A rare form of black bear--that is actually white--faces threats to its survival in its British Columbia habitat

by Jessica Snyder Sachs

FROM THE DOCK of British Columbia's Hartley Bay, guide Marvin Robinson looks across the waters of the Douglass Channel to Gribbell Island. The 96-square-mile island--thickly forested in hemlock, cedar and fir--is home to the world's highest concentration of the rare "spirit bear"--a pale color variant of the American black bear. Long revered by the First Nations of British Columbia, scientists dubbed it the Kermode bear in 1905 after one of the first scientists to study the species, Francis Kermode. ... READ MORE at NATIONAL WILDLIFE.

The editors of National Wildlife asked me to report on how wild animals are changing their diets, behaviors, and in a few cases, even their genetic makeup in their struggle to cope with global warming. It's in the December/January issue.

Copyright Jessica Snyder Sachs, as first appeared in Popular Science

LIKE A COWBOY loosely holding the reins, Larry Weatherman steers up Deer Creek Road with his left hand on the wheel, his right arm ready at his side. His upper body rocks with the motion of the pickup as he navigates the dirt road's gauntlet of potholes and rocks. Since his retirement from the Missoula County Sheriff's Department in 2000, Weatherman has adopted the bushy white mustache and Stetson of a gentleman rancher. But on a snowy Saturday in March, he has driven 50 miles down from his 20 acres above Montana's Seeley Lake to take a visitor into the forlorn woods that served, three decades ago, as the dumping grounds for Montana's most notorious serial killer.

A gust of snow hits the windshield. Through the swirl, Weatherman spots a narrow break in the pine and fir trees lining the road. He pulls into a shallow ditch and opens his door. "He liked to take his girlfriends up here to party," he says.

Weatherman was a young officer in 1974 when he investigated the first in a series of gruesome murders that ended a way of life in Missoula, a place where people had left their doors unlocked and women felt comfortable walking home alone from the local bar. The first victim was a preacher's wife found gagged, bound, and shot in the basement of her home, her husband's handgun jammed between her legs. In addition to questioning the husband, Weatherman briefly suspected a high-school boy who neighbors had spotted in the victim's backyard that day. A grand jury found insufficient evidence to charge either suspect.

Over the next 12 years, the seemingly random murders continued. Three teenage girls and a married couple were killed, and the town suffered a spate of home intrusions thought to have been thwarted rapes. Then the improbable happened. In 1986 a would-be victim, already trussed and stabbed, managed to break free and kill 30-year-old Wayne Nance in a bloody struggle. Nance, a baby-faced furniture deliveryman and part-time bouncer, was the high-schooler Weatherman had suspected in 1974. Postmortem searches of Nance's bedroom and his father's house uncovered evidence of at least three additional murders and of other break-ins.

But hope for further information about the murders died with Nance. Weatherman was left with the unidentified remains of two young victims. One of them was "Debbie Deer Creek," a teenager whose skeleton he had chiseled out of a frozen grave alongside Deer Creek Road some 21 months before Nance's death. Several strands of dyed hair enabled Weatherman to connect her to a photo of a dark-haired drifter that bar patrons knew as "Robin" before she disappeared a few weeks after moving in with Nance. Weatherman sent out scores of bulletins to the FBI and regional law-enforcement agencies. But the girl's picture and street name failed to locate family.

It would take more than hair strands and a faded picture to identify Debbie Deer Creek. It would take technology--still two decades away--that could extract minute amounts of fractured DNA to reveal an indelible link to a victim's family. It would take one brother's unceasing search to find out what happened to his runaway sister. And perhaps most of all, it would take the U.S. Department of Justice's slow but horrifying realization that there may be far more serial killers on the loose in America than anyone had ever expected.

For two decades, a facial reconstruction made from Debbie Deer Creek's skull sat on top of Weatherman's bookcase facing that of another girl, "Christy Crystal Creek," discovered by a hunter two miles farther up the same mountain road above Nance's home. "I knew somebody once cared for them," he says.

The Silent Missing

Debbie and Christy are far from alone, and the same might be true of the likes of Wayne Nance. In a recent issue of the scientific journal Homicide Studies, criminologist Kenna Quinet wrote that conventional calculations seriously underestimate the number of serial murder victims. "The problem may be 10 times worse than we imagined," she says. Instead of 180 victims a year in the U.S., there may be as many as 1,800.

Quinet, a nationally renowned homicide expert at Indiana-Purdue University Indianapolis, bases her conclusions on simple arithmetic. According to the Department of Justice, up to 40,000 sets of unidentified human remains sit in police-evidence lockers and medical examiners' offices across the nation. If resolved cases are any guide, the majority are murder victims. Against this, Quinet factors the homicides suspected in a significant proportion--as much as 20 percent--of missing-person cases, more than 100,000 of which remain open at any time in this country.

Quinet bolsters her new estimates with evidence of the lengthy careers of the serial killers who are eventually caught and convicted. "Typically, these killers operate under the radar for years, even decades," she explains. Studies show that male serial killers average six to eleven victims over a nine-year period. Female serial killers (primarily health-care workers) average seven to nine victims over the same window.

And that's just those who get caught. "I would guess that at any given moment," she says, "there are at least two people in each state committing serial murder"--more than 100 serial killers on the loose. Washington State is currently tracking at least four: the so-called 22-Caliber Killer, the Index Killer, the Lewiston Valley Killer and the Snohomish County Dismemberment Killer.

Meanwhile, other serial killers are operating too randomly or infrequently to generate a pattern or are cunning enough to prey on those unlikely to be missed. Quinet calls these possible victims America's "missing missing," the tens of thousands whose disappearance is not taken seriously by law-enforcement agencies. They include those that law enforcement assumes to be "missing" by choice: runaways, transients, prostitutes, and anyone who has an outstanding bench warrant. (The irony, Quinet notes, is that the warrant can be for the missing person's failure to appear in court.)

John Morgan, deputy director for science and technology at the National Institute of Justice, the research arm of the Department of Justice, believes that part of the problem is the increasingly transient nature of American life. "We live in a more fragmented society," he says. "A lot of homicides that occur involve strangers." And for a greater number of the victims, living far from their hometowns and disconnected from a social network, their absence won't be noticed, or they will be dismissed as having simply moved on. As a result, Morgan says, it's now less likely "that a particular homicide will be resolved and the killer brought to justice."

The first step in solving these crimes--even before a detective can start to connect the clues--is connecting the bodies to the missing. "After all," Quinet says, "it's hard to conduct a murder investigation when you don't know who the victim is."

One in a Million

Derek Bachmann was 14 in 1984 when he helped his 15-year-old sister, Marci, pack her bags and run away from their Vancouver, Washington, home. "She told me my stepfather was touching her, making her touch him," he recalls. "I told her, 'You're right, you need to get the hell out of here.' " That was the last time he saw her. "The fact that I helped her pack has always haunted me," says Bachmann, now a Web marketer living outside St. Louis. "I mean, there were five different serial killers in the Northwest at the time." (In fact, there were at least eight.)

In 1991 Bachmann began to search for his sister, if only to confirm his fears. "I think I knew that if Marci was alive," he says, "she would have contacted me." He called and wrote to scores of homicide task forces and vice squads across the country, the latter in case Marci had fallen into streetwalking. "I tried everything," he says. "I tried psychics. I hired a private investigator, spent $10,000 on him. Got nothing."

By 2000, Web sites such as the Doe Network offered Bachmann a new resource. Maintained by amateur detectives and families of the missing, these cyber-bulletin boards feature case histories and, when possible, photos or artist re-creations of the unnamed dead, typically gleaned from news and police reports. Bach-mann began spending all-nighters at his computer. His obsession put a strain on a short-lived marriage, he admits with a slow shake of his head. "The atrocities I've seen looking for my sister."

Among them was a flower-adorned memorial page dedicated to a girl named Robin, with a photo of a dark-haired girl in glasses under the banner "Do you recognize this face?" Bachmann looked again. There was something familiar about the mouth and nose. "I showed it to my relatives," he recalls. "They said, 'No way. Marci never wore glasses.' " Besides, the hair color was wrong. Still, a few months later, he dialed the number provided for the Missoula County Sheriff's Department and left a message for Captain Greg Hintz. No return call.

When Marci left home in 1984, Seattle's Green River Killer was at the height of a spree that would eventually claim the lives of as many as 49 women, mainly prostitutes and teenage runaways. Bachmann wrote to King County detective Tom Jensen, head of the Green River Task Force, who promised to compare Marci's dental records with the impressions taken from the four unidentified victims in his custody. But no dental records were available, and Jensen added Marci's file to those jamming his filing cabinets.

In 2001, King County sheriff's deputies arrested 53-year-old truck painter Gary Ridgway for the Green River killings; two years later, he was sentenced to 48 consecutive life terms. The work of the Green River Task Force was finished. But Jensen still had more than 100 missing persons and suspected homicides in his files.

Jensen's captain assigned three detectives from the disbanded task force to review the cases and make a final effort to close them. And so, in the summer of 2005, detective Raphael Crenshaw called Derek Bachmann in Missouri: Was Marci still missing? Crenshaw told him about a new program that attempted to match family DNA against unidentified remains. Bachmann was eager to supply his, but Crenshaw also needed samples from his parents.

"I knew my dad would take a lot of convincing," Bachmann says. But he did convince his mother, who still lived in Washington. The next week, she rubbed a cotton swab against the inside of her cheek, sealed it in a plastic baggie, and sent it to the sheriff, who shipped it on to Texas.

Connecting DNA's Dots

When Nance and Ridgway were going about their grisly business, no method was available to connect the missing, like Marci Bachmann, to the dead. But there's now a lab, in Fort Worth, Texas, that can close the gap.

It's another March morning, and a steady rain has Fort Worth's Trinity River running high through the city's cultural district. On the other side of Camp Bowie Boulevard, employees and students are leaping over the ponds growing in the driveway of the University of North Texas Health Science Center. The third floor of this beige stucco high-rise is home to the university's Center for Human Identification, the only academic DNA lab in the country dedicated to identifying human remains.

Photo of Dixie Hybki and Rhonda Roby at the Center for Human Identification courtesy of the University of North Texas Health Science Center

In 1989, molecular biologist Arthur Eisenberg began using DNA to settle questions of identity in cases ranging from paternity to homicide. For the next decade, Eisenberg developed many of the procedures and standards used in DNA testing today. Around 2000, he began to focus on missing persons, and in 2001, he and his staff built a state DNA database. Since then, the center's capacity has grown to handle cases from across the country.

The victim specimens that arrive at the center range from well-preserved femurs (thigh bones) to broken slivers of bone that have been sitting inside police warehouses for decades. It's far easier to extract DNA from recent samples, and the center prioritizes easy identifications. Well-preserved or relatively fresh remains for which a family connection is already suspected take precedence over colder cases with no leads. The center has been able to solve one in every four of its cases.

Still, it's the difficult cases--the shots in the dark--that tantalize, says the center's project manager, Rhonda Roby. She speaks from experience, having spent her career developing methods for extracting DNA from severely degraded remains. In 1991 Roby began working in the Office of the Armed Forces Medical Examiner, where she helped develop methods for identifying the skeletal remains of American soldiers from Vietnam, Korea and World War II. In 2001 she flew to New York City to help set up protocols for the unimaginable task of identifying more than 20,000 pieces of human tissue retrieved from the ruins of the World Trade Center. She has also helped identify victims of Chile's Pinochet regime and, in a curious aside, the remains of Nicholas II and the Romanov family of tsarist Russia.

In 2004, shortly before Roby's arrival, the center achieved its first successful DNA extraction in an extremely cold case. The remains--a slender, yellowing femur--had arrived by FedEx. Forensic analyst Lisa Sansom cataloged the bone in the center's database as F2775.1EC and carried it into the lab's bone room, behind a door flagged "Forensic Low-Copy Area. AUTHORIZED PERSONNEL ONLY." The amount of genetic material retrieved from old bone tends to be so small as to be easily overwhelmed by the ambient DNA of a floating skin flake or a saliva droplet. Inside the Low-Copy Room, analysts don full gowns, face masks and surgical gloves. A positive-pressure system keeps "dirty" outside air from flowing in, and analysts have their genetic profile entered into the center's DNA database so that those will be excluded from target sequences.

The work differs from the kind of DNA fingerprinting used to identify biological evidence left at a crime. It is extremely difficult--sometimes impossible--to extract conventional nuclear DNA markers from an old bone. The center has become skilled in extracting and analyzing a hardier but less-known source of DNA: that of the mitochondria that reside in our cells.

Except for identical twins, each person's nuclear DNA is unique. But each of us has another set of DNA located outside the cell's nucleus and inside the mitochondria, the tiny organs that supply a cell with energy. We inherit mitochondrial DNA, known as mtDNA, directly from our mothers, and we share it with our siblings. It's not unique, but mtDNA is enough to narrow the search for a victim's family.

Sansom spent almost an hour scrubbing and sanding the femur's surface before attempting extraction. Few of the bones here contain marrow, which dissolves in the first two or three years after death. F2775.1EC had spent some 20 years in a box inside a police warehouse, so DNA would have to come from the scant cellular material inside the bone's white scaffolding.

She used a woodworker's dremel to cut a rectangular window in the thickened area of bone just below the femur's rounded head, where the thigh muscles once attached. Next she chilled, pulverized, and blended the sample inside a freezer mill loaded with sterilized ball bearings. Using an automated chemical process, she broke open the bone cells, released their genetic contents, and washed, concentrated, and purified the extract.

For genetic analysis, Sansom first had to increase the DNA to detectable amounts using a process called DNA amplification. Forensic software translated the results into a four-color graph of peaks and troughs. Drawing on her training and experience, she translated each graphic peak into one of the four nucleotide letters in the DNA alphabet. It took her about a week to process sample F2775.1EC.

When the amplification signals aren't clear, the chances for a reliable match plummet. In the worst case, the sequence data prove ambiguous, and workers must repeat the extraction and analysis. Sansom got her sequence on the first try. She uploaded it to the center's DNA database. No hits. Then she uploaded the data to the FBI's national missing-persons database. Again, no hits. Not yet.

Scaling the Backlog

In 2004 the center received a major investment to help realize Arthur Eisenberg's goal of establishing a National Center for the Identification of Human Remains. It was the first of several National Institute of Justice grants given over a five-year period totaling more than $7 million. The center's mission was to perform DNA testing on unidentified skeletal remains and "family reference" samples free of charge for any local or state law-enforcement agency that requested it. It's now a clearinghouse at the heart of an effort to address the thousands of missing persons and unidentified remains discovered each year--what the justice department calls "America's silent mass disaster."

"The World Trade Center attack devastated this country with its massive loss of life," Eisenberg says. "But if people only knew how many more unidentified murder victims there are . . . If you go back even 20 years, there are literally hundreds of thousands of families who have missing loved ones." Even with generous funding, progress will ultimately hinge on making identifications cheaper, faster and more definitive, he adds.

Laboratories such as the Center for Human Identification will be swamped now that more states mandate the collection of family-reference samples with missing-person reports. The center, Eisenberg says, must advance the technology used to identify human remains as it goes. By way of example, he cites a new program that can use broken bits of traditional nuclear DNA to identify weathered bones.

The tests scan some 40 lengths of highly fragmented DNA for single-nucleotide polymorphisms (or SNPs, pronounced "snips"), one-letter variations in the genetic code. The SNPs are then combined to create unique DNA fingerprints. If the center's tests are successful--and Eisenberg says they're making rapid progress--SNPs will allow forensic analysts to identify old bones more reliably than they can using mtDNA. "If SNPs pans out, it will be another revolution in how we deal with homicide," the National Institute of Justice's Morgan says. "There will no longer be a reason to have unidentified remains."

In addition to testing such systems, the Center for Human Identification is collaborating with other institutions in the effort to improve identification. It is working with the University of Tennessee, for example, to automate DNA analysis and speed up identifications for all the investigators and families tortured by a cold case. Right now, the center's tests produce a chart of several hundred peaks and valleys that a trained forensic analyst must read one nucleotide "letter" at a time. A second analyst then reads it again to verify its accuracy. Although complete automation of the process remains a distant dream, Tennessee scientists have designed a software program that can read "perfect" sequences, or unambiguous graphics. Soon it may be able to replace the second read and thus slash personnel costs and turnaround time.

But extracting and reading DNA from unidentified remains is only half the challenge. That DNA must get linked to the right missing person. What the country has sorely lacked, Morgan says, is a central repository for information such as photos, fingerprints, dental records, DNA sequences and other identifying information on both missing persons and unidentified victims. Make that database searchable, and it becomes a profitable tool for homicide detectives. Open it to the public, and it becomes a merciful resource for the thousands who currently spend their nights combing disturbing Web sites.

In 2005 the U.S. Attorney General's office formed a Missing Persons Task Force to develop the National Missing and Unidentified Persons System, or NamUs (identifyus.org). In 2007 the first part of the system--a searchable database of unidentified human remains--went live. Last year, the program opened up a national database of missing-person reports. And later this year, NamUs plans to connect the two, with a cross-searchable database that automatically matches the missing and the dead.

The Match

Before the NamUs database is complete, though, researchers at Fort Worth's Center for Human Identification have to rely on meticulous information-gathering and luck. The center has put together a DNA-collection kit for family members of the missing, which it sends out free of charge to the nation's police and sheriff's departments. Law-enforcement officers mail cheek swabs collected from the family back to the center, where workers analyze them in batches of up to 80 to yield both nuclear- and mitochondrial-DNA profiles of parents and siblings.

As each family member's DNA fingerprint comes off the line, it too goes through the databases to search for approximate matches among the dead. The process is spellbinding, claims forensic analyst Melody Josserand. Any of thousands of mysteries could be solved at that moment. "Even though I do searches 30 or 40 times a week, I've never walked away," she says. "I sit here with bated breath."

Josserand remembers the day in March 2006 when Unidentified Person F2775.1EC flashed across her screen. She had just uploaded family-reference sample F3352.1US, submitted by the King County Sheriff's office. Like the reels of a slot machine, twin columns of numbers rolled down her monitor. The rows for six out of six mitochondrial-DNA base pairs flashed green. A perfect match. But mtDNA alone, she knew, wasn't definitive. Fortunately, back in 2004, Sansom was able to pull seven markers for nuclear DNA from the victim's bone sample. Josserand compared the family-reference sample with that. All of them matched.

Josserand retrieved the folder for Unidentified Person F2775.1EC and checked it against the file for the family-reference sample. "The metadata all matched," she says of Debbie Deer Creek's physical descriptors: female; approximate age, 17; weight, 125; height, 5'7". Estimated date and place of death: 8/19/1984, Missoula, Montana.

From the missing-person report, Josserand read the name: Marcella Bachmann. Last contact: 5/1984, Vancouver, Washington. "All I could think was, 'I wonder how this poor girl got from here to there?' " she says. Still, certainty depended on more family samples, ideally from the biological father. So the call went out to Derek Bachmann through Detective Crenshaw in King County. Crenshaw didn't say anything about the bone from Missoula. "I gave him the spiel I give everyone, so as not to get hopes up," he says. " 'The lab wants more DNA samples to make sure that if there's a hit, they can narrow it down.' "

"I called up my dad," Bachmann says, "and flat-out told him, 'You have to do this. I have to know.' "

On March 22, 2006, the Center for Human Identification received two FedEx envelopes, one containing a cheek swab from Bachmann, the other from his father. The father's nuclear DNA matched all of Debbie Deer Creek's nuclear-DNA markers. To underscore the identification, Derek's mtDNA, like that of his mother, proved identical.

Following protocol, the Center for Human Identification relayed the news to the National Center for Missing and Exploited Children, which in turn called Missoula and Captain Hintz, who had submitted Debbie Deer Creek's femur after Larry Weatherman's retirement.

"I'll never forget his call," Bachmann says. "I was in a poker tournament and had to step outside." As Hintz spoke, Bachmann suddenly realized that he didn't want "closure" after all. "I instantly grasped the idea that he was finally calling back about the Web-site photo. I told him I'd been thinking about it, that the picture couldn't have been my sister," he recalls. "Well, he disabused me of that."

Photo of Derek and Marci in 1971 courtesy Derek Bachmann; Photo of Wayne Nance and "Robin" courtesy of Missoula County Sheriff's Office

The Final Identification

Almost exactly two years later, on this snowy March day in Missoula, Weatherman waits for Derek Bachmann to step out of the county truck they have borrowed for their second visit to the place where Weatherman unearthed Marci's frozen remains on Christmas Eve 1984.

Bachmann shivers inside his leather jacket. The snow quickly saturates his sneakers as he follows the retired lawman a quarter of a mile through the woods to a bluff above the Clark Fork River. A grove of spindly conifers still surrounds the mossy depression that once held Marci's body. "It was a lot harder the first time," Bachmann says of the visit. "Yeah," Weatherman acknowledges. "That was a hard one for you."

From beyond the bluff comes the rumbling sound of construction--or rather, deconstruction--echoing up from the Milltown Dam below. A strip of orange and yellow surveyor flags marks a path past Marci's gravesite to what will be a viewing platform directly above a river-restoration project. In addition to tearing out the old dam, the county plans to build a small park. Construction is due to begin in the spring. Bachmann has come back, in part, to ensure that nothing desecrates Marci's spot. Perhaps he can even persuade the county to raise a small memorial, he proposes. Weatherman nods in agreement.

"I suppose you're ready to put all this behind you," Bachmann offers as the men head back to the truck. "I don't suppose it ever will be," Weatherman says, "until we get Christy identified."

At press time, DNA from Christy's femur had been entered into the Center for Human Identification's database of cold-case remains, as well as the national DNA database. She's ready to be found.

For this month's issue of National Wildlife magazine, I got to delve into some great environmental news. (Welcome change.) It's a feature-length roundup of newly discovered populations or rare and endangered animals--both here in North America and abroad. No random discoveries, these. Many are solid evidence that protective measures are working. 

Thanks to my longtime Parenting editor Robert Barnett for bringing me on board NBC.com's iVillage team, where he is now the top health editor. My first post is on protecting yourself from H1N1 while caring for a sickie at home. Here's the link.

If you're religious about what really matters, you can take shortcuts with the rest. Check out our guide to being a sensible slacker.

With serious food allergies on the rise, it's hard to know if your child is at risk. Here's how to keep her safe, even when you're not around.

Copyright Jessica Snyder Sachs, as first published in Parenting

Ann Wood's* son Daniel almost died when he was 2 - from a snack. At first, Wood hadn't been worried when she'd called home from work and her babysitter mentioned that Daniel had just thrown up after eating an almond butter sandwich. "These things happen," she'd reassured her babysitter. "Just keep an eye on him." When Wood called back 15 minutes later, though, Daniel had developed diarrhea. When she called a third time, as she rushed home to their New Jersey suburb, he was struggling for breath. "Call 911 right now!" she instructed.

As Daniel emerged from an ambulance at the hospital, his face was covered with large red welts. The paramedics had found him in anaphylactic shock, which meant that his throat was swelling shut and his blood pressure was plummeting toward zero. They brought him back with injections of the stimulant pinephrine and an inflammation-squelching steroid. The next day, Wood and her husband learned that Daniel's reaction was from a life-threatening food allergy to peanuts, a trace amount of which had likely cross-contaminated the almond butter.

Now in second grade, Daniel isn't the only one of his friends with food allergies. Five kids in his grade carry EpiPens, the prefilled syringes that contain enough epinephrine to reverse a severe allergic reaction. And his grade is hardly unique. In the U.S., about 1 in 12 children under 3 have food allergies, and around 150 die each year because of them. Outside the U.S., the problem is no less serious; the incidence of food allergies in kids around the world has at least doubled over the last decade.

"The increase seems to be part of a general rise in allergies of all kinds," says Scott Sicherer, M.D., a pediatric allergist at New York's Mount Sinai School of Medicine and author of Understanding and Managing Your Child's Food Allergies.

While it's not clear what's behind this disturbing trend, many experts think it may have to do with the so-called Hygiene Hypothesis: that modern life - with its lack of exposure to the "germiness" of infiltered water, dirt, and animals - can leave people's immune systems prone to overreact to harmless substances. The result: Even something as innocent-seeming as a peanut can cause the body's defenses to go into overdrive. As overactive immune cells release histamine and other inflammatory chemicals, they produce symptoms such as hives, itching, diarrhea, and in severe cases, life-threatening anaphylaxis.

While regular exposure to relatively harmless bacteria might help make us less allergy-prone, no medical expert would advocate going back to the days of rampant cholera and intestinal parasites. So where does that leave us? Fortunately, there are steps you can take to reduce your child's risk of developing food allergies, and ways to handle them if they arise.

 
A Family Affair

The first thing you'll want to figure out is your family's allergy history. "The more people in your family who have allergies, the greater the risk your child will have one," says Dr. Sicherer.

Kathleen Murray-Lyons, of Townsend, Delaware, has allergies and asthma, so her pediatrician suggested special measures to decrease her 1-year-old son James's chances of food allergies. He recommended she delay introducing James to certain foods that are common allergens, such as nuts and eggs, and offer even low-allergenic foods, like carrots and rice, only gradually and one at a time. (See What to Introduce When). "So far, so good," says Murray-Lyons.

Another tactic doctors recommend: Wait to introduce any solids to your baby until after 6 months (as opposed to 4 months), since studies have found that this significantly decreases the risk of your child developing food allergies. As for what you should eat if you're breastfeeding, studies are mixed as to whether it's helpful to eliminate allergenic foods from your diet. Talk to your doctor about your particular case.

How to Recognize and Respond

Figuring out that your child has a food allergy can be half the battle. Leslie Norman-Harris of Woolwich Township, New Jersey, recalls the night her daughter, Camryn, 4, ate a mouthful of rice with shrimp.

"When she told us her mouth felt itchy, my husband and I looked at
each other and said, 'Uh-oh.'" Fortunately the symptoms subsided, but they knew not to give Camryn any more shrimp.

Other symptoms (which almost always appear a few minutes after eating the offending food):

Nausea

Vomiting

Diarrhea

Itching (throat, mouth, eyes, skin, and/or ears)

Lip swelling

Rash (hives or a flare-up of eczema)

Throat tightness (trouble swallowing or breathing)

Tongue swelling that obstructs the mouth

Chest pain

Dizziness

Sudden paleness or blueness, unconsciousness, and/or a faint pulse

 
For a mild allergic reaction, such as stomach upset or a rash, watch your child carefully in case she gets worse, and call your doctor. To relieve discomfort, you can give her a weight-appropriate dose of an antihistamine such as Benadryl or its generic equivalent (diphenhydramine).

If your child has a severe allergic reaction (like throat tightness, lip swelling, or unconsciousness), call 911. She may need an injection of epinephrine. Later, talk with your doctor about whether you should keep epinephrine on hand.

Testing and Treatment

If you think your child has a food allergy, see your doctor, who may recommend a pediatric allergist. He'll likely perform one of two tests: the classic skin-prick, which entails scratching a small amount of the allergen into the skin and watching for a reaction, or a blood test that screens for allergy-related antibodies.

But know that allergy tests are far from perfect, says Hugh Sampson, M.D., director of the Jaffee Food Allergy Institute at Mount Sinai School of Medicine. It's possible to have an allergy that doesn't show up on a test, or for a test to show that your child is mildly allergic to a certain food even though he can eat it without a problem. Bottom line: Diagnostic tests are best used to help confirm a suspected allergy, rather than to go fishing for possible ones.

Another alternative for determining food allergies is simply to talk about your child's symptoms with your doctor. Dr. Sampson, for example, says he looks for common patterns. Does the child always develop symptoms within minutes of having a particular food? Is it a food known to provoke allergies? If the answers are yes, then you may be dealing with a food allergy.

Once you know your child is allergic to a food, the best thing to do is avoid it entirely. (Allergy shots, while often effective for respiratory allergies, aren't usually used to treat food allergies because there's a greater risk of a dangerous reaction.) If your child does accidentally eat the wrong thing, the best line of defense is to follow your doctor's emergency plan, which will likely include relieving symptoms with an antihistamine or an emergency shot of epinephrine, depending on how severe the symptoms are.

Several promising treatments are now being studied. Most involve "immunizing" a person against the food allergen by injecting a modified version of it together with a substance that tells the immune system to "back off," or treat it as harmless. If these treatments pan out, they may become available as soon as 2010.

Avoiding Allergens

Steering clear of allergenic foods can be one of the toughest jobs a mom can take on. Fortunately, as of January 2006, the Food and Drug Administration requires all food labels to state if ingredients include any protein derived from one of the eight major allergenic foods. But you still need to be vigilant about reading the fine print on labels, which can contain surprises.

"Who would ever have thought that baby-food meats would have dairy in them?" says Jennie Oko of Westmont, Illinois, who has became an ingredient detective ever since her son Matthew, 3, was diagnosed with a dairy allergy as a baby.

Next: Make Your Child Food Smart

Not only do you need to be careful about keeping problem foods out of your house, you also need to teach your child to steer clear of them in other settings. "You don't want to scare him," Dr. Sicherer cautions. Just calmly explain, "Mommy and Daddy don't want you to feel sick, so it's important that you take food only from us and Grandma."

Dr. Sicherer even suggests role-playing together - for instance, by pretending to be a visitor offering him a cookie. If he starts to accept it, say something like "Uh-oh. Remember what we talked about - visitor doesn't know about your allergies."

You'll also need to get used to explaining your child's dietary restrictions when you eat out. A recent survey found that restaurant workers generally don't realize that something as small as a cross-contaminated serving spoon or frying pan could trigger a severe reaction.

"I Want What They're Having!"

For young children, not being allowed to eat what other kids do can be upsetting. When Sabrina Sciarrotta was 18 months, "she was so eager to have everything her big sister, Julia, had," recalls her mom, Monica, of Brea, California. "But while Julia was fine with dairy, Sabrina got headaches and broke out in rashes." To avoid a conflict, Sciarrotta now doles out Julia's yogurt and milk only when Sabrina is napping.

There will inevitably be times, though - at birthday parties, for instance - when your child can't ignore her limitations. Get in the

habit of sending your child to such events with "safe" food alternatives. At school, be sure to explain her food allergy to her teachers and the nurse. If your child has a severe allergy, see if her school will even send notes home to her classmates' parents, explaining that certain foods shouldn't be sent in for sharing.

Outgrowing Food Allergies

The good news is that many children's food allergies go away by age 5. In fact, milk, egg, wheat, and soy allergies disappear nearly 85 percent of the time. So if your child has sworn off, say, soy for several years, ask the doctor if it's a good idea to reintroduce it to him again. She may suggest repeat allergy tests under medical supervision.

While you're still dealing with food allergies, however, remember that "life should not be viewed as a mine field," says Dr. Sicherer. Wood agrees: "We try to protect Daniel while letting him live a normal life."

Allergy - or intolerance?

Many people use the terms "food allergy" and "food intolerance" interchangeably, but they're very different things. An allergic reaction involves a misguided immune response to an otherwise harmless substance. The result is runaway inflammation, which produces the rashes, itchiness, and swelling typical of allergies.

An intolerance results when a child (or adult) lacks one or more digestive enzymes needed to break down a food ingredient. Gas, bloating, and an achy stomach are the hallmark symptoms. (Lactose, or milk sugar, is by far the most common offender.) An intolerance can cause serious stomach pain but, fortunately, isn't life threatening.

* Name has been changed for privacy, at the request of the family.

Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World (Hill & Wang/FSG).

 

 

 

By Jessica Snyder Sachs

If you're religious about what really matters, you can take shortcuts with the rest. Check out our guide to being a sensible slacker.

1. Work Out 5 Days a Week?

It's not your imagination: Our bodies simply become higher maintenance after 40. Indulgences of food or drink are quicker to take revenge. Muscles require more maintenance. Screening tests become more important. So there's a lot to remember -- and yet the wellness precautions keep coming, with new dos and don'ts every passing year. Can anyone do it all?

Actually, no. And if you try, say experts, you may end up throwing in the towel on some of the essentials, as well as what's helpful but optional. So find out where you can settle for good enough and still enjoy great health.

Rule 1: Work out 30 to 60 minutes a day, five days a week. 
The Midlife Shortcut: Catch up when you miss workouts.

To reduce the risk of heart disease, cancer, and osteoporosis -- all big concerns for women over 40 -- experts urge us to exercise at least 30 minutes a day, five days a week (and for maximum health benefits, make that an hour rather than half an hour). But daily workouts can be difficult to fit into a life crammed with work and family responsibilities. Then there's the knee and joint pain that many women experience after years of pounding their way through "healthful" exercise.

Why there's wiggle room: The cumulative hours -- the total time you clock each week -- is what really counts. In fact, the weekend warrior has gotten a bad rap, says exercise physiologist Jane Roy, PhD, of the University of Alabama at Birmingham. If you're too busy Monday through Friday, weekends are a great time for getting in two or more hours of enjoyable exercise a day. You can catch up by spending a weekend morning or afternoon playing tennis with girlfriends, taking back-to-back aerobic and Pilates classes, or going for a long walk or run.

Then, during the week, concentrate on interspersing sedentary activities such as computer work with small but frequent movement breaks, Roy adds.

2. Get a Pap Smear Yearly?

Rule 2: Get a Pap smear every year.
The Midlife Shortcut: Get tested every two to three years.

Sexually active women under 40 should be tested every year, but women over 40 can stretch it out to once every two to three years once they've had three or more normal results in a row, as long as they're in a long-term, mutually monogamous relationship or are not sexually active, and they're still getting annual pelvic exams.

Why there's wiggle room: When a woman is either not having sex or always has it with the same person (and that person is not having it with anyone else), she's not being exposed to new strains of the human papillomavirus, explains gynecologist Stacy Tessler Lindau, MD, of the University of Chicago Medical Center.

The majority of people who have ever been sexually active have been exposed to one or more strains of HPV. Most women clear the symptoms of the virus within a few months. But in a small minority, the infection causes cells to become precancerous over the course of several years. These are the abnormalities that show up on Pap tests.

What that means is the risk of precancerous changes (and ultimately cervical cancer) becomes very low once women pass through this latency period without being exposed anew by having sex with someone different. Even if you don't have a new partner, says Lindau, "You can be exposed to new sexual partners through your own sexual partner." That's why your relationship has to be mutually monogamous; if you're not sure it is, continue to be tested every year.

3. Eat 5 Servings of Veggies a Day?

Rule 3: Eat your veggies: five servings a day.
The Midlife Shortcut: Aim to include veggies in most meals.

Five servings a day add up to a heck of a lot of vegetables. Using USDA food guide serving sizes, you'd need to swallow up to 17 cups of salad or solid veggies a week to meet that goal -- that on top of the four daily servings of fruit you're supposed to get.

Admittedly, as the over-40 metabolism slows, substituting produce for higher-calorie foods and snacks can help with weight control. But as our lives grow exponentially busier, getting down all those veggies can become overwhelming.

"Five servings a day remains an admirable goal," says registered dietitian Christine Gerbstadt, MD, of the American Dietetic Association. And she argues that meeting it can be a lot easier than you think. "Potatoes count," she notes. "Just don't make it french fries every day." You can also add salsa, tomato sauce, or any kind of bean to the list.

But she's also willing to compromise. "A decent daily plan is to include some vegetables in most meals, then concentrate on rounding out the rest of your diet by pumping up the fibrous whole grains and healthy fats."

Why there's wiggle room: If you look at the big nutrition picture and aim for moderate goals, success may encourage you to surpass your quota. But if you don't hit the mark every single day, Gerbstadt says, you can get by with a daily multivitamin -- that will ensure you get the vitamins and minerals that are naturally abundant in fresh vegetables.

4. Brush After Every Meal?

Rule 4: Brush after every meal. 
The Midlife Shortcut: Put down the toothbrush and grab some gum.

Or a toothpick. Or gum. Or a glass of water. It's not necessary to brush your teeth after every meal if you do something else to remove the food debris.

Why there's wiggle room: Brushing when you get up and before you go to bed is just fine, according to Edmond Hewlett, DDS, of the UCLA School of Dentistry. In fact, Hewlett says it's a bad idea to brush right after consuming acidic foods or beverages such as wine, orange juice, and most soft drinks. "The acidity slightly softens tooth enamel," he explains. So habitually brushing right after eating these foods can contribute to tooth sensitivity and cavities.

Chewing sugarless gum has other benefits besides removing food residue. It also increases saliva, which contains minerals that help replace the enamel lost to acidic food and acid-producing mouth bacteria. That's particularly important after age 40, when your natural saliva production starts to decrease. And if the gum contains xylitol, you'll get an added bonus: This sugar substitute inhibits the growth of cavity-causing tooth bacteria.

5. Sleep for 8 Hours?

Rule 5: Eight hours of sleep every night -- no sleeping in. 
The Midlife Shortcut: Sleep late on weekends.

Yes, the human body does need eight hours of sound sleep each night, says Joanne Getsy, MD, of Drexel University College of Medicine, in Philadelphia. "It's a fallacy that you need less sleep as you get older," she says. "You don't need less; you simply get less." Anyone dealing with hot flashes and sleep disturbances knows this too well. But whereas many experts insist that "catch-up sleep" isn't as good as the real thing, Getsy says there's room for deviating from your normal wakeup and going-to-bed times.

Why there's wiggle room: "The aim should be to pay back your sleep debt as soon as you can," Getsy says. Specifically, she recommends scheduling twice-a-week catch-up nights. "Pick one weeknight and one weekend night, and don't plan anything on those evenings," she advises. "Let them be your nights to recover." Daytime napping is okay too, she adds: "Just keep it under an hour so it doesn't interfere with a solid night's sleep."

As for sleep-bingeing on weekends, Getsy advises staying in bed as late as you like on Saturday. Then on Sunday, split the difference between when you'd like to get up and when you have to get up on Monday. That will help ease you back into your weekday schedule.

Even better news: Getsy says that when it comes to sleep debt, it's okay to pay back less than you borrowed. Usually one full night's sleep is enough to make up for a couple of shortchanged ones, she says. "If you feel better in the morning, you've slept enough."

6. Lift Weights 3 Times a Week?

Rule 6: Lift weights three times a week.
The Midlife Shortcut: Try for one or two sessions a week.

On top of encouraging us to meet aerobic exercise quotas, the health gurus tell us to get to the gym and pump iron at least three days a week. Strength training is especially important after menopause, at which point a woman's body tends to lose both muscle mass and bone strength.

"When you make the muscle grow, you strengthen the bone that's attached to it," explains Felicia Cosman, MD, of the National Osteoporosis Foundation. Aerobic exercise such as jogging works only about 20 percent of muscle fibers, she says, while strength training with weights engages up to 90 percent.

Why there's wiggle room: There's no magic number as to how often you need to strength train. Aim for regularity, Cosman says, even if it's just twice a week. Nor do you have to schlep to a gym. "Weight machines and free weights are good," Cosman says, "but so are equipment-free Pilates and yoga moves, and push-ups."

7. Do a Breast Self-Exam?

Rule 7: Do a breast self-exam every month.
The Midlife Shortcut: Do it often enough to notice changes.

We came of age being trained to search for lumps every month. The mandate feels even more compelling now, given how greatly the incidence of breast cancer increases after 40.

As it turns out, however, there's little evidence that obsessively examining yourself really helps women catch more life-threatening lumps.

Why there's wiggle room: After years of urging women to perform monthly self-exams, the American Cancer Society recently deemed them optional. But what's still important, says ACS spokesperson Debbie Saslow, PhD, is that women become familiar with how their breasts feel and what's normal for them. "For a lot of women, that's still a monthly exam. For others, it's the occasional self-exam or simply paying attention when getting dressed or showering."

Where Not to Cheat

Here's where our health gurus draw the line. Follow these three rules, they say, as scrupulously as you can.

Keep Moving 
Yes, you get brownie points for working out on weekends, but you lose out on lots of benefits if you just sit in a chair the rest of the week, says Jane Roy, PhD, of the University of Alabama at Birmingham. So get up for a stretch break at least once an hour at work (you could walk down the hall to talk to a colleague instead of sending an e-mail), and a few times a day, catch some fresh air with a quick five-minute stroll outside.

If you need extra motivation, consider this: Five one-minute stretch breaks over the course of a day burn just 15 to 20 calories. But over the course of a year, that adds up to over two pounds of fat.

Get a Mammogram Every Year 
When cancer strikes women in their 40s, the tumors tend to be aggressive, which means fast-growing -- so the early detection offered by mammograms is crucial, says the American Cancer Society's Debbie Saslow. After menopause, women tend to have slower-growing cancers, she adds, but the incidence increases. "So going longer than a year just isn't worth the risk," she says.

Maintain a Healthy Weight 
Overweight women are more likely to develop heart disease, diabetes, and many types of cancer than normal-weight women are.

In fact, a recent analysis estimates that 20 percent of all cancer deaths in American women are linked to excess weight. In general, cancer rates increase when a woman's body mass index exceeds 25, says Colleen Doyle of the American Cancer Society. The risk rises more dramatically when the BMI passes 30. Abdominal fat appears to be closely associated with postmenopausal breast cancer and cancers of the colon and pancreas. And some experts say that the risk increases when a woman's waistline exceeds 32 inches.

Originally published in MORE magazine, February 2009.

 

Antibiotic-resistant germs are showing up in hospitals, playrooms, and gyms around the country. Here's how to keep you and your family safe

By Jessica Snyder Sachs, as first appeared in PREVENTION magazine

One summer morning in 2004, Susanne Petrosky, 37, of Perkasie, PA, woke up feeling feverish. It was a month after she'd given birth to her third child, and one touch of her left breast--hot, swollen, tender--told her it was infected. She knew the drill, having been through it with her second baby. She called her doctor, picked up a prescription for the antibiotic clindamycin, and took it faithfully for the full 7 days. No more breast infection. 

Then the diarrhea started, with cramping so bad it made her recent labor pains seem mild. She made an appointment to see her doctor and got on the Internet. "I typed in clindamycin and side effects and it came right up--severe, sometimes fatal, diarrhea," she says. On the phone, her doctor was reassuring. That was on a Thursday. She spent much of the weekend lying on the bathroom floor; on Monday morning her sister drove her to the doctor. "He took one look at me," Petrosky says, "and told us to go straight to the emergency room."

Petrosky had picked up a dangerous new strain of an old bug: Clostridium difficile. The bacteria, which produces toxins in the intestine, is common--when people on antibiotics end up with diarrhea, C. difficile is often to blame. Generally, once they've finished taking the drugs, the diarrhea clears up on its own. But the new strain is much nastier than normal. It churns out 20 times the colon-damaging toxins as the older version, causing severe intestinal inflammation, or colitis, and is resistant to several important antibiotics. When Petrosky got sick, Canadian hospitals had already reported more than 200 deaths from C. difficile--toxins had eaten right through the walls of patients' colons. Many American hospitals were experiencing similar outbreaks, and the hypervirulent strain had begun to infect people in the general community. Since then, the situation has only gotten worse.

Experts have long warned against the overuse of antibiotics because of the possibility that bacteria would develop resistance to the drugs we use to kill them. Now, researchers say, some of their fears have come to pass. The CDC estimates that of the approximately 2 million bacterial infections Americans acquire in hospitals each year, 70% are resistant to at least one of the drugs commonly used against them. Why that's scaring the experts: If standard drugs don't work, doctors sometimes have to turn to more potent--and more toxic--alternatives. In some cases, those last-resort antibiotics have caused irreversible liver or kidney problems or lasting pain from nerve damage. In others, people have died for lack of an effective treatment. The CDC says that drug resistance kills 70,000 Americans each year--more than car accidents and homicides combined.

"The superbugs are here," says Martin J. Blaser, MD, president of the Infectious Diseases Society of America and the chair of New York University Medical School's department of medicine. "And it doesn't take a crystal ball to see that even more problems are coming." 

Scientists are trying to develop new bacteria-fighting drugs, but that process takes decades. In the meantime, we have to defend ourselves. It's crucial to be able to recognize the warning signs of a superbug infection, or, even better, prevent one. Here are four of the most dangerous of these germs and how leading experts say you can protect yourself.

Superbug C. difficile: A Toxic Intestinal Bug

When Petrosky got to the hospital, doctors immediately put her on extrapowerful antibiotics. She improved, but her right arm went numb from medicine-induced nerve damage; when her physicians switched drugs, she relapsed. It took more than 9 weeks to get her out of danger. After her recovery, her 4-year-old son and a neighbor went through similar bouts of illness. The neighbor had to be hospitalized.

The number of new cases of C. difficile-associated colitis among US hospital patients has doubled over the past 5 to 10 years, to as many as 500,000 a year, reports CDC medical epidemiologist L. Clifford McDonald, MD. The infection rate outside hospitals appears to have increased many times over, as well. And the death rate has skyrocketed: from less than 2% to as high as 17%.

Prevent It

Don't badger your doctor for unnecessary antibiotics. Remember: Antibiotics don't work against viral infections such as colds or flus.

Ask about alternatives if your doctor suggests long-term antibiotics for a chronic bacterial infection such as acne. (Try remedies like benzoyl peroxide cream instead.)

Avoid broad-spectrum antibiotics, if possible, when an illness requires an antibiotic. (Broad spectrum means they kill off good bacteria along with the bad.) The broad-spectrum antibiotics most associated with C. difficile infection are clindamycin (Cleocin), and the fluoroquinolones (Cipro, Floxin, and Levaquin).

Consider upping your intake of "friendly" bacteria, such as Lactobacillus and Bifidobacterium. They can be found in many brands of live-culture yogurt. Such a step can't hurt; research continues on whether it can help deny bad bugs a foothold in your system.

 Treat It

Contact your doctor if you have diarrhea or cramping and gas that lasts longer than a few days, and avoid antidiarrheal remedies, which can prevent your body from expelling C. difficile's tissue-damaging toxins. Instead, drink lots of fluids to stay hydrated and try the BRAT diet: bananas, rice, applesauce, and toast.

Superbug MRSA: Out of the Hospital and in your Community

On Christmas night, 2005, 14-month-old Bryce Smith had a stuffy nose and slight fever--his first cold, say his parents, Katie and Scott Smith of Santee, CA. Around midnight on New Year's Eve, Bryce began to struggle frighteningly for breath. The Smiths rushed him to the hospital, where a nurse checked his oxygen level. Within seconds, Katie recalls, at least 10 doctors and nurses had crowded around her baby, looking very scared.

X-rays and CT scans showed that Bryce's lungs were riddled with holes, and a team of surgeons hurried him into the operating room. Doctors told the Smiths that Bryce had the worst kind of lung infection, one caused by a particularly virulent variety of staph bacteria. Dubbed CA-MRSA, for community-acquired methicillin-resistant Staphylococcus aureus, the bacteria is resistant to penicillin, amoxicillin, and the other "cillins." And it produces poisons--which were chewing up Bryce's lungs.

Bryce lay in a medically induced coma for a month as doctors infused his body with a cocktail of antibiotics, sedatives, and other drugs. The medicines worked: After 40 days, the doctors brought him out of sedation and removed his tubes. But his parents have to be supervigilant now, because the treatment weakened his immune system, at least temporarily. "What would be an ordinary cold for us could prove deadly for him," his dad says.

Staph causes problems only when it slips past the body's defenses, through a cut or scratch or into lungs weakened by a viral infection. Close contact--on playing fields, in locker rooms and showers, and between children in day care and preschool--has been the key to many outbreaks. (Young children appear to be particularly at risk.)

MRSA made headlines in 2005 when Miami Dolphins Junior Seau and Charles Rodgers were hospitalized with limb-threatening skin infections and college football player Ricky Lannetti of Philadelphia died suddenly of MRSA pneumonia on the heels of the flu. And a study in the New England Journal of Medicine startled physicians by revealing that the bug now causes more than half of all skin infections treated in US emergency rooms. It's crucial, say researchers, for doctors to keep the possibility of MRSA in mind--the study found that most cases of MRSA were treated with drugs that don't work against the superbug.

How To Avoid MRSA

Prevent It

* Wash cuts and scrapes thoroughly with soap and water.

* Don't share personal items such as towels and razors, and just in case you have a scratch that would offer entry to MRSA, always keep your clothing or a towel between your skin and any shared surfaces such as workout equipment or locker-room benches. *

* Get vaccinated against the flu--the disease clearly raises the risk of the most severe kind of staph infections.

Treat It

* Don't ignore an infected wound or a pus-filled boil--not even a scratch, if it seems to worsen over the course of a few days. MRSA skin infections tend to be very red, swollen, and painful, sometimes with a raised bump resembling a spider bite. Getting the right antibiotic is critical, so ask your doctor to consider the possibility of MRSA.

* Be particularly vigilant about any chest cold or flu that takes a sudden turn for the worse, or a fever that spikes over 102 degrees F. "Every major medical center is now on the alert for MRSA," says John Bradley, MD, chief of infectious disease at Rady Children's Hospital--San Diego, where Bryce was treated. "But there's still a problem with general practitioners and small community hospitals, where doctors may never have seen a case."

Superbug E. Coli: Food's Dangerous Hitchhiker

Frightening news stories recently about the damage done by tainted spinach made it horrifyingly clear: Produce, like meat, can harbor lethal germs. The culprit in spinach, E. coli 0157:H7, is not antibiotic resistant (in fact, antibiotics are not used to treat this infection), but is indisputably extratoxic; the poisons it produces can cause fatal kidney failure. Strains of other foodborne bugs, Salmonella and Campylobacter, turn out vicious toxins, as well--and these bugs shrug off many drugs that once could vanquish them. All told, these pathogens sicken 3 to 4 million Americans each year and kill several hundred.

Prevent It

Be scrupulous about washing hands after touching raw meat or eggs, and cook these foods thoroughly. (More than half of all cuts of raw supermarket chicken carry Salmonella and Campylobacter, studies show.)

Use hot, soapy water to wash cutting boards and other kitchen surfaces that come in contact with raw meat or eggs.

Rinse produce--even veggies and fruits with a thick rind, such as cantaloupe--with a strong spray of water. If produce is contaminated by irrigation water, as was the case with spinach, only thorough cooking will destroy the germs.

Wash your (and your kids') hands after handling pet rodents and reptiles or farm animals, which can spread Salmonella and Campylobacter.

Throw your kitchen sponges into the dishwasher daily and dishrags into the washing machine often; use hot water.

Treat It

 See a doctor for severe gastrointestinal distress that lasts more than a couple of days, especially if accompanied by fever. If your doctor prescribes an antibiotic, call back if symptoms worsen or don't get better within 24 hours.

Superbug UTI: Bladder Infections That Won't Quit

The first time Dena Kelley got a urinary tract infection, she ended up in the emergency room. It was the winter of 1999, and Kelley, now a 33-year-old store manager in Anchorage, was seeing what looked like tissue in the toilet bowl--the lining of her infected bladder. "It was unbelievably painful," she says, "and it scared the heck out of me."

The ER doc gave Kelley a powerful antibiotic--Cipro--to stop the infection fast, but 6 weeks later, Kelley got another UTI. Over the next year, she averaged an infection every 2 months. Finally, her doctors reluctantly turned to a drug to which she'd been allergic in childhood--amoxicillin, at four times the usual dose. Fortunately, Kelley had outgrown her sensitivity to the drug, which ended the agonizing bouts of UTIs. But she can no longer make it through the night without a trip to the bathroom. And her doctors have told her that permanent bladder damage may predispose her to chronic infections throughout her life.

Roughly half of all women get at least one UTI at some point in their lives. Until the late 1990s, doctors were able to treat the problem with trimethoprim-sulfamethoxazole (Bactrim), a narrowly targeted antibiotic with minimal side effects. But many UTIs have become resistant to Bactrim and other drugs. So doctors must use stronger antibiotics that can cause problems of their own.

"It's frustrating," says Gazala Siddiqui, MD, a urogynecologist at the University of Texas Medical School at Austin. "These powerful antibiotics increase the chances of a yeast infection, and also the chances that a woman's next bacterial infection--whether it's another UTI or pneumonia--will be drug resistant."

If a resistant UTI lingers, it can cause scarring--which predisposes a woman to even more UTIs. Some doctors try to stop the vicious cycle by keeping women on antibiotics for months at a time. But that virtually guarantees that any break-through infections will be impervious to antibiotics, says Siddiqui, who's sometimes had to admit patients to the hospital for intravenous treatment.

Prevent Antibiotic-Resistant Bladder Infections

Prevent It

Begin with good vaginal hygiene: Wipe from front to back after using the toilet and pee before and after sexual intercourse. Don't douche, and consider alternatives to spermicides; both can irritate the delicate tissue around the urethra, raising the odds of infection.

Discourage UTI-causing bacteria by making the urinary tract and vagina more acidic. "Cranberry juice is good at this. Cranberry capsules are better," says Siddiqui, who recommends two or three glasses or capsules a day for women who are prone to recurrent infection. Also helpful: acidifying vaginal jelly available by prescription (Acigel) or over the counter (RepHresh).

Try a low-estrogen vaginal cream if you're peri- or postmenopausal and getting lots of UTIs. It will keep the tissue of the urethra from thinning and becoming more vulnerable to infection.

Treat It

If you suspect a UTI, ask your doc to send a urine sample for analysis. Start antibiotics, but call back for results. If it turns out not to be a bacterial infection, stop the drugs and work with your doc to find the true cause. If a bacteria is at fault, check to make sure the drug you're on is effective against the bug you have.

3 Stay-Healthy Moves To Make Right Now

1. Scrubbing with old-fashioned soap and hot water is the best way to keep germs at bay. Do it before eating, after using the toilet or handling animals, and before and after preparing food. Wash vigorously for 20 seconds, experts say--about the time it takes to sing "Yankee Doodle Dandy."

 
2. If a sink isn't handy, clean up with an alcohol hand sanitizer. Studies show that when someone is sick in a household, classroom, or workplace, using a gel (between hand washings) reduces the spread of disease-causing bacteria and viruses. Be sure to choose a product containing 60 to 95% alcohol--some contain less and can actually help spread germs. Use a generous gob--enough so that hands still feel damp after rubbing them together for 20 seconds.

 3. Skip antibacterial soap. Household soaps and other products with antibacterial chemicals, such as triclosan and triclocarban, don't prevent infection any better than products without them, studies show. Worse, some experts worry that they may promote drug resistance. There's no proof yet that they do, admits resistance crusader Stuart B. Levy, MD, of Tufts University. "But why take the risk when they haven't been shown to be any more effective?"

Have A Healthy Hospital Stay

Ironically, "A hospital is not a good place to be when you're sick," says Curtis Donskey, MD, chief of infection control at the Cleveland VA Medical Center. Filled with the sickest patients on the strongest antibiotics, they're breeding grounds for superbugs. Unfortunately, many doctors neglect the steps that can reduce patients' risk of picking up nasty germs during their stay, says Donskey, who has spent a decade raising awareness among his colleagues. Enlist a friend or family member to help ensure that doctors and other medical personnel follow these guidelines.

* Ask your doctor to remove invasive devices such as catheters and IV lines as soon as it's safe--they provide a pathway into your body for dangerous bacteria.

* Request the most highly targeted antibiotic if you require one. Remind your doctor to take you off the drug as soon as possible.

* Demand to know more about infection rates. Few states now require hospitals to release this information, so it's next to impossible to "shop around" to avoid particularly risky facilities. That may be changing: New York recently passed a law requiring hospitals to make public their rates of hospital-acquired infection, and a number of other states are considering similar legislation.

Writer Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health & Survival in a Bacterial World (Hill&Wang/FSG) and Corpse: Nature, Forensics, and the Struggle to Pinpoint Time of Death (Perseus/Basic Books).

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