Dr. Kevin Most: Halloween and HSV1 and Alzheimer’s

Dr. Kevin Most

Last week we discussed a couple of illness that may have a viral basis for their cause and we discussed the frustration that scientists are having in figuring out how the viruses impact our health. Recently some studies have come out that link another common virus with a debilitating illness. That pair is HSV1 and Alzheimer’s. HSV 1 is the virus that causes cold sores.

All of us have a loved one or friend who have suffered with Alzheimer’s. The disease steals time and experiences from not only the patient but also the family and friends. Is there frustration with the treatment and diagnosis of Alzheimer’s? You bet there is. Anytime we get news of a study or a possible change in this illness we like to share it. One week ago an interesting study and finding came out in a neuroscience journal. It shared an interesting and concerning finding that was noted in Taiwan, now many of you are probably discounting this study already as we don’t think of Taiwan as being a hot bed of medical breakthroughs. Would it surprise you if I said that the country of Taiwan has one of the most complete databases for the health of their citizens. In fact 99.9% of the citizens are enrolled in this data base. This allows scientist to mine data and see trends that other countries are unable to do. In the United States we are just beginning to form this data base with the “all of Us” campaign, which I encourage all of you to participate in. Go to allofus.nih.gov for more information or NM.org

So, what did they find in Taiwan? They found that the simple aggravating virus that causes cold sores may be one of the causes of Alzheimer’s. What is more important is they found that those who received treatment for the cold sores saw their incidence of Alzheimer’s drop.

For those of you who have never had a cold sore or suffered from them. Cold Sores are caused by a simple virus called the Herpes Simplex Virus 1. This virus is a stubborn virus who stays alive in our body and just hangs out in a dormant state, not causing any problems. Then when we get stressed or run down by illness the virus decides to pop out and cause problems with cold sores and pain. We know this virus in some individuals can also be found in the brain.

Now you may be thinking what does this have to do with Alzheimer’s, well in Taiwan they used the national data and did a study comparing individuals with HSV 1 and their incidence of developing Alzheimer’s and compared it to those who did not have HSV 1 and their rate of Alzheimer’s. They found that the individuals with HSV 1 were 2.5 times more likely to develop Alzheimer’s. This was a large review looking at over 30,000 records. found that HSV1 can cause the protein

As we age the virus has an opportunity to become active in the brain. Just as it does in younger individuals the virus will have outbreaks often repeatedly. What they found in the brains of individuals who had HSV infections is that it causes protein to accumulate similar to what we see in patients with Alzheimer’s. This occurs in individuals with a gene mutation called the APOE4 gene.

So what does this mean? Well some researchers feel this may be the cause of a significant portion of all Alzheimer’s cases. Now certainly more studies and more research needs to be done with this. For right now it may lead to more aggressive treatment of cold sores with antiviral medicines and perhaps begin the discussion of the need for a Herpes Simplex Vaccine.

The power of data is clearly shown here, and the small country of Taiwan and what they are doing with data may hopefully lead us all to consider joining the data base that is being started here in the United States. It is called “All of Us”. It is backed by the NIH along with major teaching institutions, including Northwestern here in Chicago, along with RUSH and U of C. The website is aalofus.nih.gov and enrollment sites are scattered around the Chicago area.

Appendicitis- Surgery or Antibiotics?

Anyone in the studio have their appendix removed? In the United States each year close to 300,000 individuals have their appendix removed, almost all of them are removed urgently or emergently. The surgery is performed in every acute care hospital in the United States. We all probably know someone who has had this surgery. The appendix is a small outpouching in our intestines that can get infected and if not treated can rupture and cause bacteria into the abdominal cavity and resulting in a fairly serious infection. The traditional treatment has always been to have surgery within a day or two of the diagnosis being made and have the appendix removed. The diagnosis of appendicitis is made with a good physical exam and history, often a CT scan may be done as well. In many cases the surgeon will want to watch the symptoms instead of just rushing into surgery with any one with lower abdominal pain.

The classical history is a pain that starts around the belly button and moves down and to the right. The pain is reproduced when that area is pushed down by the physician and often hurts as well when the pushing is released. The patient often will complain about the ride to the hospital and hitting bumps along the way causes pain. The patient often will not have an appetite. I would always ask my young patients, “What is your favorite food?” and then I would ask them if I had that food right now would they eat it. If the answer is No, and they have pain it raised my suspicion of appendicitis.

Why are we talking about this? A study published last week reviewing treatment options in Finland shows that in some cases treating the patient with antibiotics for 10 days will have outcomes as good as surgery initially. The study was started in 2009, in that study they took over 500 patients with uncomplicated appendicitis and split them into two groups. One group received surgery, the other group received antibiotics. They looked at how long the individuals were in the hospital, how much lost time from work as well as complications. The study certainly has some limitations in analysis of the data. The doctor decided who would have surgery versus who would get antibiotics, so this would lead to those who are sicker to get surgery, while others who looked like they could wait got antibiotics. The complications from surgery were higher in these patients as the equipment and techniques used are not state of the art. That fact is helpful in areas of the world where the newer technology is not affordable.

The results essentially showed that of the two groups those who had the surgery had higher rates of complications from the treatment, and longer use of sick days. The two groups had similar lengths of stay in the hospital. The cost of the two treatments was not documented but one would surmise that those receiving antibiotics were probably treated at a lower initial cost.

The study also showed that 40% of those who received antibiotics as the treatment initially ended up having the surgery within the next five years, that does mean that 60% did not. The 10 year data from this study will be published in a few years

The idea of treating appendicitis with antibiotics only has not been widely accepted here in the United States and in fact it was not widely accepted in Finland when this study started. The results of this study will probably lead to larger better controlled studies in the future. A larger well run study may allow surgeons the data they need to decide which patient needs surgery urgently and which may be treated with antibiotics safely. That being said currently many surgeons will watch a patient overnight or for a period of time while they give them IV antibioitics as they watch for a response. Many patients or parents may want to have the surgeon take the patient to surgery right away, even if it is in the middle of the night. This study certainly shows that the patient with uncomplicated acute appendicitis can wait and in many cases should wait until the surgery can be performed in the most safe time frame.

HALLOWEEN

We have Halloween approaching soon, for adults it means we are very close to a time change that will mean earlier sunsets, but to children it is a fun day that ranks right up there with Christmas. Halloween should be a fun day for children but it is important that we protect the children while they are out having fun trick or treating. For many of us growing up, Halloween and safety , were probably 2 words that would not be put together at all. We all would run from house to house, across streets, often without looking. Remember when many of the listeners were growing up it was dark much earlier, in 2007 we moved that time from October to November, thus increasing the time we were actually out in the dark trick or treating. We would wear costumes that had not been checked from a safety point of view. Flamable costumes? Never considered. Swords or sticks that could impale a child, never thought of. Covering an eye as a pirate, very common. We all remember the plastic masks that had small eye openings and covered our whole face,and blocked all vision from the sides, in hind sight many of us are very lucky that we did not get harmed on this fun filled day.

Parents now should be thinking about safety as the kids go out. Costumes should be checked to make sure they are flame retardant or flame resistant, remember many homes have pumpkins that have been carved and have candles in them, so minimize the possibility of a costume starting on fire by not having baggy or billowing. Costumes should not hinder any vision for a child, so make sure if they are wearing a mask that it does not limit peripheral vision. A great idea is to put reflective tape on their costume somewhere on their body, this will highlight them in front of a car, this can be purchased at any hardware store. Consider having your child carry a flashlight as well this will allow them to safely see where they are walking. Comfortable and safe shoes should be a part of the costume, high heels will have a risk for ankle sprains and falls especially in young girls who are not accustomed to wearing them. Swords or sticks should be flexible to prevent a fall and impaling the child. Parents should also tell their children that no treats should be eaten until the parent has an opportunity to examine for any concerns of tampering.

Homeowners should also make sure their home is as safe as possible for these children. Make sure the yard is well lit, make sure hoses or furniture is moved so children do not trip over them. Clear your stairs from anything that may be a trip hazard. Keep candles off the porch and not in your carved pumpkins that day, as children do not focus on this as a concern, there focus is speed. Think of the kids as you prepare them for a day which is fun for them and they so look forward to, what can we do to protect them as well as the kids coming to your home as well.