Noro-huh?

There’s a norovirus going around my region right now.  It hit just in time to come back with the kids from winter break.  And it’s going around my school.  1/3 of the students I supervise have had it in the last week.  Every day, I get at least two cancellations (usually in the form of “no shows” then info later) on the services I provide due to the puking-pooping horror that is this intestinal bug.

And they have no idea what this is.  I mean the kids have none.  One of them said to me yesterday “Well, I’m still not feeling good.  Still having diarrhea” (he’s a bit of an over-discloser) “but I figured I can work with Sandy because she’s on a ton of antibiotics.”

Now, Sandy had a tooth abscess last week because she didn’t take the antibiotics her dentist ordered for her when she saw him the week before for a cracked tooth.  One trip to the ED later, she is now on antibiotics.  “The stomach bug that’s going around is viral” I tell the over-discloser.  “She can catch a norovirus while she’s on antibiotics.”

This is ridiculous.  They make these kids take health classes, where they talk about sex, sexuality, sexual development, alcohol and substance use, and various other associated “hot button” topics.   They do not, apparently, talk about stuff like “hand sanitizer is all well and good but there’s no substitute for washing your hands” or “if you start an antibiotic you finish and antibiotic” or the difference between viral and bacterial infections (e.g., “you don’t need antibiotics for the flu or a cold”).  I think they should.  How much nicer would it be for ye olde primary care/family doc if people were getting a good dose of education about simple stuff like this?

What I keep wondering is why our health services hasn’t sent out an announcement about the virus.  Even months after the original H1N1 outbreak, when they knew it wasn’t likely to be as bad as it had seemed initially (or as it had been hyped, take your pick), we were inundated with weekly emails about it, a list was started for staff or faculty to report students with “flu like symptoms” (which we still have, btw), and we were all encouraged to stay home until we were symptom free for at least 24 hours.  But here we are with a quite aggressive intestinal virus zipping through the dorms and classes and the school is mute.  Kinda confirms my theory that college health services are about equivalent to a first aid tent staffed by boy scouts at a town fair (my own experience with them comes from both being a student at three different schools and from working at one as an undergrad).

live free or, fuck you

Some details of a recent news story out of New Hampshire really bother the hell out of me.  I’ve highlighted those details below.

Gov seeks probe after death of N.H. woman whose power was cut off
June 25, 2010 04:41 PM, By Brian R. Ballou and Martin Finucane, Globe Staff, and Alex Katz, Globe Correspondent (
full story at the Boston Globe)
SALEM, N.H. — The governor of New Hampshire called today for a speedy review of power company shutoff policies statewide, saying he was troubled by the death, after her electricity was disconnected, of a Salem woman who used an oxygen machine.

“I am terribly saddened and troubled by the tragic situation of Kay Phaneuf, a woman from Salem who depended on an oxygen machine and whose death may be connected to a decision by National Grid to terminate her power for non-payment,” Governor John Lynch said in a letter to the state Public Utilities Commission…..

The Public Utilities Commission is investigating what happened to Phaneuf. The commission sent a letter to National Grid Thursday seeking a number of records, including records of the Phaneufs’ billing and payment history, copies of past due and disconnect notices, and a chronology and detailed description of what happened on Monday….
National Grid spokesman David Graves wouldn’t comment on the status of the Phaneufs’ account but defended the company’s policies on shutting down power to people’s homes.

He said the company sends out notices on bills that are a month late telling customers they need to submit overdue payments. After another month, they send a notice telling customers that they must pay or face shutoff of their power. After another two weeks, they send a notice saying that shutoff is imminent unless payment is made by a certain date.

Graves said the state of New Hampshire also requires that a customer, if they have a medical condition that requires electricity in the house, send a letter to the power company every 60 days. That letter ensures that the power won’t be shut off in case of non-payment. Graves said National Grid’s own policy is the letter only needs to be sent every 90 days. He wouldn’t comment on whether a letter had been sent in Phaneuf’s case.”

Because life isn’t difficult enough for someone with a chronic medical condition, they have to remember to get a letter sent out every 60 days or risk DYING.  I’ve never really had a whole lot of respect for New Hampshire.  To me, they’re sort of like the South Carolina of New England.  But really New Hampshire?  Every 60 days?

under pressure

Stressed? You will be next Monday!
PRNewswire, via Scientific Blogging
LONDON, December 6

According to the results of a recent survey, if the festive pressures haven’t got to you already, they will do next Monday – it’s officially the most stressful day of the year.

An independent survey, commissioned by healthcare provider, HealthSure, has revealed that the British public will be at its most stressed on Monday 10 December between the hours of 8am and 10am.

You can read the whole article at the link through the title above. I wonder if anyone’s done similar research for the U.S.

(A) Little Miss Informed

I’d say this is good evidence that the Lyme Disease awareness among the general population is not just limited but BAD. My guess is this kid got her information from internet searches and from friends. I don’t think internet medical information (or searching) is inherently bad, but I do think not knowing how to gauge scientific and medical information presented on the internet plus the free form and flow of information on the internet makes for a pretty horrible combination (from a public health/disease awareness perspective at least).

The medium is new but the issue isn’t. There’s always been “folk” diagnostics, word of mouth, a friend of a friend’s aunt, etc. which are often seen as at least as informative as scientifically sound medical information. And these sources are closer, easier to access, and have an affective link which characterizes few if any patient/provider contexts or relationships.

Penny wise…

…pound foolish. It’s not just insurance companies who follow this model. In some defense – some small wee bit of defense – of such policies, the financial wisdom of preventative care and education is not easy to see. Possibly for some, it feels like speculation, like placing a bet. Good odds or not, they are too queasy with the idea of spending some money now to save a whole lot of money later.

From The Boston Globe
Health support for poor to take hit
’08 budget cuts care of chronic ills
By Alice Dembner, Globe Staff
June 19, 2007

HOLYOKE — A program that has improved the health of low-income patients with chronic illnesses faces deep funding cuts in the pending state budget, even though top state officials touted similar disease management strategies just a month ago as a crucial way to improve healthcare quality and cut costs.

The 2008 budget, now being hammered out in a legislative conference committee, is likely to contain less than one-third of the $2.6 million that the statewide CenterCare program received this year to pay for a broad range of health education and support services at community health centers.

In Holyoke, where diabetes strikes hard and often, the program has helped hundreds of patients at a community health center adopt healthier lifestyles and reduce their blood sugar levels, an improvement that could eventually cut their risk of serious complications nearly in half. Diabetics are offered exercise classes, instruction about the disease, home visits by community health workers, one-on-one sessions with a nutritionist, and drop-in sessions that teach healthy eating.

“I lost 63 pounds and I’m controlling my sugar,” said Iris M. Santiago, a patient in Holyoke. “They’ve helped a lot of people’s lives.”

The proposed funding cuts threaten the Holyoke program, which has been recognized as a national model, as well as similar efforts at 29 other community health centers statewide. CenterCare this year paid for disease management services for only half the low-income patients eligible across the state — about 5,000 — according to the Massachusetts League of Community Health Centers. The program helps patients with asthma, cancer, heart disease, and depression, in addition to diabetes.

State Senator Steven C. Panagiotakos , chairman of the Ways and Means Committee, said the Senate reduced funding for CenterCare because “we are able to address many of the preventative care and disease management needs” through the state’s health insurance initiative because many of the program’s uninsured clients will get coverage.

But community health center officials say their efforts go far beyond that funded by most insurers, because their patients need more support to overcome the additional barriers to good health presented by poverty and low literacy.

CenterCare was established in 1988 as a managed care insurance program for low-income patients but never got off the ground. It then funded care for the uninsured at community health centers, and most recently has been paying for disease management, according to the community health centers league.

Since the program started at the health center in 2003 the average blood sugar levels of diabetic patients — called hemoglobin A1c — have dropped from 8.4 to 7.5, according to Dawn Heffernan, who manages Holyoke’s program.

(presumably this last bit refers to patients in the program or some subset of them who consented to sharing lab values)