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1993-02-14
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Weekly Health Bulletin
Courtesy of Black Bag Medical Information Services
America's Online Health Information Connection(tm)
302-994-3772
This document is provided for educational purposes only. The
information provided is NOT to be considered as diagnostic or
individual advice. No specific medical quidance or treatment can be
recommended without consultation with a physician. You should consult
your personal physician prior to utilizing any medical information
discussed in this document. Those contributing to this informational
bulletin, disclaim all responsibility for any actions taken by persons
in reliance upon information stated in this program. Should you choose to
disregard this warning, you assume the risk and responsibility for your
actions.
INFECTIOUS MONONUCLEOSIS
Each year about 50 out of every 100,00 Americans get
infectious mononucleosis, known popularly as "mono" or "the
kissing disease". Anyone of any age may develop mono, but the
disease is more common in persons between the ages of 15 and 30,
especially among those living in close contact at schools,
colleges, and military camps.
Infectious mononucleosis is caused by the Epstein-Barr
virus (EBV). EBV is so common that nine out of ten people have
already been infected with it by the time they reach adulthood.
However, most of these people either never develop symptoms at
all or develop symptoms so mild that they go unrecognized as
mononucleosis.
How Mono Is Diagnosed
It takes about four to seven weeks before EBV starts causing
trouble for the infected person. The person with mononucleosis
almost always has a general sick feeling (malaise) and may sleep
for twelve or more hours a day. Other typical signs are fever,
headache, sore throat, and swollen lymph nodes ("glands") in the
neck, under the arms, and in the groin. The liver is frequently
mildly affected. In about half of people that get mono, the
spleen ( a soft organ near the stomach important for filtering
the blood) becomes enlarged.
After talking with you and examining you, if your doctor
suspects that you have mononucleosis, blood tests are done to
confirm it. Usually there is an increased number of certain
types of white blood cells (mononuclear leukocytes and atypical
lymphocytes). The lab can also usually detect the presence of
antibodies to EBV in the blood. Sometimes the tests are negative
early in the disease but become positive later on, so the tests
are sometimes repeated.
Expected Course
Most children only have mild symptoms for a week. Even in
the adolescent or adult where symptoms may be more severe,
mononucleosis usually runs its course in three to four weeks.
However, in a small number of people, the disease may linger for
six months or longer. Don't despair if you do not seem to
improve right away. Your vigor will return in a matter of time.
Complications are rare. The most common complication is
dehydration from not drinking enough fluids. Breathing or
swallowing may be obstructed by enlarged tonsils, adenoids, and
other lymph tissue in the back of the throat. On rare occasions,
the enlarged spleen will rupture if the abdomen is hit or
strained, causing internal bleeding, shock, and even death.
Treatment
Unfortunately, there is still no drug that can be used to treat a
viral infection like mononucleosis the way that antibiotics are
used to treat bacterial infections. However, your doctor may
prescribe these drugs if you develop a bacterial infection, like
an ear infection or strep throat, on top of the mononucleosis.
Because over 90% of youngsters with mono will develop a rash if
they receive ampicillin or amoxicillin, these medications should
be avoided.
Aspirin or acetaminophen may be used to lower fever and to
relieve the pain of a sore throat or headache. Gargling, throat
lozenges, or throat sprays (e.g. Chloraseptic) may also help to
relieve the throat pain. Make sure to drink plenty of liquids,
and start a soft diet as soon as you can tolerate it.
You may have heard that people with mononucleosis must get
into bed and stay there. In fact, there is no evidence that
forced bed rest speeds recovery. Instead, most doctors now
suggest that people with mono reduce their activity to a level
that they are comfortable with and make sure to get enough rest.
However, contact sports and other strenuous activities are
definitely out for at least six to eight weeks. This precaution
is important to protect the enlarged spleen from injury.
Is Mono Contagious?
Surprisingly enough, infectious mononucleosis is not highly
contagious. While EBV may spread to other household members,
especially younger children, it is in fact seldom found in
members of the same family at the same time. Mono is probably
not spread by coughing or sneezing, and people who have it can
certainly have visitors, eat with the family, and return to
school or work when their strength is back. It is a good idea
though to refrain from kissing or sharing of drinking glasses or
eating utensils until recovery is complete.
Can Mono Recur?
Once someone's been infected with EBV, whether they develop
full-blown mono or not, they usually become immune to further
infection. However, EBV, like the herpes virus, remains in the
body for life. From time to time, it may reappear in the saliva
without causing symptoms. It's possible that the virus can
spread at these times. This is no cause for worry, however,
since, as mentioned earlier, 90% of people are already immune.
Follow-Up
We will usually want to see someone whose spleen is enlarged
weekly until it is back to normal size. Otherwise, you should
call for another appointment if breathing becomes difficult,
urinating is much decreased, you can't even swallow liquids, or
if ear pain occurs. Call immediately if there is sudden
abdominal pain or left shoulder pain and skin paleness. Also let
us know if the fever isn't gone in ten days, if you are not back
in school by two weeks, or if any symptoms remain after four
weeks.
Part II
ASBESTOS
WHAT IS ASBESTOS?
Asbestos is a mineral that is mined from the earth. There are
several kinds of asbestos. All types of asbestos tend to break
into very tiny fibers, many of which are not visible without a
microscope. Asbestos is resistant to fire and has high tensile
strength.
ARE ANY TYPES OF ASBESTOS SAFE?
No. Asbestos-related disease can be caused by all types of
asbestos.
WHERE HAS ASBESTOS BEEN USED?
Asbestos has been used in approximately 3,000 different products.
The amount of asbestos in asbestos-containing materials varies
from less than 1% to 100%. Examples of products that might
contain asbestos are:
* fireproofing and insulation in buildings and ships
* insulation for pipes and boilers
* putties, caulks, paints and cements
* friction products, such as clutch facings and brake
linings in automobiles.
WHEN ARE ASBESTOS-CONTAINING PRODUCTS DANGEROUS?
Asbestos-containing material (ACM) is dangerous if the asbestos
fibers ca be released. Once they are floating freely in the air,
asbestos fibers can be inhaled and cause disease.
Some ACM ca easily be crumbled by hand pressure. This soft or
loosely-bound material is called "friable" asbestos. Friable ACM
is the greatest health concern because it can easily release
fibers in place begin to deteriorate, the likelihood of fiber
release is even greater. Examples of friable asbestos-containing
materials are fireproofing on structural beams, sprayed-on
asbestos ceiling insulation and trowelled-on acoustical
insulation.
Hard asbestos-containing material, such as vinyl floor tile, in
which asbestos fibers are firmly bound or encased, does not
generally create exposure problems. However, even non-friable ACM
can release fibers and present a hazard if it is sanded, cut,
ground or disturbed in some other way. Therefore, any material
that contains asbestos has the potential to release fibers and
become hazardous.
HOW DO I KNOW IF A PRODUCT CONTAINS ASBESTOS?
You cannot tell whether a material contains asbestos by looking
at it. The only way to know if a product contains asbestos is to
send a piece of the suspect material to a qualified laboratory.
This is called a bulk sample. Only certain kinds of microscopes
can be used to analyze the sample--a polarizing light microscope
or an electron microscope. (Call the EPA at 202-554-1401 for a
list of qualified labs.)
You should take precautions to protect yourself against exposure
to asbestos during sampling. If your employer is not meeting his
or her obligation to determine whether there is asbestos in your
workplace and choose to find out yourself, contact NYCOSH at
(212) 627-3900 to find out how to take a sample safely.
Until you can prove whether or not a product does contain
asbestos, be on the safe side and treat it as though it were
asbestos.
HOW DOES ASBESTOS ENTER THE BODY?
The most common way for asbestos to enter the body is though
breathing. Larger fibers usually get trapped in the nose hairs or
in the mucous along the breathing passageways. However, some
asbestos fibers are so small that they can bypass these body
defense mechanism and get deep into the lungs.
Asbestos can also enter the digestive tract when you eat or
smoke in a contaminated area. Asbestos does not pass through the
skin.
WHAT ARE THE HEALTH EFFECTS OF ASBESTOS
EXPOSURE?
Scientists around the world have demonstrated the links between
exposure to asbestos and four serious diseases: lung cancer,
mesothelioma, digestive system cancer, and asbestosis.
*LUNG CANCER* Asbestos-exposed people are about 5 times more
likely to develop lung cancer than non-exposed people.
Asbestos and cigarettes are a particularly deadly combination. If
a person exposed to asbestos also smokes, his or her chance of
getting lung cancer increases dramatically to 50 times that of a
non-smoking, non-asbestos exposed person. If you have been
exposed to asbestos, the first thing you should do to decrease
your risk of getting lung cancer is stop smoking.
*MESOTHELIOMA* Mesothelioma is a cancer of the lining of the
lungs or of the abdominal cavity. This is a very rare cancer that
is almost always associated with asbestos exposure. Mesothelioma
has become a major public health concern because this disease can
occur after very brief or very low exposures to asbestos. Cases
of mesothelioma have occurred in spouses and children of asbestos
workers whose only exposures were from the dust brought home on
the clothing of family members who worked with asbestos.
*DIGESTIVE SYSTEM CANCERS* Increases in stomach, colon, rectal
and other digestive system cancers have been observed in
asbestos-exposed workers.
*ASBESTOSIS* Asbestosis is a scarring of the lung tissue that
can lead to shortness of breath. A person with a severe case of
asbestosis can barely get enough oxygen to walk. Sometimes the
scarring may spread so far through the lungs that it causes
death. These severe cases are usually caused by extremely high
exposures and are less commonly seen under current working
conditions.
WILL I KNOW I'M GETTING SICK FROM ASBESTOS?
No. Asbestos does not cause any immediate effects, such as
coughing or itching. The diseases caused by asbestos do not
appear until 15 to 40 years after your first exposure. This is
called the "latency period." Even if you feel healthy while you
are working with asbestos, you may get sick many years later.
CAN I GET SICK FROM ASBESTOS IF I'M NOT AN ASBESTOS WORKER?
Yes. Workers who did not work directly with asbestos, but whose
jobs were located near contaminated areas, have developed
asbestos-related diseases. There is no "safe level" of exposure
to asbestos and even "bystander" exposures can cause
asbestos-related disease. As mentioned above, family members of
workers exposed to asbestos have gotten sick from the asbestos
dust brought home on work clothes, as have people who simply
lived near an asbestos factory.
IF I'VE ALREADY BEEN EXPOSED, WHY SHOULD I TAKE PRECAUTIONS?
The more you are exposed, the more likely you are to develop
asbestos-related disease. In addition, the more exposure you
have, the sooner you will become sick. You should act to prevent
further exposures so that your chances of developing
asbestos-related disease will remain small.
IF I'VE BEEN EXPOSED, IS THERE A MEDICAL TEST THAT I SHOULD TAKE?
If you are about to begin working with asbestos, or if your job
periodically or regularly exposes you to asbestos, you should see
a doctor who is knowledgeable about asbestos disease. (Your
regular doctor is not likely to know about asbestos-related
conditions.) The examination should include, at a minimum:
- a work history
- a medical history
- a chest x-ray
- a breathing test.
Remember, the signs of asbestos disease usually do not appear for
15 to 40 years after exposure first occurs. However, if you do
get sick years later and want to seek compensation, a "baseline"
examination now will document your health status and help doctors
relate future changes in your health to your asbestos exposure.
Once you are exposed, you should see your doctor regularly.
Regular medical exams are important because the chances of curing
certain cancers are much greater when detected early.
WHY IS PREVENTION OF ASBESTOS EXPOSURE SO IMPORTANT?
1. Asbestos fibers remain in the lungs. The body cannot break
down these fibers. Each exposure adds to the body burden from
the previous exposure.
2. Asbestos disease can progress even after you are no longer
exposed. Asbestos fibers remain in the lung for life. As long
as the fibers stay in your body, you are at risk for developing
lung disease. This underscores why you must prevent exposure to
asbestos in the first place: you cannot turn back the clock.
3. Asbestos-related diseases are rarely curable. Once these
diseases are detected, there is usually little that can be
done to change the course of the disease.
ARE THERE LAWS THAT WILL PROTECT ME FROM ASBESTOS?
Yes. There are asbestos laws that offer some protection to
workers and the general public. For example, OSHA has an
Asbestos Standard that outlines proper procedures for asbestos
abatement work. New York State and New York City have passed
asbestos control laws. There is also a U.S. law, the Asbestos
Hazard Emergency Response Act, which covers asbestos in schools.
See the NYCOSH fact sheets on these laws for further information
on proper engineering controls and work practices to reduce your
exposure to asbestos.
ARE THERE SAFE SUBSTITUTES FOR ASBESTOS?
Products like fiberglass and mineral wool are being used as
substitutes or replacements for asbestos, but they are not safe
substitutes. The few studies that have been done on these
products so far indicate that glass fibers and non-asbestos
mineral fibers (which are shaped similarly to asbestos fibers)
may cause the same kind of lung scarring and cancers as asbestos.
Therefore, until we learn more about the health hazards of these
substances, you should limit exposure to fiberglass and rock wool
just as you control exposure to asbestos.
This news file is compiled weekly from the archives of the
BLACK BAG MEDICAL INFORMATION SERVICES
302-994-3772
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