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Mushrooms, soft cheeses, frozen waffles, precooked chicken, deli meats …
Over the past several months, there have been many headline-grabbing recalls of foods sold around the country. Many of those recalls have centered around products potentially contaminated with Listeria. The headlines can be unnerving, and many people aren’t sure what steps to take if they purchased or ate food at risk of Listeria contamination. In this editorial, we break down what Listeria is, the risks it poses to healthy adults and at-risk groups, and how to respond to product recalls. 
1. What’s the difference between Listeria and listeriosis?
Listeriosis is the infection caused by the gram-positive bacteria Listeria monocytogenes, usually when contaminated food is eaten. We tend to think of refrigerated food as safe to eat, but that’s not always the case. Listeria bacteria can grow in food at refrigerator temperatures, and it can survive in the freezer. That makes refrigerated, packaged, ready-to-eat products (that require no cooking before they are eaten) particularly at risk for contamination. Sprouts, melons, and other fruits and vegetables can also pose a risk. 
2. What are the risks of listeriosis?
Most of the time, individuals with healthy immune systems do not have to worry too much about Listeria exposure. However, listeriosis is one of the most fatal foodborne illnesses for individuals with weakened immune systems. People with listeriosis typically have chills, fever, and muscle aches (resembling the flu), with nausea, vomiting, and diarrhea. Usually, symptoms resolve in 1 to 7 days. 
The bacteria sometimes enter the bloodstream from the intestine and invade certain organs. This is known as invasive listeriosis. Invasive listeriosis can spread to the tissues covering the brain and spinal cord (causing meningitis), the eyes, heart valves (causing endocarditis), and joints. In pregnant women, it can spread to the uterus and fetus. In the United States, invasive listeriosis develops in only about 1,600 people each year, and about 260 people die of it.
3. Who’s at risk?
Listeriosis is most common among the following groups:

    Pregnant women
    Fetuses and newborns
    People aged 60 or older
    People with a weakened immune system, such as those with human immunodeficiency (HIV) infection
    Individuals on immunosuppressant medications

Pregnant women are about 10 times more likely to get listeriosis than the general population, and pregnant Hispanic women are about 24 times more likely to get listeriosis than the general population. Listeriosis is the reason most doctors recommend pregnant women avoid deli meats and other foods that could be contaminated. As the percentage of Americans over the age of 65 grows, older individuals need to be aware of the risks and warning signs of listeriosis and take necessary precautions.  
4. Why do there seem to be so many recalls of Listeria recently?
With all the recent headlines, it’s easy to assume listeriosis is on the rise nationwide. The reality is, there are several factors that impact the number of recalls and related media coverage. 
For starters, we have strong food safety protocols in America. Listeria contamination may not necessarily be significantly on the rise, but we are more attuned to looking for it. At the same time, an increase in consumption of processed and prepared foods, where Listeria is more likely to be present, are likely contributing factors. 
People should also know that an “outbreak” can be less threatening than they may think. We tend to think of an outbreak as dozens or hundreds of people. But the definition of a foodborne illness outbreak is just two or more people getting sick from eating the same contaminated food or drink. Tracking outbreaks can be challenging as it can take up to 10 weeks for a person to get sick after exposure to Listeria, and many healthy individuals will never get sick or show symptoms. That makes tracing illnesses back to individual exposures difficult. 
5. What should I do if I purchased or ate a product contaminated with listeria?
It’s a good idea to pay attention to recalls, especially for individuals who may be at greater risk. If you purchased a product that could be contaminated, the first step is to dispose of it. You should also thoroughly clean the refrigerator and other potential areas of cross contamination. 
In most cases, cooking the food will kill the Listeria bacteria. But if you or a family member ate the product uncooked, it’s important to monitor for symptoms and be prepared to seek medical attention immediately. 
For more about listeriosis, visit The Manuals page on the topic.

Answering Common Questions About Listeria, Listeriosis, and Food Recalls

Mushrooms, soft cheeses, frozen waffles, precooked chicken, deli meats …Over the past several months, there have been many headline-grabbing recalls of foods sold around the country. Many of...

Season 6 | Episode 3



 


 
Pediatric Myths



 
Dr. Alicia Pekarsky, MD: Parents don't have to be perfect. They have to be good. They have to be loving and attentive and they have to do their best.
 
Joe McIntyre (Host): Welcome to another episode of the Merck Manuals Medical Myths Podcast. On this show, we set the record straight on today's most talked about medical topics and questions. Today's episode will focus on the question that keeps many parents up at night. Why is my baby crying? 

I'm your host, Joe McIntyre, and to help us answer that question is Dr. Alicia Pekarsky, an Associate Professor of Pediatrics at SUNY Upstate Medical University, Upstate Golisano Children's Hospital, and she also serves as program director of Child Abuse Pediatrics Fellowship at Upstate Medical University, Golisano Children's Hospital. Dr. Pekarsky also specializes in general pediatrics, child abuse pediatrics, and neglect. She also has chapters about child neglect and abuse available for free on merckmanuals.com. 

Dr. Pekarsky, thanks for joining us on the podcast!
 
Dr. Alicia Pekarsky: Thanks so much for having me.
 
Host: Our first question for this episode is why do babies cry?
 
Dr. Pekarsky: There are so many reasons why babies cry. I think some of the more obvious reasons are things like hunger, baby is in a wet or dirty diaper, baby may be too hot or too cold, or even possibly developing a viral illness. On the other hand, there are other reasons that I think that many parents and caregivers overlook. Sometimes, the baby is overstimulated, just too much is going on in their environment, and sometimes they're bored. 

The other possibility, I think babies cry if they have an injury that just hasn't been recognized by the parent yet. And then another theory is that babies cry because they have an immature nervous system, and they're just unable to soothe themselves when they're frustrated.
 
Host: Let's move on to the question about colic. Can you explain what colic is and the symptoms it may present in infants?
 
Dr. Pekarsky: Colic is defined by frequent and long periods of crying that occur in young infants who are otherwise completely healthy and well. The crying typically begins in young infancy. In those first few weeks of life, it peaks between six to eight weeks of life and tends to resolve by three to four months of age. And then another feature of colic crying is that it typically occurs around the same time, in the late afternoon and early evening, but the child is otherwise completely healthy.
 
Host: I'm sure a lot of parents have questions like my child is crying for x number of minutes, maybe x number of hours. How long should a parent try to comfort a crying baby before deciding, hey, maybe this is an actual emergency and not just a baby who is frustrated or one of the other reasons you mentioned in the beginning?
 
Dr. Pekarsky: It’s going to be longer than minutes. I think you're right when you point out hours because babies with colic will cry for hours. I think that the most important thing to do before you chalk it up to colic is to look at your baby, check your baby, and feed your baby. But I think after a couple of hours, it should kind of quiet down. If your baby's crying from 6 pm to 9 pm, for example, most nights of the week, and then is otherwise well during the rest of the day, acting well, feeding well, and is engaged with their environment. It's not anything to worry about in terms of a medical emergency. Of course, it can cause a lot of frustration and anxiety in parents. 
 Host: I'm sure it can. I have a question here, which may be a little bit silly. When a baby is crying, that doesn't mean that the child is angry with the parent or does not like a parent or does not like someone else? It could mean a whole host of things, but probably not anger is my guess.
 Dr. Pekarsky: That's right because infants with colic are those young infants. They're not angry with the person who's caring for them. They just don't have that level of intentionality yet. And it's important; this is such a great question because the level of frustration that the parents feel towards themselves, their family, and the child just increases exponentially. I think it's important to remember that children cry for so many different reasons, as we mentioned before, and it really has to do with the child.
 Host: Is there a strategy or advice you give to parents to handle maybe the guilt, for lack of a better word, of not being able to stop your child from crying?
 Dr. Pekarsky: It really depends on the level of concern that the parents are having. If they're just having some mild feelings of guilt, one of the recommendations I will make, which may seem very simplistic, but it is effective, is just to put the baby down in a safe place and walk away, whether it's leaving the room, or it's taking a walk around your house or around the block. Interrupting that cycle and walking away may just brighten your mood. Other simple things that most people can access are turning on music or free apps that help with deep breathing, which are important. 

However, there are some parents who are really being pushed beyond guilt into postpartum depression or feeling angry towards the baby. I would recommend speaking with a pediatric medical professional. In addition to if you have a trusted friend or family member, it's important to engage our community resources when parenting because it's one of the most challenging things that people will ever do.
 Host: I'm sure plenty of parents have also held their baby trying to get them to fall asleep, finally, get them to fall asleep only for them to start crying again once they put their baby down. Can you tell us why that may be? And if there are any strategies or ways to kind of resolve that?
 
Dr. Pekarsky: Yeah, sure. Babies love to be in physical contact with their caregivers. I think, when we think about babies, not as little people, we really discourage that in pediatrics, but just as human beings, it makes sense that they want to be close to the people that they love and who love them. So, they don't have the same level of awareness as older children and adults do, but they recognize when they're being placed down, they're no longer next to their warm caregiver. And I think they respond to that because they're frustrated with crying, that's their way of communicating, they don't have a lot of other ways, especially in the first six months of life, to respond to their environment. They signal their distaste for being placed in their safe sleep space, while crying. And I know some parents there's a lot of different approaches to this. One approach is to put the baby down, walk away, close the door, and either listen to the crying because you have a monitor, or don't listen to the crying, and it will extinguish eventually, and you have several rough days when you're doing that. So that's one method of sleep training, and some people are able to tolerate that, I will say that it is really challenging for new parents, whether it's their first baby, second, third, or fourth, to listen to the baby cry a lot, and some people live in smaller homes that they really can't get away. I never recommend that if the parents are not ready to do that. 

Another technique is to put the baby to sleep, and then go back and reassure the baby that the parent is still there. And I think that has its pros and cons for the baby and the parents. It's sometimes sad if it satisfies the parents more than the baby, though, because the baby may be, like, partially asleep, and then the parent comes in to pat them or even comes into the room, and the baby wakes up again. It's based on parental preference and support and resources. I wouldn't recommend this for a parent who's parenting alone, necessarily, who has three other kids in the house and who's already really frustrated. I would, for that family, recommend lots of soothing, as much as possible, with walking with the baby, white noise, other things that may help the situation.
 
Host: Yeah, so there's no right or wrong way to handle situations like this. Which I'm sure in some ways is probably good for parents to hear and in some ways, it may be frustrating, because there is no one way. It's basically whatever feels right for the parent in some ways? 
 
Dr. Pekarsky: I think in medicine, and especially in pediatric medicine, which I practice. It's shared decision-making. In shared decision-making, even about parenting practices, the parents have the final say in everything. And if a parent comes to me and says, “What would you do?”, then I tell them what I would do and what I did do with my children when they were young. And sometimes, families just want to hear that, and I'm happy to talk to them through my professional and personal experience.
 
Host: It feels like parents can be understandably very judgmental of themselves and want to be the best parent that they possibly can be. But as you said, asking a doctor like yourself, asking a friend or someone, a family member you're close with how they handled it can be reassuring to know that hey, whatever you do, whatever you decide to do, is probably going to be right for you and your child.

Dr. Pekarsky: I think as long as they're being safe, the things to avoid are in my opinion, endorsed by the American Academy of Pediatrics, not sharing the sleep surface. If you're getting to a point where the only way you can get your child or your baby to sleep is by sleeping in the same bed with them, then we have to revisit that approach. And then the other issue that will come up, of course, no one would condone this as someone who's become so frustrated that they pick up and hurt the baby. So in those scenarios, the latter, the advice is always put the baby down in the crib, walk away. Doesn't matter if the baby's crying, the crying is not going to hurt them. It's more piercing to our ears and our hearts as parents. 

I think parents need to know that because you're right, there's so much judgment of parents, especially these days with social media, and all the resources that are online. And I think you said it best: parents don't have to be perfect, or you were kind of going there; parents don't have to be perfect; they've got to be good. They've got to be loving and attentive, and they have to do their best.
 Host: Yeah, just to maybe reiterate, it is true that if you leave your baby in the crib or in their bassinet, whatever it is, and then check on them periodically, they will eventually go to sleep, the crying will eventually stop to tell parents that hey, this won't last forever.
 
Dr. Pekarsky: It won't last forever, but for anyone who's parented or has provided care to a young infant, it feels like it's going to last forever. But I can guarantee you it won't. Particularly if you look at the length of time that this occurs during the baby's life, it is a period of time when most babies are starting to soothe a little bit better by three months of age. But it is an incredibly long period of time when you listen for hours on end to the baby’s cry. I should also mention that sometimes colic just presents as a baby who must be soothed the entire time, so that's also a baby who has colic. It's just that you can soothe them, but you must hold them the entire time, or you have to rock them the entire time, which is exhausting as well.
 
Host: What are some tips or best practices you have? You mentioned rocking, consoling kind of constantly. But some best practices for parents to console their baby who may be crying a lot.
 
Dr. Pekarsky: I’m going to share a personal tidbit because my youngest child had colic. And some of the things that worked best for her were holding her and walking around with her, which we mentioned. Another thing that I eventually figured out when she was a little bit bigger, I think probably around the one-month age, maybe six weeks, was putting her in an infant carrier that was strapped to my chest, because she needed that contact, and she was fine. If I had her against my chest, she would have been fine. That allowed me to move about my home, do chores, do the other work, and take care of her twin brothers, who were toddlers at the time. 

Some other things that help babies would be swaddling, and it's not super-duper hard to swaddle an infant, you can get help from a pediatrician or a nurse in a pediatric practice or another pediatric professional. Maybe your parents and extended family may know how to do it as well. It's just important that it's not so tight that the baby can’t obviously breathe. You must make sure that the blanket is below the collarbone of the baby so nothing comes up above their face. But they do like that sensation, it kind of mimics them being in utero when they were growing and kind of being compressed by the uterus. 

I'd say another technique is to use white noise and this makes sense again, other people, adults use white noise, kids use white noise to sleep. Sometimes that sound, whether it's a white noise machine or something as simple as putting your phone on with some white noise or the vacuum like people used to do. Those are very effective at soothing babies. It's not going to work every time, but that's a great technique as well.
 
Host: Dr. Pekarsky, there's a myth, or maybe it's not a myth, out there that sometimes crying for an infant child is their form of exercise. It's their way of moving their body, moving their muscles a little bit. Is that the truth? What's the reality there?
 
Dr. Pekarsky: That's an interesting question. I don't think I've been asked that, or anyone's shared that myth with me, but I can see it. And it kind of makes sense because if we think about crying as a way of expending energy, I think babies who are overstimulated do cry. And that's their way of getting off some of that steam that they have built up. Older children and adults could use, hopefully, their words to express themselves and other modalities, but infants have nothing else besides the sounds that they make.
 
Host: It's very interesting. We all have our own ways, I'm sure, of expending energy, whatever it is that we're looking to get out of our bodies and babies are limited, so that's interesting. Dr. Pekarsky, you're also an expert in child abuse pediatrics. Can you talk to us about Shaken Baby Syndrome or shaken baby? How does that come to be? What are some of the effects of that? And obviously, why is it so important for parents to avoid that?
 
Dr. Pekarsky: As a child abuse pediatrician, I see many victims of abusive head trauma. And while it is gratifying to make that diagnosis, to help the child and family moving forward, I think prevention is the key in terms of avoiding this because it does often lead to lifelong permanent disabilities for children. So many times, babies start crying between three and four weeks, and they peak at about two months of age. And that is the time when we start to see more cases of abusive head trauma. The peak in crying coincides with the peak in the diagnosis of abusive head trauma. 

The message I'd like to share is to normalize that for parents and caregivers, that baby is crying, it's normal, it's probably healthy for the baby, even though it doesn't feel like it to us as parents and caregivers. And the baby is fine. And you're doing a fine job as a parent. As a medical professional and as a general pediatrician, I always share with families at their child's two- and four-week visit, as part of my anticipatory guidance, that your baby is likely to start crying a lot more over the next couple of weeks. 

If we can share that with families in advance, normalize it, and say it more than just once, during a time period when they're exhausted and tired and taking care of lots of other things. Hopefully, they will internalize that and be less frustrated when their baby does start to cry more. We want to avoid parents and caregivers shaking because most times when parents and caregivers do that, they're not doing it with the intention to hurt their child or they're not waking up in the morning and thinking I want to shake my child because I want them hurt. They're doing it because they're frustrated. And their threshold for frustration and acting out on that has been crossed. Because babies are frustrated when they cry. We need to normalize crying and we need to tell parents and caregivers that they're doing a great job and be supportive of them. And hopefully, we're going to decrease the incidence of abusive head trauma over time with that and other measures.
 
Host: Finally, Dr. Pekarsky, if our listeners are looking for more information about general pediatrics, colic, crying children or just have questions about parenting, where should they go for that?
 
Dr. Pekarsky: I would reference the chapter on colic at merckmanuals.com and another great resource is healthychildren.org which is produced by the American Academy of Pediatrics. There are several pages on colic, crying and what to do for your baby there.
 
Host: Dr. Pekarsky, thank you so much for joining us on this episode of the Merck Manuals Medical Myths Podcast. As we close it out, I'll let you leave our listeners with a final word.
 
Dr. Pekarsky: I want to thank you for having me. It's been a pleasure. Medical knowledge is power. Pass it on.
 
Host: Thank you so much.



PODCAST Pediatric Myths with Dr. Alicia Pekarsky

Season 6 | Episode 3Pediatric MythsDr. Alicia Pekarsky, MD: Parents don't have to be perfect. They have to be good. They have to be loving and attentive and they have to do their best.Joe McIntyre...

Pregnancy is an exciting time that brings plenty of changes to an expecting mother’s health. This excitement also can come with its share of stressors. Soon-to-be mothers and parents need to pay close attention to changes to the health of the mother or the baby. 
One condition many expecting parents have questions about is preeclampsia. Preeclampsia is either new high blood pressure or worsening of existing high blood pressure that develops after the 20th week of pregnancy and is accompanied by excess protein in the urine. 
Preeclampsia can cause the placenta to detach and/or the baby to be born too early, increasing the risk that the baby will have problems soon after birth. In some cases, preeclampsia can suddenly cause seizures (eclampsia). If not treated promptly, eclampsia is usually fatal. It’s important for patients to be prepared to discuss preeclampsia with their physicians and know the signs of preeclampsia. Here are answers to some of patients’ most common questions about preeclampsia. 
1. What’s the difference between preeclampsia and high blood pressure?
The difference between preeclampsia and chronic hypertension (high blood pressure) ultimately comes down to timing. After the 20th week of pregnancy, new-onset high blood pressure accompanied by protein in the urine is defined as preeclampsia. Before 20 weeks, a woman with high blood pressure readings would be diagnosed with chronic hypertension (high blood pressure not related to pregnancy).  
Women with chronic hypertension, whether diagnosed before or during pregnancy are at a higher risk of developing preeclampsia. Women with chronic hypertension before pregnancy who develop worsening high blood pressure are diagnosed with what’s known as preeclampsia superimposed on chronic hypertension. 
2. Who’s at risk of preeclampsia?
Preeclampsia can occur in any pregnant woman. Even expecting mothers who have no prior health problems can be at risk. That said, preeclampsia is more common among women with certain disorders or characteristics, including high blood pressure before pregnancy. 
Other risk factors include preeclampsia in a previous pregnancy, diabetes before pregnancy (type 1 or 2 diabetes) or developed during pregnancy (gestational diabetes), obesity, advanced maternal age (over 35 years) or young maternal age (under 18 years), and relatives who have had preeclampsia.  Women who became pregnant through in vitro fertilization or with autoimmune disorders may also be at increased risk.  
3. What are the signs and symptoms of preeclampsia?
Watching for common signs of preeclampsia is vital to a healthy pregnancy, delivery, and the postpartum period. The classic symptom to watch for after 20 weeks is headaches that do not go away. Changes in vision like blurriness, flashing lights, spots or increased sensitivity to light can also be a sign. Some expecting mothers experience nausea throughout their pregnancy. But new nausea or vomiting that develops after 20 weeks could be a sign of preeclampsia. Other things to watch for include pain in the upper-right quadrant of the midsection and swelling of the face, hands, fingers, neck, and/or feet. 
A pregnant woman should call her doctor if she has a new headache that does not resolve or lessen with acetaminophen or if she has sudden swelling of her hands or face. When in doubt, contact the doctor—it’s important to make sure whether there is a health problem. 
4. Can preeclampsia ever be caused by white coat hypertension?
“White coat hypertension” is a common term for individuals who experience high blood pressure in clinical settings but not during their everyday lives. Women who typically experience anxiety during blood pressure readings during medical appointments should discuss this with their doctor. However, if a blood pressure reading is high, it is usually repeated. If it is still high, this usually means that there could be a problem that needs to be monitored and investigated to see if treatment is needed. All consistent high blood pressure readings need to be addressed and taken seriously, especially during pregnancy. 
5. How is preeclampsia treated?
Treating preeclampsia isn’t like treating chronic high blood pressure. Women with severe preeclampsia or eclampsia are often admitted to a special care unit or in some cases, an intensive care unit (ICU). At 37 weeks and beyond, delivery is most often the “treatment” for preeclampsia.
6. Can preeclampsia be prevented?
When it comes to preventing and treating preeclampsia, there are a few common myths that should be cleared up. A salt-restricted diet and bed rest will not prevent or treat preeclampsia. Nor will reducing physical and mental stress (though those are good pursuits at any time and especially during pregnancy). 
For some women at high risk, doctors may prescribe a low dose of aspirin be taken daily during the first trimester. Studies have shown this reduces the risk that preeclampsia will occur. Additionally, it is important to take steps to be as healthy as possible and get any chronic conditions under control before pregnancy.  
7. Do women with preeclampsia have to have a C-section? 
Many women with preeclampsia can have a normal vaginal delivery. Having preeclampsia does not mean a woman has to deliver via Cesarean section. Doctors will weigh a wide range of factors in deciding the recommended birthing process. Ultimately, it depends on the severity of the preeclampsia, the stability of the mother, and the baby’s status. 
8. What is the follow-up for preeclampsia after childbirth? 
After delivery, women who had preeclampsia should see their health care professional for blood pressure measurement at least every 1 to 2 weeks after delivery. It’s also important to note that preeclampsia can occur post-delivery. If a woman has symptoms of preeclampsia during the postpartum period, she should call her doctor. 
For more on preeclampsia, visit The Manuals topic or the Quick Facts on the topic.

Preeclampsia and Pregnancy —What Patients Should Know

Pregnancy is an exciting time that brings plenty of changes to an expecting mother’s health. This excitement also can come with its share of stressors. Soon-to-be mothers and parents need to...

Season 6 | Episode 2



 

Snoring Podcast
 
 
(Joe McIntyre) Host: Welcome to another episode of the Merck Manuals Medical Myths Podcast. On this show, we set the record straight on today's most talked about medical topics and questions. I'm your host, Joe McIntyre. This is part two of our two-part series with Dr. Richard Schwab, a professor at the University of Pennsylvania Perelman School of Medicine in Philadelphia, where he is the chief of the Division of Sleep Medicine. On our first episode of this series, we discussed the topic of insomnia; why it happens, how it affects us and what we can do to prevent it. If you haven't listened to that one yet, please check it out. In this episode, we will dive into another issue with bedtime, sleep apnea and snoring. Now Dr. Schwab, let's switch gears a little bit and get away from insomnia and to a couple other sleeping issues: snoring and sleep apnea. So, something I'm sure many people face, either they have or maybe their partner experiences one or the other. Why do some people snore?
 
Richard J. Schwab, MD: So, snoring is really common. 15% of women and 25% of men are chronic snorers, in terms of intermittent snoring, it goes up into the 40-45% range. And then alcohol, just as it was bad for insomnia is also bad for snoring. So you can take someone who normally doesn't snore, you give them alcohol and they'll start to snore. Or you can take someone who snores, and you give them alcohol; their snoring will get worse, and they may develop sleep apnea. Or if you have a patient with sleep apnea, and then you give them alcohol, they even get worse. But to answer your question, snoring is abnormal; it's typically a vibration of the uvula or the soft palate, that is the thing that hangs down in the back of your throat. So, it vibrates. And that's what causes the sound of the snoring. So, if your airway’s narrow, obesity is the primary risk factor for sleep apnea. But and so many people who snore have sleep apnea. But if you have an abnormal airway, in particular, a large tongue, big tonsils, big uvula, small jaw, or your jaw’s back, they will put you at risk for snoring. So it's really common, but it means there's something wrong with your airway. It's not normal to snore.
 
Host: Those nose strips that people may see in the pharmacy or on TV commercials, whether they have magnets in them or whatever they are just maybe some metal, do they actually stop you from snoring?
 
Dr. Richard J. Schwab: No. So snoring is a problem in the back of your pharynx where the uvula is. So, what these Breath Right strips do is they open up your nasal valve. So, for the audience, everybody take a breath through your nose. Okay, now push your nose up and take another breath. It should be easier to breathe with your nose up. So that's a nasal valve. So, if you have a nasal valve problem, these Breath Right strips or whatever you want to call them, will help that. But it won't help apnea at all. So, they're not expensive, it's not going to hurt you, but it doesn't help apnea.
 
Host: Good to know. One question that I'm sure a lot of listeners have in their head is how in the world do I stop my partner, or the person I'm sleeping with, or my sibling that I'm in the same room with from snoring? How is that possible? Is there a way to do it?
 
Dr. Richard J. Schwab: So there's no simple way. You can do a lot of things, though, to wake them up. So, you can wake them up, and they'll stop snoring. You can move to another bedroom so that the snoring won't bother you; you can try to move them. So, maybe they're on their back and you move them to their side. Typically snoring is worse in the supine position when you're sleeping on your back. So, if you move to your side that will help. But most of it involves somehow knocking your partner from a deeper stage of sleep to a lighter stage of sleep or waking them up. Hopefully, they'll go back to sleep. But what typically will then happen is they will begin to snore again or have apnea again. So, there's no simple way of getting rid of that outside of waking them up.
 
Host: You just mentioned that moving them from a deeper sleep to a lighter sleep, is there a certain cycle, sleep cycle, where snoring is more likely to occur?
 
Dr. Richard J. Schwab: Yeah, typically in your deeper stages of sleep, but even in stage two sleep, you can see loud snoring; stage three is deeper REM sleep. Apnea is typically worse in stage three, in REM. Snoring can be anywhere, pretty much across all those different sleep stages. You can figure out when somebody falls asleep because they often will start to snore. But you can't really fix that either. There's no way to modify that, so you’re kind of stuck with it.
 
Host: Now, if you snore really, really loud, does that mean you have sleep apnea? Essentially what is the difference between snoring and sleep apnea.
 
Dr. Richard J. Schwab: Almost everyone who has sleep apnea snores, but not everyone who snores, has sleep apnea. So, snoring may just be that your airway is narrowing a little bit and, again, fluttering your soft palate. Sleep apnea is where your airway narrows enough that you either reduce your airflow and drop your oxygen or you have complete apnea; apnea means the sensation of flow. So, you're not getting any air through and that's associated with a lot of cardiovascular diseases. But it's basically snoring, which is the first sign that you are potentially at risk of apnea. But then as your airway gets more crowded, maybe you gain more weight, or you start a sleeping pill or something else because those actually increase your risk for sleep apnea, then you develop apnea, but it's a progression. Snoring is a sign of sleep apnea. Again, you can snore and not have apnea, but almost everyone who has apnea snores.
 
Host: Okay. Why is sleep apnea such a concern? What are the risks associated with it? What happens if you have it? Take us through that a little bit.
 
Dr. Richard J. Schwab: So you can think about it, all of a sudden, you’re snoring, and then you have apnea, and you have sleep fragmentation. You're not even getting into deeper stages of sleep. So you're going up and down, your oxygen is dropping. There's sort of sleep fragmentation and arousals and changes in blood pressure as you're going off to sleep. And you wake up the next morning, you know, although you may have slept for seven or eight or nine hours, you feel like you didn't sleep at all because you never got into deeper stages of sleep. Because every time you go into a deeper stage of sleep, your oxygen drops and your body says, “I don't like that,” so they're going to wake you up. You have sleep fragmentation. There are the sleepiness effects of sleep apnea, and then obviously you worry about people driving, right? So they fall asleep driving, they are falling asleep at a red light, or they're falling asleep in movies, or they're falling asleep in face-to-face conversations. So there's a sleepiness effect, which can be important, especially if you're driving. And then there's a lot of cardiovascular effects because every time you have an apnea, it's like it's a sympathetic surge, or it's a surge of adrenaline. So all of a sudden, your blood pressure goes up. And then, so now you have high blood pressure, you're developing higher blood pressure, you can have heart attacks, or you can have strokes or different cardiac arrhythmias because your oxygen is dropping in atrial fibrillation. So, there are all these cardiovascular effects, and there are sleepiness effects. So, with treating sleep apnea, when we treat it, a lot of people feel like they've had a brain transplant. They go, “Oh my God, I can think again,” “I'm not falling asleep,” “I don't have to read a paragraph four times,” or “I'm not falling asleep or red lights.” And all of a sudden, their blood pressure gets better, they feel better and they're at less risk for heart attacks and strokes. So lots of reasons to treat it.
 
Host: Is sleep apnea only a concern for older adults or can it affect younger folks or even children?
 
Dr. Richard J. Schwab: Everybody. So, there are different anatomical reasons. Typically, it's an anatomic disease, and you have different structures in the back of your throat that put you at risk. Kids usually have big tonsils or big adenoids. So, you can take them out, and they'll get better. But the primary risk factor in adults is obesity. That makes your tongue larger, and you have more fat in your tongue, a bigger soft palate, and more fat in the soft palate. So, obesity is the primary risk. And then, as you get older, you can see it in those patients, too. A lot of times their apnea isn't necessarily as based on obesity anymore, but just as you get older, your apnea gets a little bit worse. So, all age ranges, but the most common is 30 or 40-year-old, overweight gentlemen with high blood pressure, or typically menopause makes sleep apnea worse. So typically, a woman in their 40s may not have sleep apnea, but a woman in their 50s will. Again, typically menopause creates some weight gain, and that's part of it. But almost any age range will have sleep apnea.
 
Host: Should you always see a doctor if you snore at all, or if you snore regularly, just to make sure that it's not a sign of a serious issue? When should you decide hey, I should probably see someone about this. 
 
Dr. Richard J. Schwab: Yeah, I think if you're snoring chronically, I would do it. If you snore only when you're drinking alcohol, your intermittent or nasal allergies or something like that, probably don't have to worry about it. But if you're snoring on a regular basis, and especially if you're sleepy during the daytime, you have high blood pressure, your bed partner starts to notice you stopped breathing at night. Go see your general doctor and I would get a sleep study. It's easy. You can do sleep studies at home; it's relatively easy. Sometimes, you do them in the lab, in the sleep lab, but a sleep study is not risky. And you can make sure you don't have apnea and like I said, if you have it and you treat it, you're going to feel better.
 
Host: If you have sleep apnea, is the only treatment today wearing a mask or breathing machine when you sleep? Is that the only solution now or has that changed in the past few years?
 
Dr. Richard J. Schwab: So it's changed. First of all, the masks are much better than they used to be. They're much more comfortable, a lot of them fit under your nose. CPAP stands for continuous positive airway pressure, which is the machine you're talking about. They are good in the sense that we can at least track your use. We know how many hours people use it, how many days, if it's working or not, there's a measure of efficacy and if they have mask leak. So that technology has improved, and in time, I think you're going to see personalized masks that even make it better. But it is a nuisance, and probably 30 to 50% of patients can't use CPAP. There are other options; there's oral appliances, which are appliances that fit in your mouth to pull your lower jaw forward. So, your tongue, the part you can't feel inserts into your chin. So if you move your jaw forward, it's going to pull your tongue forward, the base of the tongue, and that's going to help apnea. There are a lot of different oral appliances there; they can be a little pricey, but they work pretty well. And then there's a lot of surgeries, especially if you have big tonsils, you can take them out, that works. The newest surgical procedure is something called hypoglossal nerve stimulation, which is basically a pacemaker for your tongue. So it's a device that is inside your body and inside the right side of your chest. And then there's a lead that goes to the hypoglossal nerve, which is under your chin, and it stimulates that nerve to push your tongue toward your lips. And what's cool about that surgery is that it works about three-quarters of the time, which is better than almost any other surgery. It's reversible. It's expensive, but if insurance covers, you can take it out. But you know, if you take out your gallbladder, you can't put it back in. This you can take out and so from that standpoint, it's kind of nice, it's reversible. So if you hate it, you can take it away.
 
Host: Are there any other misconceptions or myths about snoring or sleep apnea that we haven't talked about yet that you want to address here?
 
Dr. Richard J. Schwab: So, couple points again, one with alcohol, alcohol makes sleep apnea worse, snoring worse. So be careful. And one of the things I kind of make fun of is, you know, if you drink alcohol at lunchtime, you're good to go. So the martini lunches, no problem. But if you're drinking at dinner, and you're going to be sleeping the next four to six hours, not a good idea. The other thing that's going to change, that is already here, are these GLP-1 agonists for weight loss. They're going to be a game changer, we believe, in terms of not only treating hypertension and obesity but sleep apnea and in people who are heavy. These medications do a really good job of suppressing your appetite and can absolutely help sleep apnea. So, I think that's something that people listening to this should think about and talk to your general doctor about these GLP-1's, there's a bunch of different types, and there's going to be newer ones coming out. But I think that's something people should pay attention to, at least in the treatment realm for sleep apnea.
 
Host: So Dr. Schwab one final question, at least from me, before we close out. I actually just purchased this book, “Why We Sleep” by Dr. Matthew Walker, that gets into some of the background, historical aspects of why mammals sleep in general. But in your perspective, why do humans, why do we need to sleep?

Dr. Richard J. Schwab: I would say that's a million-dollar question. It's probably a Nobel Prize kind of answer. If I knew the answer. If you think about it, from a Darwinian standpoint, survival of the fittest, sleeping is a bad thing. If you're an animal and you're sleeping, somebody can come gobble you up, right? I mean, that doesn't sound good. And so there's nothing really beneficial from a survival standpoint in sleeping. So, it must have a huge impact. It has an important effect. And as far as we know, every mammal sleeps, even fish, part of the brain shuts down in dolphins etc. So, it is clearly important. The why though, whether it's important because of memory, whether it's important for cleaning sort of waste in your brain. I mean, there's been lots of theories, but I don't think we know. But I think it's fair to say that it's really important and that you need, everyone needs to sleep and obviously if you get a good night's sleep, you have a better day at work, you can function better, think better and the whole nine yards. But to answer your question, I don't think we really know why it is, but someone will win a Nobel Prize if they figure it out. 
 
Host: Someday soon, hopefully. Final question. Dr. Schwab. If our listeners are looking for more information or have questions about snoring, sleep apnea, insomnia, where should they go?
 
Dr. Richard J. Schwab: Well, absolutely go to the Merck Manual, or merckmanual.com. There's lots of information there. You're going to not only see these podcasts, but there's information on all these different sleep disorders. So pay attention to that. That's where I would go first.
 
Host: Dr. Schwab, thank you so much for joining us on this podcast. Great conversation busting some of the myths surrounding insomnia, snoring and sleep apnea.
 
Dr. Richard J. Schwab: Thanks Joe, it was fun as usual.
 
Host: As we close out, I’ll let Dr. Schwab leave our listeners with the final word.
 
Dr. Richard J. Schwab: Medical knowledge is power. Pass it on.


PODCAST Snoring Myths with Dr. Richard Schwab

Season 6 | Episode 2Snoring Podcast (Joe McIntyre) Host: Welcome to another episode of the Merck Manuals Medical Myths Podcast. On this show, we set the record straight on today's most talked...

Season 6 | Episode 1



 

Insomnia Podcast


Joe McIntyre (Host): Welcome to another episode of the Merck Manuals Medical Myths Podcast. On this show, we set the record straight on today's most talked about medical topics and questions. Today, we're taking a closer look at sleeping disorders, specifically the common ones that most of us are familiar with but may be misinformed about: insomnia and sleep apnea. I'm your host Joe McIntyre, and I'm joined by Dr. Richard Schwab. Dr. Schwab is a professor at the University of Pennsylvania Perelman School of Medicine in Philadelphia, where he is the chief of the Division of Sleep Medicine. If that name sounds familiar, Dr. Schwab did a two-part series on sleep and dream myths last season. If you haven't listened to it, please be sure to check it out. Dr. Schwab, thanks for joining us on the podcast.
Dr. Richard J. Schwab: Thanks, Joe. Glad to be back.
 Host: Oh, we're glad to have you. So let's start off with the topic of insomnia. Can you tell our listeners what exactly insomnia is and how it is different from occasional sleeplessness?
 Dr. Richard J. Schwab: So insomnia is a perception of inadequate sleep. And all of us have insomnia some of the time, right? You don't sleep well one night and the next night, you sleep better, and you wake up fine. Typically, what happens in somebody who has chronic insomnia or prolonged insomnia, it's multiple nights where you have trouble sleeping,
 
Host: Does having insomnia mean not getting enough sleep? Or does it mean not getting any sleep? Is there a scale there? How does that work?
 
Dr. Richard J. Schwab: Yeah, it's hard because you're not measuring sleep in patients at home, at least we don't do that on a clinical basis. You could do it on a research basis. And again, it's this perception that you're not getting enough sleep, you may have actually had a lot of sleep, but you've perceived that you don't. And so we don't really know the answer that question. But you're getting some sleep. It's not as if you're getting no sleep, you get some sleep, but you just don't get enough sleep and you feel awake, you wake up and you just don't feel refreshed. You don't feel like you're yourself, you feel like you didn't get a good night's sleep. But it's more of this perception. So it's not so quantifiable.
 
Host: Does insomnia affect people in different ways? Meaning if someone gets, let's say, for example, five hours of sleep that may constitute insomnia versus if someone gets four hours of sleep, that may be okay, there may be enough sleep for them. How does that work? 
 
Dr. Richard J. Schwab: Yeah, it really depends on how much sleep you need. And everybody's a little different. People need, in general, seven and a half to eight and a half hours of sleep. But it's really hard to figure that out. The only way you can sort of determine how much sleep you get is when you go on a vacation for two weeks and the first week and just kind of recover from all the sleep deprivation because we are all sleep deprived. That's why we all drink coffee. We're all sleep-deprived. But if you take a week off, and then you don't drink alcohol, and you don't exercise differently, you might be able to figure out what the normal amount of sleep you require. But most people don't know that most people get more sleep on the weekends because we're overworked during the week, but in general, seven and a half to eight and a half hours. But there are people on both ends of that. So there are people who need or can get by with five hours of sleep and other people who get by with 10 or 11 hours of sleep. But the insomnia piece of this is, well, if I normally get seven half hours of sleep and now, for whatever reason, I'm getting six hours asleep, or at least that's what I'm perceiving, then I'll feel like I have insomnia.
 
Host: Now let's dig into some of the myths surrounding insomnia. Is it true that a person can really live on no sleep at all?
 
Dr. Richard J. Schwab: No, everybody needs to sleep and pretty much every mammal that we know of needs to sleep. How much sleep... a little more debatable, but everyone needs to sleep.
 
Host: There's a common thought that some over-the-counter products, such as melatonin, are the be-all and end-all to any person troubled with this disorder. Is there any merit to that?
 
Dr. Richard J. Schwab: There is. First of all, we can get into this, alcohol is really bad. So, one of the things people will say is you know what, I have problems with insomnia. Let's try alcohol. Alcohol causes sleep fragmentation. It may get you to go to sleep but alcohol is a really bad choice. In terms of other over the counter products of the group, melatonin is the safest. One of the problems with melatonin though, is that we don't know what the right dosage is. It's not a medication, it's just a brand, and if you buy something that says one milligram of melatonin, you may not be getting one milligram, you may be getting less, you may be getting more. In general, you don't want to take any more than 10 milligrams, but it is a naturally occurring hormone. It's not generally dangerous, but if you take too much, it will be a problem. And there was a recent report about kids taking too much and opening up the bottle. So you really need to protect it from younger people. Most of the Benadryl-type agents are like Tylenol PM, anything with PM in it. There's really very little data to know if any of those products are any good. They have a long half-life. So, if you take Benadryl, you may sleep well into the next morning; they have anticholinergic effects, so they are not good for men who have large prostates. We don't really recommend the Benadryl agents very much. And I don't think anybody should really be taking advantage of like medication unless they have an allergy or skin rash or some other reason why they're taking Benadryl, but I'd be cautious of all the PMs and of the over-the-counter, melatonin is the best, but again, very little data to support its use.
 
Host: Good to know. Now let's get into some of the differences in age for a minute here. I've heard insomnia is just a normal part of aging. As you get older, you're probably going to experience insomnia. Is that true? Is that the reality?
 
 
Dr. Richard J. Schwab: No, I don't think that's true. I do think that menopause in women causes a lot of sleep fragmentation and hot flashes. It is not uncommon for women going through their menopause to have problems with insomnia. But I see plenty of patients who are 30 years old who have insomnia which is probably more genetic than anything else. As you get older, your sleep will be reduced; you often lose what we call delta sleep and you will get less sleep. But insomnia doesn't have to be a part of aging.
 
Host: I assume most people are aware that exercise is an important part of getting a healthy night's sleep. It's an important part of a healthy life. But how does diet affect our ability to sleep either positively or negatively?
 
Dr. Richard J. Schwab: Well, first, I want to say that exercise is really good for insomnia because, first of all, it relaxes you, calms down some of the anxiety, and makes you sleepier. So exercise is a great idea. In terms of diet, eating close to bedtime is a bad idea. Probably a lot of carbohydrates close to bedtime, a bad idea. And there are certain foods that make you sleepy, that's why Thanksgiving, the turkey or the tryptophan, maybe would help but there's again, no real good studies on these different dietary manipulations for insomnia.
 
Host: Now, many self-diagnosed insomniacs may say how their body has adjusted to the lack of sleep or poor quality of their sleep. Is the human body actually capable of adjusting itself to fewer hours of sleep over a long-term period?
 
Dr. Richard J. Schwab: Not really; I mean, if you start doing it, you're going to get sleep-deprived. I mean, there's plenty of studies out there that if you reduce your sleep to four hours a night, over time, you're going to be sleep deprived, and you're not going to function as well, from a mental standpoint, physical standpoint. So, I don't think your body can adjust. Now there's a sleep debt, and you can recover that sleep debt. That's sort of what we do on the weekends, right, we recover our sleep on the weekends. And that's common because again, as I described earlier, most of our entire society is sleep deprived The other thing that I would say is not so much that it's related to your body, but patients who have insomnia, people with insomnia typically focus on their insomnia. The more you focus on it, the worse it becomes. It's kind of like breathing; if you start focusing on your breathing, your breathing becomes really weird. It's like, I don't even know how to breathe anymore. So, the more you focus on insomnia, the worse it becomes, it's very hard not to do that. But I try to tell all my patients, listen, try not to focus on this; the more you focus on it, the worse it's going to become. Don't worry about your insomnia; it's going to get better.
 
 
Host: Now, I think we can probably guess that one of the effects of insomnia is you’re tired, but what are some of the other effects of insomnia on our health, either short or long-term?
 
Dr. Richard J. Schwab: So first of all, in terms of the tired piece, a lot of that's mental, and you think you're tired, but maybe you're not really so tired, you can probably do all the things you want to do. And in fact, it may take you a little longer because you're not quite as quick, mentally, but you can do all the things you're supposed to do as long as you don't let it affect you. That's one of the reasons why we actually think coffee is not a bad idea for someone who has insomnia. You don't want to have coffee close to bedtime because it will disturb your sleep, and obviously, you probably won't want to have any coffee after lunchtime, but in the morning, it's probably a good idea. But to answer your question, insomnia, at least associated with short sleepers has been associated with heart disease. So heart attacks, high blood pressure, heart failure. So, there is some cardiovascular risk. These are in epidemiologic studies. These aren't typically one person type, you're absolutely going to get that but if you look over big populations, short sleep with insomnia is a cardiovascular risk factor.
 
Host: Now, what are some best practices our listeners can implement to prevent insomnia? Let's say it's not totally a chronic problem. At this point. Maybe it's been a week or a few nights. What are some practices that they can do to prevent insomnia?
 
Dr. Richard J. Schwab: So, as I've kind of described, exercise is really good. And it's more cardiovascular exercise, not so much core training or weight training but cardiovascular exercise. Obviously, not drinking alcohol because alcohol causes sleep fragmentation and makes things worse, and then going to bed at the same time each night. So, one of the things that you don't want to do and it's very hard if you're a shift worker and you're in that becomes even more difficult, but if you're not a shift worker is to go to bed at the same time, get up at the same time. Maybe on the weekend, you sleep a little bit longer, maybe an hour, but you don't oversleep. So, the more your body absolutely gets used to going to bed at the same time, getting up at the same time.
 
Host: How much should we avoid our phones? Is there a time before bed we should avoid our phones? I think we've all heard about the importance of avoiding them as we get closer to bedtime.
 
Dr. Richard J. Schwab: Absolutely. The bed should be used for sleeping. It shouldn't be used for working, it shouldn't be used or looking at your phone, paying the bills, watching television, any of that. In terms of the phone, yes, especially blue light affects you and makes you less likely to be able to fall asleep. You do not want to use your phone within an hour or two before bedtime if possible, and absolutely not within the bed. And the bed needs to be used for sleeping, nothing else.
 
Host: Now, let's say we've had a bit of a chronic problem or an ongoing problem with sleeplessness. When should someone consult a doctor like yourself or someone else when they feel it's become a problem? Or how should they know that it is a problem?
 
Dr. Richard J. Schwab: That's a really good question. And there's probably not a great answer for that. But I think if you start having consistent problems, and especially if there are family members who have had the same problem because maybe genetic or something's changed. Typically, insomnia can happen after a terrible event, right? Somebody dies and then it gets better. But if it doesn't get better over three months, I would think about being evaluated in the sleep center. One of the things that sleep centers can provide independent of medications is something called cognitive behavioral therapy. And that's counseling. It does a lot of different things. It teaches you sleep hygiene techniques; it tells you what to do if you can't fall asleep in bed; it teaches you what to do and how to think about insomnia in terms of not overly manifesting in ways that you might think are terrible but really aren't. What they do more than anything else is make your sleep more efficient; they actually reduce your amount of sleep and then slowly increase it. So cognitive behavioral therapy is the best treatment for insomnia if you have chronic insomnia, much better than medications, or at least as good as medications and no downside, no side effects. And so if you really do have a persistent problem with insomnia, over again, about a three month period, I would see someone in the sleep center.
 
Host: Yeah. My next question was about, quote, unquote, sleeping pills. And whether they are a safe remedy or not, what is your perception there?
 Dr. Richard J. Schwab: Yeah, the sleeping pills are interesting. They’ve all been designed for short-term use. So, six weeks, but my experience is once you get put on a sleeping pill, they are not stopped, you are on them for a long time. And they have real risks; they affect your memory, especially as you're getting older, and there are fall risks. So, you get up to go to the bathroom in the middle of the night, and you've got a sleeping pill on board, and you trip on the carpet, and you hit your head, and you break your hip. I mean, you can die from these things. So, we don't love to give out sleeping pills; sometimes, it's necessary. But they're not better than cognitive behavioral therapy. That's clear. There are real side effects. We don't really know what's the best medication; there are very few head-to-head trials, and there's some expense to this. In general, we like to do cognitive behavioral therapy. That being said, you can't get that for everybody. And again, a lot of people will try over-the-counter melatonin, which I think is fine. And you can try different sleeping pills. But that wouldn't be my first treatment.
 
Host: But there any other myths regarding insomnia that you want to clear up for our listeners or questions you’ve gotten from patients or even from students that you want to clarify here?
 
Dr. Richard J. Schwab: Sure. So again, just reiterate the fact that alcohol is a really bad choice. And then cannabis or cannabis-like products. It's not clear they help insomnia. They're very good for people with chronic pain. And they, I think, help people who have chronic pain sleep. But the one thing about cannabis in any of its forms, if you take it regularly, the one data point that I think is relevant is that when you stop it, you come off it, you are going to have very bad insomnia. So if you start a cannabis-like agent and you have insomnia, and you come off it, that's going to be a problem. Because that's the one feature of cannabis that's been shown over and over again, you stop it, you're going to have problems with insomnia. So, I'd be very cautious before I started anything like that. On the other hand, if you have chronic pain, I think kind of cannabis and the products are good for people with insomnia with chronic pain.
 
Host: Dr. Schwab, thank you so much for your time. For now, let's stop there, and on the next episode of the Merck Manuals Medical Myths Podcast, we can focus on the topic of sleep apnea; for our listeners looking for more information about insomnia, please head over to merckmanuals.com. Until next time, I'm Joe McIntyre, thanks for listening.


PODCAST Insomnia Myths with Dr. Richard Schwab

Season 6 | Episode 1Insomnia PodcastJoe McIntyre (Host): Welcome to another episode of the Merck Manuals Medical Myths Podcast. On this show, we set the record straight on today's most talked...

Ten Times to Try Telehealth from Trusted Medical Reference: MerckManuals.com
 
RAHWAY, N.J., September 10, 2024 – Merck Manuals, an authoritative online medical reference, shares advice from experts on when telehealth helps support access to healthcare and positive medical outcomes.
 
Telehealth provides patients with options to connect with their healthcare providers when a virtual visit can provide the care a patient needs and is more convenient, feasible, or safe than an in-person appointment. Doctor/patient interaction is usually done by video, telephone, or live chat and can employ patient portals, wireless devices, wearable sensors, and implanted health monitors to transmit and collect patient health data. Remote tracking is widely used for non-acute care for chronic conditions, such as high blood pressure, diabetes, and mental health disorders.
 
Telehealth Awareness Week, organized by the American Telemedicine Association, starts on Monday, September 15 and runs through Saturday, September 21.
 
Michael R. Wasserman, M.D., member of the editorial board of The Merck Manuals, observes "While there may be no substitute for an in-person office visit, telehealth serves as a beneficial supplement to traditional patient care."
 
A telehealth appointment would be an appropriate option if you:
 

    feel too ill to leave the house (but do not need emergency care)      
    get sick while traveling       
    misplace a prescription 
    want to avoid sitting in a waiting room 
    cannot take time away from work
    have mobility challenges, especially problems with ambulation 
    cannot access reliable transportation
    live in a remote area with few healthcare providers nearby
    have children who need supervision
    do not want to spread infectious diseases or be exposed to them 
     


Credible Health Information for All


More than 350 medical experts currently serve as contributors to MerckManuals.com; content is reviewed by an independent editorial board and regularly updated online. The resource is available in English and Spanish, and 12 other languages.
 
Visitors to www.merckmanuals.com can select advanced content, appropriate for health professionals and medical students, or easier to understand information developed for patients and consumers. The ever expanding online collection of assets includes a news feed, commentary, infographics, videos, podcasts, 3D models, as well as health calculators and trackers. 
 
Access to the website is unlimited and always free, there is no registration, and visitors are never asked to provide personal information. The user experience is not compromised by advertising or sponsored content of any kind.
 
Provided as a public service by Merck & Co., Inc., the digital offering is the most up-to-date version of the subject matter contained in The Merck Manuals, a series of medical reference books long trusted by doctors and patients alike.
 
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Ten Times to Try Telehealth

Ten Times to Try Telehealth from Trusted Medical Reference: MerckManuals.comRAHWAY, N.J., September 10, 2024 –Merck Manuals, an authoritative online medical reference, shares advice from experts...

Season 5 | Bonus Episode



 


 
A Veterinary Journey: Dr. Laurie Hess on Avian Medicine, Exotic Pets, and the Merck Veterinary Manual 
 
Transcript
 
Joe McIntyre (Host): Welcome to the Merck Manuals Medical Myths Podcast. On this show, we set the record straight on today's most talked about medical topics and questions. I'm your host, Joe McIntyre, and we're taking a brief break from medical myths for a minute to introduce Laurie Hess, Doctor of Veterinary Medicine and the new Editor in Chief of the Merck Veterinary Manual. After graduating with a B.A. in Biology from Yale University, Dr. Hess earned her veterinary degree at Tufts University, she then completed an internship and a two-year residency in avian and exotic animal medicine and surgery at Schwarzman Animal Medical Center in New York City. Dr Hess co-lead the Avian and Exotic Pet Service at the Schwarzman Animal Medical Center for nearly a decade, and she subsequently established the Veterinary Center for Birds and Exotics in Westchester County, New York, in 2010. Dr. Hess is also the author of the book, “Unlikely Companions: The Adventures of an Exotic Animal Doctor, (or What Friends Feathered, Furred and Scaled Have Taught Me About Life and Love)”. The book highlights her unique experiences as an exotic animal expert, with Dr. Hess, often on the front lines with pets and sometimes their demanding owners. 

On our last episode, we talked to Dr. Hess about the signs and symptoms of avian flu. If you're new to the Merck Manuals Medical Myths Podcast, be sure to check out that episode and any others on your favorite podcast platform. On this episode, we will talk to Dr. Hess about her background, lessons learned during her illustrious career and expectations as the new Editor-in-Chief of the Merck Veterinary Manual. Dr. Hess, welcome to the podcast.
 
Dr. Laurie Hess: Hi. Thanks so much for having me.
 
Host: It's great to have you. So, I want to have you talk for a little bit. Tell us more about your background. What got you interested in veterinary medicine in the first place?
 
Dr. Hess: Well, like many of my friends and colleagues, I wanted to be a vet my whole life, ever since I was 15 years old. I grew up in New York City, so I started working as a volunteer in my local small animal hospital. I didn't really know that I wanted to work with birds and exotic animals until much later in my career, but I had a crazy family. I had a mom and dad and brother. We lived in an apartment on the eighth floor of a high-rise apartment with all kinds of animals, birds and cats and dogs and fish, and we were a little crazy, but my family is very supportive of me becoming a veterinarian.
 
Host: I'm sure they're all very proud. So, during your career, you've experienced, I'm sure, a number of situations, some wilder than others, and I believe a number of valuable lessons learned. Have there been any that have stuck with you during your career?
 
Dr. Hess: Actually, there's one story that I like to share with people, because it really did shape who I am as a veterinarian. It was something that happened to me just a couple of weeks out of graduating from veterinary school. I was working during my internship, as you mentioned, and I was the night doctor, basically, the one doctor who was on all night long, running what was the largest animal hospital in the United States at the time. It maybe still is now. But in the middle of New York City, the only doctor taking care of 100 plus pets who are already in that hospital and then anything that came in the door that night. So it was a hot July night, and I walked in very nervously as a new vet into an exam room and saw that there was a man standing there with two bags, one containing a very, very large cat, not like a lion or tiger, but something definitely larger than a house cat, and then another little gym bag. And he was wildly screaming in a language I couldn't understand, but he was really, really disturbed. And I looked at him, and I looked at the cat, and I said, “it's okay, calm down. The cat looks okay”. And he said, “No, no, no”. And he took the gym bag, put it up on the table, tore it open, and in the bag was a little monkey who was unconscious. The monkey had an IV-line dripping fluids into one arm, and then the other arm was missing its hand. It was just kind of a bloody mess from about the elbow down, and he proceeded to explain to me that the cat had bitten the monkey's arm off, and he wanted me to take the arm out of the cat and put it back onto the monkey. Now, having been a veterinarian for just a couple weeks, I was not prepared for this situation, and I immediately began to freak out. It was about two or three o'clock in the morning. I politely stepped out and I called my supervisor, who was very understanding. She said, just take precautions because we know that many primates can have illnesses that are transmittable to people. And so I suited up, like in the movie Outbreak, with the whole thing on and walk back in. A little disturbing to the to the gentleman, but I took the cat, I did an x-ray, and I did see the monkey's hand. It was very tiny. It was passing through. It was almost at the other end of the cat. And I explained to him, the cat was going to be fine, and really there was no way to salvage the monkey's hand. But what I realized from this experience was this was one of the most unusual and probably the most unprepared I'd ever be for a situation, for something like this. And I realized that if I could retain my composure, and help the animals, which I did, and unfortunately, the monkey ended up having a serious illness and passing away. But we tried to help the monkey, and the cat was fine. And I got the man some peace of mind. If I could get through that at the start of my veterinary career, I could really get through anything. And so I've never had anything quite that crazy, but it was an interesting way to start my career.
 
Host: Yeah, it sounds like a TV show. I guess there's no bigger challenge to make sure you can handle the stress test early on than that. So maybe over the past few years, things have been a little less crazy than that, but I'm sure there's still plenty of wild stories you have to tell.
 
Dr. Hess: That's why I have a book. 
 
Host: Exactly right. Exactly right. We'll get to that in a minute. You are only one of about 100 board-certified avian specialists in the world. Is that correct?
 
Dr. Hess: That's correct. Yes.
 
Host: Now, can you tell our audience, what does that exactly entail? What does it mean to be a board-certified avian specialist for your winged patients and those who care for them?
 
Dr. Hess: Sure. So not many people really know this, but to be a specialist in any field of Veterinary Medicine it is not like it is in human medicine. In human medicine, it's expected that you go to medical school, you do an internship, and a residency, and often a fellowship, and then you tend to specialize. Even if you're a family practitioner, you go through additional training. In veterinary medicine, it's a little different. There are not enough internships or even residencies for people to become specialists all around the world. It's very competitive. You can theoretically just graduate from veterinary school and go out into practice. It's very hard to do that because usually you don't know enough. You go from book learning to real life, and it's very hard. So I was fortunate enough to achieve a one-year residency, as you mentioned, and then a two-year residency in avian and exotic animal medicine, and so to become a specialist, typically, you have to do some sort of residency. There are ways to do it through years and years of practice. But after that, as an avian specialist, you have to write some publications. They have to be accepted. Once you pass that stage, you have to take a test, and the test involves knowing birds all the way, from the tiniest of hummingbirds to the largest of birds like ostriches and emus and everything in between and passing that test, and then every 10 years, I have to recertify that specialty. So I'm actually doing that now, and fortunately, I don't have to take the test again. I have to show that I've kept up with my knowledge and continued education, etc. But because it's such a long haul, and it's such a rigorous process. Not many people choose to do it, and that's why there are so few of us. What it means for my avian patients is that I have a certain level of knowledge about birds and an understanding of their disease and their anatomy so that I can provide that additional care to them. And other veterinarians who are great may not have that. They may do the initial steps and then refer to me for more specialized care.
 
Host: So do you get patients, and obviously those who care for them from all over the country who come to you as a specialist and say, “Hey, I have this exotic bird that’s sick or needs some help,” and you can kind of help them out. Is that how that works? 
 
Dr. Hess: That’s how it works. I mean, we had to limit it. My animal hospital is in New York, so we try to take local patients, New York, New Jersey, Connecticut, Massachusetts, Pennsylvania. I was at one point getting emergency calls from Puerto Rico and other countries. But really, to help most animals, I have to see them. So I really try to explain, you know, I refer to my specialist friends, and the Association of Avian Veterinarians has a great network to do that, but yeah, we do get quite a few calls, and it's hard because you really do want to help everyone, but you can't.
 
Host: Yeah, for sure. Now let's switch gears just a little bit and talk about your new role as the Editor-in-Chief of the Merck Veterinary Manual. When was the first time you heard about the Merck Veterinary Manual? 
 
Dr. Hess: I heard about the Merck Veterinary Manual years ago when I was in vet school. In fact, it played a pivotal role in my passing my New York state board exams. It used to be that the New York State Board exam was an in-person exam. I think they stopped doing that, and maybe my class was one of the last ones, which was many years ago. I think it was too expensive for them to do that. But it used to be that you finished school, and then when you studied for your boards for about a month, and then in New York State, they brought you to basically a big room, a big gym. I think it was actually at the University of Pennsylvania, where they held the test, or it may have been at Cornell. They brought in animals over three days, and there were hundreds of people there, and you were brought in in small groups of like eight to ten people at a time to be asked questions, and then you'd sit around and wait for the next question. And I remember very distinctly being very, very nervous and sitting in this big gym, waiting, waiting, waiting. And someone said they brought in pigeons. So we all had our Merck Manuals with us and were frantically flipping through our Merck Manuals to read the pigeon section. And so the Merck Manual is always there with me. The Merck Veterinary Manual is a great resource, and it has been my whole career. Now, it's a website and an app which is great, and it's right at our fingertips and right on my phone, and it's a great resource for everybody, but it's been a big part of my life all the way from even before I finished veterinary school.
 
Host: I'm sure many of our listeners are not vets; they're not doctors. They're mainly consumers. Would it be valuable, or is there any ability for a consumer to read the Merck Veterinary Manual, or should they always turn to professionals like yourself instead of trying to care for their pets by themselves? 
 
Dr. Hess: That’s a great question. The first part of the answer is that yes, there's some great information. It's in the pet owner section of the Merck Veterinary Manual, again, available online and in the app, and it is a great, trusted source. Because, unlike other sources that you could find on the internet, if you Google something, we know that all the information on the Merck Veterinary site is written by veterinarians and reviewed by veterinarians. So it's reliable. It's not just something that someone picked up from a website, and it's not unreliable, and it is kept current. Certainly, if you have a sick animal, you should always go to your veterinarian and never try to treat the animal yourself. But if you're just trying to get some general information and learn about disease or care of a pet, the Merck Vet Manual is a great resource. 
 
Host: Great. Now, you're also obviously the new Editor-in-Chief of the Merck Veterinary Manual, which is exciting, but what gets you excited the most about this new role?
 
Dr. Hess: Well, as I mentioned, the Merck Vet Manual has been something that's been a big part of my career as a resource my whole life, and I'm really excited now to give back to my profession by contributing to the education of new vets, younger vets, even vets who've been out for a while, who want to brush up on some diseases or learn about new things. We try to stay current, so we're constantly rewriting the veterinary content of the chapters in there. So, you know, veterinarians can turn to that information and remind themselves of things they may have learned years and years ago. We do cover large animals and small animals, and exotic animals and zoo animals. So, there's a really huge breadth of knowledge. And I'm just really excited in this part of my career to be able to give that education back to people who are learning as my legacy to veterinary medicine.
 
Host: Now, we mentioned this at the onset of our conversation, but you are also an author of a book talking about your career and your adventures as an exotic animal doctor. Tell us about why you decided to write that book, what sorts of stories maybe are in it, about your personal and professional life. And lastly, where anyone interested in reading it can find it.
 
Dr. Hess: Sure, it was kind of something I never planned to do. I had one of my clients whose pet I was treating said, “You know, you have such interesting stories and I write books.” We started to talk. And it turned out she ended up not being the most honest of people, but I found out as I looked into this, there were people who were really interested in all the stories I had. These were all like cocktail party conversations, like my monkey story. And as I began to write them, and I was working with another author who helped me write the book. She's fabulous. I had a lot of stories, and my career has always been very intertwined with my family life. I have two now-grown sons. In the book they're young, but they're in their 20s now, and they're both interested in medicine, not veterinary medicine, unfortunately for me, but human medicine and nuclear medicine, but they were a big part of my career in supporting me as a veterinarian. And we all love animals. We always had lots of pets. So it's a fun, light read for someone who loves animals, loves interesting and funny, silly, sometimes touching and emotional stories. And it's also a little bit of a look into my life as a mom. So it's a lot of fun, and if you're interested, it's available on Amazon.
 
Host: Dr. Hess, thank you so much for joining us on this podcast. It was a pleasure learning more about you, your new role as the Editor in Chief of the Merck Veterinary Manual, and also about avian flu. As we close out, I'll let you leave our listeners with a final word. 
 
Dr. Hess: Medical knowledge is power, so pass it on.

PODCAST Bonus Episode with Dr. Laurie Hess

Season 5 | Bonus EpisodeA Veterinary Journey: Dr. Laurie Hess on Avian Medicine, Exotic Pets, and the Merck Veterinary Manual TranscriptJoe McIntyre (Host): Welcome to the Merck Manuals Medical...

For centuries, there were legends of evil spirits lurking in the tropics that would cause severe illness to visitors. Travelers would experience fever, chills, headaches, extreme fatigue and painful body aches. 
Today, we know these are, in fact, the symptoms of dengue, caused not by looming malevolent spirits but rather by mosquito bites. Dengue is a mosquito-borne viral infection that causes fever, generalized body aches, and, if severe, external and internal bleeding (called dengue hemorrhagic fever). 
For individuals living or traveling where dengue is common, there are important things to know to recognize potential signs of the disease and minimize the risk of infection. Here’s a closer look at what people should know about dengue. 
1. Not all mosquitoes carry dengue
Usually, dengue is spread to people through the bites of infected Aedes species mosquitoes. Each year, about 50 to 100 million cases of dengue and about 20,000 deaths occur worldwide. However, in the United States, only about 100 to 200 cases occur yearly, nearly all brought in by travelers returning from affected areas.
2. Dengue is spreading to new areas
Dengue is common in the tropics and subtropics worldwide. It is most common in Southeast Asia but has become more common in Central and South America, with record numbers of cases in countries including Brazil. Most often, cases of dengue reported in the United States occur in people who recently traveled to parts of the world where dengue is common. 
At the same time, Aedes mosquitoes are turning up in new places due to human activity and a changing climate. In the United States, they’ve been found in states including Florida, Southern California, Texas, Arizona and the Midwest. A few cases of locally transmitted dengue have occurred in Hawaii, Florida and Texas.
3. Dengue comes in three phases
Dengue varies in severity, and not everyone who gets infected gets seriously ill. But for those who do, it can be very serious. Dengue symptoms typically begin suddenly, causing fever, chills, a severe headache, pain when the eyes are moved, extreme fatigue and severe generalized body aches, particularly in the back, legs, and joints. These aches are often so painful that the disease has been called “breakbone fever.” 
These symptoms typically last for a few days, after which patients begin to feel better for about 24 hours. People may think they’re out of the woods, but then the fever can return, along with more serious effects, including dengue hemorrhagic fever, bleeding and shock.
4. Dengue is not contagious
In a vast majority of instances, people with dengue cannot transmit it to others. A mosquito can transmit it by biting a person with an infection and then biting someone else. Although uncommon, a pregnant woman can pass the dengue virus to her fetus during pregnancy or around the time of birth. There has been one report of dengue virus passing through breast milk.
5. There is currently no vaccine against new cases
The only dengue vaccine currently available in the United States is approved for children who have been previously infected and live in an area where the disease is common. There are a number of vaccines in development that can be used for individuals who have not had prior dengue infections as well as those who have.
6. Travelers need to take precautions
Anyone traveling to parts of the world where dengue is common should take steps to protect themselves and their fellow travelers. Before the trip, visit a travel medicine clinic and talk to the doctor about potential risks and precautions. Current recommendations and advisories are available via public health agencies like the Centers for Disease Control and Prevention. Keep in mind data often may be up to a week behind actual levels. 
When traveling, the same best practices around avoiding all mosquito bites apply. Wear light-colored, long-sleeved, loose-fitting clothing. Use insect repellant. Repellants are increasingly being added to sunscreens. Just be sure to check the labels before using any product on children. 
Ultimately, the best way to reduce the risk of dengue is to reduce the number of mosquitoes that carry it. It can be challenging to eliminate all breeding sites, but there are also innovative steps being taken to reduce mosquito populations, including introducing genetically modified mosquitoes into populations and through bacteria that blocks mosquitoes from being infected with dengue. 
7. Travelers should watch for symptoms 
Symptoms of dengue typically begin about 3 to 15 days after being bitten by an infected mosquito. Often, a traveler only starts to feel sick after they return home. If you’ve traveled and start to feel sick, it’s essential that you provide travel details when talking to your doctor. 
For more on dengue, visit The Manuals page or the Quick Facts on the topic. 

Dengue: What Travelers Need to Know

For centuries, there were legends of evil spirits lurking in the tropics that would cause severe illness to visitors. Travelers would experience fever, chills, headaches, extreme fatigue and...

Season 5 | Episode 9



 
Joe McIntyre (Host): Welcome to the Merck Manuals Medical Myths Podcast. On this show, we set the record straight on today's most talked about medical topics and questions. I'm your host, Joe McIntyre, and on this episode, we will zoom in on a virus that impacts wild birds and domestic poultry. The episode will explore the background, symptoms, and treatments surrounding bird flu. To provide expert insight, I'm joined by Laurie Hess Doctor of Veterinary Medicine and the new Editor in Chief of the Merck Veterinary Manual. After graduating with a BA in Biology from Yale University, Dr. Hess earned her veterinary degree at Tufts University. She then completed an internship and a two-year residency in avian and exotic animal medicine and surgery at Schwarzman Animal Medical Center in New York City. Dr Hess co-headed the avian and exotic pet service at the Schwarzman Animal Medical Center for nearly a decade, and she subsequently established the Veterinary Center for Birds and Exotics in Westchester County, New York in 2010. All right, so Dr. Hess, let's focus on a topic that's been in a lot of headlines lately, the avian flu. For our audience who may not be familiar with the virus, can you explain, I think what it's called is highly pathogenic avian influenza. HPAI, is that right?
 
Dr. Laurie Hess: Yes, absolutely. So avian flu, like any other flu virus, like we get flu, it's been around for years and years and years. There are different variants, as we call them. The one that you'll hear about now is HPAI, as you mentioned, highly pathogenic avian influenza, or H5N1, and the H and the N refer to proteins on the surface of the viruses, and there's different variants, but that's the one you're probably going to hear about in the news. And the reason that it's so significant now is that this particular strain of the virus is very virulent to poultry, so to chickens and turkeys, and you know guinea fowl, and birds like that and it's really kind of sweeping the nation. It's been around for years in other countries, we've seen small outbreaks in the US, but this form is very, very dangerous to chickens and turkeys. Something like 100 million poultry have been affected and, unfortunately, had to be euthanized in the past couple of years from this disease. It is something of concern because we now know that it can spread to mammals. So recently, it's been seen in cows and goats. It's been seen even in some house pets. We know that cats are susceptible to it. It is transmittable to people, but there have only been five cases, and those are cases that have occurred in dairy farm workers who are in close contact with cows who were in close contact with infected poultry. So, while we want to be vigilant about not touching infected animals, we don't have to all freak out there's been no human-to-human transmission. So again, it's something to be aware of, but not something to be extremely alarmed of right now.
 
Host: Okay, that's probably a relief for myself also, but I'm sure plenty of our listeners as well. So are there any signs or symptoms? I know there have only been five cases, but people should look out for in birds or in other poultry if they want to avoid avian flu, whether they're working on a farm or otherwise.
 
Dr. Hess: Yeah, I think the most important thing to remember is that it can affect all birds, and the way that it's spread is through wild birds like water fowl in particular, because they travel and migrate long distances, so they're not typically affected. I mean, there are some wildlife that are affected, some wild birds are affected, and there's other wildlife like skunks and foxes and things that can become affected. So if you see wild birds, in particular, that are sick. If you own chickens, if you have chickens, I know I have chickens. I have poultry. If you have turkeys or ducks or anything like that, if you see sick birds, don't handle them. If you have a sick pet chicken and you have to take it to the veterinarian, for example, wear masks, wear gloves. But if you see sick wild birds in your yard, alert your state veterinarian or your local authorities. Every state has a veterinarian or animal control, and they'll know what to do. You don't want to expose yourself unnecessarily. Ideally, you try to keep your pet birds that live outside, like your chickens, turkeys, ducks, or whatever, as separate as you can from wild migrating birds. It can be tough. I just built a big chicken coop, as I mentioned, I have a farm in Connecticut, and I really enclosed it so that wild birds can't land on the areas where my chickens are walking around. So you just want to be safe. And again, if you feel like you've been exposed to anything, certainly you want to talk to your physician, but just be smart and be safe and stay away from wild birds that are sick, wild birds in particular.
 
Host: I’m going to spread this out just a little bit. Is there anything that bird owners, whether those birds or pets or farm animals, should do when handling their avian friends who are sick, generally, versus anyone who has a sick dog or a cat or some other animal. Is there anything differently that bird owners should do? Just generally speaking.
 
Dr. Hess: Yeah, I mean, birds who are inside like parrots. I treat lots and lots of parrots. That's probably what I see most, all day long. You know, many people are not comfortable handling their parrots. I mean, we all pick up our cats and dogs. We pet rabbits, you know, all kinds of animals we handle all the time. Most people don't routinely handle their birds. Some do. But I would say it is a skill to work on with your parrots, because if you have to take them to the vet, you don't want it to be the very first time you pick up your bird and try to get that bird into a carrier. So having a carrier at home, keeping it open and maybe feeding some treats in there and teaching your pet birds to go in there, that it's not a big deal and that it's okay to get in there to travel, you know, it's something you should practice. I would say not to be crazy. You don't have to mask up and gown up to touch your pet birds inside. I would try to keep your pet birds inside. Some people like to take their birds out on their porches and hang out outside. I'd say, for right now, I might avoid that, because if you have your bird walking around on your picnic table, and there's been a wild bird who's passed over that picnic table before, you don't really want to risk unnecessary exposure. But I think all bird owners, whether you have chickens outside or parrots inside, or finches or canaries or whatever you have, should have a relationship with a local vet, because there are going to be times when your bird is sick and you don't want to be crazily searching the internet for a vet to go to, you should have someone, just like you have a dog or a cat vet available. And that bird should get an annual checkup, most people don't do that. It is very important, because, again, you're not handling that bird routinely. You might miss things, you can't tell if a bird has lost a lot of weight, because they're fluffy and they fluff up, and you can't tell what's under those feathers. So those are my general recommendations for people who have pet birds.
 
Host: Good to know. And I know this episode is not centered around myths, and you were pretty clear earlier, but I just want to make sure that our listeners are aware, is bird flu transmittable to humans by eating eggs or eating poultry in any way?
 
Dr. Hess: So, bird flu is not transmittable by eating cooked eggs, cooked poultry. We would never eat raw poultry and raw eggs, hopefully. There are a lot of diseases, including salmonella, bacteria that live in poultry and eggs that you can get if you eat them raw. And again, we would not ever encourage anyone to do that. And we don't know 100% that you can't get avian influenza from eating raw poultry products. We know that raw milk now contains avian influenza if it's come from an infected cow. So again, now we're strongly recommending that people do not drink raw milk. Pasteurization eliminates avian influenza, as does cooking eggs and chicken meat. So just cook your products and buy pasteurized milk in the store.
 
Host: Now, there can be so many sources of misinformation on many things, but also including bird flu. Where should people go to find the correct information that's sourced vetted by the people who know what they're talking about? 
 
Dr. Hess: Well, to get the most updated information on bird flu, I would definitely recommend checking out the Center for Disease Control's website, the CDC. They put up new information every day, statistics, new findings. It's very current. It's a great, reliable source of information. And of course, the Merck Veterinary Manual and the Merck Manual that covers human health, those are both sites that are reviewed by medical professionals. So, we know that the information there is trustworthy and up to date and reliable.
 
Host: Are there any best practices, Dr Hess, for people to use to avoid avian flu or other sorts of infectious diseases that may come from birds?
 
Dr. Hess: Absolutely, I think the most important thing that people who have birds who live outside, or even any other animals, even if you have indoor pets, is to practice really good biosecurity. And that's kind of a buzzword in the veterinary industry. And really what it means is, you know, it's a closed flock system. So if you have a chicken flock or a duck flock, or turkeys or whatever, that live outside, you don't bring in new birds all the time. If you're bringing in new birds, you keep them separate from your existing birds for at least a month. You want to monitor them to make sure they're not incubating anything. If you have friends come over who have their own pets, their own farm, you want them not to wear clothes that they've worn on their farm. You want them to change their shoes, or at least have, you know, like I have a foot bath, which is like a big tub of soapy disinfectant that I make people step in when they come on and off my farm so that they're not bringing things in. Veterinarians are notorious for going from place to place to place, and you know, so if you have a local vet who's coming over and doing a farm call or a house call, you want to make sure that they've changed their clothes and their shoes before they trek onto your property. And, you know, again, these are all things we have to think about. But the idea is that you don't want to serve as a source of infection on your clothes, on your hands, on your shoes. And practicing this way is really important. Even if you have a new puppy, you don't really want to bring that puppy to the park and have it play with everybody else, because that puppy's immune system is not up to date. So just smart practice don't be fearful, but just be smart and think about the action before it happens because you can't take it back.
 
Host: Dr. Hess, thank you so much for joining us on this podcast. It was a pleasure to talk to you, and also learn more about the avian flu. On our next episode, Dr Hess, will sit down with us again and chat about her background and her decision to join the Merck Veterinary Manual. As we close out, Dr Hess, I'll let you leave our listeners with the final word.
 
Dr. Hess: I really enjoyed being here, thank you so much for having me. And in the spirit of the Merck Veterinary Manual, we hope to relay education and keep everybody current on animal disease. I'd like to leave you with a thought that medical knowledge is power, so pass it on.


Avian Flu with Dr. Laurie Hess

Season 5 | Episode 9Joe McIntyre (Host): Welcome to the Merck Manuals Medical Myths Podcast. On this show, we set the record straight on today's most talked about medical topics and questions...

Few conditions garner as much attention—and controversy—as autism spectrum disorder (ASD), especially among parents of young children. People with ASD have difficulty developing normal social relationships, use language abnormally or not at all, and show restricted or repetitive behaviors. They may have a hard time understanding social cues or imagining what other people might be thinking, which can make social interactions challenging. 
Because it’s a spectrum, people with ASD experience a range of symptoms, and the disorder impacts their lives in different ways. As a result, many myths and misunderstandings have emerged around ASD, its causes, and how it affects people at various stages in their lives. Here are seven of the most common autism myths and what individuals with autism and those who support them need to know. 
Myth #1: Only boys get autism
ASD occurs in about 1 in 36 people in the United States, and it’s four times more common among boys than girls. But girls can have ASD. Another condition parents should be aware of is Rett syndrome, which is far more common in girls than in boys. Rett syndrome has many similarities to ASD, with some notable differences. Specifically, almost all individuals with Rett syndrome usually have intellectual disabilities. 
Myth #2: All People with ASD also have intellectual disabilities
Intellectual disabilities and ASD are not the same. Intellectual disabilities are more common in individuals with ASD, but not everyone with ASD has an intellectual disability, and not everyone with an intellectual disability has ASD. Attention-deficit/hyperactivity disorder (ADHD) is another condition that often—but not always—overlaps with ASD.
Symptoms that align with these conditions typically become apparent a bit later in life. For parents, the first sign to watch for is delay in language development. Other early indicators include repetitive behaviors, a need for routines, and sensory processing differences around things like noise, light, and texture. But it’s important to note that these things can be signs of a wide range of conditions. And in lots of children, these signs are not signs of any condition.
Myth #3: Nerdy kids and adults have ASD
The phrase “on the spectrum” has become shorthand for describing someone who may just be a bit shy, socially awkward or intensely interested in certain topics. These people often do not have ASD.
Pop culture tends to portray individuals with autism as savants—musical prodigies or math geniuses. Some individuals with ASD do have unique skills, but they’re not superpowers. It’s helpful to think of ASD less as a “disorder” and more as a “difference.” Sometimes those differences can be helpful in certain situations, but we are all individuals with our own unique personalities and abilities. 
At the same time, an ASD diagnosis can be a powerful tool for individuals and families. There’s no lab test to diagnose ASD. Rather, it’s based on the presence of various features. This diagnosis can be helpful as parents seek services and interventions to get their child the support that is needed, including speech therapy, occupational therapy, and more. 
Myth #4: Only children have ASD
ASD stays with a person throughout life, and the impact of the condition changes as people get older. Individuals learn to navigate social situations that evolve as they get older, including teenage years and entering the workplace as they are able. One area where young adults with ASD often need support is in navigating the healthcare system. Often, individuals will transition from a pediatrician to a psychiatrist to continue treatment and medication as they enter adulthood. 
Myth #5: There is no treatment for ASD
Doctors don’t yet know what exactly causes ASD. We know that it occurs more often in siblings and relatives, but it can affect each family member differently. It is true that for individuals diagnosed with ASD, there are no specific medical treatments doctors recommend. Yet, there are several proven ways to help individuals enhance their quality of life, including behaviorally based approaches and medications that can help control anxiety and impulsive behaviors. Individuals with ASD often benefit from practiced conversations or “scripts” to help guide them in social situations. 
Often, parents will seek out alternative treatments for children with ASD. Some of these interventions can be harmful. It’s important to discuss them with a doctor first and try things one at a time to ensure you understand the effect any one specific intervention is having. 
Myth #6: Vaccines cause ASD
Immunizations do not cause ASD. There is an abundance of high-quality research to support the lack of connection between the two. One likely reason this myth persists is that many parents start to notice the signs of ASD around the same time their children begin getting immunizations for various diseases. Despite this coincidence, it is essential that children receive the necessary immunizations to protect themselves and others from various infectious diseases. 
Myth #7: ASD is caused by bad parenting
For decades, we’ve known that “bad parenting” does not contribute to or cause ASD. Parents and caretakers play an essential role in helping their children succeed and play a major role in how their children interact with the world, but their actions do not cause ASD. 
Like each of us, every individual with ASD is unique. When we meet people with ASD where they are and find ways to connect with them, we all do better. 
For more on Autism Spectrum Disorder, visit the Manuals page or the Quick Facts on the topic. 

Clearing Up the Most Common Myths About Autism Spectrum Disorder

Few conditions garner as much attention—and controversy—as autism spectrum disorder (ASD), especially among parents of young children. People with ASD have difficulty developing normal social...

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