War, cholera, earthquakes the world is full of clear and pres-ent dangers. Big, obvious, undeniable hazards.
But sometimes danger lurks in places you would never suspect. Small places. A contact lens. A little pill. A grain of dust.Here are three stories that have come to our attention lately. They chronicle rare events, but they also serve as a reminder that things aren't always as innocent as they seem.
Dust: Southwestern deserts rife with fungus spores that can cause illness from mild to severe when inhaled.
Before that week last April when their lives suddenly changed, Arvil and Mary Harris didn't give much thought to dust. At worst it was a nuisance, tending to accumulate on end tables and in corners.
But that was before Arvil began digging in the desert.
Last winter, the Harrises rented an RV pad near St. George. To spruce up the spot - where the retired couple planned to spend part of their winters - they decided to plant more grass and some Italian cypresses, and to build a rock wall.
So early last April, Arvil began gathering flat red rock and shoveling up topsoil in the area. He kept at it for about a week.
It was a couple of days later, after the Harrises had returned to their home in Holladay, that Arvil started coughing. A week later he was worse. By then they were back in St. George, where Arvil went to a doctor and was told he had pneumonia.
When he got back to Salt Lake he saw another doctor, who confirmed the diagnosis and gave him another antibiotic. Within two days he was even sicker.
It turned out that what Arvil Harris had was not pneumonia but coccidioidomycosis, sometimes known as "valley fever" or "desert fever" or just plain "cocci" (pronounced KOK-see). The culprit was the dust Arvil breathed, dust harboring tiny fungus spores.
The deserts of the American Southwest - the tip of southwestern Utah, parts of Arizona, New Mexico, Texas and California - are full of the spores, so digging in the soil, or riding a mountain bike over the soil, or just riding in a car with the windows open on a dry, windy day means you'll be exposed.
Most of the people who are exposed - 60 percent to 70 percent, according to the Arizona Lung Association - never develop any symptoms. The other 30 percent to 40 percent develop a fever, chest pain, aches, fatigue, cough and sometimes a rash, within three weeks of breathing in the spores.
And a few of these people, like Arvil Harris, get very sick. Eleven months after being infected, Harris still coughs and feels tired most of the time. Spores have now traveled to his muscles, causing lumps in his arms. It is always possible that the spores could also move into his bones or his brain. Medicine to control the spores costs $800 a month.
Complications as severe as Harris' are rare, says his doctor, John Burke, of LDS Hospital's infectious disease department. Under one percent of the people exposed ever develop a serious disease, says Burke.
Still, he cautions, "If I were an archaeologist, I'd want to wear a mask."
State epidemiologist Craig Nichols, who also stresses that severe cases are "a rare event," suggests that mountain bikers might also want to wear masks when riding their bikes across the desert in the southwest corner of Utah.
Acetaminophen: Too many trips to medicine cabinet for everyday pain reliever may spell liver damage, death.
Fourteen-year-old Louise Richards had a few cavities in her teeth and went to the dentist to have them filled. No big deal.
When one of the teeth continued to hurt, Louise didn't tell her parents right away. She didn't want them to take her back to the dentist. Instead, when the pain didn't go away, she did what all those TV commercials tell us to do - she went to the medicine cabinet for some pills.
Every four hours, sometimes less, Louise took a few more tablets of acetaminophen. Acetaminophen can be found in pain relievers such as Tylenol, Panadol, Children's Anacin 3 and Excedrin P.M. - although Louise's was a generic brand.
When she finally told her parents how much her tooth hurt, they took her to the dentist, who gave her a prescription for a strong acetaminophen-based pain killer. She took three of those, on top of the pills from home.
Looking back on it, Louise's parents, Linda and Thomas Richards, figure that Louise took about 15 acetaminophen a day for 31/2 days - about 50 pills in all.
When she started feeling sick to her stomach they thought she had the flu, since everyone else in the family had the flu. But everyone else got well and Louise got sicker; so sick that her parents finally took her to the hospital. Five days later she was dead.
Louise suffered from acetaminophen poisoning, a rare response to a drug casually consumed by millions of people each year. The overdose - which her parents believe occurred at just three pills over the daily dose - caused her liver to shut down, which in turn caused her brain to swell. Two total blood transfusions did not help.
Dr. Joseph Veltri, director of the Poison Control Center, says that acetaminophen poisoning is "exceedingly rare."
But "a variety of medicines are toxic if overused, including multiple vitamins," he adds. "If you're not getting (pain) relief after 24 hours," Veltri cautions, "you need to stop what you're doing and get professional advice."
Acetaminophen, although a safe drug when taken in the proper dosage, "is a dangerous overdose," notes Salt Lake sports medicine physician Russ Toronto, "because the symptoms are so mild at first you wouldn't know you took too much." But once the liver is damaged, he says, "it's irreparable."
Taking more than the recommended dosage of acetaminophen, he adds, is not only dangerous but superfluous. "You don't get more pain relief. If you take two (tablets) every four hours you'll get as much relief as you're going to get."
Louise's grandmother, Dorothy Haslem, worries about other teenagers who might run to the medicine cabinet too often, not realizing the potential peril.
Contact lenses: Improper care or poorly fitting discs threaten infection, loss of eyesight or eyes themselves.
Hardly a day goes by, says Salt Lake ophthalmologist Gary Stanford, without someone coming into his office in danger of losing an eye. Nearly always it's a contact lens wearer who has failed to appreciate that there are germs lurking in the universe, just waiting to do their job.
Sudamonis, for example - a nasty critter that can penetrate the cornea and cause a person to lose his eyesight in just six hours. Or staphylococcus. Or streptococcus or pneumomcoccus. Or a hundred other bacteria.
"The major problem," says Stanford, "is that patients don't take care of their (contact) lenses properly."
Indeed, most contact lens wearers take the little plastic discs for granted, forgetting that they can be a perfect place for a germ to set up house.
When soft lenses and gas permeable lenses are not cleaned properly, Stanford explains, protein deposits build up on the cornea. The protein is abrasive and can make little divots in the corneal epithelium. The germs hop into the divots, he says.
Excess protein buildup also prevents enough oxygen from getting through to the epithelium. "When oxygen can't get through, the epithelium can die," he explains. Protein buildup can also lead to giant papillary conjunctivitis.
The same oxygen starvation can happen from a poorly fitting contact lens, he adds. It's sometimes hard to know if the poor fit is a result of faulty hygiene - that causes the cornea to swell - or if the lenses fit poorly from the moment they were purchased.
Stanford cautions lens wearers to make sure they return for a checkup after they buy new lenses. Even if the lens seems comfortable it may still not fit properly, he says.
Sandra Brimhall found out this lesson the hard way. After wearing contacts for 20 years, she recently discovered that a poor-fitting lens had caused the outer layer of the cornea to die. Her doctor has told her she may never be able to wear her contacts again.
Stanford also encourages annual checkups. As soft lenses get older, he explains, they tend to get tighter, thus preventing oxygen from getting through and allowing more lactic acid to build up. As a result, the acidity of the lens wearers' tears changes, and those changes cause the lenses to get still tighter.
Soft lenses and gas permeable lenses can also develop microscopic cracks, which act as burrowing places for germs.
Extended-wear lenses - sometimes worn for several weeks at a time without being removed - increase the risk by as much as 30 times, says Stanford, because when the eyes are closed less oxygen can get through to the cornea.
He recommends that all soft, gas permeable and extended-wear contact lens owners follow this regimen:
- Never rinse lenses with tap water. Germs live in tap water. They also live in distilled water.
- If you make your own saline solution, be sure to boil it.
- Disinfect as well as clean the lenses daily. Heat-processing sterilization works best, says Stanford. Not all eye doctors agree with him. A disinfectant that includes peroxide works just as well, says optometrist Wayne Kimball. Stanford disagrees: "There are certain bacteria that peroxide won't kill."
- Never wear daily-wear lenses overnight. Keep overnight uses of extended-wear lenses to a minimum.
- Remove contact lenses before swimming or using a hot tub. Even chlorinated water will not kill all the pool bacteria.
- Allow lens cases to air-dry after each use and wash them weekly, to avoid contamination with bacteria and fungi.