Hand Washing

After posting on Toxoplasmosis I thought we should briefly discuss the importance of hand washing.  Now you’re probably thinking why I know hand washing is important and I certainly know how to wash my hands.  Well I thought the same until I was forced sit through a 50-minute lecture on hand washing in vet school.  Yes, 50 minutes.  Hand washing to this day is the single greatest advancement in public health and is still the most important way to prevent the spread of infections, such as the flu.  As the CDC puts its “clean hands save lives.”    

So what is the correct way to wash your hands?

• Wet your hands with clean, running water and apply soap
• Rub your hands together and scrub all areas of your hands, including the back of hands, wrists, between your fingers and under your nails.  The most frequently areas missed include thumbs, fingernails, back of hands and wrists.
• Scrub for at least 20 seconds.  I repeat at least 20 seconds.  Contact time with soap is the most important factor.  I recommend singing a song such as the “ABCs” to yourself (or out loud doesn’t matter).  FYI a surgical scrub last 5 minutes.
• Rinse your hands well
• Dry your hands with a clean towel ideally paper or air-dry them

When to wash your hands

• Before and during food preparation
• Before eating
• After using the toilet
• Before and after tending to a sick person
• After blowing you nose, coughing or sneezing
• After touching an animal
• After handling garbage
• When they look dirty

Brief History of Hand Washing 

Hand washing was not recognized as a way to prevent the spread of infections until 1847 when a Hungarian physician named Ignaz Philipp Semmelweis discovered that hand washing drastically reduce the incidence of puerperal fever. 

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Toxoplasmosis

I thought the first zoonotic disease I’d cover would be Toxoplasmosis.  It's an infection that most people commonly associate with cats and pregnant women.  But as you will soon learn there are other ways you can become infected. 

What is Toxoplasmosis?

It's a disease caused by a parasite called Toxoplasma gondii.  It is estimated in the United States approximately 22.5% of the population 12 years and older are infected with the parasite and worldwide it has been estimated that in certain places up to 95% of some populations carry the parasite (CDC).  The majority of healthy people and cats infected with the parasite don’t have any symptoms.

How does one become infected?

There are three major modes of transmission 

• Congenital - a woman newly infected during pregnancy can pass the infection to her unborn child  
• Ingestion of undercooked contaminated meat, especially pork, lamb and venison 
• Worldwide this is the cause of the majority of infections
• Ingestion of oocyst passed in cat’s feces
• Cats become infected by eating infected rodents, birds or raw meat and then pass the parasite in their feces in the form of an oocyst.
• For as long as 3 weeks after becoming infected cats shed millions of oocysts in their feces.  Older cats are less likely to shed.
• Most infected cats will not show any signs of illness. 
• People become infected by:
• Ingestion of oocysts when cleaning a cat’s litter box when the cat is shedding
• Ingestion of oocysts in contaminated soil.  Remember not all cats use litter boxes!
• Eating unwashed fruits and vegetables
• Not washing their hands after gardening
• Drinking contaminated water
• Uncommon causes of transmission 
• Blood transfusion 
• Tissue or organ transplants

What does the disease look like?

•  Healthy people as stated before who become infected generally have no symptoms.  If symptoms do occur they are  typically mild “flu-like” symptoms that last for a few weeks and then resolve.  The parasite will remain in the body in a latent form and can cause illness again if the person becomes immunosuppressed.

• Immunosuppressed individuals can have more severe symptoms including fever, headache, nausea, and seizures.

• Pregnant women

o   If a woman has already been infected prior to becoming pregnant the woman has developed immunity and the baby will be protected.

o   If a woman is pregnant and becomes newly infected she can then pass the infection on to the unborn child.  Congenital abnormalities for the child include abnormal enlargement or smallness of the head, potential vision loss, mental disability and seizures.

Prevention

• Cook your food! 
• Whole cut meat cook to at least 145
• Ground meat at least 160 F
• Poultry at least 165 F
• Freeze meat at 0 F for several days prior to cooking.
• Wash fruits and vegetables before eating.
• Do not drink unpasteurized milk.
• Drink clean water.
• Wear gloves when gardening or when in contact with soil or sand and wash your hands after.

I’m pregnant do I need to give away my cat?

NO.  But you will want to take some extra precautions:

• Have someone else change the litter box.  If no one else is available wear gloves and wash your hands well afterwards.  Remember transmission is fecal-oral, so washing your hands is key. 
• Clean the litter box daily.   This is very important because the parasite does not become infectious until 1 to 5 days after it is passed in a cat’s feces.  So try to have someone clean the litter box right after your cat has defecated. 
• Don’t feed your cat raw or undercooked meat.
• Keep your cat inside. 
• Do not get a new cat while you are pregnant and avoid contact with stray cats. 
• You should also follow the above mentioned recommendations.

If you have any further questions or concerns please contact your veterinarian or physician.

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My little man Manny!

Rawhides - Why I Hate Them

The fourth year of vet school consists entirely of clinical rotations.  I tracked mixed animal so my rotations consisted of things such as small animal medicine, small animal surgery, large animal medicine, large animal surgery, radiology, anesthesiology, etc. No matter what you track (small animal, large animal or mixed animal) everyone is required to complete a necropsy rotation.  Which I’m sure to the average person sounds horrible but remember we’re veterinary students and we view it as a chance to learn.  However, I will admit the smell is horrible and no matter how many times you shower or how many times you wash your clothes the smell is still there.  So by the end of the rotation you end up throwing out every piece of clothing that you wore during that 2-week period.  Also, for whatever reason they have you dress all in white which makes absolutely no sense.  Anyway, the most rewarding cases were the ones that you immediately found the cause of the death and you didn’t have to wait for the results of histopathology or any further testing.  During my 2-week necropsy rotation there was one case that I will never forget.  A 4-year female spayed Pomeranian presented for sudden death at home.  According to the owner the dog was acting perfectly normal went outside for a few minutes, came back inside, suddenly collapsed and died.  When performing a necropsy there is a strict protocol you follow so nothing is missed.  I’ll spare you the details of the protocol but by the time I got to dissecting the larynx I had found the cause of the death.  A large round piece of rawhide was lodge in the larynx completely occluding the airway.  The pathologist in charge looked at me and said,  “this is going to be a hard phone call to make”.  I was devastated both for the dog and the owners.

After graduation I went into private practice and at least once a week we remove esophageal foreign bodies, usually rawhides.  Esophageal foreign bodies can be life threatening and need to be treated immediately.  The foreign body can cause severe injury to the lining of the esophagus including perforation, which is life threatening.  Potentially any type of foreign object can become lodged in the esophagus – bones, needles, fishhooks, rawhides, etc.  Clinical signs of esophageal foreign bodies include drooling, gagging, repeated attempts to swallow, pawing at the mouth, not being about to swallow food or water.  Many esophageal foreign bodies are easily seen on x-rays.  Once diagnosed esophageal foreign bodies should be removed immediately typically with a flexible endoscope or forceps.  If surgery is needed the overall prognosis is poor.  Complications associated with esophageal foreign bodies include stricture formation of the esophagus, severe and might I add painful inflammation of the esophagus, laceration of the lining of the esophagus and aspiration pneumonia secondary to regurgitation.

My advice is to completely avoid rawhide chews. There are many other great and safe alternatives.  I personally or I should say my dogs personally love kongs.  I also highly recommend supervising any dog with any type of chew toy.                 

What are you looking at?

Dog Parks

After seeing the end results of some pretty horrific dogfights secondary to dog park visits I decided to share the California Veterinary Medical Association recommendations for dog park safety.  While dog parks can be fun they aren’t for every dog and they harbor some serious risks such as bites and exposure to infectious diseases.

   

The CVMA has the following recommendations for keeping your dog safe while visiting a dog park: 

• Make sure your dog’s vaccination status is current
• Make sure your dog is socialized and gets along well with other animals and people
• Keep a very close eye on your dog at all times
• Make sure small dogs and big dogs are separated
• Bring water for your dog to drink
• Have your veterinarian check your dog regularly for parasites
• Talk to your veterinarian about any precautions you should take with your dog

Some other things to consider

• Promptly pick up and properly dispose of any feces
• Don’t take your dog to the park when it’s sick or recovering from an illness

Zoonotic Diseases – An Introduction

Not many people are aware but veterinary medicine has a proud history and tradition of promoting and improving the health of not only animals but of humans as well.  Veterinarians receive an education in physiology and clinical science comparable to that of physicians but they also receive extensive training in comparative medicine.  We are educated in preventive medicine, population health, parasitology, zoonotic diseases, and epidemiology and not to mention we must be familiar with a multiple number of species.  Because of this training veterinarians have and continue to make significant contributions to the control of infectious diseases of humans.   

In one way or another all veterinarians regardless of their specialty are involved in protecting humans from diseases, in particular those transmitted between humans and animals.  These diseases are called zoonotic diseases.  According to the CDC approximately 75% of emerging infectious diseases affecting humans are of animal origin and approximately 60% of all human pathogens are zoonotic (http://www.cdc.gov/ncezid/).   I personally don’t like the term emerging disease because many of these diseases aren't necessarily new.  Therefore, the more correct term in my opinion for many of these diseases is re-emerging infectious diseases.  So why are we now seeing what appears to be an increase in infectious diseases?  The difference is that theses diseases now have the potential to cause worldwide epidemics.  The world has become much smaller and much more vulnerable to the spread of infectious diseases.  Another reason is changes in our environment including logging of forests, changes in the use of land, migration of people from rural to urban areas and improper disposal of waste.  Zoonotic diseases affect and kill hundreds of thousands of people especially in developing countries, even though most of them can be prevent.

Examples of zoonotic diseases classified according to their infectious agent include:

·      Parasites: Toxoplasmosis, Cysticercosis

·      Bacteria: Anthrax, Leptospirosis, Tularaemia

·      Fungi: Dermatophytoses, sporotrichosis

·      Viruses: Rabies, Hantvirus

·      Prion: Bovine Spongiform Encephalopathy

Please don’t let this information scare you.  Throughout this blog we will cover various zoonotic diseases and ways to protect yourself, your family and pets from them.  And please remember pets provide many health benefits to humans; examples include decrease blood pressure, cholesterol levels, and triglyceride levels.  They also can provide a great source of exercise.   Although pets can carry germs, it is important to know that you are more likely to get these germs from other sources than your pet.

“However secure and well-regulated civilized life may become, bacteria, Protozoa, viruses, infected fleas, lice, ticks, mosquitoes, and bedbugs will always lurk in the shadows ready to pounce when neglect, poverty, famine, or war lets down the defenses.  And even in normal times they prey on the weak, the very young and the very old, living along with us, in mysterious obscurity waiting their opportunities” –Hans Zinsser 1934”

“The microbe is nothing; the terrain, everything.” – Louis Pasteur 1822-1895