High on Bath Salts?

They are not the bath salts you use in your bath.

These "Bath Salts," are a new and very popular designer drug that the Drug Enforcement Agency (DEA) is hoping to make illegal in the U.S. In September of this year, the DEA invoked its emergency scheduling authority to make them a controlled substance, and its sale has been banned in 35 states, as the National Poison Control Center has reported more and more calls about this drug. In an article written by Ann Bryant of Maine's Sun Journal, Deputy Chief of Farmington's Police Department Shan Cote reported that 303 calls for bath salts exposure were made to poison control centers in 2010, and that more than 5,000 calls have been made so far in 2011.

What are bath salts?

These bath salts are synthetic stimulant/hallucinogens similar to ecstasy and PCP. They were initially made in France in the 1920's , seen in Europe in the late 2000's, and here in the U.S. during the last few years. It has a number of harmless-sounding names such as Ivory Wave, Purple Wave, Oblivion Bath, Vanilla Sky, Bliss, and Snow White. Their proper names are mephedrone, MDPV (methylenedioxypyrovalerone), and methylone. They are found in mini-marts, smoke shops, and often appear as small bags of crystal white or brown powder. In the past they could be found in convenience stores and head shops next to the 5 Hour Energy products.

Why the name?

They have been marketed at "plant food" and "bath salts" and labeled as "not for human consumption," to avoid being made illegal. While it is banned in many states, it will take a federal law labeling them as a schedule 1 drug ( no medicinal value with a high potential for abuse) to officially declare bath salts illegal. For now, in some areas a small envelope of the drug can cost $25 to $50.

Are bath salts addictive? How are they taken?

It's not currently known if they are addictive but like other stimulants they are expected to cause cravings. It is snorted, injected, and mixed with food and drinks.

What does bath salts intoxication look & feel like?

One's blood pressure and pulse will rise. While high you may feel euphoria, confidence, experience increased alertness, focus, and productivity. The downside consists of depression, anxiety, aggression, delusions of superhuman strength, and a rise in body temperature causing many to remove their clothing. The downside continues with as one can become agitated, paranoid, experiencing hallucinations and suicidal thoughts. Users have been reported to be unaware of a broken limb, and to have damaged ambulances and hospital rooms.

Suicidality has been known to be ongoing after the stimulatory effects have dissipated, and suicides were reported days after use in the media.

Bath salts are part of a trend of drugs designed and named such that they are legal and thus easily obtained for long periods before detected by law enforcement. We must remain vigilant.

Holiday Heart Syndrome: An Unwanted Gift

Now that we are in the throes of the holiday season, I must warn you of Holiday Heart Syndrome, brought on by drinking too much wine, too many beers, and consuming too much sodium. You say you don't have heart disease? It doesn't matter. You can still get it.

What is it?

Holiday Heart Syndrome is not just stress. It is a real condition in which the heart is more vulnerable to disturbances of the heart's normal rhythm. It is a rapid, irregular rhythm your heart can enter when you drink too much alcohol. Most commonly the heart goes into ATRIAL FIBRILLATION, a rhythm characterized by the quivering of the heart's upper chambers called the atria. The atria normally contract in a regular fashion, squeezing blood efficiently into the lower chambers of the heart called the ventricles which send blood to the body. When the atria are merely quivering, that efficiency is lost, meaning not all of the blood will enter the ventricles but will sit in the atria. Blood that is not in motion can thicken, forming lumps called clots which can block circulation, causing strokes and heart attacks, and the loss of fingers or toes based on where they lodge themselves in the body's blood vessels. Other rhythm disturbances the heart can enter include atrial flutter, and premature beats. Premature beats can come from the lower as well as the upper chambers of the heart.

What causes it?

We are not entirely certain of the cause, but it tends to happen when a person has consumed too much alcohol, is stressed and/or is dehydrated. There are theories that it is caused by a rise in one's epinephrine or norepinephrine (adrenaline or noradrenaline) levels. These stress hormones increase heart rate.

Who is at risk?

People who usually have no history of heart disease often experience it.

What are the symptoms of Holiday Heart Syndrome?

The symptoms are caused by the heart entering a rapid and irregular rhythm. This can cause the sensation of palpitations which cause a fluttering in the chest due to the heart racing, pounding, or skipping beats. You may also feel chest tightness, shortness of breath, dizziness, or like you will faint.

How is it treated?

Go the the emergency room. You might need intravenous fluids, medication to slow the heart rate, and monitoring of your heart's rhythm. Usually the symptoms resolve when the offending agent or condition is no longer present in the system. Bring a list of all your medications. Know your personal and family medical history. Be honest when telling of any drugs or alcohol consumed. If you are without heart disease, the symptoms usually resolve within 24 hours and you will be cleared to return home. If there is concern for undiagnosed heart disease, you may need to be admitted to the hospital for additional evaluation and treatment. Underlying heart disease, combined with the symptoms of chest tightness and shortness of breath means a greater chance you may be having a heart attack.

Young Girl with Promising Future Dead over $20.

Kamisha Richards (left), 22 years old, lent $20 to her lifelong friend, sister of her boyfriend, Kayla Henriques (right), 18, for diapers. Kamisha found out Kayla spent it on something else. She confronted Kayla on Facebook with an embarrassing statement. Kayla allegedly said, "Dnt try to expose me mama, but I'm not tha type to thug it out ova facebook ima c u wen u get frm wrk."


"I'm a have the last laugh," said Kamisha.
Kamisha had her last breath later that night.
She was pronounced dead at the Brookdale Hospital.
I think of how I could have had that task....

What happened?
After the Facebook feud, Kamisha went to Kayla's apt and confronted her in her kitchen. The argument ended with Kayla stabbing Kamisha in the chest with a steak knife. Kamisha was 22, with a degree in criminal justice, and worked as a security guard with plans for law school. Kayla is 18, she's a junior in high school, and is the mother of an 11 month old boy.

Controlling your anger can save your own life.

There are 3 ways of dealing with anger:
1. Expression
2. Suppression
3. Calming.

Expression of anger is healthy. The way in which you express it key. Declaring and defending your boundaries without hurting others is difficult. How can one do this? Don't start with the word "you," when expressing unhappiness with a person's behavior. Tell the person how you feel. In this case, Kamisha could have said, " I felt used when I heard that the money was used for something else." Tell that person what you need from them. "I need to know that you will pay me back as soon as you can."
Do not shame that person with hopes the embarrassment will make them come correct. It too often creates more anger. Instead of being shamed into doing right, the person can become defensive, and hurt you even more to deflect that shame, especially when you publicly shame them. This is what happened here. Kamisha's attempt at shame escalated the anger in both of them.

Regardless of what is said, remember: Respect for yourself and the other person must be maintained. Respect prevents threats.

Suppressing anger is when a person holds it inside, and tries to ignore it. This is a popular way to deal with anger. We try to direct that energy in a positive direction. That's not always effective. Energy that isn't released needs somewhere to go. It turns inward and does its damage there, causing conditions like depression, and high blood pressure.
Anger that is not expressed can come out in other destructive ways. It may show up as a nasty attitude, a poor outlook on life, endless criticism, and poor relationship skills. This may irritate others, but they can get away from you. You cannot escape your thoughts and views on your life. Your feelings determine how you experience life. This is why your negativity hurts you the most.
Kamisha could possibly still be here if she had tried CALMING.
Calming can be as simple as telling yourself to, "calm down, take it easy." Taking slow deep breaths with closed eyes, using your diaphragm not your chest and repeating those calming words lowers the heart rate and blood pressure.
After this exercise, think.
What do you want from this person? Do you care if you risk your friendship? How could this person hurt you? Is the money worth it? Is being right worth it? Lastly, ask yourself, "Why are you friends?"
Now speak.
Then listen.
Back to this tragedy. Kayla may have truly felt bad about having to use that money for something else, and intended to pay Kamisha back ASAP. If Kamisha had calmly asked questions, she could have found out this to be the case. Asking questions during an argument slows its pace, and brings focus back to the real issue.

These girls were lifelong friends. Kamisha, who seemed to have made better life decisions over a period of years, paid for a few hours of poor anger management with her life.
When people imagine anger management, they think of protecting others. Controlling your anger can save your life.

Be safe. Be successful.
Rapp, M.D.

Serena Williams Undergoes Emegency Surgery for Pulmonary Embolus

What are pulmonary emboli (PE's)? "Pulmonary embolus" literally means "lung clots." They are blood clots in the lung. These are often formed in the calves or thighs, after long periods of immobilization, broken long bones like thigh and leg bones, and during high estrogen states like pregnancy and cancer. While in the legs and thighs they are called DVT's (deep venous thrombi). They can migrate through the heart to the lungs and if large enough, can cut off circulation and breathing altogether. When this happens, a person can suddenly collapse and die. Those who survive PE's often present to the ER complaining of shortness of breath, chest pain, heaviness, or tightness, or coughing up blood. They may or may not have accompanying leg pain or swelling. They may show a rapid rate of breathing, low oxygenation, and a high heart rate. Diagnosis is confirmed with CT scan of the chest, and a V/Q or ventilation /perfusion scan. Treatment requires blood thinners (anticoagulants) like Heparin, Lovenox, and Coumadin (warfarin) to help dissolve the clot.
Things that put us at risk include frequent and long plane/car trips without enough breaks to walk, stretch and massage the legs, especially when dehydrated, obesity, cancer, smoking, birth control pills, and smoking while taking birth control pills.
So remember, control your weight, avoid smoking, get cancer screenings as appropriate, stay well hydrated, and take frequent breaks to walk during long trips. While taking birth control, keep the symptoms mentioned in mind, so you know when to seek medical attention.

September is Gynecological/Ovarian Cancer Month

In honor of Gynecological Cancer Awareness Month, let us first discuss the most deadly one, ovarian cancer. According to the Women's Cancer Network, ovarian cancer is the most deadly cancer of the female reproductive system. It is the 4th leading cause of cancer death of women in the U.S., and is second only to uterine cancer in prevalence. According to the American Cancer Society, 22,430 women will be told they have ovarian cancer this year .
One in 57 women will get ovarian cancer, and it usually happens in women over the age of 50. It is 50% more prevalent in white women. The adjusted mortality rate is highest among white women followed by Hawaiian women, and lastly black women.

Why is ovarian cancer so deadly?
Due to it's position in the abdominal cavity, early detection is difficult, showing no or mild symptoms until it is at an advanced stage where the 5 year survival rate can be as low as 11 percent. Early detection could mean a 5 year survival rate as high as 92 percent.

What are the risk factors for ovarian cancer?

According to The Johns Hopkins University, ovarian cancer occurs more frequently with the following:

1. History of ovarian cancer in your immediate family
2. Age over 50
3. Fertility drug use
4. High fat diet
5. White race
6. Never having children
7. Hormone replacement therapy
8. History of breast cancer diagnosed before age 50
9. Being of Ashkenazi Jewish descent

Having immediate family members who have had ovarian cancer raises your risk of having ovarian cancer in your 40's rather than your 50's.

What are the symptoms of ovarian cancer?
It can present with nonspecific symptoms, meaning the same symptoms caused by many other conditions. However, certain symptoms are seen more frequently among women with ovarian cancer:

1. Bloating
2. Pelvic or abdominal pain
3. Difficulty eating, feeling full quickly
4. Vaginal bleeding
5. Urinary urgency or frequency

These symptoms tend to be persistent, and occur daily for 2-3 weeks and require a doctor's evaluation if they last that long. Other less specific symptoms include:

1. Fatigue
2. Indigestion
3. Back pain
4. Painful intercourse
5. Constipation
6. Menstrual irregularities.

How is a person screened for ovarian cancer?

1. Pelvic examination and Pap smear
2. Transvaginal ultrasound
3. Testing for the protein CA-125, elevated in 80% of women with ovarian cancer
4. Culdocentesis- a sampling of pelvic fluid found in a "cul de sac" between the uterus and the rectum.

Don't be alarmed if your doctor says you don't need the CA-125 test or an ultrasound to detect ovarian cancer early. According to the U.S. Preventive Services Taskforce, it is meant for women who have inherited a BRCA (breast cancer) gene change and who still have their ovaries. They get tested annually starting at age 35.


Once ovarian cancer is diagnosed, you have 3 treatment options. The first is surgical removal of the ovaries. The second is chemotherapy, and the third is radiation. The form of treatment is based on the stage of the cancer, the type of cancer cells present, and the patient's age and physical condition.

Can certain things be protective against ovarian cancer?
The Johns Hopkins University says there are no simple preventive measures to take that significantly reduce one's risk of ovarian cancer. However, it is said that the following are associated with a lower risk of cancer:

1. Breastfeeding
2. Hysterectomy
3. Birth control pills
4. Tubal Ligation


What can you do to protect yourself?
1. Get regular pelvic exams
2. Know your family history
3. Reduce the amount of fat in your diet.

The National Cancer Institute advises increasing one's fruit, vegetable, and whole grain intake, lowering fat consumption to <30% of calories, maintaining a healthy weight, minimizing one's intake of cured, pickled, and smoked foods, and only drinking alcohol in moderation if at all.
So many conditions, and ER visits, can be prevented by following this advice.

Be safe, be successful,
Rapp, M.D.

Diverticulitis and The American Diet

I diagnosed yet another patient with diverticulitis today. "What causes it?" he asked. My answer was...

"The low fiber American diet."

What is diverticulitis?
Diverticulitis means inflammation of diverticula. Just having diverticula means you have "Diverticulosis." Diverticula are herniations or outpouchings, marble-sized on average, that form at weak points in our intestines, usually due to excessive force needed to push waste through the digestive system. It's like the herniae that form in our abdominal walls and groin area from repeated, improper heavy lifting. Eighty to eighty-five percent of patients with diverticulosis have no symptoms.

What causes diverticulitis?
In the past, it was thought that nuts, seeds, popcorn and corn caused diverticulitis when caught in the diverticula. According to the Mayo Clinic, research has found that these foods are not the culprits. Another school of thought is that the small openings to the diverticula can trap stool, reducing the blood supply, causing inflammation.

What are the risk factors?
While the cause of diverticulitis has not been agreed upon, the risk factors are straightforward.
They are:
1. Aging-Emedicine says the prevalence before age 40 is less than 5%. According to Drs. M. Schein and R. Paladugn of Cornell University's Surgical Department, it's prevalence is 30% by age 60 and 65% by age 85. The Mayo Clinic suggests that with age may come a decrease in the strength and elasticity of the the bowel wall after age 40.
2. Low fiber diet- Diverticulitis is rare in countries where people eat high fiber diets which soften stool, but it is common in industrialized countries where processed food are more available. As the Japanese adopted western eating habits, the prevalence of diverticulitis has also risen. Diverticulitis has grown in prevalence since the invention of rolling mills that reduce the fiber content of grains and flour.
3. Inadequate exercise- A sedentary lifestyle has been associated with a higher risk of diverticulitis. Why the connection exists is not clear, but exercise helps control constipation, a risk factor for diverticulosis.
4. Obesity-The Mayo Clinic says being seriously overweight is also a risk factor for diverticulitis and diverticular bleeding.

What are the Symptoms of Diverticulitis?
Usually the pain is of sudden onset in the lower left side of the abdomen. Sometimes the pain may come on slowly and worsen over the next several days. The pain may wax and wane, your bowel habits can change, causing diarrhea or constipation. You may experience nausea, vomiting, and even fever. Even less common but possible symptoms or signs are a bloated feeling and rectal bleeding.

What's the Worst that Can Happen?
1. Peritonitis- If the inflammation or infection weakens the pouch wall enough, a hole will form, releasing stool into the abdominal cavity, inflaming and infecting it's lining, the peritoneum. This condition is called "Peritonitis," an emergent condition requiring immediate treatment.
2. Rectal Bleeding
3. Obstruction- Infection can cause scarring of the colon or intestine, which in the wrong place can block the flow of gas and stool.
4. Abscess- This is a pus collection in the pouch.
5. Fistula- An abnormal connection, a passageway, can form between the intestine and structures nearby, like your urinary bladder, abdominal wall, or vagina.

Is there a connection with colon cancer?
A direct connection has not been found, but diverticulosis can make cancer harder to diagnose.
After you recover from an episode of diverticulitis, it may be advised that you get a colonoscopy, and more frequent colonoscopies than the average person to screen for cancer and other abnormalities.

What is the treatment for diverticulitis?
This depends on the severity of your condition, and if it is your 1st time. Mild symptoms typically require a liquid or low-fiber diet and antibiotics. Usually the symptoms lessen in 3 days and you can start increasing your fiber intake then. Stronger pain medication may be needed but watch out, it can worsen constipation and thus the problem.
More severe symptoms and signs, or the increased risk of obstruction or peritonitis, calls for hospitalization and intravenous antibiotics.
The most severe cases, involving perforation, abscess or fistulas may need surgery to remove that part of your colon. One kind of surgery involves removing the diseased portion and sewing the 2 ends back together.
More severe and generalized inflammation requires the 2nd kind which involves the surgeon making an opening (stoma) in the abdominal wall. The healthy portion is connected to that stoma and your waste will pass from that healthy end into a bag attached to the outside of your body, called a "colostomy bag."

How can I prevent diverticulitis?
We cannot say it enough, an ounce of prevention is worth a pound of cure.
1. Eat More Fiber: The National Fiber Council recommends that a healthy adult consume 32 grams of fiber a day. The average American eats about 10-15 grams. The NFC says only about 10% of Americans eat enough fiber. Why? Many Americans are misinformed about foods containing fiber. For example, 53% of American believe steak is a good fiber source, and most meat products contain little or no dietary fiber.

2. Drink Plenty of Fluids. Water is absorbed by fiber. This increases the soft, bulky waste in your colon. If you eat fiber and drink little water, you risk constipation.

3. Respond to the Urge to Defacate (Pass Stool). Holding in bowel movements makes stool harder, which requires more force from the colon to pass it.

4. Exercise. This increases bowel function and lowers the pressure inside the colon. Thirty minutes of exercise on most days of the week is all you need.

Be safe, be successful,
Rapp, M.D.

Lil' Wayne, Me, and Gun Safety

Lil' Wayne and I have some things in common. We were both good students, smart kids, who, at the age of 13, handled the gun of an older relative. Holding the handle, I avoided the trigger, but silently, stared down the barrel until I could make out the bullet. I put the gun back in it's worn paper bag, and back into my Grandmother's nightstand.

Lil' Wayne's gun went off and the bullet went through his chest, just missing his heart. He described slipping in his own blood trying to get help.

Many people believe that having a gun in the home provides safety in the case of home invasion. In 2009 it was estimated that 1/2 of American homes have guns. Pediatrics' Gun Safety Guide states that a firearm in the home is up to 43 times more likely to kill or injure a family member or friend than an intruder.

Picture a curious child. See that spouse in a fit of rage against the other, or suicidal thoughts brought on by alcohol and drug use, poor health, poor finances. According to the 7/17/1989 Time magazine article, covering the week of 5/1/89 to 5/7/89, during which 464 U.S. gun deaths occurred, "Despite the cry over street gangs and drug dealers, the week's homicides typically involved people who loved, or hated each other....People in the grip of despondency or disease who turned their weapons on themselves accounted for 216 deaths, nearly half the total. This article, published before my senior year in high school, with its stories of suicide, unintentional gun deaths and so many faces to go with them, convinced me to pursue a career in medicine.

These figures are old I know, and fortunately, the numbers have gone down, but any gun death, with suicide and unintentional gun deaths being especially preventable, is one too many. In 2005, 68% of unintentional gun deaths and 75% of suicides using firearms occurred in the home, occurred in the home according to the CDC's Morbidity and Mortality World Report (MMWR) in April, 2008.
In May, 2010, the MMWR reported that in 2007, 57% of deaths were suicides, and 0.7% were unintentional gun deaths. How many occurred in the home? An average of seventy percent occurred in the home and 51% involved guns.
The highest number of unintentional gun deaths that year occurred in ages 15-19. Parents probably assume kids in this age group know better. Twenty-three percent of those deaths occurred while playing with the gun.

Numerous intellectual outlets, have found that the trend in the data found was that, "both firearm prevalence and questionable storage practices (i.e. storing firearms loaded and unlocked) were associated with higher rates of unintentional firearm deaths." This quote is from the Harvard Injury Control Center, which did a review of 24 articles featured in publications such as Aggression and Violent Behavior, Journal of Trauma, American Journal of Public Health, Pediatrics, and Injury Prevention. This of course also applied to completed suicide attempts and homicide. Lastly, thousands of guns are stolen every year.

What can you do?
1. Lock your handguns. Check for local gun shows for information or even a free lock.
2. Store them unloaded
3. Separate ammunition from the gun and store in a locked container.
4. Apply external safety devices to your gun. Your local police dept. might provide them.
5. Address the curiosity of children in the house, and alert them to the dangers of handling a gun, so they don't find out on their own, alone or with friends.


The Eddie Eagle Program sponsored by the National Rifle Association has advice for children when they come across a gun:
1. STOP!
2. Do not touch it!
3. Leave the area.
4. Tell an adult!



Had I not been so lucky during my few minutes of very poor judgment, I may not have been able to give you this information. I may not have been here at all. Too many loving and talented people were not so fortunate, and we'll never know what they had to offer.

For more information, see About.com's Pediatrics Gun Safety Guide and the Kids' Health's Gun Safety page.


Be safe. Be successful.
Rapp, M.D.

Children's Eyes More Susceptible to Long Term Damage from UV Rays

August is Children's Eye Health and Safety Month. According to Prevent Blindness America, the nation's oldest volunteer eye health and safety organization, children's eyes are more susceptible to damage from ultraviolet rays.

Why?

They spend more time outside than adults, their lenses allow more light to enter the eye, which allows more UV rays to reach the back of the interior of the eye, the retina. UV damage is cumulative over time and has been associated with cataracts, and macular degeneration among other eye problems.

To help protect the eyes of children, Prevent Blindness America has been educating the public on eye protection since 1908. It advises only purchasing sunglasses with 99-100% UV protection, as those not providing such protection may shade the eyes but allow more rays to enter the eye due to dilation of the pupils. PBA advises that we all wear wide brimmed hats and proper sunglasses.

The organization provides these tips:

1. Only wear sunglasses offering 99-100% UV protection

2. Make sure the glasses fit and shield the eye from all angles.

3. Choose impact resistant lenses made of polycarbonate, never glass, unless prescribed by a doctor.

4. Always check lenses for scratches and other damage.

5. Buy wraparound glasses to protect the eyes and the delicate surrounding skin.

6. Wear them all year round. UV rays reflecting off snow as well as water are "extremely dangerous" says PBA's president Hugh R. Parry.

Where can you get such sunglasses?

Real Kids Shades, a company that manufactures quality shades for infants and toddlers, and older, provides shades offering 99-100 UV protection. They offer infant sunglasses starting art $14.99, and all money goes to fund the Star Pupils program, the new children's eye health and education program of Prevent Blindness America. Call 1-800-331-2020

Enjoy the sun for a lifetime!

Rapp, M.D.

380 Million Eggs Recalled Due to Salmonella Outbreak.

Although no deaths have been reported, almost 2,000 cases of Salmonella (S. Enteritidis) poisoning, have been reported between May and July of this year, 1,300 more than usual, and more cases are expected as the Centers for Disease Control gather more information from the state health departments. It was this outbreak that led to the recall of Wright Country Eggs.

Which brands are on the recall list?

Albertson's
Bayview
Boomsma's
Dutch Farms
Farm Fresh
Glenview
Hillandale
James Farms
Kemps
Lucerne
Lund
Moutain Dairy
Nulaid
Pacific Coast
Ralph's
Shoreland
Sunshine
Sun Valley
Trafficanda

There are specific plant ID numbers and Julian dates for recalled brands. This means that not every egg produced by a particular brand has been recalled. Go the the Egg Safety Center for that information.

According to MSNBC, new rules requiring egg producers to do more testing for Salmonella and to take other precautions did not go into effect until July. These rules apparently were in limbo for 10 years after President Clinton first proposed raising egg standards. The Food and Drug Administration says that these new regulations could lower the number of Salmonella cases by 60 percent. More specific information is not available due to an ongoing FDA investigation.

What is S. Enteritidis?
Salmonella, along with Campylobacter and E. Coli, is one of the most common causes of bacterial food poisoning. Consumer Reports released a survey in January of this year after purchasing 382 chickens from 100 supermarkets. They included the top 3 brands, Foster Farm, Perdue and Tyson, and organic brands. Perdue was the cleanest name brand, with 56 percent of their chickens infected. They reported that 2/3 of the chickens contained Salmonella and/or Campylobacter. Salmonella lines the intestines of animals like chickens, so infected fecal matter easily contact the shells in the hen's nest. Salmonella can also infect the ovaries of otherwise healthy looking chickens, existing in the eggs before the shell is even formed!

How can I get S. Enteritidis?
A person gets Salmonella by eating foods of animal origin, such as raw or undercooked eggs or chicken. The symptoms of fever, abdominal cramping, and diarrhea, typically start 12-72 hours after eating or drinking contaminated food. A person is usually ill for 4-7 days and most people recover without antibiotic treatment.

What's the worst case scenario?
The worse that happens with Salmonella poisoning is hospitalization, usually needed when diarrhea is severe, causing dehydration. Infants, the elderly, and people with weak immune systems are vulnerable more severe forms of the illness, sometimes called Enteric Fever, which is systemic (in the blood). It is characterized by fever and the abdominal symptoms, a rash, muscle aches, anorexia, and a sore throat. The death rate is about 15 percent, but with antibiotics (ex. Ciprofloxacin, and Beta-lactam antibiotics) is usually less than one percent.

How do you prevent illness?
1. Wash hands, utensils, countertops with soap and water after contact with raw eggs.
2. Don't eat recalled eggs. They may still be in grocery stores, restaurants, and homes. If you have them take them back to your place of purchase for a refund or discard them.
3. Keep eggs refrigerated at less than 45 degrees at all times.
4. Refrigerate all egg containing foods promptly.
5. Don't eat raw eggs. Cook eggs until both the white and yolk are firm. Eat promptly after cooking.
6. Don't keep them warm or at room temperature for more than 2 hours.
7. Avoid restuarant dishes made with raw or undercooked eggs, such as Hollandaise sauce or Caesar salad dressing. Restaurants should always use pasteurized eggs but nothing is 100 percent.
8. Contact your health provider if you have eaten eggs and have become ill.
9. Have young children, the elderly, and people with debilitating illnesses or weakened immune systems avoid eggs.

Fantasia, For Real?

Did you want to die...or just "escape"?

I must ask this question every time I face a person who has overdosed. A major breakdown in coping mechanisms has occurred, allowing that person to cross an important line: that which kept them from intentionally causing themselves harm until now . How I treat it could mean life or death even after the person has made it to the ER and survived.

The blogs and news reports are saying that Fantasia's overdose was not life threatening. One went so far as to say that she's been through worse than this. I see where the blogger was coming from, she's been through and accomplished a many things, but more thought should be given to that statement.

You cannot minimize going into a closet and taking a bottle of aspirin and sleeping pills in any way, ever.

Aspirin and Tylenol overdoses are so common and so dangerous that whenever I call the National Poison Control Center (1-800-222-1222) to report an overdose, the center usually advises that I get blood aspirin and tylenol levels, even if the person took pills that have nothing to do with the two.

Why? Aspirin and sleeping pill overdoses can cause kidney failure, coma, seizures, disturbances in the rhythm of your heartbeat (dysrhythmias, arrhythmias), and drowning in your own fluids as your lungs become overwhelmed by said fluid. Many of these can lead to death. This is what we ER Dr's have to consider, prevent, and treat for a person who overdosed the way Fantasia did. The amount of aspirin and sleeping pills Fantasia took may not have been life threatening, but the behavior certainly was.

Once a person crosses the line that kept him or her from hurting themselves, in seriously considering or attempting suicide, or merely dealing with stress, the risk of it happening again is higher. This is why the mind must be addressed once the body has recovered. One cannot just wake up and go home. The situation that caused the person to do it usually has not changed, and now the person has a lower threshold for doing it again. The reason does not matter. I committed a man old enough to be my father to 3 days in a mental facility because he told his family, the paramedics, and me that he was suicidal. "I only did it to upset my daughters," he said. Too late.

Healthy stress management and coping skills must be taught and reinforced. If you or someone you know ever feels this way, talk to someone, a friend, parents, counselor, pastor, rabbi, anyone you trust. Try to let go of things you cannot control. Attempt to resolve conflicts with the source of it in a calm manner. Remember, nothing is worth inflicting permanent damage upon your own body, or taking a life. The problem is usually temporary. The physical and mental damage you cause yourself may not be.

Be safe, be successful,

RAPP M.D.

Subconjunctival Hemorrage

A subconjunctival hemorrhage is bleeding below the transparent layer of the eye called the conjunctiva.


Causes

What causes it? Violent sneezing, coughing, vomiting, heavy lifting and minor blunt trauma. People at risk for this condition are those with diabetes, high blood pressure, and those who take blood thinners such as aspirin and coumadin (warfarin). Subconjunctival hemorrhages may sometimes present without a known cause.


Symptoms
The most discomforting aspect of a subconjunctival hemorrhage is its appearance. You may not realize that you have a subconjunctival hemorrhage until you see yourself in the mirror. The blood is tends to be bright red, and is flat, meaning it does not bulge against your eyelids. It is often painless, but one may experience a slight itching sensation. Your vision is not affected.


Evaluation
While subconjunctival hemorrhages are benign, it is important to distinguish it from more serious conditions such as a bloody chemosis which is more likely to bulge, and is associated with rupture of the sclera (white part of the eye), and cavernous sinus thrombosis (blood clot in a blood vessel of the brain). Also, in the setting of trauma, if a subconjunctival hemorrhage is located at the far lateral (toward the ear versus the nose) portion of the eye, it can mean a person has a fracture of the zygomatic arch (cheekbone).


Treatment
No treatment is required. The body will absorb the blood over 10-14 days. Recurring episodes require evaluation for bleeding disorders or uncontrolled high blood pressure.


For this and more information, check out the Mayo Clinic, American Optometric Association websites, and Knoop, Stack, and Storrow's Atlas of Emergency Medicine, 2nd Edition.

Let's Talk Blood Pressure


I know, you think you've heard all there is about hypertension ( high blood pressure). You think every one has heard enough. I start to think the same but then I have yet another another patient present for cold and allergy symptoms, and I end up treating him or her for their dangerously high blood pressure.



What is blood pressure?
Our blood pressure is the force created by our blood against the walls of our arteries as it circulates through our bodies. If changes constantly throughout the day. If it stays high for a long time, it becomes dangerous, putting us at risk for heart disease and stroke, which are the 1st and 3rd leading killers of people in the U.S. Another dangerous thing about high blood pressure is that it may have nonspecific symptoms, such as a headache, fatigue, blurred vision, or nosebleeds, or absolutely no symptoms at all.


What is high blood pressure? Who is at risk?
Normal blood pressure is less than 120/80, at risk is 120-139/ 80-89, and high is 140/90 or higher.
One in every 3 American adults has high blood pressure. According the the American Heart Association, in 2006, the death rate for black men was 51.1 per 100,000 people. For white men, it was 15.6 per 100,000. For black women it was 37.7, and for white women it was 14.3.
Within the black community, those at most risk tend to be middle aged or older, less educated, overweight or obese, physically inactive, and have diabetes.

What can be done to reduce that risk?
Eat a healthy diet, containing plenty of fruits and vegetables. Exercise. Start with a walk around the block. Limit alcohol use. Stop smoking. Prevent or manage your diabetes. See your doctor, go to your nearest Harris County Health Center, or www.CDC.gov for this and more information.

Rapp M.D. TV Show-Hypertension.MOV

The Abuse, Addiction, and Affliction of Alcohol: It's in the Stars...

"Oh no, I just said I wanted to die because I was drunk. I'm not really suicidal"

"I just cut myself when I drink."

" I punched the wall and broke my hand because I had a few drinks."

" I didn't really mean to threaten her life. I was drunk."


These are just a few quotes from actual patients I have had.

Approximately 190,000 ER visits by people under the age of 21 occurred in 2008.

Alcohol is the key to Pandora's box. It makes us MORE likely to be in fatal car accidents, get STD's, have unwanted pregnancies, feel depressed, act wrecklessly due to the depression, be perpetrators and victims of violence, commit suicide, and LESS likely seek help for ANY of these problems.
It made a patient in my St. Joseph's Hospital ER more likely to set her exam room on fire 5 months ago, while the department was filled with doctors, patients, even police. She had been told that if she left the ER while intoxicated, she would go to jail. So, she set the fire, and earned a visit to the psychiatric ward before going to jail.

For people engaged in underage drinking, add disruption of normal growth and development.

While underage drinking (drinking alcohol before age 21) is illegal, according to the CDC, people aged 12-20 drink 11% of all alcohol consumed in the U.S. and more than 90% is consumed during binges. Youth drink more during binges than adults.

The Abuse, Addiction, and Affliction

What is Addiction?

According to the Encarta World English Dictionary, it is "a
physical or psychological need: a physical or psychological need to use a drug or other substance regularly, despite the fact that it is likely to have a damaging effect."

What is Abuse?
It is the "excessive consumption or misuse of substance: the excessive consumption or misuse of a substance for the sake of its non-therapeutic effects on the mind or body, especially drugs or alcohol."

According to Webster's 1913 Dictionary, Affliction is
n. 1. The cause of continued pain of body or mind, as sickness, losses, etc.; an instance of grievous distress; a pain or grief.
2. The state of being afflicted; a state of pain, distress, or grief.
Some virtues are seen only in affliction.



Would this include repeated incidents of public drunkenness, drunk driving, drinking heavily while already in trouble with the law,
calling police officers degrading names, writing "F U" on your middle finger, knowing you are going to court?

Yes.
The rich and famous culprits of the moment are, two in particular whose judgment has been so flawed that they cannot keep their issues from becoming public, overwhelming even the interest of the public in their troubles.

Now while these rich and famous folks, when presented with the title role model, shrug it off, I would say that they, especially at their worst, are the best role models through their negative reinforcement. We want the absence of such embarrassment and punishment so we act to avoid it. Many of us respond more to negative reinforcement, meaning we are more likely to abstain from underage drinking and alcohol abuse to AVOID the grief that comes with it. We look to celebrities for so much. Why not look to them to learn what not to do?

Know What to do When a Person Chokes

You and a friend are laughing it up over lunch. She/he starts to choke. What do you do?

1. Ask, "Are you choking? Can you speak?"

This sounds silly but if the person can cough, and/or speak, give them a chance. Strong coughing can dislodge the food.

If the person can do neither...

2. Stand behind him/her and wrap your arms around their waist

3. Make a fist with one hand, with the thumb side just above the person's navel, not touching the breastbone.

4. Grasp the fist with your other hand.

5. Make quick, upward and inward thrusts with your fist.

6. Continue these thrusts until the object is dislodged or the person becomes unconscious.

If this happens, it is not your fault. This is an effect of the lack of oxygen getting to the brain caused by blockage of the airway. Keep working, and work or get help fast!

What to do next?

7. Help the person to the floor.

8. Call 911

9. If you see something blocking the airway, try to remove it. Remember, only do this if the person is not conscious.

If the person is pregnant or obese....

1. Wrap your arms around the person's CHEST.

2. Place the fist in the middle of the breastbone between the nipples.

3. Thrust firmly in a backward motion.

How do you prevent choking? Take your time, chew your food thoroughly. Do not drink alcohol or if you are legal, avoid eating while intoxicated. If the person is eating with poorly fitting dentures, advise against it. For this and more information, I recommend checking out Medline Plus, or the American Heart Association.

Be safe, be successful,

RAPP M.D.

Don't Fry or Die: Be Safe in the Sun

Remember Corey Stringer? He was an All pro defensive tackle for the Minnesota Vikings football team who died at 27 due to heat stroke in August, 2001 during football practice. He was surrounded by sports professionals, plenty of water, sports drinks and ice, and still met an untimely, unnecessary death due heat stroke. This need not happen to you or your loved ones.

Heat illnesses form a continuum meaning one illness gradually progresses into the next. Heat cramps present as achy, stiff muscles or muscle spasms occurring during heavy exercise in hot environments. Muscles groups most often involved include the calves, abdominal wall, arms and back although no muscle group is immune. Treatment requires stopping the exercise, getting to a cool area, gently stretching the muscles, and drinking cool water or an electrolyte drink.

Heat syncope (fainting in the heat) typically occurs during the 1st five days of adjustment to a new activity. Teens and young adults who are beginning summer practice sessions are vulnerable to this. Weakness, fatigue and fainting are how it presents itself.

According to the American Academy of Orthopedic Surgeons, there are 2 types of heat exhaustion. One is that due to water depletion. This involves heavy sweating which starts to decrease. Danger: your body is losing its ability to cool itself. Once the sweating slows, you become dehydrated, and the body's temperature goes to about 104 degrees. You may experience excessive thirst, weakness, headache, and even loss of consciousness. The second is heat exhaustion due to salt depletion. You are at risk for this when you fail to replace normal body salts and minerals lost in the sweat. This can happen during extended exercise sessions during which you drink water alone instead of sports drinks containing electrolytes like sodium and potassium.

Treatment for heat syncope and exhaustion is the same. Get to a cool area sheltered from the sun. Take off tight clothing. If the affected person is conscious, have them drink the fluids mentioned, not soda or energy drinks. Use a fan and icy towels to lower the core body temperature, and get that person to an ER.

The most severe form of heat illness is heat stroke. This occurs when the sweating stops and the body's core temperature exceeds 104 degrees. Confusion, nausea, seizures and coma are possible at this point. It can also present without signs of heat cramps or heat exhaustion. This is indeed an emergency. Call 911.

Don't allow a beautiful sunny day turn into one of tragedy. Knowing the progression of heat illnesses from heat rash, to heat cramps, to heat exhaustion, and finally to heat stroke, should allow you and your family to enjoy fun in the sun for many days to come.


Be safe. Be successful.

RAPP M.D.

Health and Trends in Pop Culture: A look into Lady Gaga's Eyes

Lady Gaga's doe-eyed look in her "Bad Romance" video has caused a dangerous trend to catch on among teens in the U.S. Teens are purchasing "Circle Lenses," colored contact lenses that make the colored part of the eye (iris) appear larger. These lenses are illegal in the U.S. but are readily available on the Internet, so teens and young adults are buying them without seeing an eye doctor, having their eyes fitted for the lenses to ensure a proper fit, and without instruction in proper use. Poor use can cause scratches, called corneal abrasions, tears (lacerations), and infections of the eye, even blindness in rare cases.

To have even a corneal abrasion is a painful and inconvenient experience. I had it as a med student while on a trauma surgery rotation and they let me out for the day! The eye becomes extremely sensitive to light. and your vision is blurred. It causes one to feel unable to open the eye, because of the sensation that a tiny but sharp object is on the eye. The eye often waters constantly, and the more you rub and blink your eye, the worse pain becomes. The pain can be excruciating. It requires a doctor's visit for an exam and anesthetic, anti-inflammatory, and antibiotic eye drops or ointment and then follow up with a specialist. In terms of infections, even contact lenses prescribed by a doctor put people at risk for infections when not handled properly. Imagine the damage you could do using contact lenses that do not fit you and without proper instruction. The American Academy of Ophthalmology has discouraged the use of nonprescription cosmetic contact lenses which have been illegal in the U.S. since 2005.

For media inquires about Dr. Rapp's expertise, please contact Bridgett S. Joe at 713-498-0552 or via email at bhjoe@scprelations.com.

Have a question for Rapp M.D.? Send them to Kadisha.Rapp@yahoo.com!

Avoid a Summer Tragedy. Avoid Drowning Episodes

RAPP Tips
During the Summer months, people are more prone to drowning. Take these precautions to avoid unintentional drowning.







RAPP TIPS

- Supervise closely enough to touch the person
- No phone use, reading, yard work, card playing, etc.
- Never swim alone or without a life guard present
- Don’t drink before swimming or any other water activity
- Learn to swim
- Get CPR training!
-One of the most effective interventions
-Significantly affects survival
- Don’t use inner tubes, water-wings or noodles in place of life jackets

Residential Pool Safety:

- Remove all toys from your pool area after use
- Their presence entices children to enter the water with them
- Four-sided pool fencing
- At least 4 feet high
- 2/3 of 4 year olds can climb a smooth 4 foot barrier in 2 minutes!

Safety around Natural Bodies of Water :

- Be aware of local weather conditions
- Wear U.S. Coast Guard approved life jackets for all boat trips regardless of distance
- Know and obey colored beach flags
-Double Red= Closed to the Public
- Single Red= High Hazard
- Yellow= Medium Hazard
- Green= Calm conditions but caution still is necessary
- Purple + Red or Yellow= Dangerous marine life (not sharks)
- If caught in a rip current, swim parallel to shore until free, then swim toward shore.

Exported Article: Kidult Youth Leadership Conference

The following is an article written about my personal experience and professional conclusion regarding Pharrell Williams' 1st Annual Kidult Youth Leadership Conference, which was held on June 26, 2010 in New York City.

The Conference

“It is the small decisions we make in our everyday lives, which contribute to our mental and physical safety, and allow us to either continue on, or be derailed from, the road to our dreams.” This was the message given by K.B. Rapp M.D. to attendees at Pharrell Williams’ 1st Annual Kidult Youth Leadership Conference held on June 26th in New York City.

While the attendees of Pharrell Williams' 1st annual Kidult Youth Leadership Conference held in NYC June 26th were being educated, inspired, motivated and entertained by Pharrell, Mimi Valdes, award winning former editor-in-chief of Vibe Magazine, and others regarding creativity, technology and entrepreneurship, their experience was rounded out by a basic reminder: "It is the small, everyday decisions that you make regarding your mental and physical safety that allow you continue on, or be derailed from, that road to your dreams."

The Doctor, The Message and The Presentation

In the Kidult exhibitor hall was a board certified emergency physician named Dr. K.B. Rapp. As a doctor with ten years of experience in treating victims of emotional and eating disorders, STD's, unwanted pregnancies, drug and alcohol abuse, and violence, she felt the obligation to travel to the conference from Houston, Texas to spread the message of maintaining mental and physical integrity in order to achieve success in life. Her need to spread this message to youth stems from her belief that no matter how smart, creative or talented a young person may be, their efforts will go to waste if they do not protect their health by being aware of dangerous people, situations and emotions.

To explore these messages, Dr. Rapp created a PowerPoint presentation titled of "Health and Wellness in Teens and Young Adults.” While the PowerPoint ran in auto play in the background, she discussed and distributed brochures about a range of topics, such as Teen Esteem, Weight Control, Keeping Clean, and 101 Ways to Deal with Stress to STD's, Dating Safety, and Violence Prevention.

Many audience members received her presentation’s messages with an open mind and a learning spirit. Some youth and exhibitors came by to ask about becoming a physician, while others inquired about information for their own projects. Likewise, Rapp had the attendees fill out a “Health and Wellness Quiz” so she could obtain feedback, and so that she could measure effectiveness of her presentation. Feedback from youth was obtained by surveying them on pressing issues which concerned them.

The Results

Out of the eighty-one surveys completed, the top two issues proved to be Violence with 31 votes, and STD’s with 29 votes. Conflict Resolution, Emotional Disorders, Dating Safety, and Abstinence followed. The least recognized issue was Eating Disorders. Three youth filled in the "Other" slot and noted “drug and alcohol abuse”, “being the best me" and "poverty-related illnesses” as their primary concern.

The Conclusion

Dr. Rapp’s efforts at Pharrell Williams’ 1st Annual Kidult Youth Leadership Conference were a success. Not only was she afforded the opportunity to connect with youth and other audience members over her message, but she was able to gather invaluable information that she could carry back to Houston, Texas. The results and feedback she received will be used to better service her young patients and to help her better focus on the primary issues and concerns of young people today.

Dr. Rapp hopes to be apart of many other conferences and conventions aimed towards strengthening the quality of life for youth in America. In doing this, she helps sustain the livelihood and future of America.

The Truth About Propofol: A Year After Jackson's Death

About a year ago, music legend, Michael Jackson, tragically lost his life due to using lethal levels of the drug, Propofol. Propofol is a short-acting, intravenously administered hypnotic agent. It is used for sedation for mechanically ventilated adults and for regular, procedural sedation. Propofol is also found in veterinary medicine.

While this drug has been approved for medical use in more than 50 countries, and is assumed safe when prescribed or administered by a licensed physician, the improper use of Propofol is increasingly responsible for ending the lives of many people each year.

As an emergency physician out of Houston, Texas, I have used Propofol for patients for the past six years to reduce dislocated shoulders, assist Oral Surgeons in removing teeth, and reduce fractures. I have also seen it used in the operating room.

After the death of Michael Jackson last year, many of his fans, media representatives and medical professionals blamed Conrad Murray, Jackson’s personal doctor, for his death. They agreed that Murray knew the consequences of administering and allowing the administering of Propofol at dangerously high levels. While Dr. Rapp agrees that Murray was in part responsible for his overdose and death, she disagrees with those who suggest Jackson’s death to be fully his fault.

Dr. Rapp practices medicine on the platform, Safety for Success, which delegates to the public precautionary awareness, health tips, basic common medical knowledge, and the responsible use of both medical information and prescriptions. In her opinion, Jackson’s decision to continue using the prescribed drug above recommended levels was equally as harmful as Murray’s allowance of it.

Jackson’s death caused alarm throughout the United States and the world—but it proved to be even more influential to people prescribed the drug and physicians who administer and prescribe it. Rapp has noted precautions in using the drug—including the medical field’s recent attempts to phase out use because of its side affect of lowering blood pressure rapidly and significantly. While Rapp agrees it should be monitored, she simultaneously believes that Propofol is helpful in the medical field when used responsibly by patients, surgeons, medical doctors, and dentists.

Dr. Rapp’s expert advice provided by her medical experience has helped her develop guidelines and information under the following themes:
1) Pre-existing conditions
2) Post-existing affects
3) Use of Propofol in the Medical field (On-site administering)
4) Self-administering Propofol
5) Safety First (Precautionary)
6) Safety First (Emergency and Overdose)

We urge you to encourage your audience to be proactive about the potential aftermath of abusing Propofol, as well as other drugs that have the same potential fatal outcome. Media coverage has proven to help raise awareness among its audiences and motivate education.


For media inquires about Dr. Rapp's expertise, please contact Bridgett S. Joe at 713-498-0552 or via email at bhjoe@scprelations.com.

Have a question for Rapp M.D. ? Email them to Kadisha.Rapp@yahoo.com.