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He told an emergency room physician he had a liking for raw fish – specifically, salmon sashimi.
It’s what the 30-year-old man, from Fresno, California, suspected had landed him in the bathroom with stomach cramps and bloody diarrhea.
But what he did not anticipate was the moment he spotted something hanging from his rear end, and he naturally assumed the worst.
“He was like, ‘Oh my goodness, my guts are coming out from me,’ ” said Kenny Banh, the emergency physician at the University of California at San Francisco, in Fresno, who treated him. Banh recounted what the man told him on the podcast “This Won’t Hurt A Bit” earlier this month.
He gave it a pull, Banh said, and it kept coming.
“He picks it up and looks at it and what does it do? It starts moving,” he said. “He was like, ‘That’s a worm.’ ”
It was a Monday in August 2017 when the man showed up in the emergency room of UCSF Fresno’s Community Regional Medical Center clutching a plastic grocery bag and asking doctors to treat him for tapeworms – parasites that can invade the digestive tract of animals and humans. Banh said he didn’t think too much of it; he had heard patients express similar concerns about tapeworms in the past.
Banh opened the sack.
Inside, he said, was a cardboard toilet paper tube – with a tapeworm wrapped around it.
Banh said the worm was dead when he saw it but noted the man told him “it was alive when he pulled it out and it was wiggling in his hand.” Banh stretched it out on ER floor and measured it – all 5½ feet of it, he said in an interview Friday with The Washington Post.
“It got long enough that some of it was sneaking out of him,” he said about the parasite.
Banh said it’s not certain which species of tapeworm it was or how long it had been inside the patient.
He said his patient was convinced he got the tapeworm from eating raw fish. Banh said given the fact that the man had not recently traveled or been drinking questionable water – and the fact that he said he ate sushi or sashimi almost daily – he is “almost positive” that the self-assessment is correct.
However, Banh said, there are risks with any type of food.
“You have to be aware,” he said, explaining that the concern is not with the sushi or sashimi as such but with whether it is properly prepared.
The U.S. Food and Drug Administration has released guidelines for controlling parasites that may live in seafood – by cooking the food or freezing it at certain temperatures for certain amounts of time.
That said,in January 2017, a study published in the Centers for Disease Control and Prevention’s journal Emerging Infectious Diseases noted that wild salmon caught in Alaska’s icy waters were found to be infected by a Japanese tapeworm known as Diphyllobothrium nihonkaiense. As The Post’s Ben Guarino reported at the time:
“The researchers behind the study, tapeworm experts from the Czech Academy of Sciences and biologists at the Alaska Department of Fish and Game, concluded that “salmon from the American and Asian Pacific coasts and elsewhere pose potential dangers for persons who eat these fish raw.” They hunted for the tapeworm larva via microscope, and confirmed it was the Japanese species using a recently developed molecular technique.
“The fish species in the study involved several types of wild Alaskan salmon: chinook, coho, pink and sockeye salmon, as well as rainbow trout. They found a Japanese broad tapeworm burrowed in the muscles of a Pacific pink salmon, near the fish’s spine.”
Experts say Diphyllobothrium latum are among the most common – and largest – of the tapeworms that can take up residence in human bellies.
They can grow up to 30 feet, according to the CDC. In addition, the agency noted, they can live for years.
The CDC states that humans get Diphyllobothrium most often by eating uncooked or undercooked fish, such as salmon, that is infected with tapeworm larvae. Once inside the host, the larvae then grow.
The Post’s Sarah Kaplan put it best:
The life of a tapeworm unfolds over three stages. First, their larvae, which dwell in some animals’ muscle, are swallowed by another unsuspecting host. With hooks or suckers, they cling to the lining of the gut and get fat off nutrients predigested by the host as they develop. When it comes time to procreate, these hermaphroditic creatures make use of the full suite of male and female reproductive organs packed into their rear ends – they can self-fertilize or mate with another individual. Their eggs are swept out into the world via the host’s bowel movements, then swallowed by another host, when the cycle begins again.”
“It’s not like every single piece of raw fish is infected,” said Janine Caira, a distinguished professor of ecology and evolutionary biology at the University of Connecticut. Although, she noted, every day a person eats it, he or she is increasing the odds of getting a parasite.
But aside from the sheer horror of it, tapeworms do not typically do much damage to their hosts.
Infections are usually asymptomatic, although they can cause abdominal pain, diarrhea and vomiting, according to the CDC. And, doctors say, they are treated pretty easily with medication.
The patient was given medication to kill any other tapeworms, Banh said, but no others came out.
“He swore off sushi after this,” Banh said, but predicted that eventually his patient will eat it again.
Got Pain? A Virtual Swim With Dolphins May Help Melt It Away
Source: npr- Virtual reality is not new. But, as people search for alternative ways to manage pain — and reduce reliance on pills — VR is attracting renewed attention.
Imagine, for a moment you’ve been transported to a sunlit lagoon. And, suddenly, it’s as if you’re immersed in the warm water and swimming. That’s what Tom Norris experiences when he straps on his VR headset.
“It’s fantastic, I really feel like I’m there,” says Norris, who is 70 years old, retired from the military, and lives in Los Angeles with his wife. As dolphins frolic and swim by in the virtual scene, “I get a strong feeling of pleasure, relaxation and peace,” he says.
It doesn’t take long to produce that effect — about 10 minutes or so, via the headset.
Norris is no stranger to pain. He’s got chronic pain through his spine, back and hips, from injuries that go back years.
Ever since he was introduced to virtual reality, he’s been hooked. In addition to swimming with dolphins, he’s tried other VR experiences, such as wilderness walks.
“I relax. My attention is diverted and it makes the pain more manageable,” he says. Norris was on his deck when we spoke, drinking a morning cup of coffee and watching the hummingbirds. “Pain is part of my life,” he told me.
He uses lots of tools to help him cope, he says, including peer support groups, which he helps lead. But he says he finds VR particularly helpful. For him, the feeling of relaxation and ease that comes from a virtual swim with dolphins tends to linger for several days.
Can You Reshape Your Brain’s
Norris isn’t alone in his positive experience. A study published this month in the journal PLOS ONE is just the latest to document that an immersive, virtual reality experience can be an effective strategy for reducing pain.
VR “changes the way we perceive the pain,” explains study author Brennan Spiegel, a physician and the director of Cedars-Sinai Health Services Research in Los Angeles.
The research was done in a hospital where participants were undergoing treatment for various conditions; some were experiencing pain linked to cancer and others had orthopedic pain. “We divided the patients into two groups,” Spiegel explains.
One group tried VR. They used Samsung Oculus headsets that were each fitted with a phone that had a VR app. Patients could select from a library of 21 VR experiences available on the app.
They were free to use the VR devices as much as they liked, but were advised to aim for three daily sessions, 10 minutes per session. The other group of patients got to watch a health and wellness channel on TV, as much as they wanted.
“We found that virtual reality reduced pain by about three times as much as watching TV did,” Spiegel says. Using a zero to 10 pain scale, the virtual reality experience led to a 2 point drop in pain, compared to a half-point drop for watching TV.
Spiegel’s study was partly funded by a grant from Applied VR, a company that sells VR software, but the company played no role in the conduct, data collection, data interpretation, or write-up of the study, he says.
It’s not exactly clear how VR works to help reduce pain perception, but pain specialists say there are likely multiple explanations. Distraction in just one element.
“When the mind is deeply engaged in an immersive experience, it becomes difficult to perceive stimuli outside of the field of attention,” Spiegel and his collaborators write in their journal paper. In other words, when something captures our attention and uses all our senses, we focus on it. It’s like a spotlight — and everything else falls into darkness — at last temporarily.
So, a virtual swim with the dolphins can overwhelm our visual, auditory and other senses. “VR is thought to create an immersive distraction that restricts the brain from processing pain,” the authors conclude.
The study adds to other evidence pointing toward potential benefits of VR to manage pain. Going back more than 15 years, studies have shown the technique to be useful in a range of settings — from helping people cope with anxiety to helping reduce acute pain during medical procedures, during physical therapy or during dental procedures. And, there’s some evidence VR can help with chronic pain, too.
Still, there are some unanswered questions, says Zachary Rosenthal, a clinical psychologist at Duke University who has been involved in research on VR’s effect on pain. “Distraction is helpful for pain,” he says. “That’s an understood phenomenon. … But why should VR be better than any other kind of distraction?” he wonders.
Spiegel’s research “starts to answer this question,” says Rosenthal. “I do think this study moves the needle forward.”
If you’re new to virtual reality, Spiegel has some advice: “It’s always a good idea to check with your doctor first, whenever self-treating symptoms. But in general, it is safe to use VR at home,” he says. About 5% to 10% of people who try it get cybersickness, which is basically a feeling of dizziness or vertigo, similar to motion sickness. So, it’s good to be aware of this risk.
“For people who own an Oculus Go or Oculus Quest [headset], I suggest Nature Trek, which is an outstanding set of content that is peaceful and meditative” for the treatment of pain, says Spiegel, who has no financial ties to the company. And there are other companies that make a variety of software specifically aimed at easing pain.
“For cheap and easy access to VR experiences, you can simply visit YouTube and search its massive library of free VR content,” Spiegel says. “If you want a virtual trip to the beach, type ‘VR beach’ into the YouTube search engine. Or ‘VR forest.’ It’s all there for the taking.”
VR is certainly not a panacea, but it can be another tool in the pain management toolkit. Spiegel and his collaborators say there’s still a lot to learn as to which types of VR may be most effective.
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Get a 24-Hour Blood Pressure Reading to really know your heart health
- High blood pressure (hypertension) is a warning sign of multiple health issues.
- A new study finds that the best way to determine a person’s heart health is to look at their blood pressure over 24 hours.
- This method could offset “white coat hypertension,” where the stress of going to the doctor’s office can increase a person’s blood pressure.
Heart disease is the leading cause of death in the United States, accounting for nearly 1 in every 4 deaths — or about 610,000 deathsTrusted Source — each year.
It’s also the most expensive disease, costing the country nearly $1 billion each day.
The vast majority of cardiovascular disease cases are preventable, had people received earlier diagnoses and treatments.
One way to detect signs of cardiovascular disease is a simple blood pressure reading.
High blood pressure (hypertension) has long been known to be the biggest — and most treatable — risk factor associated with diseases of the heart and vascular system. But many people don’t know they have it until it’s too late, according to the Centers for Disease Control and Prevention (CDC)Trusted Source.
Now, researchers have discovered a new way to get more accurate measurements of blood pressure, which can hopefully get people on the right medications sooner and help prevent cardiovascular disease.
By recording people’s blood pressure over 24 hours rather than just once in a clinic or hospital setting, doctors can more accurately diagnose high blood pressure and effectively predict someone’s risk for heart and vascular disease, according to a new international study recently published in JAMATrusted Source.
To determine the most reliable way to measure blood pressure, researchers followed 11,135 people from Europe, East Asia, and Latin America for 14 years.
They compared the accuracy of blood pressure readings that were taken in a medical setting to blood pressure recordings that were taken during both night and day over 24-hour periods.
The researchers found that the 24-hour and nighttime blood pressure measurements provided a more accurate estimate of one’s risk for heart and vascular disease compared to the in-office readings.
“Although heart and vascular disease are strongly associated with blood pressure, irrespective of how it is measured, until now we did not know which type of blood pressure measurement captured risk in the most accurate way,” study co-author Dr. Gladys Maestre, a researcher from the University of Texas, Rio Grande Valley School of Medicine, said in a statement.
The findings suggest that blood pressure should be monitored repeatedly for 24 hours to help diagnose people’s heart issues and, ultimately, prevent cardiovascular disease, according to the researchers.
“Ever since devices to measure blood pressure were invented more than 100 years ago, it’s been known that elevation of such readings predicted the eventual development of blood vessel disease, heart attack, stroke, heart failure, and kidney dysfunction,” says Dr. Richard Wright, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California.
In general, the further a person’s blood pressure readings deviate from the ideal, the more likely they are to eventually develop any of these health issues, Wright added.
However, a huge issue comes into play when blood pressure is measured in a healthcare setting.
Many people have elevated blood pressure readings due to anxiety of being in a medical environment — known as the white coat effect — and those high readings don’t accurately reflect a person’s overall blood pressure levels.
“Unfortunately, blood pressure isn’t a fixed number for any individual and varies widely over each day, being much higher during stress or physical exercise, and typically lowest at night during asleep,” he explained.
Even the stress of having a blood pressure cuff put on the arm or seeing a doctor walk into the room can cause some people’s blood pressure to spike, he added.
Twenty-four hour monitoring can look at a person’s blood pressure fluctuations throughout an entire day rather than at a given moment.
There’s also a huge advantage of measuring blood pressure during sleep because the results aren’t affected by daytime meals or activities.
“Ambulatory monitors give us a great sense of what the patient’s blood pressure is doing in real life as well as when they are sleeping, when it should decrease,” Dr. Nicole Harkin, a board-certified cardiologist and lipidologist with Manhattan Cardiovascular Associates in New York City, said.
“They also give us a large data set of blood pressures to look at, as opposed to a one-time snapshot in the doctor’s office, which is subject to many variables, including errors in measurement as well the patient’s recent activity level, medication timing, and inadequate rest prior to measurement,” she said.
According to Harkin, the current American College of Cardiology and American Heart Association blood pressure guidelines support the use of ambulatory blood pressure monitoring to better predict cardiovascular outcomes.
Coverage for ambulatory blood pressure monitoring varies across different insurance providers. Much of the time, it’s only covered for people who experience white coat hypertension, in which an individual’s blood pressure is higher in a doctor’s office than it would normally be, she explained.
Seeing as ambulatory blood pressure monitoring can better predict long-term heart disease outcomes, healthcare providers should place a greater emphasis on 24-hour readings than those taken in a doctor’s office.
If people know their blood pressure is higher than it should be, the better they can manage it to minimize the odds they’ll develop heart disease down the road.
High blood pressure can be the biggest predictor of heart disease, so the sooner people can start managing their blood pressure, the lower their risk of heart and vascular disease may be.
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