ANTHRAX

     All of us are concerned about the possibility of bioterrorism, but we must not abandon our common sense and allow "The Evil Ones" to steal the joy from our lives.   As currently being used, anthrax serves more to terrify and paralyze us than to kill large numbers of Americans.   

     Of course the thought of anthrax is scary, but bear in mind that the odds of you or anyone you know being exposed is miniscule.   It is important to keep things in perspective - 20,000 people will die of the flu this year alone; yet the public is not panicked about that.   Statistically your long-term health is in far greater danger every time you eat a Big Mac, light a cigarette, or drive your car on MoPac than it is from anthrax.   You are far more likely to have your life shortened by a heart attack (due to high cholesterol) or an auto accident than from anthrax.

In answer to your question
NO, I CANNOT PHONE OUT A PRESCRIPTION FOR CIPRO

     Several patients have requested that I phone them out a prescription for Cipro "to have on hand just in case I start to get sick."    There are several reasons why I cannot do this:

  1. So far there has not been a single case of anthrax reported anywhere near Austin.
     
  2. The Surgeon General, the Centers for Disease Control, and all the major medical organizations have strongly advised doctors against prescribing antibiotics "on request" for well patients to try to "prevent" anthrax.    To do so would be just plain bad medicine.
     
  3. Any medication, especially antibiotics, can have significant associated risks and side-effects; and no medication should be taken unless there is a clear reason for taking it.
     
  4. Most microbes, including anthrax, can begin to develop resistance to antibiotics if exposed to low or sporadic doses over a period of time.    If doctors were to begin prescribing Cipro indiscriminately to well patients, we might begin to see the emergence of strains of anthrax that no longer respond to this antibiotic.    Then we'd all be in real trouble.
     
  5. Even if you happened to have some Cipro on hand, it would be a bad idea to take it without seeing me first for proper tests.    How would you know when to start it and for how long to take it?    Most tests for anthrax must be done before a patient starts Cipro because once the antibiotic is in the system, detection of anthrax becomes much more difficult, sometimes impossible; so we then have no way of knowing if it's safe for the patient to stop the Cipro or if the full 60-day course must be completed.
         And even if you took a full 60-day course and we were confident that you were free of anthrax at that time, there would be nothing to prevent you from inhaling some anthrax spores the day after you completed the Cipro.

     It's far better to minimize your risk of exposure to anthrax by remaining alert to your environment.   

     The most proactive thing you can do for yourself right now is to come in for a Flu Shot; so you will not be unnecessarily frightened and confused by a simple case of "garden variety" flu this winter.   
     There is a shortage of Flu Vaccine again this year, and we have received only 400 doses which we are giving on a first-come, first-served basis.    When those 400 doses are gone, we probably won't be able to get any more this year.

     Doctors and public health officials are on the highest alert for anthrax, and if even a single case were to appear in Austin, you can be confident that the response from the medical community would be swift and effective.    You can be confident that the government will supply free Cipro to everyone at risk if there ever is a serious risk.

     You know that I am always available to see you promptly; so should you develop any flu-like symptoms, come in right away; and we'll take good care of you just as we always have.    If I decide an antibiotic is appropriate, I will prescribe one after screening you for strep, anthrax, and other potential problems.

     Since September 11, we Americans have, for the first time, begun to feel vulnerable right here at home; but none of us should waste our precious life energy obsessing about things over which we have no control whatsoever when we could be investing that same life energy adding joy and comfort to the lives of those dear to us.

     We must all depend on our government to protect us from widespread aerial dissemination of anthrax spores, but each of us can significantly reduce the risk of the inhaled (more serious) form of anthrax reaching us by mail.   For more information about mail safety I suggest that you review the latest information on the U.S. Postal Service and MSNBC web sites.

     Here are the simple precautions I have instructed my staff to take with our office mail.   You may wish to post similar common sense rules in your office:

INSTRUCTIONS FOR OPENING MAIL

     Anthrax is not life-threatening unless inhaled in large quantities and even then, only if not treated for several days.    If mail is opened slowly, any anthrax spores within the envelope are unlikely to become airborne; so the very worst thing you could be exposed to is cutaneous anthrax (from skin contact) which is readily curable with common antibiotics.

     If mail is opened thoughtfully and carefully, the risk of exposure to inhalation anthrax is minimal.   Here's how to protect yourself:

1. Before opening anything, divide the mail into three stacks as follows:

  1. Envelopes with a return address you recognize, i.e., doctors, patients, or insurance companies).
  2. Junk mail and magazines from sources you recognize.
  3. Any mail with no return address or whose sender is unknown to you.

2. Slowly and carefully slit open all the mail in stacks A and B at the same time (do not remove the contents, and do not open stack C yet).

3. Now, taking your time, slowly and carefully remove the contents of each envelope in turn and unfold gently.    Don't rush or allow anyone to distract you while you are doing this.    Be alert for white powder or anything else unusual within (do not simply "whip out" the contents; since this could scatter any powdery material into the air.

4. As you open each item, staple the envelope and its contents together and place in appropriate stacks to be distributed later.

5. Now slit open each item in Stack C with SPECIAL CAUTION.    Moving slowly, peek inside the envelope, then gently remove the contents and staple together with the envelope.    If you are at all suspicious about any particular item of mail, do not open it.

6. If you see any white powder or anything else out of the ordinary, immediately place the item back on the desk, back away, then wash your hands with soap and water before touching your clothes or anything else.    Notify me at once, and we will contact the appropriate authorities.

7. Always wash your hands with soap and water after handling mail.

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     Remember that the form of anthrax currently being sent through the mail is quite sensitive not only to Cipro but also to older, common, generic antibiotics such as penicillin and doxycycline; so try to remain calm and get on with enjoying your life.

 

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