Cure your yeast infection with french knickers

July 30, 2009

A lovely reader by the name of Rashburn asked me this question:

“I’ve had about four yeast infections in my life, each after unprotected sex with one particular guy. Is this a coincidence, or is it possible he’s yeast-basting me? Is there anything he can do to prevent this besides scarf probiotic yogurt and try to keep the peen clean? (He’s asymptomatic btw. No itching or dickcheese.)”

Darling Rashburn, it is possible for men to be asymptomatic carriers of yeast, and it is possible that your friend is yeast-basting you, even without the telltale dickcheese (Davidson, 1977). Men are more likely to have symptoms if they are uncircumcised, but they are just as likely to harbor yeast if they are circumcised (Davidson, 1977). Since a person may be hesitant to go to a clinic and seek treatment for a condition that is asymptomatic, it is possible that circumcised men spread yeast infections around more than their uncircumcised brothas (Davidson, 1977). Probiotic yogurt and proper hygiene can help prevent a yeast infection, but they can’t clear an infection that’s already there, even if its asymptomatic.  Recurrent yeast infections in one person warrant examination and treatment of the partner (Oriel et al., 1972).  Treatment will probably consist of a single 150 mg oral dose of the anti-fungal drug fluconazole, or  perhaps topical treatment with Nystatin for your man (McPhee & Papadakis, 2009). Yeast infections should not be diagnosed  by symptoms alone or even by microscopy since other infections can masquerade or coexist with yeast: only culture can confirm diagnosis (McPhee & Papadakis, 2009).

My lovely Rashburn, if it turns out that your fellow is yeast-free, it is still possible that your yeast infections are more than just coincidental. Yeast is part of your body’s normal flora, and it only becomes a problem if it’s given the opportunity. I’m just speculating here, but perhaps this guy’s fluids upset your own vaginal pH balance, or perhaps the fact that the sex you’ve had with him has been unprotected means you take the morning after pill when you sleep with him (oral hormones increase your risk of a yeast infection.) Perhaps you two have long, rough sex marathons and you end up all bruised and battered down there. Or perhaps the timing is coincidental. But I think this guy’s “peen” is the culprit.

On a final note, I’m sorry to provide you with references all the way back from the ’70s, but I suppose that the good ol’ fashion basic yeast infection (as in, non-HIV related) is such old news in the medical community that no one is really studying this topic anymore. Furthermore, it seems that the only people who ever did study the yeast infection are the British. Go figure. I was annoyed to find that my 2009 diagnostic manual and my medical pathology book from 2005 make no mention of asymptomatic yeast infections in men. It’s just something we’re all kinda supposed to know about, since all the research was done in the ’70s. Most of the information here could be obtained by performing a simple Google search, but none of those stupid MD or STD websites (not even the good ones) provide references. You’re just supposed to accept that what they are saying is true.

Not that science is always all that accurate, either. I had to be careful about those articles from the 70’s. I’ll leave you with an amusing example of some of the stuff I found.

From Morton and Rashid in 1977:

“Washing after intercourse by both female partner and consort may be indicated. The wisdom of women liable to recurrences in abandoning nylon tights and pants in favor of stockings or stocking tights and cotton pants or French knickers, should be presented as a reasonable means of prevention. Abandoning underwear completely and wearing a long skirt or kaftan is preferred by some women. The cooperation of the male consort should also be actively sought.”

LOVE IT.

References:

Davidson, F. (1977). Yeasts and circumcision in the male. British Journal of Venereal Diseases, 53(2), 121-122.

McPhee, S. J. and Papadakis, M. A. (2009). Lange 2009 Current medical diagnosis and treatment (48th ed.). McGraw Hill.

Morton, R. S. and Rashid, S. (1977). Candidal vaginitis: natural history, predisposing factors and prevention. Proceedings of the  Royal Society of Medicine, 70, 3-6

Oriel, J., Partridge, B., Denny, M., and Colemen, J. (1972). Genital yeast infections.  British Medical Journal, 4(5843), 761-764.


Swine Flu Strikes Animal Farm

July 29, 2009

Over the weekend, some of you might have felt vaguely concerned that the European Medicines Agency is probably going to fast track a swine flu vaccine (meaning skip some preliminary safety testing.) Visit this Harry Potter-sounding organization’s website and read the press release for yourself here. Meanwhile, I was feeling alarmed that National Institute of Health (NIH) money was probably used to fund Raccoon Flu research. This article’s side-splitting section entitled Experimental Infection of Raccoons mentions rectal swabs enough times to make it worth reading. Although, as hilarious and ethically questionable as I found the study’s methods (which include capturing, infecting, and rectally-swabbing raccoons), I suppose I can see the rationale for studying what happens to the flu virus inside an animal that eats out of our trashcans (might I also suggest we test these crafty dumpster divers for recombinant flu strains?) I have a more difficult time understanding how this other flu research article received funding, seeing as the only population to benefit from the study’s findings is alcoholic mice. Hey, I want to study the flu’s effect on my crack-abusing newt. Any takers?

But in all seriousness folks, everyone has been a little nervous about swine flu since the media frenzy surrounding the outbreak in Mexico City in April. After the situation failed to yield piles of corpses, the story faded from the headlines, allowing the WHO to quietly declare the viral outbreak a stage 6 pandemic on June 11th, 2009. I’ve been keeping an eye on the story in anticipation of the southern hemisphere’s flu season followed by our own beginning this fall in October. The most recent WHO update can be found here, with a more comprehensive interpretation of the data here. Essentially, the WHO says we do not yet have a clear epidemiological picture of what’s going on and we should continue to monitor disease patterns as the seasonal flu and the novel H1N1 strain circulate around the globe. Similarly, the CDC reports about 43,771 cases and 302 deaths here in America. If you’re looking to protect yourself, the CDC recommends generically useful strategies like washing your hands and avoiding mouth-to-mouth contact with flu-infected raccoons.

Many of you will be deciding whether or not to get vaccinated this fall. News about fast tracking the flu vaccine triggers media-implanted concern over vaccine safety in many people. I cannot unimplant this concern (beside, concernectomy is not covered by your insurance policy), nor can I really reinstall public trust in certain organizations like the CDC or the NIH that some people now consider part of mainstream American medicine, colluding with big pharma and insurance giants and all that dirty stuff. Luckily for vaccine safety advocates, we don’t have any plans to fast track a vaccine here in the States. Safety reports should be available by the time a swine flu vaccine hits U.S. markets, although critics will rightly point out that the data will not reflect any potential long-term effects. The WHO’s expert advisory group on immunization compiled recommendations regarding H1N1 vaccine, which you can read about here. Just as the WHO recommends that each country consider its vaccine strategy based on its own unique epidemiological profile and resource availability, I recommend that you make the decision to vaccinate based on your own unique risks/benefits analysis.

Of course, it’s unwise to analyze risks and benefits if you don’t really know what they are (unless you’re an elected official.) Since I try to offer people a little something beyond my own general opinion or “informed” speculation whenever possible, I searched PubMed for additional information (beyond CDC, WHO or NIH websites) regarding the safety of routine seasonal flu vaccines, potential pandemic flu vaccines, and the great Guillian-Barre (GB) incident of 1976 in which 25 people died of GB after receiving a vaccine against a strain of novel swine flu. I also searched for information regarding the projected severity of H1N1 pandemic. My search was limited to PubMed, the Internet (including the world wide web at http://www.www.com) and various textbooks I have, which does not cover all the sources out there. Even with my limited search, flu studies are more numerous than “cute kitty” videos on YouTube, so a truly comprehensive review is beyond the scope of this blog. Still, with regards to vaccine safety, I found truckloads of articles discussing traditional inactivated and live-attenuated flu vaccine safety. I’ve pared the list way, way down to a few of the most crucial articles for review in this blog entry, but I read the others and will go ahead and disclose that they have influenced my opinion. I am always happy to provide references to anyone who is curious where I’m getting my information. For people looking for some down-and-dirty vaccine drama, I’m sorry to say that I could not find any reputable articles providing evidence that traditional flu vaccines are not safe, though I will address the Guillian-Barre link. (If you have in your paws a damning piece of flu vaccine evidence, please send it my way.) And I could not find any concrete answers regarding the projected severity of the H1N1 pandemic beyond “honestly, we don’t know.” I did, however, find an excellent expert review that is easy to comprehend for non-medical folks. The following discussion will contain some jargon, which you can easily understand after brushing up on virology 101. For those of you who want a brief review here, the next paragraph contains all the vocab you really need to know, and following the links will help you learn a bit more about genetics, microbiology and immunology as well! For readers well-versed in the sciences, skip the next paragraph.

A virus is an infectious agent composed of a nucleic acid core (like DNA or RNA, which is the virus’s genetic information) and a protein coat. The virus may also come with a few pre-packaged enzymes, which help the virus enter and exit the cell, undress inside the cell, and high-jack the cell’s genetic and metabolic machinery for the purposes of replication and proliferation. These enzymes are sometimes the targets of enzyme-inhibiting antiviral medications. (Parenthetically, viruses do what they do because they do not have their own organelles or cellular components necessary for metabolism and replication. Since the biological definition of life encompasses metabolism and replication, viruses are not alive–much like these people.) The proteins on the outside of the viral coat are called antigens. For example, the name H1N1 refers to the specific antigens on the outside of the influenza A viral particle, hemagglutinin and neuraminidase. Neuraminidase is also an enzyme (all enzyme names end in the suffix “-ase”.) These antigens are usually the targets of vaccination. A vaccine will (hopefully) help your immune system to recognize these antigens and launch an immue reponse against the virus.

When attempting to predict how safe a new vaccine will be, it might help to look at other vaccines of its kind that have come before it. The rationale here is that the new pandemic H1N1 vaccine will probably be made exactly like the others, only with an antigenic component unique to H1N1 inserted into the standard vaccine cocktail. This rationale, unfortunately, is an oversimplification, as development of an H5N1 avian flu vaccine illustrates. For example, vaccine production is switching from egg-based to cell-based methods (Ca-Ching!!$$$$.) Additionally, as Hovden, Cox and Haaheim (2007) reiterate in their excellent review of flu vaccination in people with COPD, current flu vaccines usually do not contain an adjuvant, whereas a vaccine against a novel flu strain may need an adjuvant to make it effective in an immunologically-naive population.

With these caveats in mind, the safety record of current seasonal flu vaccines is well established. Our friends Hovden et al. (2007) will vouch for this claim. These people probably wouldn’t (although check out their awesome professional credentials). Although some of the information on nvic.org is not entirely misleading (I can’t find a link to provide a warrant for that claim. I tried), I think that the article by Vellozzi et al. (2009) published in this month’s Vaccine journal is a bit more illuminating, seeing as it uses 15 years of data from the VAERS to track the safety of trivalent inactivated flu vaccines (TIV). Though there are some limitations with the study (mostly limitations inherent to the nature of the VAERS, which is a passive surveillance system subject to biased reporting and underreporting), the authors did look at a time period between 1990 and 2005, in which an estimated 747 million doses of TIV were administered. During this time, the VAERS received just over 18,000 reports of TIV-related adverse events, 14% (about 2500) of which were serious. That’s about a 0.0000033% chance of a serious adverse event related to a TIV flu vaccine, and a 0.0000244% chance of any adverse event. Guillian-Barre was reported at a rate of 0.78 per million vaccines. The study did not find any changes in overall vaccine safety between 1990 and 2005. The findings can’t be generalized in children under 18 years old or vaccines grown in anything other than egg. You can read about the safety of TIV in children and adults with asthma here and safety of H5N1 vaccine here plus here and live attenuated vaccine in adults here and TIV vs. live attenuated nasal spray vaccine in children here. Just to name a few.

On the subject of the 1976 swine flu that failed to amount one of those super-sexy killer pandemics but did generate a panic vaccine that killed 25 people by causing Guillian-Barre (GB): an in-depth analysis published in the Journal of Infectious Diseases by Evans, Cauchemez, and Hayden (2009) notes that around 45 million people received this vaccine over a 10-week period in 1976, with a risk of GB between 4.7 and 11.7 cases per million vaccines. That amounts to a 0.0000117% risk of getting GB from the vaccine and a 0.0000005% chance of dying from it (I’d like to credit my calculator with these numbers.) The study also provides an excellent breakdown in Table 3 of the number of study participants that would be needed to detect rare adverse events–you can see why clinical trails have difficulty in this area. If you’re a statistics nut, read this sucker. My point here is not that those 25 deaths were insignificant, but that these risks weighed against the possible risks of a severe flu pandemic warrant consideration. Even if the new flu vaccine is as “unsafe” as the 1976 disaster vaccine, it might still be worth the risk. Plus, we’re a little better at treating GB now.

So what are the chances that pandemic H1N1 will be a bust like it was in 1976? Be suspicious of anyone who assuredly, confidently answers this question with anything other than an “I don’t know.” The best review I found was published in Virology Journal and written by a dude named William R Gallaher, retired professor emeritus from LSU, holder of a U.S. patent for an Ebola antiviral strategy, and all-around nice guy. His review is comprehensive and easy to read. He concludes that, although the future course of the outbreak can’t be predicted, the current pandemic H1N1 strain has significant pandemic potential and warrants rapid development and possibly worldwide administration of a new vaccine. He’s also generously offered to be the new vaccine’s first test subject. His conclusions come from analysis of antigenic drift in both of the viral surface proteins. If we are going to trust CDC numbers, you have around a 0.0069% chance of death from this current pandemic H1N1 strain, although I won’t even attempt to calculate your chances of actually contracting the virus.

Like Gallaher, I’ll be getting a flu vaccine this fall. I’ll get a flu vaccine because I’m a health care worker and I would not want to transmit flu to any of my patients. However, I won’t let them poke me unless there’s been at least some preliminary safety testing. I mean, what if some sort of new adjuvant causes one to write overly verbose blog entries??? I certainly wouldn’t want that.

I hope this review has been educational in terms of H1N1 vaccination and flu information in general.

References:

Evans, D., Cauchemez, S., and Hayden, F. G. (2009). “Prepandemic” immunization for novel influenza viruses, “swine flu” vaccine, guillian-barre syndrome, and the detection of rare severe adverse events. The Journal of Infectious Diseases, 200, 321-328.

Gallaher, W. R. (2009). Towards a sane and rational approach to management of influenza H1N1 2009. Virology Journal, 6(51). 7 pages.

Hovden, A. O., Cox, R. J., and Haaheim, L. R. (2007). Influenza: the virus and prophylaxis with inactivated influenza vaccine in “at risk” groups, including COPD patients. International Journal of COPD, 2(3), 229-240.

Vellozzi, C., Burwen, D., Dobardzic, A., Ball, R., Walton, K., and Haber, P. (2009). Safety of inactivated trivalent influenza vaccine in adults: background for pandemic influenza vaccine safety monitoring. Vaccine, 27, 2114-2120.


Answering the TOUGH questions

July 25, 2009

I want this blog to address the healthcare-related concerns of anybody who is lucky enough to be reading it. Please feel invited to leave comments demanding that I inform you about topics of interest to you (though may I suggest you leave your comment anonymously should you be asking about your scrotal lesion, which you fondly refer to as Mister Blister–you know who you are.) Any topic, from toe jam to “socialized” medicine, is fair game. My knowledge is extensive, my insight is uncanny, and my goodwill towards my fellow humans has been clinically-proven in a randomized, placebo-controlled, double-blind study. So ask away, friends. Don’t be shy or embarrassed. This is the safety circle. If you leave topic selection up to me and me alone, then this whole blog will be about home remedies for herpes. Consider yourself warned.


The Mirror Stage

July 23, 2009

Momma always said that trying to discern the genetic underpinnings of human nature is like trying to reconstruct this recipe for coulibiac merely from tasting the finished product. Now, Momma wasn’t Russian, but she was an alcoholic, so I didn’t take her metaphors too seriously. This article, however, gave me a new appreciation for Ma’s insight. Not only does the article use real science refute a branch of academia that I am prone to detest, but it also quotes former UNM anthropologist Kim Hill, who I know personally. Yeah, that’s right. I gots connections.

The article, which addresses the issue of rape genes and jealously genes and all that hot n’ heavy Darwin stuff, touches on something that I think is really fascinating: human evolution in the past 10,000 years. I mean, like, wow man. Maybe these trendy new genes are the reason why we’re not all dying from leaky-gut syndrome. This whole ongoing evolution thing may turn out to be a boon for chubby chasers, since obese chicks have more children. Does that mean we’re passing on the gene that turns donuts into cellulite with a greater frequency than gene that turns donuts into abs of steel? I’m thinking that the next 10,000 years of evolution will turn us into a species of buoyant blubber balls who can sustain ourselves on nothing other than corn derivatives. Also, new and improved humans will sprout flippers instead of limbs since, you know, global warming and all. Hey, we already have gills. (By the by, how awesome is it that the Missouri Association for Creation website has a tab called Get the Facts?)

Unfortunately, my vision for the New American Century has been sullied by confounding variables. Turns out property values may be the strongest predictor for obesity: that is, as your property value goes down, your waist-to-hip ratio goes up. How do you pass on your property value gene? In a trust fund? Does your property’s value count as a pre-existing condition under Obama’s endangered public option?

Whatever our evolutionary heritage, it’s obvious that we humans are pretty obsessed with figuring ourselves out. Despite the obvious genetic variability in our species, it seems that the gene for self-voyeurism is nearly universal. I hope that the current battle betwixt those macho, speculatin’ evolutionary psychologists and their more egalitarian critics yields a bunch of cool new science for me to blog about. What else am I supposed to do? I mean, I can help treat obesity, but I can’t give anyone a pill to increase their property value. YET.


Do I dare disturb the universe?

July 22, 2009

14th president of the United States Mr. Franklin Pierce would have faded into the unglamorous historical background of political insignificance had it not been for his single famous quote, “Life sucks and then you die.” This quote has survived into the present day, despite solid counter arguments put forth by humble scholar Denis Leary. Although the quote’s shallow, exasperated humor may resonate with sufferers of middle-class ennui, many victims of tortuously slow terminal illness might take issue with the factual basis of the statement. For instance, sometimes life sucks and then you don’t die… you keep on living with unrelenting pain invading every crevice of your skeleton, or brain-eating dementia annihilating your memories, or a lack of control over your own body leeching you of your autonomy. Unfortunately for the aforementioned unfortunates, Washington and Oregon are the only two states in the union that have legalized physician-assisted suicide. As per the country at large, I find the whole “right to die” debate has been twisted into tiresome headwork that’s spring-loaded with hypocrisy and fear. Although The State does not really take an interest in your education, your access to health care, or your corporation’s carbon footprint, it somehow decides to take an interest in your life once you’re riddled with cancer and longing for death. Weird, huh? You can brush up on the fascinating right-to-die debate here.

There are a few different caveats worth noting. The issue of practical concern is not really whether you have the “right to die”: the issue is whether you have the right, under certain circumstances, to a medically-facilitated death. If you have a right to a medically-faciliated death, that implies that someone with a medical background has the right to facilitate your death. If health care providers have the right to prescribe a therapeutic death, what kind of patients and what kinds of deaths should be covered by your supplementary insurance plan? And how do we write laws that prevent the Kevorkians out there from getting all trigger happy?

The right-to-die debate received a brief resurgence last week, at least amongst opera-loving folks (most of whom have reached that age when right-to-die starts to take on a personal significance), when British conductor Sir Edward Downes and his wife ended their lives in a Swiss suicide clinic. Fo’ real? Switzerland has suicide clinics? That sounds nice. Oh, wait. I’d probably rather die at home. Is that not legal in your state or country? For a nominal fee, you can go on suicide holiday! Can’t afford that? You didn’t hear it here (in fact, you heard it from the NIH), but I’m pretty sure heroin makes you stop breathing the same way morphine does.

On a personal note, death is interesting, and scary, and sad and stuff. I held a guy’s hand yesterday as he took his last breath. This has happened many times during my career, since we have a lot of hospice patients on my floor . It’s always a primordially-charged experience for me. My last words to this particular patient were “at least you still have a full head of hair!” Obviously, I did not know he was going to die. I had just arrived on shift and the patient was handed off to me with the assurance that, although he was a hospice patient, he was as strong as a horse. At least the man’s family was there. And I’m not some DNR/DNI-loving angel of death or anything. It was hard to realize that the man was done breathing and I was legally prevented from doing anything about it. But it seemed to be a peaceful death, whatever that means. It’s an honor to be present during someone’s last moments of life, just as it is an honor to be present at someone’s first moments of life (with the latter being generally more joyous.) But with death being like the biggest thing that the (presumably) conscious mind has to grapple with (besides the Snuggie phenomenon), I can see why people are so weirded out by the notion. I got the heebie-jeebies when I zipped that sweet man into the body bag. I even shuddered when confronted with the thought that, someday, someone would be zipping my wonderful mother, or my beloved sisters, or my indispensable self into one of those bags. I just don’t think the weirdness my own (alleged) mortality, or the painful thoughts of losing my own loved ones, or even my own conviction in the eternal discomforts of hellfire, should prevent someone from pursuing a humane, supportive end to their suffering. And I’m pretty sure we can find a way to legislate this without giving permission to a bunch of homicidal psychos to start “euthanizing” anybody in a hospital bed. Besides, most homicidal psychos go into patent law anyways.

What do you think?