Is Swimming Pool Water Safe?

Swimming season has arrived, and patients often ask me about whether or not you can catch this or that disease from a swimming pool or hot tub. First of all, let me assure you that no, you cannot catch STI's (sexually transmitted infections) directly from a hot tub...as long as all you are doing in the hot tub is enjoying the water. There are, however, diseases that can be contracted from swimming pools- typically from accidentally swallowing the pool water. How does that happen? Easily, especially for kids and adults who play around with getting mouthfuls of pool water and spraying that out like a whale (we've all seen them!)

The most common swimming pool contracted illness that we see is diarrhea, especially from the parasite giardia or the pathogenic strains of the bacteria, E. coli. Of course, there is also the potential to contract a few skin diseases such as athletes foot or plantar warts when you are hanging out in public swimming areas.

A recent study, Microbes in pool filter backwash as evidence of the need for improved swimmer hygiene-metro-atlanta, georgia, 2012, published by the Center for Disease Control (CDC) looked at the microbes collected in pool filter backwash. Over half the samples contained Pseudomonas and E. Coli. Pseudomonas  can invade ear canals and any open skin lesions/cuts/scratches- including "razor burn" areas, and is a special concern for diabetics, who can tend to develop more severe infections.  E. coli is the most common bacteria in a healthy human gut, but can also cause significant illness, as is evidenced by the food poisoning we see from time to time from this organism. Ultimately, this study reinforces the need for public awareness of good swim hygiene, which includes showering before swimming (to remove any fecal matter- the quick, already bathing-suited dash under the poolside shower does nothing for this, though it may reduce oils and residue from sunscreens) and refraining from swimming when you have a diarrheal illness. Most importantly, keep a close eye on your non-potty trained toddlers in swim diapers, making sure to check those diapers on an hourly basis.

BOTTOM LINE: Swimming is great fun and generally good for your health, but pay attention to good swim hygiene, and if you develop persistent diarrhea this summer, don't ignore it- head to your doctor and get checked out (and please stay out of public pools till you are cured.)

Flu Vaccine- It's Not Too Late!

Okay, it's January, and now EVERYONE you know is getting the flu! Is it too late for you to get vaccinated? ABSOLUTELY NOT! The truth is that now that we're all scared, it's tough to find somewhere that has the flu vaccine in stock! Call your doctor or your pharmacy and find out how many they have left, then jump in your car and head over.

This year is another one of those "really bad" flu years. Yes, if you are vaccinated today, you have to wait a couple weeks for your shot to protect you. BUT...the flu season is just catching its stride, so all you have to lose is a temporarily sore shoulder.

This year's flu seems to be bringing with it the added bonus of nausea and vomiting, as if muscles that feel like a Mack truck hit you were not enough. The flu is NOT just a stuffy or runny nose and cough- that's a cold. The flu is OMG, I can NOT get out of bed and function, because my head is splitting, my muscles are screaming, and yes, this year's bonus is the vomiting and diarrhea. Believe me, a sore arm for a few days is a happy trade for the flu.

Who should be vaccinated? Hello, it's EVERYONE. The CDC (Center for Disease Control and Prevention) recommends that everyone over the age of 6 MONTHS get a flu vaccine each year.

Wash hands, wash hands, and oh yes, wash your hands...for 20 full seconds! When you dash them under the water or take 5 seconds to apply hand sanitizer, you are nicely moving your germs around, so spend the extra 15 seconds and scrub a bit to be more effective.

BOTTOM LINE: FLU SEASON is in FULL SWING- Strike back by getting your FLU VACCINE and WASHING YOUR HANDS...for a full 20 seconds!

For more info, check out the current stats on this year's flu at the CDC at: 
http://www.cdc.gov/flu/about/season/flu-season-2012-2013.htm

Celiac Disease and GF: What is it?

You may have noticed a new section cropping up on menus in restaurants these days- the gluten-free choices. What's up with that? Celiac disease. This disease is very common in the United States, affecting 1 in 133 people. In people with this disease, eating gluten (the wheat protein) causes an auto-immune reaction that damages the small intestine, causing poor absorption of food and nutrients.

What symptoms show up? Diarrhea is the classic symptom, but it turns out there are probably more cases of celiac disease without diarrhea. The symptoms are often rather nonspecific: fatigue, irritable bowel, anemia, vitamin deficiencies, and osteoporosis. There is, though, one symptom that is 85% specific for celiac disease-a rash called dermatitis herpetiformis, DH for short. This rash has nothing to do with herpes, however (nope, no STD talk in this topic!) This rash is intensely itchy, symmetrical eruption on the face, buttocks, elbows and knees.

The good news is that celiac disease can usually be treated with dietary changes alone-no medications required! The bad news is that gluten is found in many products beyond the obvious wheat breads and cereals, so to completely avoid gluten requires significant effort and education. Stay tuned this week for more about Celiac disease diagnosis and diet.

BOTTOM LINE: Problem: Celiac disease, a very common challenge. Answer: Gluten-free diet.

Coming Up or Running Out- the GI Drugs in the Cabinet

Finishing up what doctors keep in their medicine cabinets, I need to include the GI (gastrointestinal) emergency stash- drugs for throwing up and diarrhea.
For one or two episodes of vomiting, we simply cautiously hydrate with sips of gatorade and wait and see. However, for those occasional wicked stomach viruses that cause nonstop puking all night, we reach for a prescription that we keep on hand- phenergan (promethazine). This drug comes in suppositories as well as pills, and we know when a family member is ready to deal with a suppository, they really need it! Note that phenergan makes you sleepy, which is often a desired side effect, but it also can be addictive- this is for infrequent intense nausea, not for daily use!

What about the other end? No prescription here, we simply keep OTC liquid and pill forms of Imodium. The most important thing with diarrhea is to stop dairy products for a couple days, as you become temporarily lactose intolerant after a day of loose stools.
We also keep a bottle of acidophilus (probiotics) tablets for preventative use when someone is on an antibiotic (to avoid diarrhea from killing off the good bacteria in the gut.)
This is perhaps the least frequently used part of the medicine cabinet, but desperately desired when the occasion arises.

BOTTOM LINE: Phenergan and Imodium make up the gastrointestinal portion of our medicine cabinet.