Kara Jackson never imagined those endless hours of piano practice and her pursuit of a secretarial position would put her on the surgery table.
However, Jackson, 21, secretary at Bridgerland Applied Technology Center in Logan, is one of thousands of people in the United States afflicted with carpal tunnel syndrome. The condition, which affects the carpal tunnel nerve connecting the wrist to the hand, is caused by repetitive hand action and has increased dramatically in the workplace with increased use of computer terminals.Carpal tunnel syndrome is one of several health conditions surfacing or peaking in the '90s. Social trends such as more technology, longer lifespans, increased mobility of people, more sexual promiscuity, as well as new medications and therapies, are creating dramatic health trends.
Although medical professionals disagree on the single disease of the '90s, they agree many trends are evident. For example, AIDS is shifting from intravenous drug users and homosexual men to youth and the heterosexual population; cholera and red measles, once considered close to eradication, are resurfacing in epidemic proportions; osteoporosis cases are rising rapidly.Heart disease
Dr. Quinton Harris, president of the Utah Medical Association, said although heart disease is still the No. 1 killer in America, its incidence is decreasing. Today, doctors can decrease its symptoms and even prevent the disease thanks to research and new medications.
"Two years ago, we talked about not progressing with the illness. Now we're talking of reversing the illness," Harris said.
In a study reported in 1990, 2,000 people with plaque-filled, hardened arteries were put on a controlled diet and medication for two years. In comparison with X-rays of their arteries before the treatment, tests showed no progression of the disease and in some cases, dissolved plaques.
"In the last few years, we've seen a marked reduction in both heart attacks and strokes because of the change in our ability to treat and prevent the disease," Harris said.
New at-risk groups
Doctors speculate that AIDS, probably the most talked about disease the last few years, will afflict increasingly more children, adolescents and heterosexuals. Since the start of the AIDS epidemic in the early 1980s, the overwhelming majority of patients have been adults, primarily homosexual or bisexual males.
"I continue to believe that the adolescent population is the next population at risk because they are risk-takers anyway," predicted Dr. Alan R. Nelson, past president of the American Medical Association, in January 1990. "And they are at risk because they aren't practicing sex as safely as they should."
Nelson said babies aren't immune from the deadly global disease, noting that one of 60 babies born in New York City is infected with HIV, the precursor to AIDS.
Because of deteriorating morals, Harris said, AIDS is going to afflict more heterosexuals.
"Homosexuals are learning how to prevent it. The drug addicts don't care. But it's going to move into the heterosexual community," Harris said.
Craig Nichols, state epidemiologist, said that in addition to AIDS, other sexually transmitted diseases are resurging in Utah.
"We've gotten close to the point that we're talking eradication of gonorrhea and syphilis (in Utah)," Nichols said, "but chlamydia is now our biggest sexual concern."
Some medical officials recently linked the revival of tuberculosis to AIDS.
"It's on the rampage now," said Dr. Harry L. Gibbons, director of Salt Lake City and County Health Department. Many doctors thought the disease had been eradicated.
Gibbons attributed the revival to an increase in homeless people who don't stay in one place long enough to be treated. He also blamed it on the suppressed immune systems of AIDS victims. But, he said, the strain affecting AIDS victims is not a threat to the general population.
Resurfacing
Besides tuberculosis, several other diseases once thought eradicated or nearly eradicated are resurfacing. Red measles and cholera top the list.
Harris said the 170 cases of red measles reported so far in 1991 are at epidemic levels because people vaccinated after Jan. 1, 1957, received a gamma shot along with the vaccination that destroyed the vaccine.
This discovery was made only three years ago, and doctors encourage anyone vaccinated after 1957 to receive another one.
Gibbons said that although many people know this, they aren't re-vaccinating themselves because of the high cost of vaccines.
"What used to cost a few cents for the vaccine is now $26 . . . and we now need a second shot because the vaccine isn't lasting as long as it should."
Cholera, which doctors hadn't seen in North or South America for 90 years, hit New Jersey earlier this year after a stint in South and Central America.
Although it hasn't reached Utah yet, Harris said cholera can be prevented with wise food handling.
"It's going to go all over if we don't pay attention to how we handle our food," Harris said.
Nichols agreed, adding that several diseases now surfacing are caused by careless food handling, including hepatitis A, shigellosis and salmonella.
"I don't think people are as cautious as they ought to be," Nichols said. "All three diseases emphasize the need for better training in food preparation."
He listed potato salad left in the sun and undercooked chicken as examples.
In June alone, Utah saw 45 cases of salmonella, 10 times more than usual, according to Harris.
Traveling bacteria
The mobility of people - Americans traveling more to distant lands and immigrants moving to the United States - has caused the upswing of several bacterial infections, including cholera, dysentery, giardiasis, roundworms and parasites.
Nichols said cholera often spreads after people get the disease from eating raw oysters and shellfish in South America and bring the bacteria back to the United States.
These mobile diseases are especially prevalent in Utah because of the high number of missionaries returning from foreign countries, said Harris, head of the Health Advisory Committee for The Church of Jesus Christ of Latter-day Saints' missionary program. He said the church is attempting to treat missionaries in the field so they don't bring the illnesses home.
Osteoporosis
Elderly people living longer is another sociological trend with a direct effect on the medical world. And one of the most devastating effects is osteoporosis, the deterioration of bone with the onset of age.
"Thirty years ago we used to have to hunt for much osteoporosis. Ten years ago we used to see it occasionally. But now we're seeing it several times a day," Harris said.
He said in addition to people living longer, a change in what people drink has caused this marked increase.
"When I was a kid, I just drank milk," Harris said. "My kids drink anything but milk . . . That makes a difference because the most impressionable time for building bones is during growth."
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Diseases of the '90s
Both old and new diseases have been making their appearance and are likely to continue through the decade.
Carpal Tunnel Syndrome
What is it? A condition affecting the nerve connecting the wrist to the hand.
Cause: Repetitive hand actions, wrist fractures or fluid retention.
Symptoms: pain, numbness, tingling, weakness or burning in the wrist or hands.
Diagnosis: Observation of symptoms and nerve reaction to shock treatment.
Treatment and prevention: Splints, braces, therapy, a corticosteroid drug or out-patient surgery, which cuts the ligament to relieve the pressure on the nerve.
Chronic Fatigue Syndrome
What is it? complex illness characterized by incapacitating fatigue, neurological problems and a variety of other symptoms.
Cause: Theories include a dysfunction of the immune system, Epstein-Barr (mononucleosis) virus, a spumavirus, candidiasis (yeast of vaginal infections).
Symptoms: Fatigue, recurrent flulike symptoms, painful lymph nodes, severe nasal and other allergies, weight change, aching muscles and joints, abdominal pain, diarrhea, nausea, night sweats, severe premenstrual syndrome, uncomfortable or recurrent urination, insomnia, headaches, dizziness, balance problems, memory loss and others.
Diagnosis: Working case definition developed by the Centers for Disease Control.
Treatment and prevention: There is no proven cure for CFS. However, trials of medications are under way.
Acquired Immune Deficiency Syndrome
What is it? A deficiency of the immune system from infection with the HIV, which eventually leads to death.
Cause: The human immunodeficiency virus, passed through sexual contact, blood to blood (through transfusion or needle sharing in intravenous drug addicts) and from woman to fetus.
Symptoms: At the time of diagnosis, symptoms can include skin disease, respiratory problems, gastrointestinal infections or brain and neurological disorders. Weight loss, fatigue, fevers and loss of appetite are common.
Diagnosis: Testing a blood sample for antibodies to HIV and Western blot (a confirmatory test), along with observation of the characteristic infections and tumors.
Treatment and prevention: no cure exists for AIDS, only supportive treatment for its complications and infections. Risks are reduced by having only one sex partner, using condom and avoiding shared needles with IV drug users.
Note: This disease is spreading into the heterosexual community as well as infectiong more adolescents and children.
Cholera
What is it? Infection of the small intestine cause by bacterium vibrio cholerae.
Cause: Poor food handling and sanitation practices.
Symptoms: Diarrhea, often accompanied by vomiting, 1-5 days after infection.
Diagnosis: observation of symptoms.
Treatment and prevention: Replacing lost fluid with drinks and water with the correct proportions of ssalt and sugar and taking antibiotics can shrten the period of diarrhea and infectiousness to others. it is prevented by improving sanitation (in particular by ensuring that sewage is not allowd to contaminate drinking water). Travelers to cholera-infected countries should restrict themselves to bottled drinks or boiled drinking water.
Note: At the turn of the century, the world saw an epidemic of cholera, which killed 370,000 in India. But in recent decades the disease was thought eradicated. Today cholera is resurfacing in the United States. It has spread to this country by people who get the disease from eating raw oysters and shellfish in South America and bring the bacteria back with them.
SOURCE: "Listen to Your Body," by Ellen Michaud, Lila L. Anastas and the editors of Prevention magazine. *****
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(Additional information)
How to prevent carpal syndrome
To decrease your chances of getting carpal tunnel syndrome, physical therapists recommend you adjust your work habits or work station design, take periodic rest breaks and exercise and stretch your hands. Here are a few more suggestions:
- Keep wrists relaxed and straight. Elbows should rest by your sides or be supported by special arm rests now available on some office chairs. Shoulders should be relaxed and level.
- Your typing table should be slightly higher than elbows when arms are held relaxed at your sides. Keep wrists straight. Use only finger movements to strike keys - don't move wrists.
- Press keys with the minimum of pressure necessary. Make sure keyboards are kept clean and in good working order to minimize resistance.
- Move your entire hand to press hard-to-reach keys rather than forcing the hand into awkward positions. Use two hands if necessary to execute combination keystrokes such as shifting to upper case.
- Break up typing tasks with other activities such as proofreading, filing or telephone work to give fatigued muscle groups a rest.