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Plague confirmed in New Mexico

—Dr. Francine Olmstead

It may sound like a disease from the Middle Ages, but it still affects New Mexico nearly every year. It’s the plague. Of the 10-20 cases annually in the United States, New Mexico is usually the most common site. In 2009, six residents living in Sandoval, Bernalillo, and Santa Fe Counties were diagnosed with the plague. One of those, an eight-year-old boy, died.

Already in 2011, three cases of plague in New Mexico have been confirmed in two dogs and a cat. The New Mexico Department of Health reports no humans have yet contracted the disease, and all the pets recovered after prompt antibiotic treatment.

Plague is a bacterial disease of rodents, but it can spread to humans and pets, usually from the bites of infected fleas. If someone has been exposed, symptoms usually develop in two to six days.

It is a treatable disease when it’s promptly diagnosed and treated with antibiotics. If you suddenly develop a high fever, especially if you’ve been bitten by a flea or handled any wild rodents, you should immediately seek medical help.

When a person is infected, the plague bacteria move through the bloodstream to the lymph nodes. The lymph nodes swell, causing the painful lumps (“buboes”) that are characteristic of bubonic plague. Other symptoms are fever, headache, chills, and extreme tiredness. If bubonic plague goes untreated, the bacteria can multiply in the bloodstream and produce plague septicemia, a severe blood infection. Symptoms include fever, chills, tiredness, abdominal pain, shock, and bleeding into the skin and other organs. Untreated plague septicemia can be fatal.

Pneumonic plague, or plague pneumonia, develops when the bacteria infect the lungs. People with plague pneumonia have high fever, chills, difficulty breathing, a cough, and bloody sputum. Plague pneumonia is the only type that can be spread by humans. It’s considered a public health emergency because a cough can quickly spread the disease to others. Untreated pneumonic plague is usually fatal.

To help prevent the illness, control fleas on pets, stack woodpiles 100 feet from your home to prevent rodents from nesting in them, and avoid contact with rodent nests or burrows. If a pet that has outdoor access suddenly develops a fever and seems very tired, contact your veterinarian.

The peak season is May through September. Animals that are most often infected are rock squirrels, prairie dogs, pack rats, chipmunks, rabbits, and mice.

Millions of people died of the “Black Death” plague in Europe because homes were often infested with rats that hosted plague-infected fleas. With some precaution, plague can be almost eliminated from our world today.

Dr. Francine Olmstead earned her M.D. from the University of New Mexico School of Medicine in 1997. Since 2001, Dr. Olmstead has subspecialized in international travel medicine and is one of just a few thousand medical providers worldwide to have earned the Certificate of Knowledge in Travel Health, administered by the International Society of Travel Medicine. She has been providing consultative services to patients, medical professionals and companies regarding international travel health and pandemic planning and awareness education. She is the medical director for New Mexico Travel Health, a division of Olmstead Health Care Services, LLC, with offices in Albuquerque and Farmington. Dr. Olmstead is also board certified in internal medicine.


Uninsured New Mexico residents have a new option

—Bob Moos, Southwest Public Affairs Officer for the Centers for Medicare & Medicaid Services

If you’ve been unable to get private health insurance because of an illness or disability, you may now have an answer to your dilemma.

The Pre-Existing Condition Insurance Plan (PCIP), created as part of last year’s Affordable Care Act, is making health care coverage available to people who couldn’t buy or afford it because they have a preexisting medical condition.

As many as seven million Americans, including 56,070 uninsured New Mexico residents with pre-existing conditions, may be eligible for the new insurance. The federal government and individual states are administering the PCIP’s, as they’re called.

The publicly funded PCIP program has been designed to help the uninsured until 2014, when the Affordable Care Act will begin requiring the private insurance industry to cover people despite their preexisting illnesses or disabilities.

The new plans are an alternative to the high-risk pools that many states now offer to people locked out of the insurance market. The PCIP’s have lower premiums, and they require no waiting period for the coverage of preexisting conditions.

The PCIP program will improve the health care of the previously uninsured, help them become more self-sufficient, and ease the financial burden on the health care professionals and facilities that have had to provide uncompensated care.

If this new insurance program sounds intriguing, here’s what you’ll need to know to decide whether it’s the right fit for your individual needs.

Who’s Eligible?

You need to meet three requirements: 1) You must be a New Mexico resident and a U.S. citizen or legal resident. 2) You must have a preexisting condition. 3) And you must have been uninsured for at least the last six months. Your income isn’t a factor in determining eligibility.

What’s Covered?

The New Mexico Medical Insurance Pool runs the PCIP program in this state. As in all states, the PCIP provides comprehensive coverage, paying for primary and specialty care, hospital stays, skilled nursing care, home health care, and prescription drugs.

The coverage comes at the same price that healthy people pay for individual insurance policies. And if you have a limited income and qualify for New Mexico’s premium assistance program, you’ll pay a reduced monthly rate.

What’s the Cost?

You may choose from three coverage options, with annual deductibles of $500, $1,000, or $2,000. After your deductible, your out-of-pocket costs for most services will be 20 percent of your charges. Your yearly out-of-pocket maximum will be $2,500 or $3,500 for medical care and $2,450 or $2,950 for prescription drugs, based on the plan you pick.

The monthly premium for the $500 deductible plan ranges from $140 to $596, depending on your age. For the $1,000 deductible plan, the premium is $124 to $534. And for the $2,000 deductible plan, it’s $112 to $479.

To find out more about the new insurance options available in New Mexico, visit the New Mexico Medical Insurance Pool’s Web site at www.nmmip.org, and look at the side-by-side comparison of the three choices. Or call (877) 573-3676 with your questions.

How Can You Apply?

You can download an application at www.nmmip.org or request one by calling (877) 573-3676. Complete the form, and mail it, with a check for the first month’s premium, to: New Mexico Medical Insurance Pool, P.O. Box 27049, Albuquerque, NM 87125-7049.

To prove you have a preexisting condition, you’ll need a signed physician’s statement, a denial letter from an insurance company for individual coverage, or an offer of individual coverage that says your illness or disability won’t be covered if you purchase the policy.

If you’ve thought you were out of options and out of luck because of a medical condition, you owe it to yourself to consider this insurance. Assuming you’re eligible, your coverage will start several weeks after the PCIP has received your completed application and all required documents.


The Healthy GeezerThe Healthy Geezer

—Fred Cicetti

Q. My understanding is that angina is not as serious as heart disease. Is this true?

Angina pectoris—or simply angina—is the medical term for chest pain or discomfort usually caused by coronary artery disease. Angina is a sign that someone is at increased risk of heart attack, cardiac arrest and sudden cardiac death. If you get angina, you should get medical attention immediately.

Angina (pronounced “an-JI-nuh” or “AN-juh-nuh”) hits when the heart doesn't get enough blood. This usually happens when there is a narrowing or blockage in one or more of the vessels that supply blood to the heart.

Angina can come from exertion. It may make you sweat or lose your breath. The pain can strike your arm or neck, too.

“Stable angina” comes on with exertion and then goes away easily. You can have this kind of angina for a long time.

When the pattern of angina changes a lot, it's called “unstable angina.” This is a danger sign. Unstable angina may be the first sign of a heart attack.

Then there is “variant angina pectoris” or “Prinzmetal's angina.” It usually occurs spontaneously and almost always occurs when a person is at rest.  It doesn't follow physical exertion or emotional stress, either. Variant angina is caused by transient coronary artery spasm.

Physicians have a variety of diagnostic tools.

  • An electrocardiogram (EKG or ECG) can tell a doctor if your heart has been damaged by a heart attack. If the EKG is done while you are having chest pain, it can also show if your angina is caused by a problem with your heart
  • A stress test is often done while you walk on a treadmill. Your doctor will look at your EKG to see if it's abnormal when you exercise. Your doctor may also have x-rays of the heart taken before and after you exercise. These pictures can show if an area of the heart is not getting enough blood during exercise.
  • A cardiac catheterization involves inserting a long, thin tube into an artery in the arm or leg and then guiding it into the heart. Dye is injected into the arteries around the heart. X-rays are taken. The x-rays will show it if any of the arteries that supply the heart are blocked.
  • Most people diagnosed with heart disease have to take medicine. Medicines called beta blockers, calcium channel blockers and nitrates can help relieve angina.

There are surgical options.

  • Angioplasty uses a tiny balloon to push open blocked arteries around the heart. The balloon is inserted in an artery in the arm or leg. A stent (a small tube) might be put into the artery where the blockage was to hold the artery open.
  • In bypass surgery, the surgeon takes pieces of veins or arteries from the legs and sews them into the arteries of the heart to bring blood past a blockage and increase the blood flow to the heart.

If you have a question, please write to fred@healthygeezer.com


Researchers link herpes to Alzheimer’s disease

“Cold sores” connected to cognitive decline

Laboratories at the University of New Mexico (UNM), Brown University, and House Ear Institute (HEI) have developed a new technique to observe herpes simplex virus type 1 (HSV1) infections growing inside cells. HSV1, the cause of the common cold sore, persists in a latent form inside nerve cells. Reactivation and growth of HSV1 infections contribute to cognitive decline associated with Alzheimer’s disease. Details are published in the March 31 issue of PLoS ONE magazine from the Public Library of Science.

“Herpes infects mucous membranes, such as the lip or eye, and generates viral particles,” submits study Principal Investigator Elaine Bearer, M.D., Ph.D.,

Harvey Family professor and vice chair for research, Department of Pathology, UNM School of Medicine. “These viral particles burst out of the cells of the mucous membrane and enter sensory nerve cells, where they travel inside the nerve toward the brain. We now can see this cellular transportation system and watch how the newly formed virus engages cellular amyloid precursor protein (APP) on its journey out of the cell.”

Tagging herpes virus inside cells with green fluorescent protein, scientists used live confocal imaging to watch HSV1 particles emerge from infected cells. Newly produced viral particles exit the cell nucleus and then bud into cellular membranes containing APP. Electron microscopy at HEI detailed the ultrastructural relationship between HSV1 particles and APP.

This dance between viral particles and cellular APP results in changes in cellular architecture and the distribution of APP, the major component of senile plaques found in the brains of Alzheimer’s disease patients. Results from this study indicate that most intracellular HSV1 particles undergo frequent, dynamic interplay with APP, which facilitates viral transport while interfering with normal APP transport and distribution. This dynamic interaction reveals a mechanism by which HSV1 infection leads to Alzheimer’s disease.

In developed countries such as the U.S., approximately 20 percent of children are infected with HSV1 prior to the age of five. By the second and third decades of life, as much as 60 percent of the population is infected, and the late-in-life infection rate reaches 85 percent.

Symptoms of primary HSV1 infection include painful blisters of the mouth, lips, or eyes. After infection, HSV1 persists in nerve cells by becoming latent. Upon reawakening, new viral particles are made in the neuron and then travel back out its pathways to reinfect the mucous membrane. Many infected people experience sporadic episodes of viral outbreaks as the well-known, recurrent cold sore.

“Clinicians have seen a link between HSV1 infection and Alzheimer’s disease in patients, so we wanted to investigate what might be going on in the body that would account for this,” adds Dr. Shi-Bin Cheng, postdoctoral associate, Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University. “What we were able to see in the lab strongly suggests a causal link between HSV1 and Alzheimer’s Disease.”

“It’s no longer a matter of determining whether HSV1 is involved in cognitive decline, but rather how significant this involvement is,” Bearer asserts. “We’ll need to investigate antiviral drugs used for acute herpes treatment to determine their ability to slow or prevent cognitive decline.”

Researchers recommend people treat a cold sore as quickly as possible to minimize the amount of time the virus is actively traveling through a person’s nervous system. The faster a cold sore is treated, the faster the HSV1 returns to a dormant stage.

Additional authors include: Paulette Ferland, senior research assistant, UNM; Paul Webster, House Ear Institute, Los Angeles, California; the participation of Kathleen Kilpatrick, UNM; and many undergraduate students at Brown who contributed to this project are acknowledged.

     

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