Posts Tagged ‘Tuba City’

Measles, a word the 7-year-olds haven’t heard

April 9, 2017

Here’s a contagious word to the wise

If there’s rash and runny eyes

With a cough, I suppose

Look! How runny the nose!

And it’s MEASLES! The CDC cries!

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

About 3 weeks ago I received an email from the Iowa Department of Public Health about a case of measles. The person (age and gender not given) had been in the Omaha airport on March 12.  Diagnosis of measles had come on March 15, after visiting 3 different healthcare facilities.

So I was on the lookout for a disease I hadn’t seen for 30 years.

Finishing my Indian Health Service contract in 1987 at the Tuba City, Arizona Indian Health Service Hospital, I saw hundreds of cases, and I had to learn about the disease. Measles discussions center on the 3 c’s: cough, conjunctivitis (runny eyes), and coryza (runny nose); the patient looks sick, and has a fever.  The rash starts on the face, and in the next three days works down the body, concentrating in the midline, armpits, and groin.  The 3-day or German measles has a similar looking rash that also starts on the face and spreads down, but people don’t get nearly as sick.

At the time, that reservation had an immunization rate close to 100%, but when the dust settled, the case count came very close to a 5% vaccine failure rate. Since then, the MMR has gone to a two-dose immunization schedule.

With the alert fresh in my mind, I had reason to think of the things I learned and saw so many decades ago. Working a game of incomplete and imperfect information, I called the state Department of Health.  Connecting eventually with an expert who had never seen the disease, but knew what to order, I heard for the first time of a viral transport medium called M4.  And I learned to use a culturette or a Dacron swan, not cotton and certainly not wood.

We still have no treatment for the disease. And with the illness almost extinct, we probably won’t invent one.  Yet measles still runs into complications in almost 10% of those who have it.

Exposure confers lifelong immunity, and only humans can get measles. Thus as an undergrad in anthropology, in one class we did calculations based on 2 week contagion, 3 week incubation, and generation length of 20 years to figure out how what size population can support the disease.  We decided, eventually, that measles couldn’t be more than 50,000 years old.

Measles remains contagious in the air for 2 hours after a person with an active infection leaves a closed room. Thus the case that triggered the alert, arriving on an airplane, exposed a lot of people.

I want to know about that case. What irony or drama surrounds the circumstances of inadequate vaccination?  Who did the exposing, and how sick did that patient get?  Where was the exposure, and was it linked to the Disneyland outbreak?

I never had measles as a child. The son of a physician, I served as a test patient when I was 14 for the first measles vaccine that only served to deplete what my meager natural immunity.  I had to wait till middle age to get an effective vaccine.

Later that day I asked a 7 year old if he’d ever heard the word, measles. “No,” he said, “What are they?”

The antivax movement makes no sense. Mercury has been removed from the vaccine, and all the evidence linking MMR to autism was fabricated by one researcher who has since owned up to his deception, yet that myth persists.

I fear that the antivaxxers may get enough traction to let the genie back out of the bottle, and that the word, measles, may once again become part of the language.

Surrounded by measles, I turn in my beeper and my key doesn’t work

May 21, 2010

Could my happiness ever run deeper?

Could a thrill come any cheaper?

     I took the thing from my belt,

    Oh, the joy that I felt!

Today, I gave up my beeper.

 

I slept very badly my last night on call, from vigilance rather than need.

Thursday dawns cloudy, windy, and cool as I drive down Pierce Street for my radio segment.

I discussed measles.

During my childhood everyone knew what the word measles meant, though common knowledge didn’t help distinguish between the hard measles, the three-day measles, or the German measles.  Now measles is so rare that most docs in town have never seen a case.

If I hadn’t worked Tuba City, Arizona in the spring of 1987, I wouldn’t have seen measles at all.

A terrible disease, I announced to the radio audience, with high fever, a rash, and the three C’s: cough, conjunctivitis (runny eyes), and coryza (runny nose).  I remembered vividly the epidemic in the Navajo and Hopi patients at Tuba City and the distinctive rash: deep red and bumpy, heaviest in the midline and the armpit and groin creases.

One MMR injection confers 80% immunity and two gives 99%.  The Indians I worked with in Arizona had a very high single immunization rate, but the current standard demands two shots.  The vaccination protects so well that most nine-year-olds have never even heard the word measles, let alone mumps or rubella.

Four measles outbreaks surrounded Iowa as I spoke.

I enjoyed the show and the repartee with the DJ before, during and after my microphone time.  I stepped out to the parking lot, into the wind and the fresh air. 

I drove to St. Luke’s and parked under the portico by the valet, assuring him I won’t be but 30 seconds. 

The two phone operators work just inside the front doors of the hospital.  At 7:02 I handed my beeper over, explaining that as I have just finished my last night on call I won’t be needing it again.

Perhaps the beeper only weighed three ounces, but it felt like I’d carried a 60 lb albatross on my neck for the last 23 years and I had just put it down.

I turned and I took a step towards the electric door and then I couldn’t help dancing, kicking high, into the driveway, past the valet to my parked car.

I walked the way I walked in May 1972 when I finished my last exam over a very good demographics course, taught by Henry Harpending (still a distinguished academic who makes an occasional appearance on The History Channel) which forever changed the way I view politics and social trends.  I finished early and turned in my blue book to the professor seated at the front of the room. I slapped high fives with every student still writing in the first row, and strode out into a hazy, warm spring day.

But it wasn’t my last exam.  Eight months later I decided to become a doctor, and for the next seven years I kept taking tests.  When I took the last examinations in med school in 1979, I wrote my mother a letter that started, “It is the end of an era.  I have taken my last exam.”

Except that wasn’t my last exam, either.  All the tests I took were merely exercises before the three-day monster called the FLEX.  I did well on it in 1979 and I got my license.

Nowadays I just have one six-hour test every seven years.

And it wasn’t my last night on call,  just the last night on call till I start my next job in Barrow.

I don’t have to but I drive out to the clinic in the early afternoon.  The lock has been changed and my key doesn’t open the door.  The artwork has been taken off the walls in my office, and boxed up.

A little premature, but I don’t mind.