I've been reading _Is it All In Your Head?_ by Suzanne O'Sullivan, MD. On the whole, it is a very good, very important book. Unfortunately, there are a few things in it that I had a problem with. All of my complaints involve when O'Sullivan steps outside her neurology arena and starts applying what she is talking about in patients she sees in her neurology practice who have symptoms (seizures, paralysis, weakness, loss of feeling, etc.) in her area of expertise which do not behave the way those symptoms should behave when objective tests are applied (EEG, electrical stimulation of nerves, reflex testing, etc.) in areas in which she has no expertise. Especially allergies and food intolerance.

Some people have meat allergy which appears for the first time in adulthood, and which in some people disappears after a few years. The onset of the allergic reaction tends to be quite delayed vs. most food allergies.

https://en.wikipedia.org/wiki/Alpha-gal_allergy

This is a _classic_ instance of "Oh that must be medically unexplained but surely can't be a REAL allergy because real allergies don't behave that way." Adult onset. Delayed. Etc. ON TOP OF THAT, it's a reaction to a _carbohydrate_, and allergies are reactions to proteins. Right. RIGHT?!? (ETA: I am describing a rhetorical position here; it is not mine.)

To be clear, O'Sullivan makes no mention of meat allergy or alpha-gal. (ETA: Technically, it is not hers, either.) I am using it as an example. We got really incontrovertible evidence of the _mechanism_ that alpha-gal delivered via tick bite causes adult meat allergy when scientists wanted to figure out why there was regional variation in negative reactions to cetuximab. (ETA: My position is the science-y one. Science has shown conclusively that at least some adult onset meat allergy which behaves very unlike some allergies is caused by a tick bite.)

O'Sullivan is ALSO very clear that every year, something with no medically known cause is found to have a medical cause. She just figures that it happens so rarely that people are really bending way too far over backward looking for medical causes and not looking for psychological causes and that needs to change. I don't actually disagree with her general thesis.

On page 190, she talks about candida and candidiasis, and that period of time now past when a lot of people thought they had it but actually didn't test positive for it even when medical professionals looked really hard. On the next page, she says:

"In the twenty-first century the exact same symptoms are more likely to be attributed to gluten sensitivity or allergies."

I'm not necessarily going to argue about the basic idea: there is a fraction of the population -- not trivial in size but not by any stretch of the imagination most people -- which will tend to latch on to the latest Oh This Is Causing All Your Problems, adopt an associated set of health prescriptions (usually diet oriented Don't Eat This / Do Eat That) and try to pester everyone they know into doing the same, while claiming that it cured all their ills. I'm not even _opposed_ to the general phenomenon. I figure each one of these things helps some subset find the thing that really was wrong with them, they stick with what worked for them, and the herd moves on to the next thing. My theory is that some day, everyone will have finally found the thing that worked for them and we'll all feel about as well as we can. (Is my progressivism / optimism showing? Oops! I'll try to cover that up again. I know it is unseemly.)

Here is what she says:

"I recently went to a dinner party where every person bar two, at a table of ten, reported that they had an intolerance of or allergy to at least one foodstuff. Most had developed the allergy in middle age, which is not how an allergy typically behaves."

She's a neurologist. How did she become so expert at allergies? Adult onset allergies are not particularly uncommon. Adult discovery of allergies is also not uncommon and sometimes deeply tragic. And every time someone decides to actually do a general population study for food allergy, we learn all kinds of new things, which means the field is by no means all caught up with reality. (See alpha gal above, but did you know that 2-3% of the general population is allergic to shellfish? I didn't. I am, and I didn't know how common it was. Legal Sea Foods has employees who have been quoted in the press saying that every little bit somebody shows up from the Midwest, eats something they've never had before and drops from anaphylaxis at the table and often is never revived. Don't you think this is something that maybe shouldn't fucking be dismissed so readily?)

I live in an area where food allergy is taken very seriously by restaurants, in part because of restauranteurs like Ming Tsai (mmmm Blue Ginger):

https://www.bostonglobe.com/lifestyle/food-dining/2015/09/22/when-food-allergies-dine-out/bflRHxlP0y3Gv4blUw13pO/story.html

I've got food allergies and intolerances (yes, Dear Reader, both the proteins AND the sugars in milk cause me problems -- and not just cow's milk either, alas), some of which were detected in infancy and some of which I learned about the hard way as an adult. My husband has food intolerances. Many of my friends have food allergies and intolerances. The group that the author encountered may well have self-selected -- this was a party, I'm assuming some of these people hang out together on purpose. I know it's much easier to socialize with people who have or know someone who has food issues. Dealing with doctors like that one at T-weekend a while back -- or Dr. O'Sullivan -- is the worst. Here we've finally figured out a way to stay out of the doctor's office, and the doctor is now joining us for dinner and trying to tell us that it's just a phase.

No, dear doctors. No, it's not just a phase. It's not all in our heads. And just because food allergy now doesn't look like we used to understand it before is actually reflective of progressively better understanding of food allergy. Which it would be nice if you put some effort into catching up on.

She also disses IBS as probably psychosomatic; she seems blissfully unaware of FODMAP.

Oh, and as near as I can tell, this book is further evidence that in the UK, when people say "learning disabled", they mean something super-different than people mean in the US.

I have no reason to disregard O'Sullivan's neurology based expertise. I agree with her that there is a population over-using (to their own detriment and our shared expense) the medical system in pursuit of something which would be better found through the mental health professions. We part ways whenever she steps out of her area of expertise, which leads me to suspect she hasn't really understood the mental health side of this problem at all.

https://www.ncbi.nlm.nih.gov/pubmed/26737584

R. showed me a short article in Spectrum, thinking that this was what I had posted about the other day. It is not. This is ultrasound. I posted about photoplethysmography, which I have probably spelled wrong this time. Not the same at all, notably in that the ultrasound version actually works.

Very exciting development! People have been fiddling around with ultrasound for BP for decades (since before the early 80s, for sure), but generally the solutions involved cuffs. This is a cuffless, non-invasive strategy and would allow measurement of the full waveform which might give us more insight into what is going on with the cardiovascular system.

Here's hoping they productive this puppy and sell it on amazon in a few years! I know I would buy one.

We went to the Cape for a week, Aug 20-27. I'll try to get those posts in, but that might take a little while because A. doesn't start school until Wednesday and T. not till next week. But the sitters are back at work at the schools, leaving me with Actual Responsibilities.

In the meantime, I read my email this morning, and ran into this:

http://www.medpagetoday.com/Blogs/CareerConsult/59896

While I certainly love that Dutch medical care for chronic conditions that have a crisis (say, diabetes and the possibility of amputation) lead to actual, in person conferences including the patient, patient's spouse or other family member/advocate, and involved health care professionals, we don't really do that here. We should, but we don't. The patient in the description is, basically, the person managing her care, unless she is unable to, and then someone else is responsible and if she wants to control who that is, that's what Living Will/Health Care Directives accomplish in our system.

I recall some years ago TV news coverage of a woman who called an ambulance to pick her up at the waiting room for the emergency department of a hospital. She had been there for some time, waited for hours, and was, according to the news report, suffering from an asthma attack and in need of immediate care.

While is is certainly very exciting to read about things like an asthma patient waiting for hours in the emergency department, it calls into question the meaning of a word like "asthma". Our general sense of the condition is either not critical (like the kind I, my husband and our son have), manifesting largely as a variety of terrifying sounding coughs that never actually result in breathing stopping or even being all that impaired (they didn't call it asthma when I was a kid, then they called it asthma for a while, and then they were back to not being asthma but maybe being some kind of reactive airway or who the hell knows. But if is very manageable without meds or anything else other than Don't Stop Exercising Suddenly and keep up with your allergy maintenance regime) or rapidly deteriorating. If you have the not critical kind, then calling for an ambulance to pick you up in the waiting room of the emergency department to find a more cooperative hospital no longer sounds like We Need to Fix Our Health Care System and now sounds more like, okay, who exactly is paying for this, anyway.

The story at MedPage made me think of the asthma story. So I thought about that for a while, and I thought about what I knew about POTS and I looked up Ehlers-Danlos, where I saw that it typically has minimal impact on life expectancy and yet this young woman had already died. I know, it is terrifying to see things like tachycardia and a rare medical condition one has never heard of, but lots of things (including some kinds of tachycardia and many rare medical conditions) have much, much, much scarier names than health outcomes. Also, there is a flavor of Ehlers-Danlos with no genetic test.

Then I read the MedPage piece for a third time, and I thought to myself, Self, you have read books about personality disorders. When Jess says:

"But as a human I know that "Tears = Bad" and anyone that cries for twelve hours while begging someone, anyone, to call their physician of record isn't faking it. She didn't stop crying until a doctor with some humanity sedated her following shift change. The complete disregard for her pain stripped her of her dignity and brought me to tears.""

I start immediately thinking of all kinds of stories I have read in these books about personality disorders and other mental health conditions. Jess is right: when someone cries for twelve hours, they are not "faking" it. And I don't doubt that knocking her out stopped the crying. But I also start thinking about the phrase, "personality disorder". But I was having a really hard time thinking which one. I could think of several this _could not possibly be_, and I know you've already figured it out, because the record keeping pretty much is a dead giveaway, but what I did was give up on the thinking and went back to what I do best.

I typed, no quotes: hypermobility ehlers danlos syndrome personality disorder

This is the top result:

http://www.ncbi.nlm.nih.gov/pubmed/24272065

Perhaps, some day, we will have a genetic test to explain why so many people in my extended family have agoraphobia, or something that looks sorta like it (I always think of it as Won't Leave the House Syndrome, and over time it degenerates into Won't Talk On the Phone and, in the last decade of life, Won't Actually Talk At All Syndrome). I would not be surprised one teeny tiny bit that virtually all mental health issues have at least a partial genetic/physical underpinning. Nor would I be surprised to learn that there were immune system, nervous system, autonomic system, joint system implications (the joint pain in my family alone is epic).

But until that Shining Day in the Future when All Has Been Debugged, we are stuck working with what we know. Plenty of sleep at a consistent time. Good food in the right amounts. Clean water. Appropriate physical activity. Supportive friends and family. Meaningful work. Etc. If you have a medical condition that doctors can't help you with, more time in the hospital trying to make them fix you isn't going to actually change the fact they can't help you with it. It is tragic. It is wrong. We should collectively work to fix it.

I sure felt sorry for the nurses, and I'm a little surprised that it didn't occur to Jess that maybe that "broken" call button had been intentionally disabled. I mean, it's damn easy to do (happened accidentally to A. when we were in for her appendectomy; when the bed call button didn't work, I found the staff call button on the wall and hit that. We sure got action then! And the people who showed up made for damn sure the bed alarm was hooked up after that. I, of course, apologized profusely for hitting the wrong button. "By accident." The staff call button cannot be disabled. Why Jess didn't just hammer on that puppy is beyond me. *shrug*).

Anyway. I hope to hell someone makes progress on Ehlers-Danlos. Things like this look interesting:

http://www.ncbi.nlm.nih.gov/pubmed/25821094

This description is a nearly perfect description of one of my cousins:

http://www.ncbi.nlm.nih.gov/books/NBK1279/

I'm pretty selective about how I access the medical system, but I see a lot of positives in the primary care model where a patient has a relationship with a professional who then supports access to the rest of the system. However, I have also become increasingly clear on how ill-prepared primary care physicians often are when they encounter that complex nexus of mental and physical health problems with no adequate solution within allopathy.

This isn't a new idea, but I'm starting to see coverage of it in new areas.

http://www.businessinsider.com/opioids-could-actually-make-pain-worse-2016-7

Secondary coverage of this:

http://www.ncbi.nlm.nih.gov/pubmed/27247388

This is interesting, because the secondary coverage in this case is written by one of the (many) study authors. Some of the other study authors -- ones who probably did more of the actual research work, given that their names occur later in the list and Cynicism -- produced this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2783351/#R58

Basically, if you take opioids for some kinds of pain which involve glial cells Acting Up and Making Things Hurt That Would Normally Not Hurt, the pain will continue much longer -- even after you quit taking the opioids. Yikes! I knew about opioid induced hyperalgesia, and that was heartbreaking to learn about (truly, a Fate Worse Than Death --- you take something thinking the worst it will do is kill you, but you hurt so bad you can't stand it, and it instead makes the pain worse). Now it turns out that you can't even narcan your way out of this Fate Worse Than Death.

Good news:

"the U.S. Food and Drug Administration (FDA) has now approved two glia-targeting drugs for Phase 2 clinical trials for the treatment of neuropathic pain: ibudilast (Avigen’s AV411) and propentofylline (Solace’s SLC022). In addition, ibudilast has FDA approval for testing its ability to increase the clinical efficacy of opioids. While having distinct mechanisms of action58,59, both ibudilast and propentofylline are orally available, blood-brain barrier permeable, glial activation inhibitors (based on microglial and astrocyte activation marker suppression) that have strong support treating pain from various rodent models58,59. Ibudilast has a long history of safety in humans for the treatment of asthma and post-stroke dizziness. Propentofylline has previously been tested in humans as far as Phase 3 trials for treating Alzheimer’s disease, with the trial discontinued for lack of efficacy."

ETA: Yeah, I just noticed that too. You CAN narcan your way out of this Fate.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588470/

http://www.cnn.com/2016/06/27/politics/supreme-court-abortion-texas/index.html

I was worried about this. It was a relief to get the ruling and see that it went the way I thought it should. It is terrifying and depressing when Freedom and Liberty and Rights are eroded just because it so happens that it is a woman's Freedom, Liberty and Rights in question.

The opinions are worth a look:

http://www.supremecourt.gov/opinions/15pdf/15-274_p8k0.pdf

A lot of the losing argument is really offensively technical, imo (res judicata). It feels like the conservative side grasped at straws through this whole process.

I look toward the future with more optimism for women having to make difficult decisions. This will be one less thing dragging them down.

http://www.bostonglobe.com/metro/2016/06/18/the-other-side-america-war-opioids/i9YYLR0bGWFdP9z1T1pwjI/story.html

As I expect nearly every reader knows, public interest in opioid abuse/overuse/overdose/death has been quite high in recent months/years. This is probably mostly because the number of people dying as a result of opioid overdose has gotten to be on a level with things like automobile related deaths. There has been a push -- at the state level, at various agency levels, etc. -- to get doctors to prescribe fewer opioids for shorter periods of time. There is a community of patients suffering from chronic pain and the doctors who serve them which has objected to this additional regulatory pressure. The article examines the problem.

"Dr. Julia H. Lindenberg, a primary care doctor at Beth Israel Deaconess Medical Center in Boston. ... But when Lindenberg’s practice stepped up urine testing, the doctors found that a few longstanding patients, who had been considered at low risk for abuse, in fact were misusing drugs. Some had cocaine or other drugs in their urine, and some were not taking the prescribed opioids, suggesting they were selling the pills."

Contrast Lindenberg's story with this primary care doctor's:

"Baratz said he, like most other primary care doctors, has long experience managing patients who take opioids for chronic pain. These people, he said, have no part in the addiction crisis. He monitors them closely and stops prescribing at the first hint of abuse."

I sort of wish the Globe had asked Baratz if his practice was also doing regular urine testing on chronic pain patients who had long-standing opioid prescriptions.

The article concludes with people making dire predictions that people unable to get legal pain meds will switch to illegal ones (indeed, some will -- that's exactly why we're trying to reduce opioid prescriptions. They have such a tendency to result in people becoming addicted and turning to illegal opioids for cost and convenience reasons) and people with chronic pain will commit suicide.

I predict we will be seeing more articles like this over the coming months. I hope more of them include details about which people being quoted are doing urine testing and which ones are not. That's a helpful detail, that lets us know who is actually committed to best practice ... and who is committed to status quo ante. Anyone committed to status quo ante who is worried about an increase in suicide has perhaps not taken seriously the increase in deaths due to opioid overdose over the last few years.

Also, if you are thinking along the lines of, those poor people, don't just take their pain medication away, I would point you at this:

https://en.wikipedia.org/wiki/Opioid-induced_hyperalgesia

In at least a few cases -- as Lindenberg pointed out -- taking away the pain medication actually helped with the pain.

I don't actually have any idea if I have a penicillin allergy. However, when asked if I have any allergies to medications, I do mention that I have always had horrendous GI effects from taking *cillins, and for whatever reason, it winds up on my chart as an allergy. I just won't take *cillins which are prescribed to me (sort of a moot point these days, because I've reduced the going-to-the-doctor to the point where no one has a chance to prescribe me anything. Huge improvement all around and much cheaper, too) anyway. I do have _lots_ of other allergies, however, including a shellfish allergy (not all shellfish: crab, prawns, lobster, shrimp, etc.) that leads to hives and monster migraines and GI problems; milk products cause GI and respiratory problems and a list of other things that I try to avoid because they seem to trigger respiratory problems and really, why go there?

Anyway. My husband sent me something recently asserting that penicillin allergy was over reported, and I was skeptical, however, here is an interesting development. Someone did a bunch of skin testing!

http://www.medpagetoday.com/MeetingCoverage/AAAAI/56591

Initial N = 225. People who had a health record stating they were allergic to penicillin.

"Patients on antihistamines and beta-blockers were excluded from the trial."

This got them down to 206. They skin tested them. 201 did not have reactions to the skin test.

"A cohort deemed likely to benefit from penicillin therapy was prioritized for inpatient testing. In patients who were nonreactive to both tests, a penicillin G test with 500 mg of oral amoxicillin challenge was administered."

The size of this cohort is not stated in this summary (is it the 206? Or something else?). Of this group, one person reacted to saline (!). 10 people had a negative histamine test (what does that mean anyway?) and were removed.

Overall, out of the 206 that survived from the original 225, only 5 had positive reactions to skin testing. Everyone else got the label taken off their chart and could be prescribed *cillins. The idea is NOT just to save money -- some of those other abx have really disturbing side effects (altho not as bad as dying from a penicillin allergy, presumably).

I am, however, a bit flummoxed. On the one hand, I'm sort of tempted to go in for skin testing now. On the other hand, I'd have to completely go off allergy meds to do so. So. Hrm. Maybe during one of those months when I'm super ambitious and am not reacting to anything at all.

ETA: Here is an explanation of the saline and negative histamine test results and what they mean when doing allergy testing. Basically, the people who did this study did the study according to current best practice skin testing practice.

http://www.healthcommunities.com/allergy-testing/overview-types-of-allergy-tests.shtml

And let me tell you, back in the 1980s, they didn't do it this way, and I suspect that's why I knew a couple people who were allergic to everything (even things they said didn't bother them, but which skin tests showed they were allergic to). Nice to know they're getting this all sorted out!

I've been reading a lot of different things lately and NOT blogging about them, for a variety of reasons. Here's today's trigger for blogging:

Every election season, somebody, somewhere, feels compelled to diagnose one or more candidates with mental health issues. And it is SO EASY! Because if you are running for president, you probably have some combination of three things going on:

(1) You think you're right for the job. (Megalomania, delusional thinking, narcissism)
(2) You think the country needs you to do the job. (martyr complex, savior, codependency)
(3) You've never met any form of attention that you didn't just LOVE! (see (1), and probably plenty of other things)

Over time, our therapeutic framework has evolved, and so we call similar clusters of "stuff" by different names. This time around, Trump has a personality disorder that once would have been called narcissistic personality disorder, but is now lumped in with a bunch of other stuff. VF is inadequately respectful of this evolution -- I'll get to that in a minute. Or, you know, maybe never if I forget.

http://www.vanityfair.com/news/2015/11/donald-trump-narcissism-therapists

As long as we're clear that I'm not endorsing _anything_ in that article, please feel free to enjoy it. It's very funny. Altho I've lost the last vestiges of respect I once had for Howard Gardner, who has apparently never encountered reality TV, and especially not WWE.

I would instead like to focus on one George Simon. I think the George Simon quoted in the article is this guy:

https://en.wikipedia.org/wiki/George_K._Simon

And let me just say, I'm not sure this is the guy I would go to for expertise on narcissism, unless, you know, you think someone with some experience at it from the inside is a good plan. He got his degree at Texas Tech, which brings me to another bit of reading (much more serious) that I ran across lately:

http://www.cnn.com/2016/02/26/health/texas-abortion-access-desert/

Really good article, very nuanced and balanced. Also, very sad. Texas Tech gets a mention in this article as an example of a place which is such a desert of information about reproduction that it has an STD with its own name: Raider Rash. Oh look! It's in Urban Dictionary!

http://www.urbandictionary.com/define.php?term=Raider+Rash

Urban Dictionary's understanding of the term is a little different than CNN's -- I think I believe Urban Dictionary's understanding more than the article, actually.

Texas is also home to the Castros, Julian, widely rumored as VP pick if HRC gets the nomination:

https://en.wikipedia.org/wiki/Julian_Castro

and his twin brother Joaquin:

https://en.wikipedia.org/wiki/Joaqu%C3%ADn_Castro

Their mother was a political activist in the past, including in a regional third political party in Texas.

http://www.mysanantonio.com/news/local_news/article/From-political-matriarch-the-sons-also-rise-3905913.php

Nice picture of her and her boys! And their father was involved in community organizing as well.

Texas is a big place, full of big egos (which the Castros show no real evidence of having), struggling with an enormous demographic change, and at the center of a major Supreme Court case involving what kinds of regulations with what kinds of intentions and what kinds of results can be applied to clinics which offer reproductive service. Once again, Kennedy is likely to be the swing vote, and he's taking an interesting perspective on the whole thing.

https://www.washingtonpost.com/news/wonk/wp/2016/03/04/the-odd-thing-justice-kennedy-noticed-about-abortion-in-texas/

He doesn't seem too happy that an effect of this law is to move Texas in a direction opposite to the rest of the country: reducing medical abortion and increasing surgical abortion (presumably due to the delays and problems of access that the law creates).

“My reading indicated that medical abortions are up nationwide, but down significantly in Texas,” Kennedy said. “This may not be medically wise.”

Honestly, when you have a major candidate for the Republican nomination for POTUS, and everyone is going on and on and on about how big his ego is (or how narcissistic he is or whatever we call it these days when a guy is just way too full of himself, too much of a blowhard and too inclined to talk up the size and caliber of his Manly Parts -- and attack everyone else for the size and caliber of theirs) and he's NOT from Texas, in a year when Texas is so much at the center of the universe, well, that's kind of interesting, right?

Because door number two -- sure, he was born in Canada, whatever -- is FROM Texas! And he's on the ban abortion side of things. That's kind of more how we would expect this to go. And yet, he's the young guy on the side of an argument that is at some sort of tipping point.

It's a weird, weird election cycle. When the too big guy from NY is beating the young guy from Texas, and the guy from NY has a string of marriages and can't correctly verbally express second corinthians -- really, how hard is _that_? -- that guy is kicking ass and taking names. The opposing team is engaged in a brutal elimination battle, trying not to self-destruct and let that guy win it by default, the swing voters who incline to social liberalism and can't tolerate a blowhard are looking at Mayor Mike -- another NY billionaire -- and wondering if he might save them.

A lot of people are openly talking about what all this means for Mental Health in America. I mean, geez, if people are crazy enough to like Trump!?!

At least we're talking about it. If we took our 2016 eyes, and pointed them at previous election cycles, I'm pretty sure we'd be a lot more critical of them than people were at the time. It's not that we are that critical as a set of voters, or even in that critical of a mood, or at that terrified a point in the business cycle.

It's just that it's so _easy_ to share our criticism, our witty, clever, entertaining criticism, that makes us look _so, so smart_. And so we do. Which I don't see any particular problem with, altho I do hope that when the dust settles, we'll all pull back up out of the hyperbole and go back to some semblance of calm.

I had no idea this had happened, but I guess I should not be surprised. There are permethrin resistant lice. Yuck!

So, screw that pesticide crap anyway, and ditch the comb. Get yourself to a licensed AirAllé / Lice Clinics of America and (as long as you're old enough and don't have contraindications) get the hour long heat treatment. Assuming you can avoid reinfestation (like from family members, so maybe have everyone done at once, or at least be assessed), it's one-and-done, and there's no reason to believe lice, "super" or otherwise, are going to evolve some sort of resistance to desiccation.

Inconveniently, the Seattle area option is on Bainbridge. There are numerous Boston area options. The Lice Clinics of America has a finder feature on their website.

There are lots of other things you can try, of course, but this is the first time I've ever run across anything that has had clinical testing (FDA approved!) and a guarantee.

ETA: Standard advice is to quarantine clothing and bedding for some unreasonable amount of time and/or run it through a dryer on high for 30 minutes to an hour. Judging by Ms. Flynn's research on ticks, I'm betting the already VERY low risk of reinfestation of lice from clothing and bedding can be reduced to zero with a lot less time than that in the dryer. 10 minutes on low will probably do it.

https://www.bostonglobe.com/metro/2013/03/31/braintree-student-tick-experiment-catches-attention-cdc-scientists/eH2Sga4HgeDandLJDFwQKI/story.html

Re: my husband's remark about shaving his head. Yeah, sure, but he does that occasionally anyway. _I_ would shave my head, too (at this point, I'm just looking for a good excuse anyway). But asking children or people with long hair to do so is probably cruel.

So, I get that everyone is working up to a total freakout about Brazil, the Olympics, etc.

However, I noticed this.

http://www.reuters.com/article/us-hawaii-dengue-idUSKCN0VI0G2

It's mostly about dengue in Hawaii, which is a problem. However, it includes this:

"Last month, a baby born with brain damage at a hospital in Oahu, Hawaii, was apparently the first case of the mosquito-borne Zika virus in a birth on U.S. soil, health officials said."

And that makes me go, wait. How sure are we that all that dengue in Hawaii is actually dengue? Because misdiagnosing zika as dengue is _common_.

http://www.wpro.who.int/mediacentre/factsheets/fs_05182015_zika/en/

"The disease has similar clinical signs to dengue, and may be misdiagnosed in areas where dengue is common."