Tag: Healthy Consumer

My Vacation With a Brain-Eating Amoeba

Water rushes along the course at the National Whitewater Center at dusk. The chlorination and filtration systems at the artificial water rapids course were inadequate to kill a rare, brain-attacking organism this summer.

Water rushes along the course at the National Whitewater Center at dusk. The chlorination and filtration systems at the artificial water rapids course were inadequate to kill a rare, brain-attacking organism this summer. Robert Lahser/The Charlotte Observer, via Associated Press

I expected a bumpy ride on a whitewater trip, so when I fell off my raft and coughed up the water I’d inhaled, I wasn’t afraid. But at the time I didn’t know I was swimming with a deadly parasite.

I’d been at a bachelorette party at the U.S. National Whitewater Center in Charlotte, N.C., but after returning home I learned that I had shared the churning rapids with Naegleria fowleri, a single-celled amoeba found mostly in soil and warm freshwater lakes, rivers and hot springs. An Ohio teenager had contracted the amoeba infection after visiting the center around the same time I did, and some of the waters and sediment at and around the center had tested positive for the bug.

News that my friends and I had all been at risk of exposure triggered a few days of worry. The illness is rare and, if infected, symptoms show up between one and 10 days after exposure. Chances were that we were fine (we were), but the experience prompted me to learn more about the parasite.

Naegleria fowleri lives in fresh water, but not in salt water. If forced up the nose, it can enter the brain and feed on its tissue, resulting in an infection known as primary amebic meningoencephalitis. Death occurs in nearly all of those infected with the parasite, usually within five days after infection.

The 18-year-old Ohio woman who died most likely contracted the parasite when she sucked water through her nose after falling from a raft during a church trip.

Samples from a channel at the rafting center, collected by the Centers for Disease Control and Prevention, tested positive for the bug. The center’s channels are man-made, and it gets its water from the Charlotte-Mecklenburg Utilities Department and two wells on its property. The center has announced that it disinfects all water with ultraviolet radiation and chlorine, and it added more after the water tests.

Sediment from the nearby Catawba River, where visitors to the center can paddle board and kayak, also tested positive for the amoeba, although the actual water from the river did not test positive. Dr. Jennifer Cope, an epidemiologist at the C.D.C., said natural bodies of water might have their own ways of controlling the bug. The parasite possibly entered the artificial river through storm water runoff or people tracking it in on their shoes, said Dr. Cope.

Between the time of the young woman’s visit in early June and when the whitewater center voluntarily shut down its rafting activities a few weeks later, thousands of people could have been exposed to the parasite, but there were no additional reports of infections.

“The interesting thing about this infection is it’s almost always one single case that occurs in one location,” said Dr. Cope.

Experts say record-breaking temperatures that week may have enabled the presence of the bug, which thrives at warmer temperatures, and murky water possibly disrupted the effectiveness of the UV and chlorine disinfectant.

The amoeba is more frequently reported in southern states, especially Florida and Texas in the summer. However, after the C.D.C. received a report in Minnesota in 2010, they started tracking the bug to see how climate change might be influencing its habitat. Infections have also been documented in Kansas and Indiana. According to Dr. Cope, cases in Minnesota and other places have followed heat waves or a number of days where the temperature was above 90.

According to the C.D.C., since 1962 only 138 people have been infected, and all but three of them have died. Between 2006 and 2015, there were only 37 documented infections, mainly associated with recreational swimming, but one involved contaminated water on a slip-n-slide, and three cases were from rinsing sinuses with infected tap water, including two involving Neti pots.

Clearly, Naegleria fowleri is not your biggest risk in the water. By comparison, between 2005 and 2014, 3,536 people — which averages to about 10 a day — died of unintentional drownings in the United States.

“Millions of people participate in water activities all the time, and this is a very rare infection,” Dr. Stephen Keener, the medical director for the Mecklenburg County Health Department, said at a press conference. “It’s not the kind of thing where just getting in the water with Naegleria is going to cause you to get sick.”

There are ways to reduce exposure, and even though the risk of infection is low, you should follow them. Avoid putting your head under water in hot springs or other warm, fresh bodies of water. If you do go under water, hold your nose, or use nose clips if you know there is a risk of submersion. Avoid digging scum and sediment up near the water. Avoid fresh water activities during very warm weather, which is not very practical advice for people who enjoy swimming or water skiing in lakes or kayaking in streams and rivers. But you can remind yourself about precautions, especially after several days of 90 degree weather.

“Living in Arkansas, one of my favorite things to do is spend time at the lake,” said Dr. William Matthew Linam, a physician at Arkansas Children’s Hospital, in an email. “Having said that, I make my children hold their noses if they are going underwater.”

If you’ve been playing around in warm fresh water, especially during summer months, and come down with a headache, fever, nausea or vomiting, experts say to tell your doctor where you’ve been. And the sooner the better. Later symptoms include stiff neck, confusion, loss of balance, seizures and hallucinations.

Dr. Linam thinks early detection is critical. In 2013 he saved a 12-year-old girl named Kali Hardig, who was exposed at an Arkansas water park and is one of only three documented victims of the amoeba to ever survive the infection. He called the C.D.C. immediately, and the amoeba was found in a sample of her spinal fluid. He administered a cocktail of drugs that the C.D.C. has proven effective in the lab, including miltefosine, a breast cancer drug that the C.D.C. is working to make available in hospitals in Texas and Florida, where reports are more common.

But “even with early detection and treatment, survival is not guaranteed,” he said.

Would I go whitewater rafting again? Yes. But probably only on a cool day. And I’d wear nose plugs.

A Call for Action on Toxic Chemicals

Cosmetic and lotion bottles contain phthalates, a chemical that allows the plastic to be flexible. Absorption of phthalates are also linked to preterm births and impaired neurodevelopment in girls.

Cosmetic and lotion bottles contain phthalates, a chemical that allows the plastic to be flexible. Absorption of phthalates are also linked to preterm births and impaired neurodevelopment in girls. Getty Images

Every day, children and adults are exposed to a variety of chemicals found in common household items. Now a growing body of research suggests that many of these chemicals — which are used to make plastic more flexible, fruits and vegetables more abundant and upholstery less flammable — may also pose a threat to the developing brain.

While the link between early chemical exposure and neurodevelopment disorders in children remains a matter of scientific debate, a unique coalition of top doctors, scientists and health advocates is calling for more aggressive regulation. The goal is to protect expectant mothers, infants and children from neurotoxic chemicals by stepping up efforts to curb air pollution, remediate old lead pipes, phase out certain pesticides, ban endocrine-disrupting chemicals used in food packaging and plastics and come up with a plan for getting rid of furniture laden with fire retardants.

The scientists note that neurodevelopmental disorders are complex and have multiple genetic, social and environmental causes. But most chemicals in use today were not adequately tested for safety before being allowed on the market, said Dr. Jeanne Conry, an obstetrician-gynecologist and a past president of the American College of Obstetricians and Gynecologists, which is part of the coalition.

“Before we can prescribe medicine, we have to prove it’s safe,” she said. “So how come with the chemical industry, we assume everything is safe and have to prove there’s harm?”

On Friday the coalition endorsed a first-of-its-kind consensus statement called Project Tendr, which stands for Targeting Environmental NeuroDevelopmental Risks. The statement was published in the scientific journal Environmental Health Perspectives, and related articles are being published over the next few months in endocrinology, nursing, pediatrics and epidemiology journals.

“We as a society should be able to take protective action when scientific evidence indicates a chemical is of concern, and not wait for unequivocal proof that a chemical is causing harm to our children,” the statement says.

This chart shows a list of common chemicals and their possible effects on the body. <a href="https://static01.nyt.com/images/2016/06/30/health/wellchart/wellchart-superJumbo.png">Click here to view the entire chart.</a>

This chart shows a list of common chemicals and their possible effects on the body. Click here to view the entire chart. Centers for Disease Control and Prevention and Project Tendr

The call to action comes just one week after President Obama signed into a law a much-debated overhaul of the nation’s 40-year-old toxic chemical rules. The update to the 1976 Toxic Substances Control Act subjects some 64,000 existing chemicals to eventual safety testing. But critics say the changes don’t go far enough, and the testing of chemicals is far too slow — just 20 chemicals at a time with a deadline of seven years per chemical. And the new law doesn’t cover pesticides used in food production – which critics say are one of the largest sources of childhood chemical exposures.

An official with the American Chemistry Council, which represents companies that make flame retardants, plastics and phthalates, said the new law already addresses the concerns raised by the Tendr coalition. The new rules give more authority to the Environmental Protection Agency and require the agency to take into account vulnerable populations like pregnant women, children and the elderly, she said.

“This new law will give Americans greater confidence that chemicals in commerce are being used safely,” the American Chemistry Council said in a statement.

The Tendr coalition includes pediatric neurologists, several minority physician associations, nurses, learning disability advocacy groups, environmental organizations, and the Endocrine Society, which has compiled several scientific statements documenting adverse health effects linked to endocrine-disrupting chemicals that mimic or disrupt the hormones in our own bodies. Dozens of scientists and health providers have signed the statement, as has Linda Birnbaum, director of the National Institute of Environmental Health Sciences and the National Toxicology Program.

The bottom line: The group wants the chemical industry to prove a chemical is safe, rather than waiting on the medical and scientific community to prove it is harmful. “We’re saying, shift the burden of proof,” Dr. Conry said.

Wading into a potentially contentious issue like regulation of chemicals is unusual for ACOG, a professional medical association for doctors who care for pregnant women. The group has been alarmed by rising rates of neurodevelopmental disorders and other health problems in children, which it linked to toxic exposures in a 2013 scientific paper.

National health surveys show that 15 percent of children had a developmental disability in 2008, up from 12.8 percent in 1996. Researchers say changes in diagnostic criteria and a greater awareness of developmental disorders including autism, attention deficit disorders, and other learning disabilities may explain some of the increase in rates, but not all of it.

The chemicals singled out by the coalition are widely used, and manufacturers and some experts say more research is needed to demonstrate they have harmful effects. They include:

  • Organophosphate Pesticides: Although health concerns led to a ban on residential use of some of these pesticides, they are still permitted on crops like fruit, vegetables, wheat, soy and corn. In one study, women who were pregnant when they lived near areas where these pesticides were in use were up to three times more likely to have a child who developed autism or other developmental disorders. Janet Collins, a senior vice president at CropLife America, which represents pesticide manufacturers, said the studies show only an association between pesticide levels and autism disorders, not a cause-and-effect relationship.
  • Flame Retardants: Recent studies have found that children exposed prenatally to higher levels of flame retardants had lower I.Q.s and higher hyperactivity scores. Similar effects have been found in animal studies. Flame retardants are used in fabric and upholstery padding, plastic casings for televisions and computers and baby products. A major source of exposure is household dust, which can accumulate with residue from treated products. American retailers and manufacturers have phased out one commonly used flame retardant, some of which still lurk in old sofas and other items; some scientists worry that they are being replaced with similar chemicals that may not be any safer.
  • Lead: The government has banned leaded gasoline and household paint, but old homes and pipes often still contain lead that gathers in dust and leaches into water. Lead is so toxic that no level of exposure is considered safe, and even low blood levels are associated with lower intelligence and attention deficits. In 2010, an estimated 535,000 children were identified with alarmingly high levels of lead.
  • Phthalates: These chemicals cross the placenta during pregnancy, and prenatal exposure has been linked in studies to problems with attention and intellectual deficits. The Consumer Product Safety Commission has banned the use of six phthalates in toys and child care products, but they are still widely used in all kinds of products, from food packaging to personal care products and building materials.
  • Combustion-Related Air Pollutants – These include nitrogen dioxide, particulate matter (a mix of small solid particles and liquid droplets) and other toxic chemicals including benzene and formaldehyde, as well as polycyclic aromatic hydrocarbons (or PAHs). Air pollutants can cross the placenta, and prenatal and early childhood exposure to some pollutants has been linked with preterm birth and low birth weight, as well as developmental delays, inattention and reduced I.Q.

Studies show almost all American women have these chemicals circulating in their bodies during pregnancy. A recent study of about 300 women found detectable levels of pesticides, flame retardants, phthalates, PCBs and other chemicals in 99 percent to 100 percent of the women tested.

Gestation is a particularly vulnerable time for the developing fetal brain, because it is growing so rapidly, said Irva Hertz-Picciotto, co-executive director of Project Tendr and director of the MIND Institute Program in Environmental Epidemiology of Autism and Neurodevelopment at the University of California, Davis.

Many chemicals of concern are endocrine disruptors, which can interfere with the activity of the body’s own hormones, like thyroid hormones, estrogen and androgens. These hormones play an important role in healthy brain development, said Heather B. Patisaul, professor at the Center for Human Health and the Environment at North Carolina State University at Raleigh.

“The goal is not to demonize every chemical on the market,” Dr. Patisaul said. “We need to find the group that are harmful, and figure out why, and develop new chemicals that are significantly less harmful.”

How to Limit Your Exposure to Toxic Chemicals

A coalition of doctors, scientists and health advocates says you may be able to reduce your overall exposure to toxic chemicals by taking the following steps:

  • Reduce pesticide exposure by choosing organic strawberries, apples, nectarines, green beans, celery and spinach.
  • Choose seafood low in mercury like salmon, sardines, trout.
  • Breast-feed your baby if you can; if you use formula, make sure the water is lead-free.
  • When buying furniture with padding like a high chair, sofa or mattress, ask for products that are labeled free of toxic flame retardants.
  • Avoid exposing the family to tobacco smoke, wood smoke from fireplaces and wood stoves, idling car exhaust, cooking fumes from stoves and grills.
  • If you’re putting in a new floor, choose either phthalate-free vinyl flooring or wood, bamboo or cork.
  • Avoid plastic toys, backpacks, lunch boxes and school supplies made of polyvinyl chloride (PVC) which can be a source of phthalates.
  • Choose fragrance-free personal care products to avoid phthalates in fragrances .
  • When using stool softeners, laxatives and other time-release capsules, look for phthalates on the list of inactive ingredients so you can avoid them.
  • Use nontoxic alternatives to pesticides in your yard and on your pets.
  • Screen your house for lead. If it was built before 1978, lead paint may place your family at risk. If paint is chipping or peeling, it can build up in house dust and stick to children’s hands.
  • Reduce household dust that may contain lead, flame retardants, phthalates and pesticides. Take shoes off before you come into the house and use a doormat to trap dirt outside and inside the doorway. Damp mop, use a HEPA-filtered vacuum cleaner and dust with a microfiber cloth.

Choose a Thyroid Surgeon Who Does Dozens of Operations a Year

For surgeons who do thyroid operations, practice makes perfect.

Thyroidectomy, the removal of the thyroid gland, is a common operation, performed more than 130,000 times a year in the United States, but doing it right is difficult.

Researchers, writing in the Annals of Surgery, studied 16,954 patients, about half of whom underwent thyroidectomy for cancer and half for benign conditions.

After adjusting for age, sex, diagnosis and other factors, they found that the risk of complications went down as the number of operations the surgeon performed went up. There was an 87 percent risk of complications for surgeons who did one operation a year; 68 percent for two to five; 42 percent for six to 10; 22 percent for 11 to 15; and 10 percent for 16 to 20. Only 3 percent of patients of surgeons who did 21 to 25 operations a year had complications; those who did more had a similar rate of complications.

Patients of high-volume surgeons had fewer complications not only with the thyroid gland itself, but also less bleeding and wound infection, and fewer respiratory problems. They also spent less time in the hospital after surgery.

The senior author, Dr. Julie A. Sosa, the chief of endocrine surgery at Duke, said that a patient has to be his own advocate. “If you can only ask only one question,” she said, “the most important is: ‘Who are the surgeons who do more than 25 thyroidectomies a year?’ ”

Short Men, Overweight Women Face Lower Pay

Being tall is associated with higher income for men and being overweight is associated with lower income for women. A new study shows that height and weight may have a direct cause-and-effect relationship with pay.

The study used Mendelian randomization — a genetic technique that helps clarify the causal relationship between human characteristics — to show that genetically determined height and weight can directly affect worldly success.

British researchers studied 119,669 men and women who either had or did not have various genetic variants known to influence height and B.M.I.

The study, in BMJ, found that for each two and a half inches of genetically determined extra height, a man was 12 percent more likely to work in a high-status job and earned an average $1,611 more a year. In women, a 4.6-point increase in B.M.I. resulted in $4,200 less in annual income. These differences between the sexes strengthen the conclusion that the effect has a genetic basis, independent of environment.

That taller men and thinner women are more successful has been shown in several observational studies, and environmental factors are certainly involved.

“But your environment, your lifestyle, can’t change your genes,” said the senior author, Timothy M. Frayling, a professor of human genetics at the University of Exeter. “The data shows that there is a causal effect from being genetically a bit shorter or fatter that leads you to being worse off in life. Previously we didn’t know that.”

For Transgender Patients, Challenges at the Hospital

Beck Bailey has encountered some health care professionals who were unsure how to treat transgender patients.

Beck Bailey has encountered some health care professionals who were unsure how to treat transgender patients. Kieran Kesner for The New York Times

After a skiing accident in January left him with a smashed knee, Beck Bailey, a transgender man in Greenfield, Mass., spent 15 days in a Vermont hospital undergoing a handful of surgeries. As part of his normal routine, Mr. Bailey gives himself regular shots of testosterone. But the endocrinologist on duty in Vermont told him that patients should not take testosterone post surgery.

Mr. Bailey explained that he couldn’t just stop his hormone treatment. But the doctors were so resistant that he finally had them call his primary care physician, who explained he should resume his usual protocol.

“I don’t expect every doctor in the world to become an expert in trans medicine, but I do think they should be knowledgeable enough to know what they don’t know and pick up the phone and call an expert,” said Mr. Bailey, 51, deputy director of employee engagement at the Human Rights Campaign, an advocacy group for gay, lesbian, bisexual and transgender people.

Mr. Bailey’s experience is echoed by many transgender patients, both those who have fully transitioned and those in the process. Research on nontransition-related medical needs is limited; most medical schools don’t prepare doctors for treating this community.

“What happens once you get past the immediate issues of transition, and you run into problems with diabetes, cancer, with the E.R.?” said Karl Surkan, 46, a professor of women’s studies at M.I.T. and Temple University.

Mark Makela for The New York Times

Mr. Surkan, who is transitioning from female to male, has firsthand experience: He carries the BRCA1 gene and was given a diagnosis of breast cancer. When he inquired about whether testosterone would affect his cancer treatments, his oncologist told him, “It probably would, but we don’t have any data on whether testosterone would cause a recurrence of your cancer. We wish we could help you.”

Indeed, there are few longitudinal studies on hormone use in the trans community. Many doctors aren’t aware that some transgender men may still need pap smears, breast exams and mammograms, and that all transgender women should be screened for prostate problems.

“Many transgender men and women have not had genital affirmation surgery and retain reproductive organs they were born with,” said Dr. Harvey Makadon, the director of education and training programs at the Fenway Institute in Boston and a clinical professor of medicine at Harvard Medical School. “All transgender women still have a prostate gland, and a good clinician will need to learn about the current anatomy and provide appropriate preventive screening and care.”

In addition to medical concerns, many trans patients say they are discriminated against by doctors and other medical staff members who misuse pronouns, call them by incorrect names or house them with people of the wrong gender.

According to a 2010 report by Lambda Legal, 70 percent of transgender respondents had experienced serious discrimination in health care. And a 2011 study of more than 6,000 transgender people by the National Center for Transgender Equality and the National LGBTQ Task Force found that 19 percent said they had been denied health care because of their transgender or gender nonconforming status. Many of them avoided the doctor’s office altogether: 28 percent had postponed getting health care when they were ill or injured, and 33 percent had delayed or not sought preventive care because of their past experiences with doctors.

A 2014 report by the HRC Foundation found that out of 501 hospitals researched, 49 percent did not include both “sexual orientation” and “gender identity” in their patient nondiscrimination policies.

Hospitals, for their part, are often flummoxed. Where, for example, should they put a patient who identifies as female, but is anatomically still male or listed that way on their birth certificate?

Mr. Surkan said that he has been placed in hospital rooms with other women. “It doesn’t bother me as much as it bothers people who are housed with me,” he said. “I do have a friend who is much more masculine appearing who had a hysterectomy, and he was put in the ward with women. That was pretty awkward for everybody.” He has since co-founded the TransRecord, which, together with sites like RAD remedy, act as a kind of clearinghouse for trans people seeking medical care.

In July, a transwoman alleged sex discrimination at Brooklyn Hospital Center after being placed in a room with a male roommate. “We didn’t realize that the individual was transgender,” said Joan Clark, a hospital spokeswoman. The hospital now requires all employees to undergo sensitivity training. “I think it’s made us a better organization,” she said. “They don’t want different treatment, they just want equitable treatment.”

Wrene Robyn, 46, a transwoman in Somerville, Mass., began her transition in 1989, when she changed her name on her driver’s license and Social Security cards, and the gender on her driver’s license from male to female. While she integrates fairly well into mainstream society, she has avoided the doctor for years. “Most trans people don’t go to the hospital, because they’re terrified of the room situation,” she said. “They’re terrified of it all. They don’t want to be misgendered, and they don’t want to explain what they have or don’t have in their pants.”

In April, after a bout of pancreatitis, Ms. Robyn spent a week in Massachusetts General Hospital in Boston, where she was given a single room. “Nobody really asked me what my preference was,” said Ms. Robyn, who works as a software engineer at the hospital and also serves on a transgender care committee there. In addition to worrying about being discriminated against, “What goes through a lot of trans people’s minds is, is this going to cost more? Usually we can’t afford private rooms.” (It was covered by her insurance.)

Some hospitals are now overhauling — or implementing — policies on treating transgender patients. At Mass General, for example, transgender patients are now asked if they prefer a private room or double. “If they are going to be placed in a double room, we ask them how they identify themselves,” said Terri Ogan, a spokeswoman. “If the patient identifies as a woman, they will be placed in a room with a woman. If they identify as a man, they will be placed in a room with a man.”

Transgender patients at Mount Sinai Health System, which encompasses seven hospitals in New York City, have been housed according to their current gender identity, regardless of where they are in their physical transition, since 2013. They can also request a single room. Previously, the hospital always put them in private rooms, but that had drawbacks: Many patients felt as if they were being segregated, and worried that they would be charged extra (they weren’t). “Often the transperson would be delayed or in the E.R. waiting for a single room to open up,” said Barbara Warren, the director for L.G.B.T. programs and policies at Mount Sinai’s office for diversity and inclusion.

Terry Lynam, a spokesman for North Shore LIJ Health System, which has 21 hospitals in New York City, Long Island and Westchester, said that their transgender policy, which was approved in November of 2014, is to treat transgender patients like any other patient. “So, we wouldn’t necessarily give them a private room,” said Mr. Lynam. But, he acknowledged, the issue becomes a bit more complicated with patients who still look like the sex they were assigned at birth. In that instance, if a roommate objects, “We’ll try to accommodate them and move the person who complains,” he said.

Advocates see this as a long time coming. “I’ve been telling hospitals that they really need to think about this and adopt some policies proactively,” said Tari Hanneman, deputy director of the Health and Aging Program at the Human Rights Campaign. “The first time you think about where you are going to put a transgender patient should not be when they arrive.”

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Tylenol During Pregnancy Tied to Asthma in Children

Paul Sakuma/Associated Press

Taking Tylenol (acetaminophen) during pregnancy is associated with a slight increase in the risk for asthma in offspring, a new study has found.

Norwegian researchers used health data on 95,200 pregnant mothers between 1999 and 2008, and followed 53,169 of their children after birth. The mothers completed questionnaires on medication use for themselves and their children.

After controlling for various health and behavioral characteristics, they found that prenatal exposure to Tylenol was associated with a 13 percent increased risk for asthma at age 3. The more Tylenol the mother had taken during pregnancy, the higher the risk.

The study, in the International Journal of Epidemiology, was designed to minimize the possibility that the increased risk was caused by an illness rather than by the Tylenol itself. The association persisted whether the mother took the medicine for pain, fever, flu or any other respiratory tract infection.

“Based on this modest increased risk, there is no need to be concerned if a child has been exposed,” said the lead author, Maria C. Magnus, of the Norwegian Institute of Public Health. “It might be possible to limit the amount of Tylenol used, but mothers should not be afraid to use it when necessary.”

According to the Centers for Disease Control and Prevention, 65 percent of pregnant women use Tylenol.