Often I have patients ask about something they have read on the Internet about their health.  It has been said that you can’t believe everything you read, and this is especially true online.  Without the high cost of publication of printed books, just about anyone can put their knowledge and opinions out there for all to see.  Just like you wouldn’t trust just anyone to fix your car or work on your home, you should be even more careful with information you use to make medical decisions. 

So how do you sort through all the available websites and find reliable medical information.  By using a few simple guidelines, you can avoid serious pitfalls.  Here is a list of critical information you should review about a medical website BEFORE you consider using its information to make medical decisions.

 By whom? – Who is the author?  Is there a  sponsoring organization or company?

1. For whom? – Who is the intended audience?
2. Why? – What is the purpose of the website?
3. When? – How current is the information?

 Let us take a closer look at each of these questions.

 By whom? 

All websites should provide information about its author and / or sponsor.  Typically this can be found in the “About Us” or “Contact” area of the site.  Vague or misleading information should raise concern about the validity of the information you find there.  If the site if sponsored by a company or organization, it should be clear what that relationship involves.  Finally, look at the contact information.  Is there a street address?  Is there a valid e-mail address?  Unreliable sites may only provide an email link to the webmaster for the site.

 Some examples of “By Whom” would include pharmaceutical companies, professional organizations, patients with a specific disease looking to increase knowledge or awareness, attorneys, or disgruntled persons.

 Often, the best way to make sure that the information you find is reliable, is to use sites that are operated or maintained by reputable organizations, such as the Academy of Family Practice (of which I am a member) or the Mayo Clinic.  Both of these operate very good patient information websites.

For whom? 

Often I have patients that ask about legitimate medical information they have found, but it is intended for a different audience.  Research articles are a good example.  While there is much to learn from primary research articles, many times the findings are many years from being widely used in usual medical practice.  Typically, usual medical practice should be based on multiple studies that give similar results.

 Not only is your “role,” such as patient or physician, important when considering “For Whom,” so is your age, gender, health status, and race.  What might be good advice for one individual may be harmful to another.

 As a general rule, patients should look for websites that provide information designed for them.  There may be exceptions, as I have had some patients who have become very knowledgeable about specific topics, and may benefit from more in depth information.

 Why? 

This is a very important question, as the answer may not be readily identified.  It is not uncommon for a website to first appear to be primarily informational, but then try to direct you to options to buy specific products or provide personal information.  Be VERY CAREFUL when you realize this is the case.  Some clues would include repeated references to specific products or asking you to register (and provide personal information) prior to receiving information.

 One particularly troublesome practice that is becoming more common is a marketing technique of pharmaceutical companies.  These companies will often market the disease to the patient, rather than their product.  However, at the same time, pharmaceutical representatives are marketing their product, such as medication, very heavily to physicians.  How many times have you heard, “Ask your doctor about new treatments for …?”  Guess who is most likely spending the money to run these ads or websites.

 Common “Why’s” include patient information, product promotion, disease awareness, and patient support.

 When?

You should be able to identify when the information was written.  Often, at the bottom of the page there will be a “Last updated …” notation.  Medical information changes rapidly, and what was common practice 5 years ago (or even less) may not be considered appropriate now.  Exercise caution if you cannot identify the timeliness of the information, or if that information is more than 1-2 years old.

 So what do I do now?

The simplest answer is, “Just use some common sense.”  Remember, a flashy website does not insure accurate health information.  Be hesitant to provide personal information.  And if you have questions, ask YOUR doctor.

Below are few links to patient websites that I have found to be generally reliable.  I cannot insure that all the information is correct, so once again, ask your doctor if you have questions.

 FamilyDoctor.org (sponsoredbytheAmericanAcademyofFamilyPractice)

MayoClinic.com (sponsoredbytheMayoClinic)

 Or you can check out this list of “TopTen” MostUsefulConsumerHealthwebsites from the Medical Library Association.

 About the author

Rollin Wycoff, MD is a frequent volunteer physician at the Christian Health Center.  He is board-certified by the American Academy of Family Medicine, an active elder of the First Presbyterian Church, a Cub Scout den leader, a husband, and a proud father of two.

It’s been a long and productive day and now, as I sit to write, I itch all over. All I want is some rest and know none is in the offing. At first I wonder then realize: I’m thinking about Bed Bugs yet again!

You and I know by now they are back, and with a vengeance. But where do we get them? Like most things in public health, wide spread illness generally begins from defined sources. Once offensive organisms find themselves beyond their original habitat they spread through populations very quickly and afar. In the case of the bed bug several fundamental habitats have been identified. These include hotel and motel rooms and, to a lesser degree, other elements of travel. Not surprisingly, “second hand “ activities such as flea markets and used clothing stores pose a threat. Unfortunately the threat even extends to friends and relatives that have traveled to visit you.

The most affected cities in United States, listed in order of the severity of infestations include:

1) New York              8) Los Angeles          15) Dallas

2) Cincinnati               9) Boston

3) Detroit                   10) San Francisco

4) Chicago               11) Columbus, Ohio

5) Philadelphia          12) Dayton, Ohio

6) Denver                  13) Baltimore

7) Washington, D.C. 14) Louisville, Ky                                  

Don’t give up on flea markets and second hand clothing stores. They are a lot of fun for many. They are a very positive community resource at many levels. As you move about, however, look closely for these critters. They can often be seen, with adults measuring ¼ to 3/8 inches. They emit an odor that we can appreciate when their numbers are great enough. It is a distinct musty, sweet odor, not unlike raspberries. When you buy an item, clean its surface and, if clothing, wash it two times with the hottest water you can. Then put it in a drier, very hot, for at least 30 minutes.

There are several things you can do to protect yourself while traveling.

As you pack your suitcase: 

*Give thought to your plans and take just what you need.

*First place clothing, shoes and toiletries in sealable plastic bags.

*Tuck a couple extra large sealable plastic bags in your luggage for storing those things you’ve worn or acquired.

While on your trip: 

*Inspect your hotel or motel room very closely.

Turn back the comforter, the sheets and mattress pad.

Look most closely at the seams of the mattress and comforter.

Casts (the exoskeleton of maturing organisms) and fecal spots are the easiest to recognize.

*DO NOT put your luggage on the bed or floor.

Put it on the rack provided by the facility.

Pull that rack and your luggage away from the wall.

OR

Some suggest you put your luggage in the bathtub.

*DO NOT unpack your luggage and put its content in the dresser.

*DO NOT put worn items back into your suitcase…place them in sealable plastic bags.

*DO NOT put purchased items in your suitcase, especially shoes and clothing. Put them is sealable plastic bags.

*Before packing to leave, inspect your luggage looking for bugs. Look all places, but look especially in the seams, zippers, and pockets. 

Once you are home:

*Leave your luggage outside…DO NOT take it into your home.

*Remove items from your suitcase and look for bugs again…at both the luggage and its content.

*Store your clothing outside until it has been washed and dried in a hot drier for at least 30 minutes.

Items that cannot be washed and dried can be dry-cleaned or frozen for 2 weeks.

*Store your luggage outside your home (garage or storage shed) OR if you must bring it into the house, place it in tightly sealed plastic bags.

Wow! All that for a weekend out of town! It might seem like a lot, but when you see or experience the tremendous efforts that go into ending an infestation your assessment changes. There is simply too much to say on this subject. Suffice it here to say: You begin with a magnifying glass and tweezers, used to find and harvest hundreds if not thousands of individual bugs. You upend furniture, lift carpet edges, remove electric socket and light switch covers, and more. Efforts can involve heat. One Little Rock motel owner has access to a portable industrial heater. He closes infested rooms and heats them to 120 degrees for 30-60 minutes. Then on to cold. Thirty two degrees for several days might kill them. Freezing furniture and other items at 0 degrees for 4 days MIGHT end an infestation , but even at this temperature it can take a month. There are sticky traps and pesticides and even specially trained dogs. Dogs? Yes, the industry that profits by helping us now certifies dogs that can sniff out and lead us to the bed bug. Be sure, if you invest in one, that the dog working for you is in fact certified. The industry is fraught with unscrupulous handlers. For all these services you can expect to pay many hundreds to thousands of dollars. Broken budgets and lost businesses are all a part of the legacy of the bed bug.

Once the first “Integrated Pest Management” intervention has been made you should expect additional inspections through time. Don’t be surprised if the first round is not entirely effective. You should not be upset with those you’ve paid so dearly to help you. It is the tenacious nature and elusive presence of this beast that condemns you to months of expense, discomfort and discord.

 As if all that is not enough you might find yourself in a doctor’s office. “Doctor, what can you do about this hideous rash and overwhelming itch?” you say. The doctor says, “Not much. Benadryl? Cool oatmeal bathes? Sure…they help some. There is not much else.” As a physician I might be moved to take your hand in mine as an expression of compassion, but……NO!…..I don’t want your cooties!!!

Good night, sleep tight,

Don’t let the bedbugs bite.

And if they do

Then take your shoe

And knock ‘em ‘til

They’re black and blue!

The Christian Health Center recently hosted a dinner and time of sharing with a diverse group of community members. We heard that night that the work of the Center is essential to the community but that the model we have chosen is not doing enough and is unsustainable. They are right. We see only a small fraction of our uninsured. Every day since then has been given to a search for some way to make the work of the Center profitable enough to permanently sustain a medical practitioner and his or her supportive staff. Lots of ideas have been looked at and to date the answer has not been found.

Frustrated but not discouraged, these are issues of both challenge and opportunity, I have been led write, and to make that writing available to any with interest. My goals are threefold. First, I hope to effectively communicate issues of medicine that are important to you. Second, and I have no apologies, I hope to bring you back, time and time again, to the Christian Health Center web site (under development) where you can be informed as you are coerced into friendship with and financial support for, the Center. And third, to have fun.

As unlikely as the call to write is my choice for a first subject: Bed Bugs

“Bed bugs? That’s crazy. Who cares anything about bed bugs?” That may seem an appropriate response but wait….read a bit and see if you don’t change your mind.

“They’re back“….a haunting phrase given to us by a little girl from a movie long passed. Filled with fear and loathing. A phrase appropriate to the bed bug. A disturbing resurgence in the incidence of bed bug infestations has been evident within the last decade, and these parasites seem blind to the demographics we so often call upon to define “the other guy” as our attempt to soothe personal anxieties. Their success belongs, in great part, to such things as a global economy, our mobile society, immigration, and a flourishing underground economy.

Most of us have never had an experience with the bed bug. It was a common pest in the United States at the turn of the 20^th century. We witnessed their near eradication with the use of DDT during the 1940’s and 50’s. DDT is no longer available to us and these new and improved bugs have proven resistant to our modern pesticides and pest control methods. A current infestation generally means MUCH physical suffering and a complicated combination of interventions that can cost victims many thousands of dollars.

Throughout history, bed bugs, scientifically known as Cimex lectularious (cimex is Roman for bug and lectus is Latin for couch or bed), has been a persistent pest of humans. They have likely evolved from parasites of cave dwelling mammals such as bats and evidence supports a pervasive presence amongst human cave dwellers. As humans moved from caves to tents and houses bed bugs came with them. References to bed bugs can be found in Christian and Jewish ancient writings and in the records of colonial Americans. Fossilized bed bugs have been found while excavating a 3,550 year old site in Egypt. The Roman philosopher Pliny wrote in 77 AD that bed bugs could heal snakebites, earaches and other physical ailments.

They were first introduced to the Americas by early colonists and records speak of severe problems in the colonies and Canada. They were ever present in old sailing vessels. In the early 20^th century, rare was an individual that had never seen or had not been bitten by a bed bug. At that time at least 1 in 3 households in some cities was infested.

The bed bug prefers the environment that is the human in bed, covered with sheets and blankets. This combination provides the warmth and higher carbon dioxide levels that these beasts flourish in. They typically feed at night and our blood is their sustenance. We cannot feel its bite (really a piercing) as their saliva is active as both anticoagulant and anesthetic. It takes the bed bug 3-15 minutes to complete its meal. A feeding will increase its weight 150-200% if an adult and up to 600% if less mature. They eat a meal every 3-5 days but an adult can live more than 1 year without a meal….oops. That’s bad news for any of us that thinks living away from home a few days will end his suffering. Though their preferred fare is human blood, in a pinch they will settle for rodents, bats, birds and household pets.

Once bitten, one third of us will develop an intensely itchy and visibly obvious rash. Two thirds of us will not, and may never know they sustain, help flourish, and disseminate cimex lectularius. For those that itch, scratching can hardly be restrained. With scratching comes a breakdown of the integrity of the skin. With this breakdown comes a threat of secondary bacterial infections.

Though there is no proven direct transfer of disease through these bites, such bacterial greats as the well known MRSA (methicillin resistant staphylococcus aureus) and the lesser known and more dangerous VRE (vancomycin resistant enterococcus) have been found in the pureed bodies of bed bugs in the laboratories of researchers. Put these facts together and you can begin to understand the concern of public health officials as we learn to live again with these not so friendly and deeply scorned bedfellows.

So comes the questions:

“Where are they?”

“How can I protect myself from infestation?”

“If infested, how can I be rid of them?”

Enough writing and reading for now. Let’s continue very soon. (English for :“We go talk laydahs”)

…….Bed Bugs bite

Wake up bright

In the morning light.

To do what’s right

With all your might.