by Jorge Rodriguez | Oct 27, 2014 | Cuomo, Ebola, Vaccines
Sure, it’s a little affected to title an article referencing an Ibsen play; but the similarities are too great. In that play, a doctor was darling of a community until he did not do what the community wanted. This is similar to what is happening to healthcare workers who treat Ebola patients.
The facts here are changing by the minute. The more I write, the more the news changes. The quarantining in New Jersey of the nurse who returned from western Africa has raised many issues. She is currently threatening to sue the State of New Jersey because she feels her civil rights have been violated. As of now three states, New York, New Jersey and Illinois have executive orders stating that they will quarantine anyone who has had direct contact with an Ebola patient, including American healthcare workers returning from Africa. (What about someone sitting next to them on a subway? Is that direct contact? )
What bothers me is how she was apparently being treated. According to her she is being kept in an unheated tent outside of Newark Airport and being given nothing to wear but hospital scrubs. Where are we, in Liberia? Obviously the fear and “cootie syndrome” created by one doctor who tested positive for Ebola and roamed the streets of New York while possibly contagious, has caused politicians to act rashly if not illegally. Without knowledge of Ebola and the science that surrounds it, they have caved in to public frenzy and have jumped the shark. They had no plan of action as how to quarantine anyone exposed to Ebola, except to isolate them. They have no definition of what “exposure” is. Does someone sitting next to someone on the subway who turns out to have Ebola count as an exposed person? Will they then be quarantined? Where does it end? They don’t know. They are playing it by ear. That is a scariest thing.
I do know one thing, in the long run this type of quarantining may be increasing EVERYONE’s chances of getting Ebola. Soon few doctors and nurses will go to western Africa to treat patient’s with Ebola if this is what awaits them upon their return. You cannot expect good Samaritans to risk their lives to save us all and then accept being treated like lepers upon their arrival home.
But don’t we quarantine people with dangerous communicable diseases all the time? The answer is yes. The HUGE difference is that we do that once we KNOW they have a communicable disease, not when we just suspect they do. You may think that the stakes are higher here because Ebola is so dangerous. But as of now no one has died from contracting Ebola in the US. Which causes me to have a huge moral dilemma. I believe in quarantining health care workers on the honor principle as a way of stopping spread… but I do not agree with the way it is being done now. However, there may be a solution. The solution once again is science.
There is a test that is used both to detect and follow the progression of HIV. It is called the PCR (polymerase chain reaction) test. It is also used to test for progression of the Ebola virus in someone’s body. If you do not have Ebola in your blood this test will be negative. It is not like the antibody test that can take days or weeks or months to be positive. If you do not have the Ebola genetic material in your blood this test will be negative. What I have not been found in the medical literature is how soon after you are infected with Ebola will this test be positive. If this test is positive within a day or two after infection then problem solved.
When a health care worker returns to America from an endemic area he or she should be given an Ebola PCR blood test and then be placed under home observation, in his or her own home. They must report to health authorities twice a day after that. They must have a PCR test every two to three days. If they have successively negative PCR and do not develop symptoms after a set period of time that “science” has determined to be safe, they can then be released from observation. That is of course if we know that my theory is correct.
Regardless, I hope that the government is taking Ebola PCRs form all health care works returning from western Africa so that we can learn more about the natural progression of this disease. If not, they should create a voluntary research protocol that does this.
If it looks like I have reversed my position on mandatory quarantine, I have! After seeing the reaction of the public and the government, I am now much more concerned about the frightened town’s people storming Frankenstein’s castle, than I am of the virus.
by Jorge Rodriguez | Oct 26, 2014 | Africa, Ebola
Last Friday night I was asked again by CNN to be a medical expert regarding the Ebola epidemic. Unbeknownst to me, in the interim between CNN’s ask and my actual on air segment, the governor’s of New York and New Jersey had decided to imposed mandatory quarantine on anyone, including healthcare workers, who landed in their state from the most Ebola ridden countries of western Africa. I heard a little bit about this on my earphone before my segment. While one air was then asked what I thought about mandatory quarantine.
I said, that I believed in quarantine. I had thought long and hard about this in the prior days; but obviously not long and hard enough. I gave what I thought was a thoughtful and educated answer. My friend, who was waiting in the greenroom, was uncharacteristically silent when I returned. When he finally gave me his opinion about my segment, all hell broke lose. I feel our discussion was representative of many discussions occurring throughout the U.S. Science vs. Fear. Practicality vs. Rights.
My friend was a bit in shock about my on air response. He felt that my opinion was more in step with the very conservative FOX network than with CNN. (By the way the good people of CNN and FOX have both used my services) He wondered how I could be in agreement with mandatory quarantine, in a hospital or hotel, of ANYONE returning from western Africa; whether they were symptomatic or not. Apparently, the woman who was quarantined at Newark International had a horrible experience; almost to the point of being treated like a prisoner. Much like Japanese-Americans were treated during World War II. The more I read about the episode the more I understood my friend’s anger toward me. The more I read about the incident, the more it became evident that I had to clarify my stance, because we, and I mean America, were at the intersection where fear, science and action meet. We need to be clearheaded here, because it can get ugly quickly if we don’t.
Firstly, let me make my opinion very clear. I believe that anyone who comes from an area where Ebola is endemic must go through a 21-day quarantine period before they can resume their normal day-to-day activity. I also do not believe that this should be at a hospital or make shift quarantine facility being managed by people who are poorly educated on medical facts and techniques. Did we not learn anything from Dallas? People who come from these unfortunate areas, should be sent to their homes for 21 days. They need to report to local or national health authorities twice a day. If they elicit any symptoms they must then report to a designated “Ebola-knowledgeable” hospital to be evaluated.
From what I understand, Doctor’s Without Borders, makes their health care workers follow rules similar to this once they return home. However, find their recommendations not stringent enough. The New York case tends to prove this. The physician in New York City who recently tested positive for Ebola, upon his return from Africa was advised not to go to work and to check in twice a day with his temperature reading. However, he was not prohibited from going out to public places. This walking among the masses when one is possibly infectious is what is fueling the fear that is making many people, including politicians, have knee jerk reactions.
I know that Ebola is not transmissible until someone has symptoms. But what I don’t know is what those symptoms really are. The physician in New York said he felt sluggish two days before he spiked a fever. Is that when he was contagious? Should he have reported it then? Should he have gone to a hospital at that time? I say yes.
The danger that we are facing, which is as menacing as, if not more than, Ebola is that fear may lead to behavior that strips good law abiding American citizens of their rights. We are risking that doctors and nurses not go to western Africa to help contain this epidemic because of what they may face upon their return. This cannot happen. EVERY expert will tell you that the best way of keeping Ebola from coming here is by stopping it there.
I am supporting a middle ground. I am suggesting that anyone coming from an area where Ebola is endemic, who has had direct contact with someone infected with Ebola, be placed under house quarantine under his or her own supervision. They must not go out in public and must report to the appropriate HEALTH authorities under penalty of law. Hopefully this will not deter the good people going to Africa to fight OUR fight from doing so.
We are all a bit scared; but fear cannot prevail. I saw inhumanity win too many times during the beginning of the AIDS epidemic. Let us not repeat those mistakes. We must walk a fine line between humanity and civil responsibility. There is no other choice. We must walk carefully; if not we run the risk of becoming more horrific than Ebola.
by Jorge Rodriguez | Aug 26, 2014 | Diabetes
So, you just got the word that your blood sugar is high and you have pre-diabetes. You’re most definitely not alone. Roughly 80 million Americans have it as well. But you might still be wondering what does that even mean and why is it important? In short and simple terms, pre-diabetes is a WAKE-UP call, a chance to make some changes that could not only prevent type 2 diabetes but will improve your overall quality and quantity of life.
In medical terms, pre-diabetes is blood sugar levels between 100 and 125 deciliters per milliliter. This isn’t something to be taken lightly because studies show that damage to your internal organs can begin even at this level. So, it’s super important to get your blood sugar levels down. In order to do so, there are four major things that you need to focus on:
1. Take your meds religiously (if needed). In many cases, medication isn’t needed at the pre-diabetic level but we’re finding more and more often it can be a useful tool to prevent organ damage. The good news is that if you need medication at this stage, you can often reverse that need by improving your diet and exercise.
2. Lose that belly fat! Even a small amount of weight loss can make a huge difference. I recommend starting with five to seven percent of your current weight. Keep it simple and break down your goals into manageable chunks. For instance, instead of shooting for 50 pounds, try starting with a goal of losing three to five pounds. You’ll find that it’s not too hard to see results quickly when you work on smaller goals at any given time.
3. Improve your diet. What you eat is just as important (and even more so) as how much you eat. It’s crucial that you’re eating balanced meals that provide all of the essential nutrients. This will help to prevent binge eating, keep you feeling satiated and satisfied for longer, improve energy etc. I strongly recommend working with a nutritionist who can help you to create an individualized meal plan that meets your specific needs, lifestyle and taste.
4. Get up and get moving. Exercise is critical to improving your blood sugar levels and your overall health. Studies show that regular exercise reduces your riskof developing diabetes by up to 80%! So, make yourself a priority and stick to a regular exercise routine.
I recommend 30 to 45 minutes of exercise every day — seven days a week. This doesn’t have to be painful or difficult. Find something that you enjoy and work it into your schedule. You can even do it in 10 to 15 minute increments throughout the day. Try making fitness decisions that you can fit into your daily life such as taking the stairs instead of the elevator, parking further away, taking your dog for a walk, going for a bike ride with your kids etc.
It won’t happen overnight but if you’ll take the steps right away to improve your overall health, you’ll find that not only will your blood sugar levels drop, but you’ll begin feeling better and more vibrant. And you’ll greatly decrease the likelihood of developing type 2 diabetes and all of the risks and side effects that come with it.
For more tips on reversing pre-diabetes, check out my book The Diabetes Solution.
by Jorge Rodriguez | Aug 11, 2014 | Diabetes
We all talk about diabetes and very few of us really know what it is, what causes it, or why it is so dangerous. Over the next few months I am dedicating my blog almost exclusively to in depth discussions about diabetes. That’s how important it is. I would love it if you became an active participant by asking me questions and sharing my blog with your friends and acquaintances. You never know who you might be helping.
If you’re reading this, you likely either have diabetes yourself, have been diagnosed with pre-diabetes or have a loved one dealing with diabetes. It is a disease with monumental effects that continues to grow exponentially. According to the National Diabetes Education Program (NDEP), “The number of people diagnosed with diabetes has risen from 1.5 million in 1958 to 18.8 million in 2010, an increase of epidemic proportions.” Plus, there are at least 80 million people with “prediabetes”.
Over the years, awareness of the disease has definitely improved, but we still have a long way to go as the numbers continue to rise and the statistics are alarming.
The numbers are staggering.
1. Diabetes is the 7th leading cause of death in the United States and the American Diabetes Association says the numbers may be underreported.
2. 29.1 million Americans, or 9.3% of the population, have diabetes. 8.1 million of those don’t even know they have it!
3. There are 1.7 million new diagnoses each year.
4. 86 million Americans — that’s 1 in 3 adults — have pre-diabetes… and 90% of them don’t know they have it. This may be the most alarming statistic of all because in many cases the disease can be reversed at this stage with some simple lifestyle changes.
The effects of diabetes are debilitating.
- 71 percent of adults diagnosed with the disease also suffer from high blood pressure.
- Diabetics are 1.7 times more likely to die from cardiovascular disease than the general population.
- Heart attack rates are 1.8 times higher among diabetics.
- Diabetics are 1.5 times more likely to suffer from a stroke than the general population.
- Between 2005 and 2008, 4.2 million diabetics over the age of 40 had diabetic retinopathy — damage to the small blood vessels in the retina that can lead to loss of vision.
- Diabetes was listed as the primary cause of kidney failure in 44 percent of all new cases in 2011.
- In 2010, about 73,000 non-traumatic amputations were performed on adults with diagnosed diabetes.
- And the list goes on….
The impact is widespread.
Approximately one in every nine adults has diabetes and many more have prediabetes. What does that mean for you? It means that even if you don’t personally suffer from the disease, chances are you know someone — or several people — that does.
Diabetes has a great and sometimes devastating impact on individuals, families and society as a whole. And the impact is not only physical in nature, but also emotional, psychological and financial. And recent studies show that prevention and treatment tactics work best when they are tackled as a team rather than by individuals alone.
What now?
Get tested.If you have never been tested for diabetes, do it now. This disease affects all ages and starts wreaking havoc long before any symptoms appear. In this case, what you don’t know can definitely hurt you. On the other hand, early diagnosis can go a long way toward managing, and possibly curing, symptoms. At the very least, it will be educational for you to know where your blood sugar levels lie and how you can keep them at healthy levels.
Make healthy lifestyle changes.It’s never too early, or too late, to start implementing lifestyle changes that have a far-reaching impact, such as increased physical activity, eating more fresh fruits and vegetables, eating less processed foods, limiting sweets, etc. This is even more critical if you suffer with obesity or have a family history of diabetes.
Subscribe.Follow me on my blog, on Twitterand on Facebook. I have several posts in the pipeline that offer tips for managing diabetes, making diet and lifestyle tweaks as well as some easy and delicious recipes.
Get the book. Order my book “
The Diabetes Solution.” It goes into great depth on how to manage diabetes and includes an easy-to-follow lifestyle and eating plan with simple and enjoyable recipes.
by Jorge Rodriguez | Aug 6, 2014 | Africa, Ebola
As I sit in an airplane heading toward New York City, a man in front of me coughs. Coincidentally, I am reading an article on CNN stating that there are now five documented cases of Ebola in Nigeria; one of them being a nurse who took care of that American citizen that died there of Ebola after taking care of his ill sister. They also report that a businessman died of a hemorrhagic fever that is very likely Ebola in Saudi Arabia after being in West Africa. There is no doubt in my mind now. Ebola has gone global. The man in front of me continues to cough.
I try not to be an alarmist; but I have a foreboding sense of immediacy. I completely believe in the ability of science to soon discover a vaccine to prevent the spread of Ebola and medication to treat it. But “soon” may be a year. In the meantime transcontinental transportation and mass transit may spread this virus like no one has ever witnessed before. The approximately 30 million people worldwide who have died of HIV may pale compared to the number that may die of Ebola.
I have spoken on CNN a few times recently about this epidemic. Perhaps it is my 25 years as a researcher of HIV and Hepatitis C and a frontline clinician that gives me some credibility…and pause. As a researcher I know that an answer WILL be found. I also know that even under the best circumstances it will take months to years to get treatments approved by the FDA. As a clinician, I know that if we wait any longer to enact strict preventative guidelines the thousand people who have died of Ebola could quickly become the tens of thousands or God forbid, the millions.
Therefore the time to set guidelines to prevent the spread of Ebola is now. Here are a few of my recommendations:
- Create a mass producible assay that is both specific and sensitive to diagnose Ebola. The luxury of waiting days to receive a lab result while quarantining a patient will soon be unrealistic. Hospitals will run out of appropriate isolation areas. Plus, with the impending cold and flu season, worried symptomatic patients will undoubtedly be rushing to their health care providers for diagnosis and treatment. There needs to be a quick method to diagnose Ebola vs. has viral enteritis.
- Give definite guidelines to physicians and nurses on how to properly handle a person with Ebola. The rate at which healthcare workers are contracting Ebola is infinitely higher then medical personal contract HIV or Hepatitis C from their patients. We don’t want doctors being vectors of this disease.
- Institute strict travel guidelines. In my opinion anyone who has a fever should not be allowed to board an airplane and eventually other forms of mass transit. A questionnaire is valuable only if the person is honest. Travel personal must receive preventative education and perhaps even special equipment (gloves, etc.) to protect themselves and others.
Alarmist? Perhaps, but let’s start the dialogue anyway shall we? This is as good a launching point as any. Remember, an ounce of prevention is worth a pound of cure. By the way, he is still coughing.
