.

3. The flu shot works/the flu shot doesn’t work

Both facts are true, so both fact are false. I know, it’s a mindf@#k, crazy world we live in. Again, the flu changes every season. The flu shot is a calculated guess on what viruses will be targeting us this year, giving you about five different flu virus digit combinations for your immune system to remember. Seeing that it’s a guess, you can still get the flu. However, with the flu shot, your immune system will have a lot more digits right at the first try. This means that if you had the flu shot and still get the flu, you’re less sick then you would have been without the shot. It is like coming to a party in a black dress, but everyone is wearing colored padded dresses. At least you wore a dress.

4. The flu shot gives you the flu

The whole idea of a vaccine is that you get immune without getting the disease. So no, this is not true. The viruses in the flu shot are dead or better, inactivated. They just serve as a practice for your immune system. They can’t do anything else. You know someone who got the flu after a shot? Well that’s obviously possible, since you’re surrounded by viruses.

5. H1N1 was a hoax organized by the pharmaceutical industry

The whole H1N1 hysteria resulted from the fact that this particular virus had a lot of different digits. People would get very sick, very fast and could (and did) die. Maybe the pharmaceutical companies benefitted in the end, but the threat was real. No hoax.

For the real nerds (like me): the H and N stand for the proteins “Hemagglutinin” and “Neuramidase”, they live on the surface of the virus and differ all the time (the 100 digits). 

6. Everyone has had the real flu at least once in their life

My husband would ask: what is real? But he is in that philosophical stage in life that all close-to-forty-year-old men are in. So, let’s stick with my answer: everyone has had the real flu? No. N. O. Definitely no. The real flu makes you so sick! Just ask the people that suffered the Spanish Flu in 1918. Oh, wait you can’t, they died.

7. You can catch the flu by going outside in the cold with a short skirt

That’s at least what my mother tried to convince me off in order to get me to wear trousers. Although a short skirt can get you in all sorts of trouble (no, not deserved), it won’t give you a higher risk of getting the flu. You can get the flu if you, with your mini skirt on, go to a bar with a lot of people that cough in your face or, better yet, put their face on your face.

8. Chicken soup cures the flu

Well, maybe partly true. Just the fact that someone takes care of you might make you feel better. And the warm liquid in your throat helps as well. And a foot-massage. And a Friends marathon. And chocolate. But not really.

So let’s stop whining and accept things as they are. Stay at home not because you’re so sick (“man flu” doesn’t count) but because you don’t want to infect others. Cough in your hand, not somebody’s face. Get the flu shot and be happy you can get it. Put on your mini skirt (yes, also the guys can if they want) and dance until this season is over.

Antibiotic Resistance Crisis P3: Ugly fights, ugly truths

After the basics and history of Antibiotics, it is finally time to look at what’s going on right now. Why are we about to lose the biggest battle against infectious diseases of all time? And can we come up with new – or better; old – ideas to end the War?

Ugly Fights
A simplified explanation about the fighting skills of antibiotics is as ugly as Weinstein’s pick-up lines. When antibiotics target bacteria, they attach to it like a tree hugger dipped in supper glue and spray their loads of antibiotic snot into the bacteria. This kills the bacteria. They die, maybe because of disgust and shame, probably because their cell walls are destroyed, and all their mini-intestines are bursting out.

However, it appears that bacteria had found multiple ways to defend themselves against our antibiotics. One of which is that, when we bomb them, only the bacteria in the bomb shelters will survive. Well, these clever families had an aha-moment and told their kids to get bomb shelters as well. And not only that, no, they also told their neighbors about the shelters. In fact, they’re telling everyone that gets into close contact with them. So all information about getting resistant are being shared constantly.

Ugly truths

In every war mistakes are made. And for some it might be difficult to admit: in the Antibiotic War it is no different. We, humans (well most of you are), are to blame.

In the first Article on this topic I mentioned that Antibiotics kill bacteria and bacteria only. But still many people and doctor want to treat viruses and/or parasites with antibiotics. It doesn’t help the war, on the contrary, it provides bacteria the opportunity to practice their fighting skills and create bomb shelters.

We are also making mistakes in this War, by practices in an area which doesn’t seem to be linked to this War: the Meat Industry. As a species we eat meat and want a lot of it. To keep up with demand, farmers made a growth cocktail for their stock to make them grow faster and fatter. In this cocktail they put, you guessed it, antibiotics. The same kind as we use to treat diseases are being used for perfectly healthy animals to make them grow. Now this is a problem in two ways:

  1. directly: when we eat the meat of the cow with so many antibiotics in them, we also eat the resistant bacteria that’s in the meat. And they are planning to stay.
  2. indirectly: more stock with resistant bacteria ensure resistant bacteria all around them. They tell the bacteria from the farmer the tricks of resistance. And the fertilizer made from the dungs of these cows contains the resistant bacteria which we are spreading over the fields where our vegetables grow, we drive past it, we touch it. You get the picture.

The new, but also old Superhero? Bacteriophages

It’s like we had a battleplan and showed our entire arsenal to the enemy years before actually attacking them and then keep showing it to their families in the hope they won’t tell or act on it. Well, of course they will and of course they did.

What can we do? Well, I’m an infectious disease specialist and if I want to kill a lot of terrorists in a short time and I know where they’re hiding, I’ll might just throw some Ebola on their heads. That will get rid of them. Can we do this with bacteria? Yes, we can. Do we need Obama? Well, maybe, but for this war we need a “disease” that can actually kill bacteria. Its name; Bacteriophage. Discovered in 1919 and severely neglected since the rise of antibiotics. But it has potential people, really. It’s being used already in some countries to treat local wound infections. It’s not developed yet to survive the whole complexity of a human. In my view we need to spend some of our scientific budget to explore this option. We can throw away our original battle plan and attack the bacteria in a way they never saw coming. And who knows, maybe we’ll find Viral-“phages” and Parasito-“phages” as well.

In the meanwhile: some advice to survive the War

We all know how long it takes for a new idea to get to the public. So, in the meanwhile let’s try this:

  1. Don’t take antibiotics if you don’t need to! People specialized in this – ID specialist like me or medical microbiologists – should be consulted if there is any doubt on this point. I expect a lot of calls!
  2. For doctors: Take cultures before starting antibiotics and change to a sniper as soon as possible
  3. For doctors: Stop antibiotics if a different cause is proven as the source of the infection
  4. For governments: demand a stop on antibiotic use for growth of stock.
  5. Eat other things than just meat and think about what kind of meat you’re eating
  6. Wash your hands before you eat, like really, wash them, no kidding.

Do this, and we might stand a chance against this crisis until we implement our bacteriophages.

Good luck everyone, see you on the other side!