Stroke Month: Young Survivors and Rehab Goals

Stroke: Think F - A - S - T, published in the Kitsap Sun Newspaper, November 29, 2009

A stroke happens when a blood clot blocks an artery that carries blood from the heart through the body. Brain cells die when there is interrupted blood flow to the brain. Stroke is also termed “brain attack.” When brain cells are impacted during a stroke, speech, movement and memory can be affected depending on where in the brain the stroke occurs and how much brain damage ensues.

Stroke is the third leading cause of death in the United States. Heart disease is the first and cancer is the second cause of mortality. Stroke is the leading cause of disability and more than 2/3 of stroke survivors suffer some type of disability.

Small strokes may only cause minor problems such as weakness of an arm or leg while larger strokes can cause paralysis or inability to speak.

About 87% of strokes are ischemic strokes; occurring when arteries are blocked by the gradual build-up of plaque and fatty deposits or a blood clot. Hemorrhagic strokes happen when a blood vessel in the brain breaks and blood leaks into the brain. Hemorrhagic strokes account for the remaining 13 %, and more than 30 % of all stroke deaths. Since two million brain cells die every minute during stroke, recognizing symptoms and getting medical attention immediately can be life saving.    

Symptoms of stroke include sudden onset of weakness of the face, arm or leg, especially on one side, sudden confusion, trouble speaking, understanding, seeing, difficulty walking, severe headache without a known cause, dizziness and loss of balance or coordination.

 F.A.S.T. is a method for recognizing and responding to stroke symptoms:

 F = FACE Ask the person to smile and look for face droop on either side

A = ARMS Ask the person to raise both arms and look to see if an arm drifts downward

S = SPEECH Ask the person to repeat a simple sentence and listen for slurred or strange speech

T = TIME If any of these symptoms are observed, call 9-1-1 or bring the person to the nearest hospital.

 Source: National Stroke Association.

 Vaccines for H1N1; who is a candidate, published September 27, 2009

On September 15th, the Food and Drug Administration announced four vaccines for the 2009 H1N1 influenza virus have been approved.

National distribution of the vaccines is expected in early October, including nasal spray, available for those healthy people ages 2-49 years, according to the Centers for Disease Control and Prevention.

The new H1N1 vaccines endorsed have undergone the same FDA product quality testing, manufacturing oversight and lot release procedures applicable to seasonal influenza vaccines.

What about adverse reactions?

Initial data provided from adults participating in clinical studies has shown the H1N1 vaccines induce a strong immune response in most healthy adults 8 to 10 days after a seasonal influenza vaccine — the same as the seasonal influenza vaccine.

Nasal spray vaccine for the novel H1N1 virus and for seasonal influenza is not recommended for people with severe or life threatening allergies to chicken eggs.

As with the seasonal flu vaccine, the H1N1 version is not recommended children under 2, adults 50 years of age and older, those with medical conditions that could place them at high risk from influenza complications, including chronic heart or lung disease, diabetes or kidney failure and pregnant women.

Side effects of flu vaccines for children may include runny nose, headache, wheezing, vomiting, muscle aches and fever and for adults, possible side effects are runny nose, headache, sore throat, and cough.

For those who prefer avoiding injections otherwise known as “shots” of medication the nasal spray is a less painful alternative. In addition, the nasal mucous provides a targeted site for drug delivery, and is widely used for the administration of decongestants and anti-inflammatory steroids. The nasal passages are also effective for systemic drug delivery because of their high surface area, high permeability and the potential for rapid plasma absorption and transfer of drugs into the central nervous system.

So there you have it. The H1N1 is coming — but so are vaccines to help you resist it. Once they’re available, the choice will be up to you.

Consider this if considering vaccine for H1N1, formerly known as Swine Flu, published in the Kitsap Sun Newspaper, August 30, 2009

As the month of August concludes and fall is approaching, many look forward to Indian summer and planning autumn activities.Along with the annual transition, September kicks of vaccination season. In April this year, “swine flu”, now Known as H1N1 as of June of 2009, was detected in the United States.

Vaccines for H1N1 are expected to become available this Fall, as manufacturers take steps in the process to manufacture a novel H1N1 vaccine and as clinical trials are conducted. It is not expected the seasonal flu vaccine will provide protection against the “novel” H1N1 flu. It is anticipated the seasonal flu vaccine will be available earlier than the H1N1 vaccine, however, if available concurrently, both vaccines may be administered on the same day. The Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices recommends vaccination for H1N1 to the following groups as higher priority than the rest of the population: pregnant women, people living with or caring for children younger than 6 months, health care and emergency medical personnel, individuals from 6 months and 24 years and people ages 25 through 64 who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

Although availability and demand for the H1N1 vaccine is not entirely predictable, a shortage is not expected.

Vaccine-preventable infections account for more lost lives of Americans annually, than HIV/AIDS, breast cancer or traffic accidents. Approximately 50,000 deaths ensue each year from vaccine-preventable diseases in the U.S. according to the National Foundation for Infectious Diseases.

The CDC lists these antiviral drugs as available for treatment and/or prevention of H1N1: oseltamivir or zanamivir. Once ill, with H1N1, antiviral drugs can reduce symptoms and may prevent serious flu complications. Influenza antiviral medications taken within two days of illness onset is optimal. Antiviral medications may also be prioritized by severity of illness or higher risk for flu complications.

For more information, please visit the Centers for Disease Control and Prevention Web site at www.cdc.gov/swineflU/. Consult your physician for advice and medical treatment.

Don't Wait to Draft Advance Directive; Personal Decisions. Published in Print Edition, Kitsap Sun Newspaper, LIFE Section August 16, 2009

Most of us have heard the expression “nothing is certain but death and taxes.”  The advantage with the latter is, the date taxes are due is predictable and even if procrastination ensues, the finish line looms. With the former, waiting until the last moment to prepare is rarely an option, due to the uncertain and inevitable nature of passing.  Creating an end of life plan or Advance Directive form puts forth instructions desired regarding future medical care if a person becomes incapable of describing his or her wishes.  An individual may state wanted and unwanted care.  In Washington State there are three advance directives available relating to end of life: the Health Care Directive (Living Will or Directive to Physician), The Durable Power of Attorney for Health Care (DPOAH) and the Physicians Orders for Life-Sustaining Treatment (POLST). 

The Health Care Directive tells others whether one wants life artificially prolonged and if nutrition and hydration are wished. The Health Care directive is only followed if one is in a terminally ill condition or certified by two physicians to be in a permanent unconscious condition.

A (DPOAH) is a document that names another person to make health care decisions if one is unable to do so.  The person identified in the DPOAH should be familiar with what is expected  as stated in the Living Will.  This document remains in effect unless revoked by the DPOAH creator  or by a court order or court appointed guardian. 

A POLST form is a document that is discussed between a patient and a physician regarding end of life decisions.  The POLST is a physician order that requires signature of the patient or legal surrogate and the physician and it is not an Advance Directive. The POLST compliments an Advanced Directive and is portable from one health care setting to another.

Local Hospitals have Advance Directives available to the public and the forms are free of charge and available in print and for download at the Washington State Department of Health, www.doh.wa.gov/livingwill/, The Washington State Medical Association; www.wsma.org, Compassion and Choices of Washington: www.wsma.org/patient_resources/advance-directives-qa.cfm.  

Project Management, Stealthily avoiding scope creep, published in the Kitsap Sun, August 9, 2009

http://www.kitsapsun.com/news/2009/aug/09/jennifer-hardgrove-ask-jenny-how-to-maximize-in/

Mission creep has been cited at the United Kingdom Parliament, www.parliment.uk as a potential source, causing increased cost and lengthened time in executing military operations. The term means the expansion of a goal beyond its original scope and is commonly used in reference to military operations in foreign countries. Initial success may have occurred with an original project, however, newly adopted practices and plans (mission creep) could deter from the original objective through distraction and lack of resources.  

The phrase “scope creep” in reference to project management in the United States functionally resembles the term “mission creep.  Alternate terms for scope creep are: focus creep, requirement creep, function creep, feature creep and kitchen sink creep.  According to the Project Management Body of Knowledge (PMBOK) guide, project management is “the application of knowledge, skills, tools and techniques to project activities to meet project requirements.” Scope creep, as defined by the Project Management Institute (PMI) consists of changes in the project that result in additional work, expanded expectations, creeping elegance, and gold plating.  The primary problems with allowing scope creep to advance are; going over budget and projects that are past due.

Scope creep is the bane of most project managers due to the inevitable and insidious nature of unforeseen barriers and challenges. Once obstructions are identified, project managers can adopt skills and strategy to minimize the impact of roadblocks. Scope creep, has been identified most commonly in the fields of information technology, engineering and health care project management.

In order to facilitate success in the initial project planning stage: designate results to be achieved, timeline and cost, so that if scope creep takes root, the project management leader and team can refer back to the original outline. Some common causes of scope creep are; new or revised requests from project drivers, new task requirements, problems unrealized by the project management team, and market changes. 

Ways to avoid scope creep are to be prepared, align business with information technology resources, use unilateral decision making and take measures to deter inflexibility.

Scope keeps creeping Continued...

Progressive Elaboration and Scope Creep

The 4^th edition of the Project Management Body of Knowledge (PMBOK) Guide explains that the term progressive elaboration indicates a project management technique in which a plan for a project is continuously and constantly modified for improvement.  As more detailed knowledge and communication become available the project management leader and team take more involved measures to more accurately complete the project.  As an influx of improved information is delivered in a series of successive iterations, progressive elaboration is a fundamentally important step in refining the project plan.  

A Project Scope Statement is initiated in the project planning stage and it provides information regarding the project scope and major deliverables.  The project scope management plan describes how the scope will be controlled and how changes to the scope will be managed.  Scope Creep refers to obstacles and challenges, which present as barriers to completion of the project.  If scope creep barriers are not addressed and regulated, the results are detrimental to the project, quality, deadline, resources and customer approval. Variance analysis can measure whether a project is on course through using information from project performance reports.  Consequently, problems or changes that impact the project scope, need to be investigated and approved or the project team is best served by reverting back to the original project plan.

Cross Training Your Brain, published in the Kitsap Sun Newspaper, June, 2009

Is cross-training on your mind since temperatures are slowly creeping upward?  Runners and athletes enthusiastically report: incorporating multiple kinds of strength training and cardio-workout tactics enhances the ability to physically compete.  In the world of technology, conditioning has also shown the brain’s capacity to maintain youthfulness and make complex decisions.  Researchers from the University of California, at Los Angeles (UCLA) compared people ages 55 – 76 that search the internet to those who read books and didn’t surf the internet and found more than twice the brain activity in the frontal lobe on MRI, an imaging procedure in which a magnetic field and pulses of radio wave energy can be used by physicians to determine parts of the brain that are handling the critical functions of thought and speech.  Studies at UCLA showed an hour a day of web-surfing, five days a week stimulates activity in the frontal lobe as shown on MRI.  Dr Gary Small, director of the UCLA Memory & Aging Research Center at the Semel Institute for Neuroscience & Human Behavior and co-author Gigi Vorgan have written a book called iBrain: Surviving the Technological Alteration of the Modern Mind.  Parents pose the inquiry to Dr Small: With increased use of technology, will kids’ grades be adversely affected if children are simultaneously instant messaging, text messaging and listening to iPods? On the website, www.drgarysmall.com when speaking on CBS News, Dr Small answers parents with a question; how are kids’ grades and how are we adapting to technology? The CBS video on this site illustrates “Your Brain on Google” evidenced by dramatic differences on MRI for “net savvy” brains compared to “net naïve” brains reading text vs. searching the internet.

To partially understand the relevance of relating increased brain function relies on study of the functions of the frontal lobes of the brain; known as the personality headquarters and emotional control center of what’s enclosed in the cranium.  Problem solving, motor function, memory, language initiation, impulse control, spontaneity, judgment are among the areas the frontal lobes orchestrate.   

Links to see for Healthcare Resources:

Government:

Centers for Medicare and Medicaid Services:  www.cms.hhs.gov/

Federal Registrar: www.gpoaccess.gov/fr/

Medicare’s quality improvement organization (QIO) in Idaho and Washington State: www.qualishealth.org/

WA State Hospital Association: www.wsha.org/

Fiscal Intermediary information  www.procritline.com/

The Office of the Actuary at CMS: http://www.cms.hhs.gov/nationalhealthexpenddata/

The Center for Studying Health System Change: http://www.hschange.com

The Henry J. Kaiser Family Foundation (particularly their annual series on health insurance and healthcare marketplace trends) http://www.kff.org

Managed Care:

Sanofi-Aventis Managed Care Digest Series, annually updated: http://www.managedcaredigest.com

Physician Information:

www.ama-assn.org/

Consulting

Health Information Technologies and Interqual:

(Criteria Medicare uses to audit hospital/SNF Care) www.mckesson.com/

Resources for health care clinicians and actuaries (criteria used by Regence, Group Health and other payers to review hospital los/svc provision): 

www.milliman.com/ 

Institute For Health Improvement:  www.ihi.org

Audit of the Department of Justice Information Technology Studies, Plans, and Evaluations:

 www.usdoj.gov/oig/reports/plus/a0739/exec.htm

corporate integrity agreements/ US Dept of Health and Human Services Office of Inspector General:

http://oig.hhs.gov/fraud/cia/cia_list.asp

Current News Sources:

Wall Street Journal: online.wsj.com

Drudge Report:  

www.drudgereport.com

Fox News:

www.foxnews.com/

Heritage Foundation: www.askheritage.org

Medical Journals:

New England Journal of Medicine content.nejm.org

JAMA pubs.ama-assn.org

Private Insurance Payers/Insurance Information

State by State: Contact Government officials

Aboard Washington State Ferry

The Buzz on Yellow Jackets, published in the Kitsap Sun Newspaper, July 2009

Do you avoid bees for fear of getting stung? The common ways of shunning bee stings include wearing light colored clothing, avoiding perfumes, and scented lotions, staying away from nests and covering food and drinks. Less conventional and slightly suspect ways to fend off bees include: standing still and pretending to be a statue or alternately waving hands vigorously to scare bees away.  Blow on bees to encourage them to move along or hold your breath so they lose interest.  Not swatting the targets to avoid angering bees vs. smashing to show the bee who’s boss. Bee catchers, insect repellent, pesticides or contacting an interested beekeeper or exterminator might work too. You may have tried some of these things and were injured regardless.  I was stung by a bee in a parking lot filled with cars, without obvious signs of budding flowers, uncapped soda or hives anywhere. After a double bee sting my son, age 6 developed a keen fear of bees. I tried the usual methods to ease his fears; explaining that bees produce honey, beeswax and pollinate plants. With an attitude of “if you can’t beat them, join them” I studied the perceived stinging nuisances and uncovered some interesting facts: There are 20,000 known species in nine recognized families, found everywhere but Antarctica.  Bees obtain nectar from flowers with a long complex tongue, i.e. proboscis.  A group of researchers at Technische Universitat Berlin have recently reported that division of labor among honey bees impacts learning performance as they age.   By switching their social role, the aging bees keep learning intact or improve.  The oldest foraging bees show decreased capacity for associative learning, however the nurse bees who care for the brood and Queen inside the hive demonstrate improved learning performance. When foraging bees assumed nursing roles their brains showed evidence of becoming “young” again.  

Source: Society for Experimental Biology (2009, July 5). A Young Brain For An Old Bee. ScienceDaily.   

Next time something is bugging you, before you run away or get rid of it, check it out.

Alzheimers Disease, published in the Kitsap Sun, 2006

Based on current research the exact role (if any) of aluminum pots, pans and cans is still being researched and debated.  Not enough evidence exists to conclusively consider aluminum a risk factor for Alzheimer’s disease (AD) or a cause of dementia according to current research findings. Scientists are continuing to learn a lot more about what causes AD. In addition to genetics and apolipoprotein E (ApoeE), education, diet, and environment are being studied to learn more about the development of this disease. Scientists are finding increasing data that some of the risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, and low levels of the vitamin folate, may also increase the risk of AD. Proof for physical, mental, and social activities as protective factors against AD is also increasing.

The only risk factor gene identified so far for late-onset AD is a gene that makes one form of the protein ApoE. Everyone has ApoE, which helps carry cholesterol in the blood. Only about 15 percent of people have the form that increases the risk of AD. Other genes may be likely to increase the risk of AD or protect against AD, but have not been discovered to do so records the Alzheimer’s disease Education and Referral (ADEAR) Center. 

Eat a healthy diet, exercise regularly, challenge yourself mentally, and stay in touch with friends and family are ways to improve health. Staying more physically and mentally active, and more socially engaged may lower the risk for developing dementia. Combining these activities is even better.Please consult your healthcare provider for diagnosis and treatment.

Alzheimers Disease Fact Sheet: www.nia.nih.gov/Alzheimers/Publications/adfact.htm 

Comprehensive Overview of of Symptoms: www.mayoclinic.com/health/alzheimers-disease/DS00161

More about Alzheimers Disease: www.alzheimers.org

A bone mineral density scan is a low dose x-ray which checks an area of the body such as the hand, hip or foot for signs of mineral loss and bone thinning.  The lower the density of a bone, the higher the risk of fractures.

 Bone Scans and Bone Denisity Scans, published in the Kitsap Sun, 2006

Denser bones are less likely to break.  Bone Scans require an injection prior to the scan, while Bone Density Scans do not. Virtually no preparation is needed for a bone density scan. The procedure is fast, and painless, according to the Mayo Clinic Website at www.mayoclinic.com The site further indicates that your score will be measured as a T-Score, which is the number of units – standard deviations (SD) that your bone density is above or below the standard. Above 1 means your scan is considered normal, a score between 1 – 2.5 indicates osteopenia, which is a condition that involves below normal bone density and can lead to osteoporosis. Above 2.5 indicates osteoporosis. Utilizing a Z-score is also used to interpret the test: which means the standard deviations are used along with what is normally expected for your age, sex, weight and ethnic background.  The Z score can help your Dr identify an underlying cause for low bone mass.  Only a small amount of radiation is involved and a bone density scan can be a useful aid in evaluating the probability of a fracture along with your medical history to determine if any preventative treatment is needed. This information is not intended as medical advice. For any medical guidance please consult your physician.

To learn more about Osteoporosis and Bone Density scans, visit:

www.medicinenet.com/bone_density_scan/article.htm

www.radiologyinfo.org/en/info.cfm?pg=DEXA

Care Needs

Entually the challenge of assisting our parents and grandparents to find either help in their own home or a new home with staff and amenities to meet their needs. Also facing most of us is that obtaining the ideal situation for our loved ones may mean trying more than one option and re-addressing care needs as they change.

Becoming familiar and understanding terms such as retirement apartments, assisted living, group homes, skilled nursing care, custodial care and home health care is a start into navigating what is a journey that you will return to more than once.

Talking about options for financing care is another area we can sit down with our parents and grandparents and talk about, keeping in mind talking about money isn?t always something comfortable, but necessary to do before there is a crisis and care needs to be implemented right away.

Retirement apartments are an option for many seniors once they sell their home and want to downsize. I have heard many who have moved to a retirement community exclaim, why didn?t? we do this sooner. Typically lawn maintenance is done for the recipient living in a retirement community and other services are readily available for a fee, such as laundry, housekeeping and shuttle van service for appointments. The social activities can be an added draw for staying active and can be appealing to those living alone. Many places have onsite beauty salons and other services so that one doesn?t even need to leave the grounds unless going out on the bus for an excursion or outing. Some retirement homes have the option to transition to assisted living or a nursing home when and if needed.

Assisted Living facilities (ALF) applies to a living arrangement where there is staff available that may assist with some meals, and help with medication management as well as with housekeeping. In some cases ALF are staffed with nurses who are available on a fee for service basis.

Many patients and families ask what is the difference between skilled nursing care and custodial care as viewed by Medicare guidelines. Ultimately a patient?s physician along with possibly a physical and occupational therapists determine what skilled needs are involved. Assessments by nursing care managers are also important to help determine what needs an individual has and what will be paid for by insurance. In most cases skilled care follows and acute event that requires hospitalization, such as a hip replacement surgery, heart surgery, or stroke. Skilled care involves, nursing care, physical, occupational and possibly speech therapy and implies that the patient?s level of care at the beginning of treatment can be improved by the nursing and therapy given. Custodial care or non-skilled care might also involve care from nurses and therapists, however the key difference is that improvement in the level of function is not expected. To further elucidate this point, someone who has undergone surgery and needs assistance to learn to walk again and build up endurance in order to return home may qualify for skilled care, while another patient who needs help getting dressed, walking and having meals prepared on a long term basis may need care for everyday needs which would be considered custodial or non-skilled. Differentiating between these two types of care also involves a financial component. Care at a Nursing home or Subacute or Acute Rehabilitation center may cost in the range of 3,500 to 7,000 per month inclusive and may not be covered by Medicare or other Insurance, based on the expected outcome of the treatment. Also something to keep in mind is that if Medicare does cover treatment for skilled care, the implication is that once optimal improvement has been reached, care may need to continue but Government assistance discontinues. Care needs are usually determined on a week to week basis and sometimes determined every few days, depending on the expected duration of the plan of care.

After completing a course of skilled care at a Rehabilitation facility many patients and families choose to transition into a long term room where therapy can still be available and nursing is provided around the clock. This care, again is custodial and is either paid for through the individuals estate or application for state assistance can be made for qualifying patients.

Other patients choose to have caregivers in the home. Typically caregivers are paid by in the range of $18.00 per hour. You may be able to negotiate a lower rate for 24 hours of care at a time, e.g a daily rate, although many charge hourly for their time. Finding the right caregiver can be done through an agency, which has checked references for their staff or you may have success checking with people you know through the community. Some people run an add in the local paper to seek a caregiver and many caregivers advertise to find work under the Domestic Services section in the Classified advertisements. Finding the right person has a lot to do with personalities and how your loved one would feel about having someone in their home each day. Many patients become very close with their caregivers and enjoy the companionship and having the benefit of having some light housekeeping and meals made, as well. Caregivers also can be available to help you with picking up prescriptions, errands and even a trip with you to your favorite restaurant for lunch now and then.

Sitting down and talking about options before you need them is so important and vital to do early. It is not uncommon that an unexpected fall or illness takes place and the patient and family are not prepared for the financial burden of caring for a loved one, or a spouse wants to provide the care but physically cannot. Another scenario is that the children of the person needing care is still working or caring for their children and cannot be away to care for their parent. So many families are caught off guard and overwhelmed at what is needed for their loved one when the time comes, that if you stop and sit down now when your loved one can make decisions while things are going well, you will better be better guided to respect his or her wishes when the time comes to make extra care arrangements. Sitting down initially can be anxiety provoking and your loved one might not be ready to talk about the future on the first try. You may want to do a little research on your own and if it is the case and get some brochures and information by phone or over the internet for your next discussion and leave that for your parent or grandparent to look over. Also mentioning experience a friend or someone you know has had can also break the ice. If at first you don?t get through on the topic, don?t give up. The important thing is to keep trying and if you find that you aren?t getting anywhere, share your concerns with another family member that may be able to break the ice. If it appears that care needs are approaching faster than you are ready for, an intervention with several family members could be beneficial. Care managers in your community can be hired to help with exploring options and mediating as well. Talking about getting older and needing care isn?t an easy topic so give yourself and your loved one some time to absorb the information and remember you are doing this for someone who needs your help and in the long run, planning ahead makes the transition as smooth as it can be in a difficult time.

Published in the Kitsap Sun, 2007, Prescription Medication Disposal

Dear Jenny,

How do we dispose of expired prescription and over the counter medications to protect our environment?  I read in a Magazine not to flush meds down the drain or toilet or throw them in garbage because they leach into soil and harm our environment. I have also heard that scientific studies show human hormones found in fish have increased significantly.

Ga Neille, Bremerton

Dear Ga Neille,

Medications can be disposed in household garbage after removal from the original container and placement of the medications into a zippered bag and a second non-transparent bag as recommended by The Kitsap County Health District in conjunction with Waste Management. Improper disposal of medications via toilets, sinks, septic or household drains may harm water quality and the environment. In King County the protocol is to put medications in original containers in a “sealed heavy-duty zip-lock bag; conceal that bag in a second plastic bag to prevent being found.” To discourage unintended use, consider dissolving tablets or capsules in container with small amount of water. To see the complete list of things not to flush down the commode or sink go to http://dnr.metrokc.gov/wtd/community/oldstuff.htm Although water should not be a means of disposal, “traces of pharmaceuticals have been detected in landfill leachate and the disposal of pharmaceuticals in engineered landfills may merely postpone pollution of surface water and ground water, according to “Disposal of Medications from Residential Consumers”, dated October 12, 2005. To read the complete publication, please visit http://www.productstewardship.net for information compiled with the Washington State Board of Pharmacy, local Hazardous Waste Management Programs, Public Health, and the Northwest Product Stewardship Council among others. Researchers suspect hormones and medicines in water may have effects on fish although short or long-term human health effects on humans are currently unknown according to the document.  

Reader asks about Rabies, Published in the Kitsap Sun, 2008

Dear Jenny, 

Could you explain about rabies and how people contract the disease?

 Signed, “Bat Man”

 Dear Bat Man,

Rabies is an infectious viral disease affecting the nervous system. Rabies can be spread to humans from mammals.  Wild animals that might have rabies are raccoons, skunks, fox, coyotes or bats. The disease is transmitted through biting. Rarely, people get rabies from a rabid animal’s saliva, if it gets directly into the eyes, nose, mouth or a wound. Rabies is considered a fatal disease, so if bitten by any animal, it is imperative to seek prompt medical attention. Rabies can only be confirmed in a laboratory.  According to the Centers of Disease Control and prevention, (CDC) tens of thousands of people are treated successfully for rabies each year. Few people die each year from rabies in the United States. 

Most human rabies cases, in the United States, have been caused by rabid bats. Some Bat Facts: Bats are not blind, are neither rodents nor birds and won’t suck your blood. Bats are mammals and most don’t have rabies. Many bats are nocturnal creatures that are major predators of night flying insects, including agricultural pests. Bats play key roles in ecosystems around the globe - from rain forests to deserts.

Bats that are not flying and found in unusual places, such as at a home or on a lawn, in the daytime may have rabies. Rabies cannot be contracted only from seeing a bat. Bats should not be handled. According to the CDC, people cannot get rabies from contact with bat guano (feces), blood, and urine or from touching a bat’s fur. Contact your veterinarian and the health department if you think your pet has been bitten by a bat. Keep vaccinations current for your animals. Teach children not to handle unfamiliar wild or domestic animals.

Bat information sources:

Bat Conservation International, Inc.
P O Box 162603
Austin, Texas 78716
www.batcon.org

U S Fish and Wildlife Service
Division of Endangered Species
4401 N. Fairfax Drive, Room 452
Arlington, Virginia 22203
www.fws.gov

Deception Pass, Whidbey Island, WA Picnic Shelter built by the Army CORPs of Engineers in the 1930's -The Golden Age of Rustic Design