Staying Healthy Through The Holidays
November 23, 2012 1:01 p.m.
Dr. Christian Tomaszewski, professor of Clinical Emergency Medicine, Associate Director of Clinical Operations, Department of Emergency Medicine, UC San Diego Health Sciences.
Related Story: Staying Healthy Through The Holidays
CAVANAUGH: Our top story on Midday Edition, when we talk about healthy living around the holiday, we usually discuss how to eat lighter and keep exercising throughout this season of indulgence. But today, when we discuss staying healthy, we're talking about not catching a cold or flu, not getting injured, not getting poisoned, and trying to stay out of the ER through the holidays! Joining me to talk about the potential health hazards of this season is my guest, doctor Christian Tomaszewski, professor of Clinical Emergency Medicine and associate director of clinical operations, department of emergency medicine at UC San Diego health services. Thank you so much for coming in today.
TOMASZEWSKI: Sure, Maureen. Thank you for having me.
CAVANAUGH: Now, let's start talking about how diseases travel at this time of year. People fly, they drive long distances to visit friends and relatives. That must create clusters of colds and infections that wouldn't otherwise happen. Do hospital ERs see evidence of that?
TOMASZEWSKI: Yeah, but there's always a lag time. If I was a virus, this would be my favorite holiday season. This is the perfect opportunity for me to spread.
TOMASZEWSKI: As people get in crowded environments, a lot of hand-holding, shaking, people in your face. I mean, viruses spread very easily. And remember, there's an incubation period of days after that.
CAVANAUGH: So when you say you see it, you would expect to see maybe some people come in with colds and flus they wouldn't necessarily have because of what's going on here in San Diego but because of out of town guests maybe sometime next week?
TOMASZEWSKI: Of spreading, right, and bringing them to the schools. So there's always a lag time as the indexed case comes to your community and spreads it to the people around them, and the children take it to school. Right now, we're on the shoulder of the flu season. We're really sporadic. Not that many cases. But a couple more weeks, people being in crowded situations, and a lot of travel, and being huddled in schools because it's colder, January, February we should start seeing a big surge.
CAVANAUGH: Now, what about airplanes? Are they especially incubators when it comes from communicable diseases?
TOMASZEWSKI: I don't know if I'd say incubators.
[ LAUGHTER ]
TOMASZEWSKI: You're implying that the plane is growing the virus. But the air is circulating in there, so if someone has a virus next to you, it's more likely it's not going to be blown away. Most of it is spread by hand-holding and hand-shaking, and we inadvertently touch our face. We do that so many times a day we don't even realize it.
CAVANAUGH: When does flu season usually start?
TOMASZEWSKI: Usually January or February. Some years it's been as early as October. We're lucky because it hasn't started yet. And that means you have an opportunity to get immunized, which is the main way to combat influenza.
CAVANAUGH: What is most at risk from the flu?
TOMASZEWSKI: The patients we're most scared of getting the flu are seniors, 65 and older, infants, and then across the board anyone with coexisting illnesses, like heart disease, lung disease, where they don't have the capacity to handle an illness that could make it harder for them to breathe.
CAVANAUGH: When is a child old enough to start receiving a flu vaccine?
TOMASZEWSKI: Usually 3-4 months.
CAVANAUGH: Oh, I see. So infants can get them.
TOMASZEWSKI: Yeah, but what we're depending on is in the first couple months of life, the infant has passive immunity for the mother. So that's why it's important for pregnant women to become immunized.
CAVANAUGH: So seniors, people whose immune systems are compromised in one way or another should get immunized. But people in the emergency room, doctors, nurses who work with sick people all the time have a tendency not to catch a lot of flus or colds. What is their secret?
TOMASZEWSKI: Well, I can't reveal that secret because --
[ LAUGHTER ]
TOMASZEWSKI: No. The secret is, we feel like we're invincible, and some of us do succumb to illness, but we are very stringent about hand-washing. We stress that with our staff and ourselves to make sure we clean our hands with the alcohol cleansers that are available in every single room in the hospital. Every emergency department room has a hand cleanser. So we clean before we see the patient, and we clean afterwards. And I think that has really cut down the spread of germs, and especially viruses and most bacteria in healthcare settings am
CAVANAUGH: So people who take a lot of vitamins and take a lot of things that are supposed to be barriers to colds and flu, they might be better off if they just washed their hands more frequently?
TOMASZEWSKI: Just get some hand cleanser. I've seen a lot of people carry it in their purse or pocketbook. I think that's a great idea.
CAVANAUGH: How busy are emergency rooms around the holidays?
TOMASZEWSKI: On the holidays usually we have an ebb in the population. People are putting things off, paying attention to their families and taking care of holiday needs. And what's when payback comes because after the holiday, we have a surge as people that put things off, finally they have time to deal with whatever was bothering them during the holiday. And a lot of times right after the holidays, there are reduced hours in a lot of the clinics. So we're serving our role again that the emergency department is always a safety net for the community, and that's when we see a surge.
CAVANAUGH: If someone has to go to the ER, who can you tell them about navigating their way around there serious?
TOMASZEWSKI: I don't want to dissuade anyone from coming to my department, but if you don't need to be there, you really don't want to go there. If you're coming down with a flu, the last thing you want to do is spread it to other patients. Can you handle it at home on your own? If you have a personal doctor, that's a great time to give them a call. You get a call back from the doctor themselves or the nurse to give you some advice to hold off until after the holidays or the weekend to be seen in the office. But if you do have to come, come on in. We're there for you. Make sure that if you feel really ill, the nurse knows about that. But of course you may not be brought back right away if we're really busy because we have to stratify based on degree of illness. And if we put you in the waiting room, it's not because we don't care about you. It's because we think you're safe to wait. And we will get to you as soon as we take care of other, sicker patients.
CAVANAUGH: Right. Let's move away a little bit from diseases and talk about what types of conditions and injuries you see in the ER during the holidays.
TOMASZEWSKI: Well, let's put it together. We have a lot of fat, salt, sugar, and throw in some alcohol for good measure. You mix that all together, and you overindulge, it's a perfect recipe for emergencies. And that's why right after the holiday, we see a surge of cardiac case, heart disease, heart failure where people build up fluid in their lungs, heart attacks. It's a perfect time for that. And people have been putting off their chronic illness, they may have felt not too well right before the holiday. They go, oh, I can just make it another 24 hours. And then I hate to say it, but they can crash and burn right after.
CAVANAUGH: Right. That's interesting. Are there certain symptoms if someone is listening to this, not that they have them, but are there certain symptoms that you should be aware of that you need more than just visiting the emergency room, like perhaps you should call 911?
TOMASZEWSKI: You should definitely call 911 if you're having chest pressure, especially if you're a senior and you're older or you know you have risk factors for heart disease. Chest pressure, chest pain, having trouble breathing. If you're having numbness and tingling or inability to use an extremity, then you're thinking stroke. Stroke and heart attacks are time-sensitive illnesses where we really have the technology to intervene and prevent almost entirely most of the damage. For that to work, people have to come early. And we're talking minutes. It can't be hours.
CAVANAUGH: And would you suggest if people are feeling this kind of thing, pressure in their chest or tingling, instead of driving in they should call 911?
TOMASZEWSKI: Absolutely. I don't want those people driving themselves in. Of the horror of them not making it or hurting themselves or others is astronomical. If they're just a couple blocks, someone can drive them there. But if you have doubts, the subject doesn't look good, they're perspiring, chest pressure, even mild pain, I think that's a job for an ambulance.
CAVANAUGH: There are many of people traveling at this time of year, many with small children, maybe staying with relatives who don't necessarily have the kind of child-proof homes they have at home. Does that as a result in emergency room visits?
TOMASZEWSKI: Yes, the toxicologist, the emergency department, and poison centers see a surge in calls and exposures. We're disrupting the normal routine. You have small toddlers coming into home where is there are seniors that aren't used to having children around. Things may not be locked up safely. And remember, a lot of the safety caps are not necessarily on there. If you're a senior and you don't have children in your home, you may elect not to have safety caps. If you travel, you may leave that bottle lying around, or you may open it and lay down the pills before you take them. We always say children act fast, so do poisons. That's a perfect opportunity for a poisoning or an accident to happen.
CAVANAUGH: I believe you mentioned the idea of these new sort of laundry detergents pods, and dish pods they have. They are pods, and they're multicolored, and they look a little bit like candy.
TOMASZEWSKI: Oh, absolutely they look like candy! They come in bright colors, they're these concentrated detergent packets. But they have other chemicals in them to help them dissolve in your laundry and do a good job. Because they do a good job in the laundry, they do a good job of dissolving in the mouth and releasing these toxins that can cause problems with breathing and actually we have had children lose consciousness from ingesting these things. They're more dangerous than we think.
CAVANAUGH: So it's good to keep them under wraps. I know you're a toxicologist with the poison control center. What are other typical things people should watch out for when it comes to poison and accidental poisonings during the holiday?
TOMASZEWSKI: Well, as we talked about, keeping cleaning supplies locked up is a great idea, especially if you have little ones visiting and you're not used to them. The other thing we run into is there may be older kids that have toys that are appropriate for them, but then when you have toddlers running around grabbing those thing, we have had cases of supermagnets being ingested and causing intestinal obstruction. It blocks the gut because these magnets stick to each other, and then things can't move. We had a teenager last year, for fun she had them in her mouth and swallowed them. She ended up in the operating room. And they have now these little balls that are really cool, you add water and they expand, well, if a child swallows it, which has happened, they're going to expand and block up their gut. Stuff like that can happen. Little toys that are choking hazards, you don't think about it because you have teenagers. So unusual things can happen because we're disrupting the normal routine. And the thing that always scares me when I see a toddler that's acting funny or been poisoned is who was visiting? Who may have dropped a pill? One cardiac medication for blood pressure can be devastating to a small toddler that weighs less than 20†pounds.
CAVANAUGH: Absolutely. Are there any accident injuries that are typical of the holidays?
TOMASZEWSKI: Well, like we said, we're missing alcohol with a bunch of fat and sugar. We're also mixing alcohol with knives and a lot of Julia Child wannabes. So a lot of people are handling knives that aren't used to that. So we see the classic cutting a bagel in your hand instead of using a cuttingboard.
CAVANAUGH: Oh, that hurts just thinking about it.
TOMASZEWSKI: Or a mandolin injury.
CAVANAUGH: I don't know if it's an old wives' tale, but people run themselves down a lot during the holidays. Does exhaustian make you more prone to actually catch a disease?
TOMASZEWSKI: We think that, yeah, if you're exhausted and your immune system is not tuned up, you're not sleeping enough, you're probably more prone to illness. And that's where the main things in terms of prevention come into play. Make sure you have flu immunization this year. You can help both yourself and the community. And the other thing is hand cleansing. I can't stress that enough.
CAVANAUGH: And when should people actually stay out of the emergency room? You must see a lot of people there who don't necessarily need to be there simply because they've eaten too much or maybe they have a hangover or -- are there any guidelines to, you know, say you can handle that at home?
TOMASZEWSKI: The ABCs. If you're breathing okay, and you're alert, and you feel like you have good profusion. You can stand up and walk okay. You probably don't need to come into the emergency department for some reason, the cold or the flu. If you've got routine flu and you don't have coexisting illness, you're going to get better on your own. We don't have a magic bullet for most viruses. Even bronchitis will get better on its own. And also, the CDC is trying to encourage us to give less antibiotics, not more because most things do get better on their own. But if you do have coexisting illness, you're worried about heart disease or stroke or you have belly pain or things that don't get better with over the counter things like Tylenol or, you know, a little bit of malox, you probably should come into the ER.
CAVANAUGH: Because you like patients.
TOMASZEWSKI: Well, we want to see patients, we don't wish you there, but we're there to take care of you.
CAVANAUGH: Thank you very much for coming in and speaking with us.
TOMASZEWSKI: Sure, thanks for having me. Take care.