http://www.cherokeephoenix.orgThis Centers for Disease Control shows a map with 2010 incidence rates for ehrlichiosis in the United States. Oklahoma had a rate of 3.3 to 26 cases per million, one of the highest. CENTERS FOR DISEASE CONTROL
This Centers for Disease Control shows a map with 2010 incidence rates for ehrlichiosis in the United States. Oklahoma had a rate of 3.3 to 26 cases per million, one of the highest. CENTERS FOR DISEASE CONTROL

Nice weather can bring tick illnesses

This Centers for Disease Control shows a map with incidence rates for Rocky Mountain spotted fever shows Oklahoma with an incidence rate of 19 to 63 cases per million, one of the highest in the United States. The American dog tick, Rocky Mountain wood tick and brown dog tick can carry the disease. CENTERS FOR DISEASE CONTROL This Centers for Disease Control shows a map with incidence rates for tularemia. Most incidences occur in the Midwest and Plains states as well as the Rocky Mountain areas. CENTERS FOR DIESEASE With warmer weather here, ticks such as this lone star tick can carry different diseases such as ehrlichiosis and tularemia. COURTESY
This Centers for Disease Control shows a map with incidence rates for Rocky Mountain spotted fever shows Oklahoma with an incidence rate of 19 to 63 cases per million, one of the highest in the United States. The American dog tick, Rocky Mountain wood tick and brown dog tick can carry the disease. CENTERS FOR DISEASE CONTROL
BY STAFF REPORTS
05/25/2017 12:00 PM
TAHLEQUAH, Okla. – People tend to spend more time participating in outdoor activities in warmer weather. But it’s important to remember that warmer weather brings ticks and the illnesses they can carry.

Oklahoma ranks among the states with the highest rates of ehrlichiosis, Rocky Mountain spotted fever and tularemia, and May through August are the months when ticks are most active.

Ehrlichiosis

Human ehrlichiosis is caused by Ehrlichia chaffeensis, Ehrlichia ewingii and a third Ehrlichia species provisionally called Ehrlichia muris-like.

Ehrlichiae are transmitted to humans by the bite of an infected tick. The lone star tick is the primary vector of both Ehrlichia chaffeensis and Ehrlichia ewingii in the United States. Typical symptoms include fever, headache, fatigue, chills, nausea, vomiting, diarrhea, confusion, rash and muscle aches. Usually, these symptoms occur within one to two weeks following a tick bite.

Ehrlichiosis is an illness that can be fatal if not treated correctly. The estimated fatality rate is 1.8 percent. Patients who are treated early may recover quickly on outpatient medication, while those who experience a more severe course may require intravenous antibiotics, prolonged hospitalization or intensive care.

The severity may depend on the patient’s immune status. People with compromised immunity caused by immunosuppressive therapies, HIV infection or splenectomy appear to develop a more severe disease and may also have higher fatality rates.

Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever ehrlichiosis is suspected.

Use of antibiotics other than doxycycline and other tetracyclines is associated with a higher risk of fatal outcome for some rickettsial infections. Doxycycline is most effective at preventing severe complications from developing if it is started early in the course of disease. Therefore, treatment must be based on clinical suspicion alone and should always begin before laboratory results return.

Rocky Mountain spotted fever

RMSF is caused by the bacterium Rickettsia rickettsia and is transmitted to humans by the bite of infected ticks. In the United States, these include the American dog tick, Rocky Mountain wood tick and brown dog tick.

Typical symptoms include fever, headache, abdominal pain, vomiting and muscle pain. A rash may also develop, but is often absent in the first few days, and in some patients, never develops. RMSF can be severe or even fatal if not treated in the first few days of symptoms. Doxycycline is the first line treatment for adults and children of all ages, and is most effective if started before the fifth day of symptoms.

The first symptoms of RMSF typically begin two to 14 days after the bite. The disease frequently begins as a sudden onset of fever and headache and most people visit a health care provider during the first few days of symptoms. Because early symptoms may be non-specific, several visits may occur before the diagnosis is made and correct treatment begins. It is a serious illness that can be fatal in the first eight days of symptoms if not treated correctly.

A classic case involves a rash that first appears two to five days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to include the trunk and sometimes the palms and soles. Often the rash varies from this description, and people who fail to develop a rash, or develop an atypical rash, are at increased risk of being misdiagnosed.

The red to purple, spotted (petechial) rash is usually not seen until the sixth day or later after onset of symptoms and occurs in 35 percent to 60 percent of patients with the infection. This is a sign of progression to severe disease, and every attempt should be made to begin treatment before petechiae develop.

Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever RMSF is suspected.

Tularemia

The bacterium that causes tularemia is highly infectious and can enter the human body through the skin, eyes, mouth or lungs. In the United States, ticks that transmit tularemia to humans include the dog tick, the wood tick and the lone star tick. Deer flies have been shown to transmit tularemia in the western United States.

The signs and symptoms of tularemia vary depending on how the bacteria enter the body. Illness ranges from mild to life-threatening. All forms are accompanied by fever, which can be as high as 104 degrees Fahrenheit. Main forms of this disease are:

• Ulceroglandular. This is the most common form of tularemia and usually occurs following a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears at the site where the bacteria entered. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.

• Glandular. Similar to ulceroglandular tularemia but without an ulcer. Also generally acquired through the bite of an infected tick or deer fly or from handling sick or dead animals.

• Oculoglandular. This form occurs when the bacteria enter through the eye. This can occur when a person is butchering an infected animal and touches his or her eyes. Symptoms include irritation and inflammation of the eye and swelling of lymph glands in front of the ear.

• Oropharyngeal. This form results from eating or drinking contaminated food or water. Patients with oropharyngeal tularemia may have sore throat, mouth ulcers, tonsillitis and swelling of lymph glands in the neck.

• Pneumonic. This is the most serious form of tularemia. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the bloodstream to the lungs.

• Typhoidal. This form is characterized by any combination of the general symptoms (without the localizing symptoms of other syndromes).

Tularemia is a rare disease, and the symptoms can be mistaken for other, more common, illnesses. It is important to share with your health care provider any likely exposures, such as tick and deer fly bites, or contact with sick or dead animals.

Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline and ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used. Although symptoms may last for weeks, most patients completely recover.

Preventive Measures

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months when ticks are most active.

• Avoid wooded and brushy areas with high grass and leaf litter.

• Walk in the center of trails.

• Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.

• Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.

• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5 percent permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.

• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.

• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.

• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats and day packs.

• Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors.

• If the clothes are damp, additional time may be needed.

• If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks effectively. If the clothes cannot be washed in hot water, tumble dry on low heat for 90 minutes or high heat for 60 minutes. The clothes should be warm and completely dry.

Health

BY STAFF REPORTS
12/08/2017 04:00 PM
TAHLEQUAH, Okla. – Cherokee Nation physician Dr. James H. Baker was recently awarded a Mastership through the American College of Physicians for his contributions. According to ACP, “Election to Mastership recognizes outstanding and extraordinary career accomplishments and achievements, including the practice of internal medicine, academic contributions to our specialty, and service to the College.” During review of candidates, the ACP’s Awards Committee considers several qualities, including strength of character, perseverance, leadership, compassion and devotion. Clinical expertise and commitment to advancing the art and science of medicine are also taken into account by the committee. “I am so honored to receive this award from my peers and colleagues at the American College of Physicians,” Bake said. “I thank our Oklahoma ACP Chapter of 1,000 internal medicine physicians and medical students for nominating me.” Baker, of Muskogee, is a general physician with more than 30 years of experience. He serves as medical director for CN Three Rivers Health Center and the tribe’s Wilma P. Mankiller Health Center. Baker completed medical school at the University of Oklahoma in 1982 and completed his internal medicine residency at Kansas University in 1987. The mastership is the third award Baker has received from the ACP, including the Meritorious Service Award in 2014 and the Laureate Award in 2015. He is a former governor of the Oklahoma chapter of ACP and a current member. The ACP will honor 2017-18 master recipients at the organization’s annual convention in April 2018 in New Orleans. For more information, visit <a href="http://www.acponline.org" target="_blank">www.acponline.org</a>.
BY STAFF REPORTS
12/05/2017 12:00 PM
TAHLEQUAH, Okla. – According to an Oklahoma influenza summary for Nov. 19-25, the influenza geographic spread is “widespread” within the state. The report states that there were 162 positive rapid flu tests at sentinel sites with 78 percent of those positive specimens being influenza A. The summary also states that between Sept. 1 and Nov. 28, 105 influenza-associated hospitalizations were reported to the Acute Disease Service with ages ranging from 0 to 95 years with a median of 62 years of age. The report states that two influenza-associated deaths have been reported among residents of Johnston and McClain counties, and officials said that Oklahoma is experiencing a higher than normal level of influenza activity early in the season. “Our influenza-associated hospitalizations are the highest they have been at this time of year since the 2009-2010 pandemic,” Dr. Sohail Khan, Cherokee Nation health research director, said. “Our influenza-associated hospitalization count is three weeks ahead of the 2014-2015 season when our influenza activity peaked in December and declined to minimal levels by the end of March. This early activity does not mean we will have a more severe season. It does indicate that more influenza will be circulating during the holidays.” Flu, or influenza, is a contagious respiratory infection caused by a variety of flu viruses. Symptoms of flu involve muscle aches and soreness, headache and fever. It enters the body through the mucus membranes such as the nose, eyes or mouth. “Every time you touch your hand to one of these areas, you are possibly infecting yourself with a virus,” Khan said. “This makes it very important to keep your hands germ-free with frequent and thorough hand washing. Encourage family members to do the same to stay well and prevent flu.” Khan said there are three types of flu viruses: A, B, and C. He said type A and B cause the annual influenza epidemics that have up to 20 percent of the population sniffling, aching, coughing and running high fevers. Type C also causes flu, however type C flu symptoms are less severe. The flu is linked to between 3,000 and 49,000 deaths and 200,000 hospitalizations each year in the United States, and seasonal flu vaccines are created to try to avert epidemics. Khan said the best way to prevent seasonal flu is to get vaccinated each year, but good health habits such as covering a cough and washing hands often can help stop the spread of germs and prevent respiratory illnesses such as the flu. There also are flu antiviral drugs that can be used to treat and prevent flu. To prevent the spread of flu, Khan said to avoid close contact; stay home when sick; cover mouth and nose; clean your hands; avoid touching your eyes, nose or mouth; and clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. He also suggests getting plenty of sleep, being physically active, managing stress, drinking plenty of fluids and eating nutritious food.
BY LINDSEY BARK
Reporter
12/05/2017 08:00 AM
TAHLEQUAH, Okla. – In 2015, the Cherokee Nation became the first tribe to launch an elimination project with the U.S. Centers for Disease Control and Prevention to screen and treat tribal citizens for hepatitis C. And since the project’s inception, more than 40,000 people have been screen. CN officials proclaimed Oct. 30 as Hepatitis C Awareness Day and said the tribe continues its efforts to reach it goal of screening 80,000 patients. “Hepatitis C is a virus that affects primarily the liver but it can affect other organs, too. It was isolated in 1989, although we knew it existed long before that time,” Dr. Jorge Mera, CN director of infectious disease, said. Hepatitis C was identified as non-A or non-B hepatitis before it was labeled as a third virus. Symptoms are not present unless it has not been identified or treated for a period of time and cirrhosis of the liver sets in. “The symptoms are basically symptoms of cirrhosis. So anything that inflames the liver for many years may end up causing a lot of scarring of that liver and when the scarring is sever enough we label it as cirrhosis,” Mera said. The virus can be contracted several ways. Mera said in approximately 90 percent of cases, people who inject drugs and share needles, syringes or paraphernalia, contract it. In the past, blood transfusions played an important role in contracting the virus until 1992 when blood banks began checking for it. Tattooing in a non-professional parlor can also play a role. There is also a small chance, roughly 5 percent, that a mother can transmit the disease to her newborn child, Mera said. He said there are ideal and practical ways to prevent the disease from spreading. “Ideal would be that people would not use illegal drugs and not inject them. We know that we can mitigate that but we will never reach zero on that. That’s a reality. People have been using illegal drugs for millenniums, and it’s not going away soon,” Mera said. He said if people use drugs they should use clean needles and syringes each time they inject and to not share needles with anyone. He added that there is a need for needle and syringe exchange services, which is illegal in Oklahoma. Other tribes and places in the United States, such as New York City and San Francisco, are creating their own hepatitis C elimination programs. “Now the advantage they have over us is that they have needle and syringe services. It’s going to be very difficult to eliminate hep C if you don’t have needle and syringe services because there will be a point that people will continue to transmit, and I can only go and catch them and treat them. But I would like to cut that transmission,” Mera said. To prevent the disease’s consequences once it is contracted is for people ages 20 to 72 years old to get screened. “We offer free screenings and free treatments at W.W. Hastings Hospital in Tahlequah, Oklahoma,” Mera said. “In Cherokee Nation, 3.4 percent of Cherokees ages 20 to 72 are positive for hepatitis C. In other Native American communities there have been reported rates as high as 8 percent and also lower rates.” He said hepatitis C is the top “killer of blood-born pathogens” than any other reportable disease of the CDC and has killed more than the rest of the reportable diseases combined. “Hepatitis C mortality is greater in Native Americans in general than non-Native American populations in the United States,” Mera said. Mera said the screening process is simple and all one has to do is request a screening in the Urgent Care or with their providers at W.W. Hastings Hospital. The screening contains a blood drop, in which results are ready in 24 hours. He said treatment options, depending on the severity of the virus, is taking a pill regiment for eight to 12 weeks, in which 95 percent cure rates have been seen. “It’s the only chronic infectious disease that you can cure and, to my knowledge, is the only chronic disease you can cure. Because you can’t cure diabetes or high blood pressure, those you have to treat for life, or HIV for that matter. But this is eight to 12 weeks and you’re done.” He said though the treatment is simple the hard part is getting people to get tested. Roughly 50 percent of the population of the 85 percent goal has been screened. Approximately 78 percent have tested positive and more than 90 percent have been cured of the virus. “On cure rates we’re meeting our goal. On screening we still have a ways to go. And in engagement of care there’s still room for improvement,” Mera said. “I would really like to eliminate hepatitis C from Cherokee Nation. That would be my goal.”
BY KENLEA HENSON
Reporter
11/24/2017 02:00 PM
TAHLEQUAH, Okla. – During the Nov. 13 Health Committee meeting, Secretary of State Chuck Hoskin Jr. said Health Services Executive Director Connie Davis had resigned and was being replaced in the interim by Dr. Charles Grim. Davis, whose career experience spans over 28 years in the health field, began her career at W.W. Hastings Hospital in 1988. In 2004, she joined Tahlequah City Hospital as vice president of patient care and chief nursing officer until she became the Cherokee Nation’s Health Services executive director in 2012. “She is going to devote some more time to her family, particularly her mother,” Hoskin said. “We certainly appreciate her service. Dr. Grim has been named interim executive director of Health, effective immediately.” Grim, a CN citizen, is a retired assistant Surgeon General and rear admiral in the Commissioned Corps of the U.S. Public Health Services. During his career, Grim has received honors and awards, including a Lifetime Achievement Award from the Oklahoma Area Indian Health Service, Health Leader of the Year from Commissioned Officers Association of U.S. Public Health Service, Community Leadership Award from the CN as well as multiple U.S. Public Health Service medals and citations, including the U.S. Surgeon General’s Exemplary Service Medallion. Since 2013, Grim has served as Health Services deputy director, in which he was second in charge of Hastings Hospital, eight outpatient health centers, Emergency Medical Services, finance and billing services, facilities management, the Jack Brown Youth Regional Treatment Center and a host of public health and community health services and programs. Prior to that, Grim served as Health Services senior director of for more than three years. Preceding his CN employment, Grim spent 26 years working for Indian Health Services in numerous clinical, administrative and executive leadership positions. In 2002, President George W. Bush appointed him as director of IHS with a unanimous Senate confirmation. During that time he administered a nationwide multi-billion dollar health care delivery program, with 12 administrative regional offices and over 16,000 employees. Grim holds a bachelor’s degree in microbiology from the University of Oklahoma, a doctorate of dental surgery from the University of Oklahoma College of Dentistry and a master’s degree in health services administration from the University of Michigan School of Public Health. “When I retired from the Indian Health Service and got hired to work for the Cherokee Nation it was pretty incredible for me. It’s a dream come true. I thought I might go the rest of my career and never get to work here. I’ve learned a lot over the years, both educationally and experientially and the thought that I have got to apply a lot of that here for my tribe and my citizens and my people has really meant a lot,” he said during the Health Committee meeting. Grim also thanked Davis for her time as Health Services executive director. “We have one of the biggest tribal health systems in the country, one of the largest populations to serve in the country, and she did a very, very good job of trying to stay on top of all the issues that were thrown at us on a daily basis. She had a good team of people around her, many of those sitting behind me but some of them you never see. You see some of them in your clinic when you’re going around, but I just wanted to thank her publically…” he said. Grim will serve as interim director until an executive director is named. “We always want to fill positions parentally, and the resignation was just tendered so naturally our first move was to name an interim, and we could not have a more capable interim than Dr. Grim. As the days and weeks pass we will be looking at a permanent person to fill that position, but we have all the confidence in the world in Dr. Grim,” Hoskin said.
BY STAFF REPORTS
11/15/2017 04:00 PM
CLAREMORE, Okla. – The Claremore Indian Hospital will sponsor a Veterans Affairs Enrollment Fair on Dec. 7 in the hospital’s Conference Room 1. Hospital officials said the fair is set for 10 a.m. to 2 p.m. to assist their Native American veteran patients in applying for eligibility for health care services through the VA. “We will have Claremore Indian Hospital benefit coordinators and representatives from the VA and Disabled American Veterans to assist with the application processes,” Sheila Dishno, Claremore Indian Hospital patient benefit coordinator, said. “Please make plans to attend and bring your financial information (income and resource information) and DD-214 (military discharge) papers.” If already enrolled, call 918-342-6240 or 918-342-6559 so a hospital official can update your file.
BY STAFF REPORTS
11/13/2017 12:00 PM
TAHLEQUAH, Okla. – According to a Cherokee Nation Communications release, the tribe’s Health Services has screened more than 40,000 tribal citizens for hepatitis C after becoming the first tribe in the country to launch an elimination project two years ago with the U.S. Centers for Disease Control and Prevention. Principal Chief Bill John Baker declared Oct. 30 as Hepatitis C Awareness Day in the CN as tribal and Health Services officials gathered for a proclamation signing ceremony. The release states the tribe’s goal is to screen 80,000 patients between age 20 and 65 for hepatitis C during a three-year period. In October 2016, the tribe had screened 23,000 patients. “When this program started in 2015, we had high hopes for what it would mean for the long-term health of Cherokee Nation citizens,” Baker said. “The positive results have been beyond even our highest expectations. We have treated and cured more than 680 people with a 90 percent success rate. That success is allowing people once afflicted with the hepatitis C virus to live healthier and happier lives. The Cherokee Nation Health Services staff has collaborated with international infectious-disease experts to create and sustain this modern health care blueprint. It’s not often a disease can be completely eliminated from a citizenry, but it’s something we are achieving in the Cherokee Nation with our hepatitis C efforts.” Of those screened, about 1,200 patients tested positive and more than 680 patients are either currently being treated for hepatitis C or have been cured. “The Cherokee Nation is demonstrating to other communities across the United States how to effectively test and treat those living with hepatitis C and prevent new infections, so that someday the threat of hepatitis C will be eliminated,” Dr. John Ward, director of CDC’s Division of Viral Hepatitis, said. Hepatitis C is a liver infection caused by the hepatitis C virus, usually through the transfer of blood. Most people become infected with the hepatitis C virus by sharing needles, through unlicensed tattooing or because they had a blood transfusion before 1992. For some people, hepatitis C is a short-term illness, but for about 70 percent of people who become infected, it becomes a long-term, chronic infection, according to the CDC. Dr. Jorge Mera, Health Services’ Infectious Disease director, said the project continues to gain momentum with his office looking more at prevention of hepatitis C and the potential increase from the opioid crisis happening throughout the United States. “Our efforts now need to be directed at preventing hepatitis C, which in the United States today is driven by injected drug use,” Mera said. “Prevention strategies include expanding our medication-assisted treatment program for opioid addiction. We are also beginning a serious discussion about needle- and syringe-exchange programs.” Health Services has partnered with the CDC and the Oklahoma Department of Health to track and share knowledge. For more information about the elimination project or to get screened, visit <a href="http://www.cherokee.org/Services/Health/HealthCentersHospitals.aspx" target="_blank">http://www.cherokee.org/Services/Health/HealthCentersHospitals.aspx</a>.