Ebola has arrived in USA

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Just saying the word “Ebola” is enough to start a conversation with heated view points and get everyone in a tizzy. It seems we are not in control. The hospitals, government, Wall street, and of course CDC (Centers for Disease Control and Prevention) appear to be scrambling. The global disease which until a few weeks back was somewhere in a place called Liberia, Africa is very much a reality and in fact it has arrived in USA.

The alarming thing is that we now have evidence of spread in our soil with two health care workers who have tested positive for Ebola after taking care of a patient who brought the disease from Liberia.

Yes we will likely have more people die of car crashes, flu, heart attacks, diabetes, falls and any cause other than Ebola. But there is no reason to die from this disease because it is not inherent to USA. Even one person getting infected and dying of Ebola in USA is one too many.

In this day and age of globalization it is inevitable we had to get infected. It just happened to be sooner rather than later.

We cannot hide from this disease, however we definitely should not panic.

The let down for CDC has been that it depended on the local health agencies and health care workers to be responsible about following the guidelines which have been set by them. On paper the guidelines are perfect and if everything is followed as it is written nothing will go wrong. But when we add the human factor, it does not always go so smooth. Yes mistakes were made but the best thing we can do now is to learn from our mistakes. This is not the time to waste our energy on playing the blame game or even pointing fingers at each other.

Let us get a fresh start. Hospitals should become extra vigilant and increase the training. CDC monitors the situation more closely and offers quick and efficient help to the health care agencies. We need to all work together to take control of this dreaded disease “Ebola” both in USA and globally.

Flying the Skies- Smoke free and Peanut/Nut Free

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Life Saving Drug for Allergy Anaphylaxis

Life Saving Drug for Allergy Anaphylaxis

What will it take to get peanut/nut free flights? While equating cigarette smoking to peanut allergy is not necessarily an apple to orange comparison, they are both fatal. There is no points to guess which one is immediately fatal and which one an eventual fatality.

While everyone knew that smoking was harmful to our health it was quite a struggle to have smoke free flights (1). It took almost two decades for it to happen from the moment smoking was first identified by U.S. Surgeon general in 1964 as being responsible for increased mortality and diseases.  The Federal Aviation Act of 1988 signed by President Ronald Reagan made short duration flights smoke free. It was not until 2000 when President Clinton finally signed the Reform act to a law in which all the flights to and from USA were finally smoke free (2). However sometimes even now the smoking population continues to defy the law. In 2013 a family of smokers caused a costly diversion when they could not stop smoking (3)

Peanuts and tree nut allergy individuals and their families quality of life is compromised because of the constant worry of impending exposure and a drastic immediate result of death. It is way more than an inconvenience. The smoking family is slowly killing themselves and others around them, which also totally unacceptable.

Is it realistic to even conceive that such a thing is possible in which peanuts/ tree nuts will stop being served on flights? We have seen a rapid increase in allergies over the past decade. Per data from Food Allergy and Research Education (FARE) it is estimated that up to 15 million Americans have food allergies, and it affects 1 in every 13 children. For those who look at everything in monetary terms the economic cost of children’s food allergies is $25 billion per year (4).  These statistics deal with all food allergies. The eight major food allergens are Peanuts, tree nuts, Milk, Shellfish, Eggs, Soy, Wheat, Fish and Shellfish.  Usually the allergies to milk, eggs, soy and wheat are outgrown by 16 years of age. The allergies to peanuts,tree nuts, shellfish and fish are generally lifelong and yes there is no cure. Hence the emphasis on Peanuts/tree nut free flights. Avoidance is the only way to ensure that someone with life threatening allergy does not get exposed.

One may ask why not Shellfish/ fish free flights? Well as those people who travel frequently know, there are not that many flights which serve fishes of any kind because fish is an expensive food even though it is healthier than other items on the airplane menu. The fish foods do not emit dust or particles in the air as do peanut bags when they are all opened in a closed plane environment by the passengers.

So we come back to Nut free flights. Perhaps we need a bigger population pool of nut allergic people to justify this change in our flying habits. Maybe we need to be just as persistent as those who made the smoke free flights possible. It is to be expected that a fierce fighting with education would have to be done for ignorance and uninformed to make it happen.

For those who believe that food allergic population are big whiners and babies and they just need to grow up! After all there are those of us who have severe chronic conditions and we live with those everyday. If we started to cater to everyone then we would never get anything done. Well- chronic conditions have treatment options. Avoidance is the only treatment for food allergy anaphylaxis.

Use of epinephrine both a life saving measure and the only line of treatment. Once it is used the person needs to be in a hospital care setting within a few minutes where they can be monitored for a relapse and control of the allergic reaction.

Being enclosed in a plane thousands of miles above ground with no possibility of escape and God forbid some one develops a reaction. The only recourse is to have an emergency landing. Recently United airlines flight from Dublin, Ireland to Houston,Texas,USA had to have an emergency landing in Dublin because a four-year old child developed allergic reaction to cashew nut (5).  Luckily for the child there was an allergist on board. Think of the financial ramifications for airplane company and passengers. Lets not forget the emotional, psychological and physical trauma sustained by everyone connected with that flight. No matter how nonchalant, “cool” or “strong” you may be  – the experience is rather humbling and it will affect you at the sublimal level.

The rapidity with which food allergies are developing is alarming. However, the answer to why the allergies are increasing is nowhere close to being answered.  Until it is figured out or there is a magical potion to treat those with allergies  avoidance of the food allergens is the only way to go. As a community is it too much to ask to help each other in any which way that it can be done? May be that is the question which needs to be answered that are we willing to step up and help each other?

The cigarette lobby was very strong and it still is. Yet the skies, restaurants, public places and workplaces have smoke free skies, restaurants, and workplaces.

The peanut/nut lobby is also quite strong. We need to persevere and work together to make the skies nut free. The work has started with petitions being signed to create safe flights for those with food allergies (No Nut Traveler.com). However the journey has just begun and there is a long way to go. For the sake of those with food allergies hope that the end comes sooner than later.

I am a licensed physician and a Forensic Pathologist by profession who does postmortem examinations everyday to determine cause and manner of death. I usually deal with unnatural deaths in our community. Some days I see cases in which I ask myself the question, if only such and such had not happened would the person have been alive today? Sometimes it is not so clear because death is a very complex event.

A food allergy death is definitely one of those deaths in which the question is –  if only the person had not been exposed to the allergen,  could they have lived? Sadly the answer is always a big vehement YES.

A smoker does not start out by wanting to become addicted to smoking and eventually dying from the tobacco related diseases. But it happens, because he/she has  to bear his/her own cross. There are so many programs in place to help the smokers give up the habit while also discouraging the behavior by creating prohibitive laws. One of those was for smoke free skies.

The origin of food allergies is unclear. They are genetic, environmental or due to completely different causes, which have yet to be identified.  It is not an easy task to navigate through life with food allergies and each person has to deal with it all by themselves. However making skies friendly towards the food allergens will at least make sure that the fatality does not happen 30,000 feet above ground.

References:

1. Should smoking be banned on planes? Article The Telegraph May15 1981

2. Smokefree Transportation Chronology January 2005

3.Family of smokers on airplane forces costly diversion CBC New Feb 3rd 2013

4. Food Allergy Facts from Food Allergy Research and Education (FARE)

5.Allergist Calls for Change After Saving Girls Life During In-flight reaction from Allergic Living 2014

6. No Nut Traveler