Listeria infection

Listeria account for less than 1 percent of reported cases of bacterial foodborne infection. Most identified cases can be traced back to contaminated food and the attack rate can be 50-100%. The lucky victims have subclinical infections.

Common symptoms include fever, watery diarrhea, nausea, vomiting, headache, and pains in joints and muscles.The typical duration of symptoms is two days or less, and recovery is generally complete. Invasive infection seems to be rare, with the risk being greatest in immunocompromised, pregnant, or older adult patients. Listerial infection in pregnant women can lead to fetal death, premature birth, or infected newborns. 

The following represents a compilation of the precautions recommended by the Centers for Disease Control and Prevention:

●Do not drink raw (unpasteurized) milk or eat foods that contain unpasteurized milk.

●Wash raw vegetables thoroughly before eating.

●Keep the refrigerator temperature at 40ºF (4.4ºC) or lower; the freezer at 0ºF (-17.8ºC) or lower.

●Eat precooked, perishable, or ready-to-eat food as soon as possible.

●Keep raw meat, fish, and poultry separate from other food that will not be cooked and from cooked foods and ready-to-eat foods.

●Wash hands, knives, and cutting boards after handling uncooked food.

●Thoroughly cook raw food from animal sources to a safe internal temperature: ground beef 160ºF (71ºC), chicken 170ºF (77ºC), turkey 180ºF (82ºC), and pork 160ºF (71ºC).

The following additional recommendations were made for individuals at high risk such as pregnant women and those who are immunocompromised:

●Do not eat hot dogs, luncheon meats, bologna, or other delicatessen meats unless they are reheated until steaming hot; avoid the use of microwave ovens for reheating such meats since uneven cooking may occur.

●Avoid contamination of utensils and food preparation surfaces with fluid from packages containing hot dogs, luncheon meats, delicatessen meats, raw meat, chicken, turkey, or seafood. Handwashing is also important immediately after handling of any of these products.

●Do not eat prepackaged salads containing ham, chicken, egg, tuna, or seafood.

●Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pasteurized milk.

●Do not eat refrigerated pâtés or meat spreads. However, canned or shelf-stable products are safe and can be eaten by pregnant women.

●Do not eat refrigerated smoked seafood, unless it is cooked as in a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." Such fish products are typically found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. However, canned or shelf-stable smoked seafood may be eaten.

The CDC has a comprehensive discussion.

Shingles Shot

A new shingles shot has been released. The new shot is more effective than the old one, so much so that adults who received the old vaccine should be re-immunized with the new one.

Shingles is caused by the herpes zoster virus, the same one that causes chicken pox. Once a person has had chickenpox, the virus lies inactive in nerve tissue. Years later, it may reactivate as shingles. The C.D.C. estimates that about one million cases are diagnosed in the United States each year.

The new vaccine is given in two doses at least eight weeks apart. However, about 80 percent of individuals had some type of vaccine reaction, compared to 30 percent of people who got a placebo.

Most symptoms were mild or moderate. Most common was a sore arm and pain after injection. About half the people also developed more general side effects, such as muscle ache, fatigue and headaches that resolved in two to three days. It’s important to understand that these side effects are expected and resolve fairly quickly, and they should not discourage anyone from getting the second dose.

About 15 percent of people who got the vaccine had a reaction that interfered with their normal daily activities. Those resolved within two to three days.

The cost of the two shots is estimated to be $280 and insurance coverage may vary.

Information from the Centers for Disease Control and Prevention. 

Should I Eat the Same Thing Every Day?

Research shows that eating the same thing every day may help you lose weight. Psychologists believe that eating the same thing every day results in psychological "habituation" (or boredom), which tends to reduce calorie intake. Also, when you have a plan in place it means you’re less likely to make a fast food run or grab the endless bag of chips. 

If you eat the same things day after day you can miss out on important nutrients. Studies have also found health benefits associated with eating a more diverse diet. A 2013 study with over 5200 people found that the greater diversity of healthy foods was associated with a lower risk of metabolic syndrome. A 2002 study published in the International Journal of Epidemiology found that increasing the variety of healthy foods increases life span. Researchers concluded that if you increase the number of healthy foods regularly, you also tend to decrease the number of less healthy foods consumed.

Eating a variety of good foods can play an important role in promoting a greater bacterial diversity in your gut. Bacterial diversity (the “microbiome”) not only may keep the weight in check but also can help prevent more serious illnesses such as diabetes.

What to do? Whatever works best, everything in moderation.  Portion controlled servings of many foods is generally recognized to the best choice. Alternatively, you could eat the same thing every day but switch up the menu every week.

Vitamin K

Vitamins are a number of chemically unrelated families of organic substances that cannot be synthesized by humans but need to be ingested in the diet in small quantities to prevent disorders of metabolism.

Vitamin K plays a crucial role in blood clotting. Vitamin K is found in green vegetables such as spinach and broccoli. The liver and pancreas work together to help the body absorb vitamin K from food. Vitamin K deficiency in a health adult is very rare, but a deficiency can develop with long-term antibiotics or with starvation. Symptoms of vitamin K deficiency include easy bruisability, gum bleeding or blood in the urine.

Vitamin K deficiency is common in the newborn, and if vitamin K is not replaced, the infant is at risk for vitamin K deficient bleeding. Vitamin K is given to infants at birth and infant formula is supplemented. High doses of vitamin A or E can also cause vitamin K deficiency.

Blood thinners, such as warfarin, act to block the action of vitamin K and can be reversed with the administration of vitamin K. Vitamin K toxicity is rare and the upper limit for supplementation is not defined.

In addition to its role in blood clotting, vitamin K has role in cardiac and bone health.

Appendicitis

Acute appendicitis is the most common abdominal surgical emergency in the world. The appendix is a pouch that projects from the large intestine on the lower right side. The pain often starts near the navel and then moves to the right side. There is often nausea, vomiting, fever and chills. The standard treatment is immediate surgical removal; these days the surgery is most often done via a laparoscope (Band-Aid operation).  If not treated, an acutely inflamed appendix could burst and cause a life-threatening infection.

There are some trials that show that treating acute appendicitis with antibiotics alone is effective. The risk with this choice is a recurrent/relapsing infection or missing a hidden cancer. It is easy, even with sophisticated imaging, to underestimate the severity of disease.  Many medical centers have operating rooms ready to go twenty-four hours per day but it appears safe to wait twelve hours (the next morning) if the patient presents in the middle of the night. Antibiotics need to be started immediately in any case.

Thirteen to twenty percent of acute appendices will perforate (burst). The surgery may be delayed if the diagnosis of perforation is made initially. The patients are often sicker and delay of surgery allows stabilization and better antibiotic coverage.

Less than one percent of cases of acute appendicitis will show a cancer. The diagnosis may not be made until the pathologist reviews the specimen.

Severe abdominal pain, especially when accompanied by fever, chills, nausea and vomiting, requires prompt evaluation by a medical professional. Imaging and blood tests are almost always required. The emergency department might be the first and best place to seek care.

Cold Feet

The most obvious reason that you have cold feet is because your feet are cold. If it’s cold enough to wear a jacket and your feet are bare – maybe you just need to put on some socks. However, there could be medical reasons that your feet are cold.

It’s possible that not enough (warm) blood is getting to your feet. This could be due to poor circulation when the heart can’t pump well enough or from not moving around enough. With exercise, the leg muscles help the veins return blood to the heart allowing fresh blood to enter the feet. It’s counter-intuitive, but blood flow is better with leg elevation so too much sitting can be a problem. Smoking causes blood vessels to constrict, also reducing reducing blood flow. Raynaud’s phenomenon, which causes blood vessel spasm from cold, can be so severe as to temporarily cut off blood supply entirely.

An underactive thyroid can reduce the body’s temperature and heart rate. Both of these can cause cold feet. A partially clogged artery due to high cholesterol will reduce the blood flow to the lower extremities. Not only will there be cold feet, but also pain with exercise since the muscles will not have enough oxygen-rich blood.

Nerve damage can give the sensation that the feet are cold as well as reduce blood flow. An unfortunately common cause of this kind of damage is diabetes.

What to do? First, put on a pair of socks and get some exercise. The next step is to check with your physician to make sure that you don’t have any underlying disease that causes cold feet.