Skip to Navigation

Foodborne Illness (transcript)
Share This:

 

 

SECOND OPINION

EPISODE #904

FOODBORNE ILLNESS

 

 

Announcer:

 

MAJOR FUNDING

FOR "SECOND OPINION"

IS PROVIDED BY THE BlueCross

AND BlueShield ASSOCIATION,

AN ASSOCIATION OF INDEPENDENT, LOCALLY OPERATED,

AND COMMUNITY-BASED BLUE CROSS AND BLUE SHIELD COMPANIES.

FOR MORE THAN 80 YEARS,

BLUE CROSS AND BLUE SHIELD COMPANIES

HAVE OFFERED HEALTH CARE COVERAGE IN EVERY ZIP CODE

ACROSS THE COUNTRY

AND SUPPORTED PROGRAMS

THAT IMPROVE

THE HEALTH AND WELLNESS

OF INDIVIDUAL MEMBERS

AND THEIR COMMUNITIES.

THE BlueCross AND BlueShield ASSOCIATION'S MISSION IS

TO MAKE AFFORDABLE HEALTH CARE AVAILABLE TO ALL AMERICANS.

NEWS ABOUT OUR INNOVATIONS IS ONLINE AT BCBS.COM

AND ON TWITTER

@BCBSAssociation.

 

 

 

"SECOND OPINION" IS PRODUCED

IN ASSOCIATION WITH

THE UNIVERSITY OF ROCHESTER MEDICAL CENTER,

ROCHESTER, NEW YORK.

 

Salgo:

 

WELCOME TO "SECOND OPINION,"

WHERE YOU GET TO SEE,

FIRSTHAND, HOW SOME OF THE

COUNTRY'S LEADING HEALTH CARE

PROFESSIONALS TACKLE HEALTH

ISSUES IMPORTANT TO YOU.

I'M YOUR HOST, DR. PETER SALGO,

AND TODAY I'M HAPPY TO WELCOME

FOOD SAFETY SPECIALIST

FROM NORTH CAROLINA STATE

UNIVERSITY,

DR. BENJAMIN CHAPMAN.

OUR "SECOND OPINION"

PRIMARY CARE PHYSICIAN,

DR. LOU PAPA.

DR. MICHAEL APOSTOLAKOS FROM

THE UNIVERSITY OF ROCHESTER

MEDICAL CENTER.

DR. BARBARA MAHON FROM

THE CENTERS FOR DISEASE CONTROL

AND PREVENTION.

AND ELIZABETH ARMSTRONG, WHO'S

HERE TODAY TO SHARE HER PERSONAL

STORY -- A STORY THAT OUR

PANELISTS, ALONG WITH YOU AT

HOME, WILL BE HEARING

FOR THE FIRST TIME.

THANK YOU SO MUCH FOR JOINING

US, ELIZABETH.

NOW, I KNOW THIS IS NOT AN EASY

STORY TO TELL, BUT TAKE US BACK

IN TIME JUST A LITTLE BIT.

YOU'RE A MOTHER OF TWO.

LET'S GO BACK TO 2006, WHEN THIS

ALL BEGINS.

HOW OLD WERE YOUR CHILDREN

BACK THEN?

 

Armstrong:

 

4 AND 2.

 

Salgo:

 

AND THEY WERE HEALTHY

AT THE TIME?

 

Armstrong:

 

THEY WERE PERFECTLY HEALTHY

LITTLE GIRLS.

 

Salgo:

 

AND WHAT KIND OF DIET

WERE THEY EATING?

 

Armstrong:

 

WE TRIED TO EAT VERY HEALTHY.

TRIED TO HAVE VERY LITTLE SUGAR,

MOSTLY FRESH FRUITS

AND VEGETABLES.

WE MADE A CONCERTED EFFORT

TO FEED THEM WELL.

 

Salgo:

 

BUT THEN SOMETHING

HAPPENED.

WHAT HAPPENED?

 

Armstrong:

 

IT WAS SUNDAY DINNER, AND WE

MADE A FRESH SPINACH SALAD.

NOT UNUSUAL -- MY KIDS LIKED

SALAD, AND THEY ACTUALLY LIKED

THE BABY SPINACH THAT I PUT IN

THE SALAD.

 

Salgo:

 

OKAY, NOW, BABY SPINACH,

THAT'S THE STUFF THAT COMES IN

THE BAGS SOMETIMES?

 

Armstrong:

 

YES, I BOUGHT THE BAGGED,

PREWASHED, READY-TO-EAT SPINACH.

 

Salgo:

 

>> WHAT HAPPENED NEXT?

 

Armstrong:

 

ABOUT FOUR OR FIVE DAYS

LATER, MY OLDEST DAUGHTER, WHO

WAS 4, STARTED HAVING A LOT OF

DIARRHEA.

AND THAT LASTED FOR TWO OR THREE

DAYS, AND THAT'S WHEN WE WENT

AND SAW HER PEDIATRICIAN TO FIND

OUT IF MAYBE SHE HAD A BUG.

AND THE DOCTOR SAID THAT SHE

LOOKED FINE, IT WAS PROBABLY

JUST VIRAL, JUST KEEP HER

HYDRATED.

BUT SHE WANTED ME TO LET HER

KNOW IF I FOUND ANY BLOOD

IN HER STOOL.

 

Salgo:

 

WHAT HAPPENED NEXT?

 

Armstrong:

 

ABOUT TWO OR THREE DAYS LATER,

SHE STARTED TO GET BETTER, SO WE

THOUGHT WE WERE OUT OF THE

WOODS.

BUT THEN OUR YOUNGEST DAUGHTER,

WHO WAS 2, STARTED EXHIBITING

THE SAME SYMPTOMS.

 

Salgo:

 

THEN WHAT?

YOU TOLD THE DOCTOR?

 

Armstrong:

 

UM, WELL, WE KEPT AN EYE

ON HER.

WE THOUGHT IT WAS JUST THE SAME

VIRUS THAT THE OLDER SISTER HAD.

HER BEING 2 AND SHE WAS STILL IN

DIAPERS, WE WERE ABLE TO KEEP A

BETTER EYE ON WHAT WAS GOING ON,

AND A COUPLE OF DAYS IN, WE

DISCOVERED BLOOD IN HER STOOL.

 

Salgo:

 

ALL RIGHT, SO THIS IS WHAT

THE DOCTOR WARNED YOU ABOUT.

AND YOU CALLED THE DOCTOR

AND SAID...?

 

Armstrong:

 

"WE FOUND BLOOD IN HER

DIAPER, AND SHOULD WE BE

ALARMED?"

AND SHE JUST SAID TO BRING HER

IN, JUST TO TAKE A LOOK AT HER.

 

Salgo:

 

AND SHE TOOK A LOOK AT HER?

 

Armstrong:

 

SHE TOOK A LOOK AT HER.

THE DIAPER WENT BACK TO THE LAB,

WHERE THEY TOLD HER -- THEY

TESTED IT AND FOUND OUT

IT WAS BLOOD.

BUT THE DOCTOR WASN'T CONCERNED,

AND SHE SAID THAT SHE THOUGHT MY

DAUGHTER MIGHT BE A LITTLE

DEHYDRATED.

SO THAT'S WHAT SHE WAS WORRIED

ABOUT, AND SO SHE SENT US TO THE

HOSPITAL JUST TO GET AN I.V.

TREATMENT.

 

 

Salgo:

 

ALL RIGHT. LOU, YOU'VE

HEARD THIS STORY.

BLOOD IN THE STOOL.

WHAT'S WRONG WITH ELIZABETH'S

KIDS?

 

Papa:

 

WELL, I MEAN, ONE OF THE

THINGS YOU THINK ABOUT WHEN YOU

HAVE DIARRHEA IS, IT'S USUALLY

AN INFECTIOUS CAUSE, ESPECIALLY

AMONG SIBLINGS.

SO THAT SEEMED PRETTY

REASONABLE, BUT THE BLOOD IN THE

STOOL RAISES A LITTLE BIT MORE

CONCERN -- THAT'S NOT SOMETHING

YOU EXPECT TO SEE, ESPECIALLY

IF, ON EXAMINATION, THERE'S NO

OBVIOUS CAUSE FROM IT, LIKE,

WITH THE DIARRHEA, THE BACKSIDE

KIND OF GETS RAW, AND SOME

PEOPLE GET SPLITTING OF THE SKIN

AND BLEEDING FROM THE SKIN

ITSELF.

 

Salgo:

 

SO, BASICALLY, YOU'RE LOOKING

AT THE COMMON STUFF FIRST.

 

Papa:

 

RIGHT.

 

Salgo:

 

BUT HER PEDIATRICIAN SAID,

"WATCH OUT FOR BLOOD."

 

Papa:

 

RIGHT.

 

Salgo:

 

AND SHE FOUND BLOOD.

OKAY, SO, DOES THAT CONCERN YOU

AT ALL?

 

Papa:

 

IT DOES, BECAUSE THERE ARE

SOME PATHOGENS THAT CAN CAUSE

BLOODY DIARRHEA, A NUMBER OF

DIFFERENT PATHOGENS, THAT CAN BE

INFECTIOUS IN THE COMMUNITY OR

INFECTIOUS FOODBORNE ILLNESSES

THAT CAN BE VERY SERIOUS.

 

Salgo:

 

OKAY, WHAT'S GOING THROUGH

YOUR MIND?

 

Papa:

 

WELL, ONE OF THE THINGS I

WORRY ABOUT IS, IF IT'S ONE OF

THESE CONDITIONS THAT CAUSES

BLOODY DIARRHEA, THAT THE

PEOPLE, INDIVIDUALS, ESPECIALLY

SMALL CHILDREN AND THE ELDERLY,

CAN GET SICK VERY QUICKLY

AND CAN CAUSE SERIOUS ORGAN

COMPLICATIONS, SO THEY HAVE TO

BE WATCHED CLOSELY.

 

Salgo:

 

SO YOU'RE IN THE

PEDIATRICIAN'S OFFICE, THEY

WANT TO TAKE HER

TO THE HOSPITAL?

 

Armstrong:

 

MM-HMM.

 

Salgo:

 

AND THEY WANT TO GIVE HER

SOME FLUID.

HOW ARE YOU DOING,

AT THIS POINT?

 

Armstrong:

 

A LITTLE CONCERNED.

MY BIGGEST CONCERN WAS, MY

NORMAL, HEALTHY, RAMBUNCTIOUS

2-YEAR-OLD WAS JUST VERY

LETHARGIC, AND SO WE WERE

HAVING TO CARRY HER AROUND, AND

THAT WAS JUST UNUSUAL.

SO IT'S A LITTLE DISCONCERTING

TO KNOW THAT YOU HAVE TO GO TO

THE HOSPITAL TO GET AN I.V.

 

Salgo:

 

OKAY, SO SHE GOES

TO THE HOSPITAL.

THEY PUT AN I.V. IN.

I'M GUESSING THEY ALSO WANTED TO

CHECK HER URINE OUTPUT.

DID THEY PUT A CATHETER IN?

 

Armstrong:

 

MM-HMM, AND SHE WAS NOT

ACTING LIKE HERSELF, AND --

SHE STARTED ACTING MORE AND

MORE DIFFERENT, THE LONGER

WE WERE IN THE HOSPITAL.

 

Salgo:

 

OKAY.

PANEL, WHAT'S GOING ON

WITH -- IT'S ASHLEY, RIGHT,

YOUR LITTLE DAUGHTER?

 

Armstrong:

 

ASHLEY.

 

Salgo:

 

WHAT'S GOING ON WITH ASHLEY?

ANYBODY HAVE AN IDEA?

 

Apostolakos:

 

WELL, WHAT I WORRY ABOUT IN

CHILDREN ESPECIALLY IS, THEY

HAVE LESS FLUID VOLUME TO LOSE,

SO THEY GET SYMPTOMATIC MUCH

EARLIER WITH FLUID LOSS

THAN AN ADULT.

AND THE BLOOD --

IN AN ADULT, THERE'S A LOT OF

DIFFERENT INFLAMMATORY AND OTHER

DISEASES, BUT BLOOD IN THE STOOL

OF A CHILD, I'D BE THINKING

VERY HIGH OF INFECTION.

AND WITH THE MENTAL STATUS

CHANGES, IT SUGGESTS TO ME

EITHER SHE'S REALLY SICK FROM

THE INFECTION OR DEHYDRATED AND

NOT GETTING ENOUGH BLOOD FLOW

TO THE BRAIN.

 

Mahon:

 

AS A PUBLIC HEALTH

PERSON, I'M JUST

HOPING THAT A STOOL CULTURE IS

ABOUT TO BE DONE TO FIND OUT

WHAT THE PATHOGEN IS, 'CAUSE I'D

BE VERY CONCERNED THAT THIS IS

AN INFECTIOUS CAUSE, AND THAT A

STOOL CULTURE WOULD BE NEEDED TO

GET THE DIAGNOSIS.

 

Salgo:

 

ALL RIGHT, SO THEY

START HER ON AN I.V.

AND THE HOPE WAS THAT IF SHE'S

JUST DEHYDRATED, SOME OF THIS

MENTAL STATUS CHANGE IS BECAUSE

HER BLOOD PRESSURE MIGHT BE LOW,

SHE NEEDS TO RE-EXPAND A BIT.

DID SHE GET BETTER?

 

Armstrong:

 

NO, SHE GOT MUCH, MUCH WORSE.

Salgo:

 

OH. TELL ME ABOUT THAT.

 

Armstrong:

 

WELL, AS A 2-YEAR-OLD IN A

HOSPITAL BED, THEY'RE IN A CRIB,

AND SO THAT SHE WOULDN'T FALL

OUT AND HURT HERSELF,

THE BARS WERE UP.

AND MY SWEET LITTLE 2-YEAR-OLD

IS GRABBING THE BARS OF THE

CAGES, AND JUST NOT HERSELF,

SCREAMING, VERY AGITATED,

WOULDN'T LET US COME NEAR HER

OR COMFORT HER.

DIDN'T EVEN WANT US

TO LOOK AT HER.

AND SHE'S STARTING TO VOMIT, AND

THE VOMIT IS GETTING DARKER AND

DARKER.

 

Salgo:

 

SO YOU'VE GOT DARK -- IS IT

 

BLACK-COLORED?

 

Armstrong:  IT EVENTUALLY GOT BLACK.

 

Salgo:

 

ALL RIGHT, DOES THAT TIP

ANYBODY TO ANY DIAGNOSIS YOU

WANT TO EXPLORE?

 

Papa:

 

IT SUGGESTS TO ME THAT THAT'S

BLOOD THAT'S COMING UP NOW,

DIGESTED BLOOD THAT SHE'S

VOMITING UP, THAT THE BLEEDING

IS BECOMING MORE EXTENSIVE.

 

Salgo:

 

OKAY, SO WE HAVE

A 2-YEAR-OLD CHILD

WITH BLOODY DIARRHEA IN THE

HOSPITAL WITH A CATHETER, WITH A

MENTAL STATUS CHANGE,

AND NOW DARK VOMITUS.

WHAT'S GOING ON?

ANYBODY HAVE AN IDEA?

 

Apostolakos:

 

WELL, I'M CONCERNED --

THERE ARE CERTAIN BACTERIA

THAT RELEASE TOXINS,

SHIGA TOXIN, ESPECIALLY, IN

CHILDREN, THAT CAN LEAD TO

PROFOUND SYSTEMIC EFFECTS,

TOTAL-BODY EFFECTS, WITH

PLATELET COUNTS DROPPING,

BLOOD CELLS HEMOLYZING,

CHILDREN GETTING QUITE SICK,

AND BLEEDING.

 

Salgo:

 

ALL RIGHT, LET ME

TRANSLATE A LITTLE BIT.

YOU'RE WORRIED ABOUT A TOXIN.

NOW, SOME BACTERIA MAKE YOU SICK

BECAUSE THEY GET IN THE BLOOD,

AND THE BACTERIA THEMSELVES

DO BAD THINGS.

SOME BACTERIA CAN MAKE YOU SICK

BECAUSE THEY EXCRETE, IF YOU

WILL, A POISON, A TOXIN.

 

Apostolakos:  

 

CORRECT.

 

Salgo:

 

AND SOME OF THESE TOXINS CAN

BE REALLY DANGEROUS.

 

Apostolakos:

 

CORRECT.

 

Salgo:

 

AND DO THINGS LIKE TRASH THE

ELEMENTS OF YOUR BLOOD THAT

ALLOW YOU TO CLOT, LIKE YOUR

PLATELETS, AND MAKE THEM

GO AWAY.

THEY CAN TRASH YOUR RED BLOOD

CELLS, SO YOU CAN'T MOVE ENOUGH

OXYGEN AROUND THE BODY TO

SUSTAIN LIFE.

THIS IS A BAD SITUATION.

WHAT HAPPENED NEXT?

 

Armstrong:  

 

I GOT A CALL FROM OUR

PEDIATRICIAN, WHO TOLD ME SHE

WAS GOING INTO RENAL FAILURE

AND THEY NEEDED TO LIFELINE HER

DOWN TO THE CHILDREN'S HOSPITAL.

 

Salgo:

 

WHAT WAS THAT LIKE?

SHE WENT IN AN AMBULANCE?

TELL ME ABOUT THAT.

 

Armstrong:

 

SHE DID.

THEY WHEELED IN THE AMBULANCE,

AND THEY STRAPPED MY LITTLE TINY

2-YEAR-OLD TO THIS BIG GURNEY.

AND WE ASKED IF WE COULD COME IN

THE AMBULANCE, BUT THEY

EXPLAINED THAT THERE'S JUST TOO

MANY DOCTORS AND TOO MANY

MACHINES IN THERE TO KEEP HER

ALIVE FOR US TO COME IN THE

AMBULANCE WITH HER.

AND SO WE HAD TO FOLLOW THE

AMBULANCE DOWN TO THE HOSPITAL.

 

Salgo:

 

OH, MY GOSH.

WHAT DID THAT FEEL LIKE?

 

Armstrong;

 

WORDS DON'T REALLY DO IT

JUSTICE.

I MEAN, YOU'RE JUST,

YOU'RE TERRIFIED.

 

Salgo:

 

WHEN DID YOU FIND OUT WHAT

WAS WRONG WITH ASHLEY?

AND WHAT DID THEY TELL YOU?

 

 

Armstrong:

 

WHEN WE GOT TO THE EMERGENCY

ROOM AT THE CHILDREN'S HOSPITAL,

THE RECEIVING PHYSICIAN TOLD US

THAT SHE HAD HEMOLYTIC UREMIC

SYNDROME, AND THE MOST COMMON

CAUSE OF THAT IS E. COLI.

 

Salgo:

 

OKAY. WHAT'S E. COLI?

 

Apostolakos:

 

E. COLI IS A BACTERIA THAT A

LOT OF US HAVE IN OUR

GASTROINTESTINAL TRACT, BUT

THERE ARE CERTAIN STRAINS THAT

ARE PATHOGENIC AND CAUSE

DISEASE, AND SOME OF THEM

MORE SERIOUS THAN OTHERS.

 

Salgo:

 

HOW BAD CAN

E. COLI BE?

 

Mahon:

 

WELL, IT CAN BE

VERY BAD.

ONE OF THE WORST IS THE

SHIGA TOXIN-PRODUCING E. COLIS.

 

Salgo:

 

SHIGA TOXIN IS

A POISON, A TOXIN THAT SOME

E. COLI CHURN OUT.

 

Mahon:

 

MM-HMM. THE SHIGA

TOXIN-PRODUCING E. COLI, THE BAD

ONES, CAN CAUSE SEVERE KIDNEY

FAILURE, THE HEMOLYTIC UREMIC

SYNDROME, AND DEATH.

AND THE YOUNGER THE CHILD IS,

THE MORE LIKELY THEY ARE TO GET

HEMOLYTIC UREMIC SYNDROME

IF THEY HAVE IT.

 

Salgo:

 

BUT THIS IS A 2-YEAR-OLD

GIRL, A 2-YEAR-OLD GIRL, WHO HAD

A MEAL OF SEVERAL DAYS BEFORE,

WASHED RAW VEGETABLES.

SPINACH, RIGHT?

AND SUDDENLY, WITHIN HOURS,

IT SEEMS, SHE'S AT DEATH'S DOOR.

HOW DOES THIS HAPPEN?

 

Papa:

 

WELL, INFECTIOUS AGENTS HAVE

A BILLION-YEAR HEAD START ON US,

SO THEY'VE BEEN AROUND A LONG

TIME, AND OUR SOCIETY IS

MASS-PRODUCING FOOD, SO THERE'S

A LOT MORE HANDS THAT ARE COMING

IN CONTACT WITH THAT FOOD.

SO THERE'S A GREATER CHANCE FOR

SPREADING FOODBORNE DISEASE.

AND THEY USUALLY COME ON PRETTY

QUICKLY, AND A LOT OF PEOPLE GET

SICK -- THEY GET DIARRHEA --

AND THEY GET BETTER.

THE VAST MAJORITY.

YOU KNOW, IT HAPPENS

TO ALL OF US.

 

Salgo:

 

THAT'S WHAT HAPPENED TO YOUR

4-YEAR-OLD DAUGHTER.

 

Armstrong:

 

MM-HMM.

 

Salgo:

 

RIGHT?

AND IT WAS LIKE, WHAT, THE

4-YEAR-OLD DAUGHTER GOT SICK HOW

MANY DAYS AFTER EATING?

 

Armstrong:

 

ABOUT FOUR OR FIVE.

 

Salgo:

 

AND THEN YOUR LITTLE

2-YEAR-OLD SEVERAL DAYS THERE--

IT'S A LONG TIME OUT.

WHAT'S GOING ON THERE?

 

Mahon:

 

WELL, DIFFERENT

SORTS OF BACTERIA HAVE

INCUBATION PERIODS -- THE TIME

BETWEEN THE TIME WHEN YOU EAT IT

AND THE TIME WHEN YOU GET

SICK -- OF DIFFERENT LENGTHS.

SO, FOR SOME OF THE SORT OF

WHAT WE CLASSICALLY THINK OF AS

FOOD POISONING, YOU EAT THE BAD

STUFF, AND YOU'RE VOMITING TWO

OR THREE HOURS LATER -- THAT'S

JUST A TOXIN, SHORT-ACTING

TOXIN, VERY SHORT INCUBATION

PERIOD.

BUT IN A SITUATION LIKE

E. COLI, THERE'S A WHOLE SERIES

OF EVENTS THAT ARE GOING ON

INSIDE THE PERSON, WHERE,

YOU KNOW, THE PATHOGEN GROWS,

IT ATTACHES TO THE INTESTINES,

IT MAKES THE TOXIN, THE TOXIN

ENTERS THE BLOODSTREAM, IT

TAKES TIME FOR IT TO ACT.

SO YOU CAN SEE INCUBATION

PERIODS THAT ARE A LOT LONGER

THAN JUST A FEW HOURS.

 

Salgo:

 

WE HAVE A QUESTION

FROM TWITTER.

KRISTEN, I BELIEVE, ASKS US,

WHY WAS IT THAT THE TWO

CHILDREN GOT SICK, BUT YOU

DIDN'T GET SICK, AND YOUR

HUSBAND DIDN'T GET SICK?

YOU ALL ATE THE SAME FOOD.

I'M ASSUMING YOU ATE A LITTLE

BIT MORE THAN THE KIDS DID.

HOW DO YOU EXPLAIN THAT?

GOOD QUESTION.

 

Papa:

 

I THINK IT WOULD BE NICE TO

UNDERSTAND THAT.

THAT'S TRUE WITH MOST INFECTIOUS

AGENTS.

WHY WOULD SOMEBODY GET

PNEUMONIA IN THE HOUSEHOLD, GET

A SINUS INFECTION, RESPIRATORY

TRACT INFECTION, AND OTHERS

DON'T?

YOUNG CHILDREN, OLDER FOLKS ARE

MORE SUSCEPTIBLE FOR GETTING AN

INFECTION.

 

Salgo:

 

E. COLI -- SPINACH

BOUGHT IN THE SUPERMARKET SHOULD

BE SAFE, BUT WE'VE HEARD OVER

AND OVER ON THE NEWS, RIGHT,

ABOUT FOODBORNE ILLNESSES, AND

E. COLI IS ALWAYS IN THIS MIX.

 

Chapman:

 

YEAH, E. COLI DEFINITELY

POPS UP A LOT OF THE TIME.

IT'S THE ONE THAT I THINK

CREATES SOME VERY TRAGIC

SITUATIONS, AS ELIZABETH SHARED.

WE SEE 48 MILLION CASES OF

FOODBORNE ILLNESS EVERY YEAR

IN THE U.S.

E. COLI MAKES UP A SUBSECTION

OF THAT GROUP, AND WHEN IT COMES

TO FRESH FRUITS AND VEGETABLES,

IT'S NOT A SURPRISE THAT WE SEE

CONTAMINATION.

IT'S NOT SO MUCH THAT THESE

THINGS AREN'T SAFE, IT'S JUST

THE FACT THAT THEY'VE -- THEY'RE

RAW, THERE ISN'T A COOK STEP OR

A KILL STEP FOR THESE PRODUCTS,

MAKES IT SO ANYTHING THAT'S COME

IN CONTACT WITH THEM COULD

CONTAMINATE THEM.

IT PUTS A LOT OF ONUS OF THIS

BACK ONTO THE PRODUCERS THAT

PRODUCE THIS FOOD TO MAKE SURE

THAT THEY'RE DOING WHAT THEY CAN

TO MAKE SURE THERE ISN'T

CONTAMINATION BEING ADDED TO IT,

BECAUSE THERE ISN'T ANYTHING

THAT ELIZABETH COULD HAVE DONE

IN HER KITCHEN.

I MEAN, YOU MENTIONED THAT IT

WAS A WASHED PRODUCT, AND IN

FACT, OUR RECOMMENDATIONS ON

LOOKING AT FOODBORNE ILLNESS

WOULD SAY, DON'T WASH THAT

AGAIN, 'CAUSE YOU'RE AT A

GREATER RISK OF CONTAMINATING IT

WITH SOMETHING THAT'S IN YOUR

KITCHEN THAT'S ATTACHED TO THAT

LEAFY GREEN, AND YOU REALLY

CAN'T DO ANYTHING ABOUT IT.

 

Salgo:

 

SO, WHAT DO YOU DO?

YOU'RE AT THE RECEIVING

HOSPITAL, IN COMES LITTLE

ASHLEY, RIGHT, AND THEY'RE

TELLING YOU, "MENTAL STATUS

CHANGE," AND YOU MUST BE

THINKING, "HEMOLYTIC UREMIC

SYNDROME."

 

Apostolakos:

 

ABSOLUTELY.

 

Salgo:

 

WHAT DO YOU DO FOR IT?

 

Apostolakos:

 

WELL, THE BEST TREATMENT

WE HAVE IS PLASMAPHERESIS,

WHERE IT'S SIMILAR TO DIALYSIS

BUT YOU EXCHANGE, FOR LACK OF

A BETTER TERM, THE PLASMA OR BAD

HUMORS FOR NORMAL,

FRESH-FROZEN PLASMA, WHICH IS

ESSENTIALLY THE SERUM,

THE NON-RED CELLS IN HER BLOOD.

AND THAT HAS REALLY CHANGED

THE COURSE OF THIS DISEASE.

 

Salgo:

 

WHAT DID THEY TELL YOU

WHEN ASHLEY GOT TO THE HOSPITAL?

 

Armstrong:

 

THE RECEIVING DOCTOR WAS

ACTUALLY A SPECIALIST IN HUS.

AND HE SAID -- WELL, THEY SAID,

THE PROBLEM WITH HUS IS YOU JUST

ESSENTIALLY MANAGE SYMPTOMS.

THERE'S NO CURE FOR IT.

AND SO THE ONLY THING THEY CAN

DO IS TRY AND KEEP HER ALIVE

AND MANAGE THE SYMPTOMS.

AND HE SAID FOR HER, BECAUSE HER

KIDNEYS HAD SHUT DOWN, THAT SHE

NEEDED PERITONEAL DIALYSIS.

 

Salgo:

 

I WANT TO PAUSE

FOR A MINUTE.

I WANT TO SUM UP WHERE WE ARE,

AND THEN WE'LL KEEP GOING.

E. COLI.

A DANGEROUS FOODBORNE PATHOGEN

THAT CAN CAUSE SEVERE ILLNESS

AND EVEN DEATH.

IF YOU ARE SICK AND YOU SUSPECT

A SERIOUS FOODBORNE ILLNESS,

OF WHICH E. COLI IS ONLY ONE,

SEEK MEDICAL CARE RIGHT AWAY,

BECAUSE DELAY CAN BE LETHAL.

SO, WE'RE TALKING WITH ELIZABETH

AND YOU'RE SHARING YOUR STORY

ABOUT YOUR DAUGHTER, WHO BECAME

DEATHLY ILL BECAUSE OF E. COLI.

WHILE YOU WERE IN THE HOSPITAL

AND E. COLI WAS NOW RISING TO

THE SURFACE AS THE CAUSE OF ALL

THIS TROUBLE,

WAS THE HEALTH DEPARTMENT

INVOLVED?

 

Armstrong:

 

YEAH. WHEN THEY PUT US IN THE PICU,

THEY KIND OF QUARANTINED US,

BUT I THINK IT WAS A FEW DAYS

LATER WHEN WE GOT A CALL FROM

THE HEALTH DEPARTMENT.

 

Salgo:

 

AND WHAT DID THEY

ASK YOU?

 

Armstrong:

 

THEY JUST RAN THROUGH THEIR

LITANY OF QUESTIONS ON, "WHAT

DID YOU EAT IN THE PAST,

YOU KNOW, WEEK OR TWO?"

 

Salgo:

 

DID THE CDC COME?

 

Armstrong:

 

NO.

 

Salgo:

 

WHEN DO THEY GET INVOLVED?

 

Mahon:

 

WELL, A LOT WAS GOING ON

BEHIND THE SCENES, I THINK, THAT

ELIZABETH AND HER FAMILY

PROBABLY DIDN'T SEE AT THE TIME.

SO, THE WAY WE DO SURVEILLANCE

FOR FOODBORNE OUTBREAKS IS BY

GETTING REPORTS IN FROM DOCTORS

AND FROM LABORATORIES THAT HAVE

TAKEN CARE OF PATIENTS THAT HAVE

DIAGNOSED THESE INFECTIONS.

THEY REPORT THEM TO

THE HEALTH DEPARTMENT.

FOR E. COLI, FOR SALMONELLA,

THEY ALSO SEND THE ACTUAL

BACTERIA THAT WAS ISOLATED FOR

THE PATIENT TO THE HEALTH

DEPARTMENT, AND THE STATE PUBLIC

HEALTH LABORATORY DOES SUBTYPING

ON IT.

 

Salgo:

 

DID THE HEALTH DEPARTMENT

EVER COME TO YOU, DID THE CDC

EVER COME TO YOU AND TELL YOU,

"THIS IS PART OF AN OUTBREAK,"

THAT "WE'VE SEEN OTHER CASES"?

 

Armstrong:

 

NO, BUT WHEN YOU'RE IN

THE PICU, THERE'S NOTHING MUCH

TO DO BUT WATCH TV, AND THAT'S

WHEN THE NEWS WAS BREAKING THAT

THERE WAS AN E. COLI OUTBREAK IN

SPINACH.

 

Salgo:

 

SO YOU SAW IT ON TELEVISION?

 

Armstrong:

 

MM-HMM.

 

Salgo:

 

SHOULDN'T SOMEONE HAVE TALKED

TO HER?

 

Mahon:

 

WELL, WHEN THEY TALKED TO HER

AND FOUND OUT WHAT HER CHILD HAD

EATEN, THAT WAS GATHERING THE

INFORMATION THAT WAS NEEDED TO

DETERMINE WHAT THE CAUSE OF

THE OUTBREAK WAS, SO THAT THEY

COULD INTERVENE TO STOP IT.

 

Papa:

 

AND I THINK THE PUBLIC

HEALTH OFFICIALS' ROLES IS,

THEY'RE NOT REALLY INVOLVED IN

HER CARE.

IN TERMS OF WHAT CAUSED IT AND

WHAT THE TREATMENT PLAN, THAT'S

PART OF HER CARE TEAM.

HER CHILD HAS BEEN EXPOSED.

WE NEED TO GET THE WORD OUT SO

THE REST OF THE COMMUNITY KNOWS

THAT THERE'S THIS OUTBREAK AND

THEY NEED TO AVOID THE POSSIBLE

EXPOSING AGENT.

 

Salgo:

 

I UNDERSTAND

THAT, PRIOR TO YOUR DAUGHTER'S

GETTING SICK, SOME OTHER

CHILDREN HAD GOTTEN SICK FROM

SPINACH PURCHASED IN

THE GROCERY STORE

AND THAT THERE WAS A HIGH

SUSPICION, IF NOT CERTAINTY,

THAT THIS SPINACH WAS THE CAUSE

OF THE E. COLI.

IS THAT TRUE, IN YOUR MIND?

 

Armstrong:

 

AS WE GOT FURTHER AND FURTHER

ALONG IN HER ILLNESS, AND MORE

AND MORE RESEARCH WAS DONE,

YEAH, BY THE DATE THAT WE HAD

BOUGHT THE SPINACH, THERE WERE

ALREADY CASES --

YOU KNOW, WEEKS PRIOR.

SO, IF THE SPINACH WOULD HAVE

BEEN PULLED BACK THEN, IF IT

WOULD HAVE BEEN IDENTIFIED AS

AN OUTBREAK AND THE FDA WOULD

HAVE BEEN ALLOWED TO FORCE

A RECALL BACK THEN,

THEN THE BAGGED SPINACH WOULD

NOT HAVE BEEN ON THE SHELF

BY THE TIME WE BOUGHT IT.

 

Salgo:

 

CAN THE FDA FORCE A RECALL?

 

Chapman:

 

YES.

 

Salgo:

 

THEY CAN?

 

Chapman:

 

YEAH, THEY CAN,

AND BACK IN 2006 WHEN THIS

HAPPENED, THEY DIDN'T HAVE THAT

LEGISLATIVE AUTHORITY TO

DO THAT.

THAT'S PART OF MORE UPDATED

RULES THAT PASSED SINCE THEN.

BUT WHAT THE FDA WAS ABLE TO DO

AND HOW THAT INFORMATION GOT OUT

WAS THEY WERE ABLE TO PUT

A HEALTH ADVISORY OUT,

WHICH IS --

IT SOUNDS LIKE SEMANTICS BETWEEN

A RECALL AND A HEALTH ADVISORY,

BUT WHEN PUBLIC HEALTH OFFICIALS

SAY, "DON'T EAT SPINACH FROM

THIS PRODUCER OR THIS COMPANY,"

IT HAS A SIMILAR EFFECT

ON THAT PRODUCT.

 

Salgo:

 

BUT IT PUTS THE ONUS

DIFFERENTLY, RIGHT?

A RECALL PUTS THE ONUS ON

THE STORE.

OR, IF YOU WILL, THE PRODUCER,

RIGHT?

 

 

Chapman:

 

RIGHT, BUT I THINK ONE THING

WE NEED TO POINT OUT HERE IS

THAT, OFTEN WHEN THOSE HEALTH

ADVISORIES HAPPEN, THOSE STORES

GO AHEAD AND RECALL THAT PRODUCT

THEMSELVES.

 

Mahon:

 

WITH THIS OUTBREAK, WHAT I

UNDERSTAND HAPPENED -- I WASN'T

THERE AT THE TIME --

WAS THAT, IN THE MORNING,

THE REALIZATION HAPPENED

WITH THE PUBLIC

HEALTH AGENCIES, CDC,

AND SEVERAL STATES THAT WERE

INVOLVED, THAT IT LOOKED VERY

MUCH LIKE IT WAS SPINACH.

AND THAT AFTERNOON, FDA MADE

AN ANNOUNCEMENT TO THE NATION

THAT PEOPLE SHOULDN'T EAT

BAGGED SPINACH AT ALL.

AND AT THAT POINT,

THE INFORMATION ABOUT WHAT

BRAND, WHAT LOT, THAT WASN'T

AVAILABLE, SO THE ANNOUNCEMENT

WENT OUT, "JUST DON'T EAT

BAGGED SPINACH."

 

Salgo:

 

FROM YOUR PERSPECTIVE,

THOUGH, AND I THINK WE CAN

UNDERSTAND WHERE YOU'RE COMING

FROM, YOUR DAUGHTER'S IN

THE HOSPITAL, DEATHLY ILL,

LITERALLY LIFE AND DEATH,

AND THE BAGGED SPINACH IS STILL

OUT THERE IN THE SUPERMARKET.

 

Armstrong:

 

YEAH. A FEW DAYS AFTER WE HAD

GOTTEN INTO THE PICU IS WHEN

THE ANNOUNCEMENT WAS MADE BY

THE FDA AND THE SPINACH WAS

RECALLED OFF THE SHELVES.

 

Mahon:

 

ONE OF THE DELAYS THAT PUBLIC

HEALTH DOESN'T HAVE A LOT OF

CONTROL OVER

IS THE DELAY FROM, THE PERSON

GETS SICK AND GOES TO THE DOCTOR

AND THAT STOOL SPECIMEN IS

OBTAINED, AND IT TAKES A COUPLE

OF DAYS IN THE LABORATORY FOR

THAT BACTERIA TO GROW.

 

Salgo:

 

THAT'S JUST BASIC

SCIENCE.

 

Mahon:

 

IT HAS TO BE SENT TO THE

STATE LABORATORY.

THAT COULD BE ANOTHER DAY.

THE STATE LABORATORY HAS TO

SUBTYPE IT.

THAT COULD BE ANOTHER

SEVERAL DAYS.

AND THEN THAT INFORMATION IS

SENT TO THIS NATIONAL

REPOSITORY, WHERE THE

INFORMATION CAN BE COMPARED.

SO, YOU PUT ALL THAT TOGETHER,

IT COULD BE EASILY A COUPLE

OF WEEKS.

 

Salgo:

 

YOU SAID SOMETHING

INTERESTING, AND I WANT TO

REVISIT THIS.

THIS WAS, WHAT, TRIPLE-WASHED

SPINACH?

THREE TIMES.

IN A SEALED PLASTIC BAG.

NOW, IS THERE ANYTHING ELIZABETH

COULD HAVE DONE

TO MAKE THIS ANY SAFER?

SHOULD SHE HAVE WASHED IT?

AND I THINK I HEARD YOU SAY NO.

IT WAS MORE DANGEROUS TO

WASH IT, PERHAPS, THAN NOT.

 

Chapman:

 

RIGHT, YEAH.

IN FACT, THAT'S THE SITUATION

WITH THIS PRODUCT.

THE BACTERIA IN THE FIELD OR IN

THE PROCESSING PLANT ATTACHES SO

WELL TO THAT ROUGH PART OF

THE LEAFY GREEN LEAF OR IN

THE STOMATA, THAT THERE'S

NOTHING THAT ELIZABETH COULD

HAVE DONE TO REDUCE RISK

IN HER HOME.

IT REALLY COMES DOWN TO, WHAT

THOSE GROWING PRACTICES WERE AND

WHAT THE PRODUCTION

PRACTICES WERE.

WHAT WE DO KNOW IS THAT, IT'S

PRETTY UNLIKELY THAT ANYBODY

COULD HAVE WASHED IT FURTHER.

WHETHER IT'S INSIDE THE PLANT OR

REALLY ATTACHED HARD ON THE

OUTSIDE OF THE PLANT, AT THIS

POINT WE'LL NEVER KNOW BECAUSE

WE CAN'T GO BACK TO SEE THOSE

INDIVIDUALS,

BUT THAT'S POSSIBLE.

IT'S ENTIRELY POSSIBLE THAT

LEAFY GREENS CAN INTERNALIZE

E. COLI 0157:H7.

 

Salgo:

 

AND IN THIS PARTICULAR CASE,

THE E. COLI WAS TRACED ALL

THE WAY BACK TO A FIELD WHICH

HAD BEEN USED FOR ANGUS

CATTLE AND CONTAMINATED BY

THE CATTLE FECES.

IS THAT WHAT I UNDERSTAND?

 

Mahon:

 

THERE WAS A FIELD

THAT HAD, AS YOU SAID, BEEN USED

FOR CATTLE PREVIOUSLY.

THERE WERE CATTLE IN

A FIELD NEARBY.

THE SAME STRAIN OF E. COLI WAS

ACTUALLY ISOLATED FROM WILD PIGS

THAT WERE IN THAT AREA.

I DON'T THINK WE KNOW EXACTLY

WHAT THE SOURCE WAS, BUT

CERTAINLY THERE WERE PLENTY OF

OPPORTUNITIES IN THAT AREA FOR

STUFF THAT WAS GROWING THERE TO

GET CONTAMINATED.

 

 

Salgo:

 

NOW, I DON'T WANT TO LEAVE

OUR VIEWERS WITH THE IMPRESSION

THAT, "AH, DON'T BOTHER WASHING.

IT CAN'T COME OFF ANY MORE."

IN FACT, THERE ARE THINGS YOU DO

IN YOUR KITCHEN EVERY DAY,

RIGHT, WHICH CAN PROTECT YOU IN

A VERY REAL SENSE FROM

CONTAMINATED FOOD.

WHAT WOULD YOU SUGGEST?

WHAT DO YOU TELL FOLKS WHO ASK

YOU ABOUT THAT?

 

Papa:

 

WELL, IT'S LIKE ANY

FOOD HANDLING, THAT, YOU KNOW,

YOU USE CLEAN SURFACES,

YOU USE CLEAN HANDS.

YOU KEEP YOUR MEAT AND YOUR

VEGETABLES SEPARATED.

THOSE ARE ALL VERY IMPORTANT.

 

Apostolakos:

 

WASH YOUR HANDS.

 

Salgo:

WASH YOUR HANDS.

 

Apostolakos:

 

WASH YOUR HANDS

OVER AND OVER AGAIN.

IT'S IMPORTANT IN THE HOSPITAL.

IT'S IMPORTANT AT HOME.

IT'S IMPORTANT WHEN YOU'RE

HANDLING FOOD.

 

Mahon: 

 

THANK YOU. AND ESPECIALLY

AFTER TOUCHING ANY RAW MEAT.

OR ANY RAW FOOD OF ANIMAL

ORIGIN.

AND THE OTHER THING THAT'S ONE

OF MY PERSONAL FAVORITES IS TO

KEEP FOODS THAT ARE SUPPOSED TO

BE REFRIGERATED, REFRIGERATED AT

THE RIGHT TEMPERATURE.

A LOT OF PEOPLE'S REFRIGERATORS

AREN'T AS COLD AS THEY SHOULD BE

AND A LOT OF PEOPLE LEAVE

STUFF OUT, AND BACTERIA LOVE

WARMER TEMPERATURES.

 

Salgo:

 

THIS BEGS THE QUESTION, WHAT

TEMPERATURE SHOULD YOUR

REFRIGERATOR BE AT?

 

Chapman:

 

YOU WANT TO KEEP THAT FRIDGE

AT 41 OR BELOW, REALLY, AND

THAT'S GOING TO CURB THE GROWTH

OF MOST OF THOSE PATHOGENS.

AND ONE OTHER THING THAT I'D

ADD IS, IF WE ARE COOKING FOODS

OF ANIMAL ORIGIN, THAT YOU COOK

THEM TO A TEMPERATURE WHERE

YOU'RE GOING TO KILL ANY OF

THOSE PATHOGENS IN THERE.

AND THE BEST TOOL THAT I HAVE IN

MY HOME IS A MEAT THERMOMETER.

I USE A DIGITAL MEAT THERMOMETER

FOR EVERYTHING SO I KNOW THAT

I'M REDUCING RISK FOR MY FAMILY.

 

Salgo:

 

WHAT HAPPENED TO

ASHLEY?

SHE'S GETTING DIALYSIS.

WHAT HAPPENED TO HER OVER

THE NEXT FEW DAYS AND WEEKS?

 

Armstrong:

 

WE FOUND OUT THAT HER BRAIN HAD

SWELLED, AND THAT WAS WHAT WAS

CAUSING SOME OF THE

BEHAVIOR PROBLEMS.

SHE DEVELOPED PANCREATITIS.

 

Salgo:

 

OH, MY GOSH.

THE PANCREAS IS AN ORGAN IN YOUR

ABDOMEN THAT DEALS WITH A LOT OF

FUNCTIONS, INCLUDING A LOT OF

ENDOCRINE FUNCTIONS

LIKE INSULIN.

THAT'S A NASTY COMPLICATION.

 

Armstrong:

 

YEAH. LUCKILY, AFTER SEVERAL

DAYS, THAT STARTED

TO HEAL ITSELF.

THAT WAS FINE.

WHAT THE DOCTORS WERE MOST

CONCERNED ABOUT WAS, SHE HAD NO

URINE OUTPUT FOR WEEKS.

WE WERE ON 24-HOUR DIALYSIS

FOR...

WELL, THE WHOLE TIME WE WERE IN

THE PICU, SO SIX, SEVEN WEEKS?

AND THEN...

ONCE HER LEVELS STARTED TO

BECOME A LITTLE BIT MORE NORMAL,

WE WENT TO THE MANUAL DIALYSIS

EXCHANGES.

AND WE WERE TRAINED ON HOW TO DO

THAT SO THAT WE COULD

BRING HER HOME.

 

Salgo:

 

WE'VE HAD A LOT OF

INFORMATION OVER HERE, SO I WANT

TO STOP AND SORT OF SUMMARIZE

WHAT'S GOING ON.

WHILE FOODBORNE ILLNESS CANNOT

ALWAYS BE PREVENTED, IT'S ALWAYS

A GOOD IDEA TO USE FOOD SAFETY

PRECAUTIONS, THE SIMPLE STUFF

IN YOUR KITCHEN,

AND THESE INCLUDE THOROUGHLY

WASHING FRUITS AND VEGETABLES,

COOKING FOODS AT

THE RECOMMENDED TEMPERATURE.

IT DOES WORK, IT DOES WORK.

EVEN IF SOMETIMES IT WON'T HELP,

IT'S GOING TO PREVENT THE VAST

MAJORITY OF FOODBORNE ILLNESSES.

IS THAT FAIR?

 

Mahon:

 

WELL, IT PREVENTS THE VAST

MAJORITY THAT THE CONSUMER CAN

PREVENT.

 

Salgo:

 

WELL, YOU'RE SIX YEARS OUT.

HOW IS ASHLEY DOING?

 

Armstrong:

 

SHE'S STABLE.

SHE HAS PERMANENT KIDNEY DAMAGE

AS A RESULT OF THE E. COLI.

HER KIDNEYS ARE FUNCTIONING WELL

ENOUGH THAT SHE DOESN'T HAVE TO

BE ON DIALYSIS, BUT THEY'RE FAR

FROM NORMAL.

HER NEPHROLOGIST ESTIMATES THAT

THEY'RE WORKING ABOUT 10%

TO 15%.

 

Salgo:

 

AFTER ALL OF THIS, WITH

EVERYTHING WE'VE HEARD,

WITH ALL THE DISRUPTION THAT IT

CAUSED -- IT ALMOST KILLED ONE

OF YOUR DAUGHTERS --

ARE YOU ANGRY ABOUT ANY OF THIS?

 

Armstrong:

 

I WOULDN'T SAY I'M ANGRY, BUT

I WAS DEFINITELY NAIVE BEFORE.

I ASSUMED THAT OUR FOOD WAS SAFE

AND I ASSUMED THAT IF IT WAS,

ESPECIALLY, BEING SOLD IN

A GROCERY STORE, THAT STEPS HAD

BEEN TAKEN TO MAKE SURE THAT

IT WAS SAFE.

AND I REALIZED THAT THAT'S

NOT TRUE AND THAT WE ALL AS

CONSUMERS HAVE TO BE OUR OWN

BEST ADVOCATES.

AND SO, WE MAKE SURE THAT WE

GROW A LOT OF OUR FRESH FRUITS

AND VEGETABLES AT HOME SO THAT

WE CAN KIND OF AT LEAST HAVE

A SEMBLANCE OF CONTROL.

AND THEN WE DO A LOT AS A FAMILY

TO ADVOCATE FOR BETTER

FOOD SAFETY PRACTICES.

 

Salgo:

 

I WISH YOU AND, ASHLEY, YOUR

ENTIRE FAMILY ALL THE BEST.

THANK YOU SO MUCH FOR

JOINING US.

IT WAS A TERRIFYING STORY AND

THANK YOU FOR SHARING IT.

WELL, UNFORTUNATELY, WE ARE OUT

OF TIME, BUT I HOPE THAT YOU

CONTINUE THE CONVERSATION ON

OUR WEB SITE.

THERE, YOU ARE GOING TO FIND

THE ENTIRE VIDEO OF THIS SHOW

AS WELL AS THE TRANSCRIPT

AND LINKS TO RESOURCES.

THE ADDRESS IS

SecondOpinion-tv.org.

THANKS FOR WATCHING.

I WANT TO THANK ALL OF YOU FOR

BEING HERE.

THANK YOU ESPECIALLY FOR SHARING

YOUR STORY.

I'M DR. PETER SALGO, AND I'LL

SEE YOU NEXT TIME

FOR ANOTHER "SECOND OPINION."

 

 

 

Announcer:

 

MAJOR FUNDING

FOR "SECOND OPINION"

IS PROVIDED BY THE BlueCross

AND BlueShield ASSOCIATION,

AN ASSOCIATION OF INDEPENDENT, LOCALLY OPERATED,

AND COMMUNITY-BASED BLUE CROSS AND BLUE SHIELD COMPANIES.

FOR MORE THAN 80 YEARS,

BLUE CROSS AND BLUE SHIELD COMPANIES

HAVE OFFERED HEALTH CARE COVERAGE IN EVERY ZIP CODE

ACROSS THE COUNTRY

AND SUPPORTED PROGRAMS

THAT IMPROVE

THE HEALTH AND WELLNESS

OF INDIVIDUAL MEMBERS

AND THEIR COMMUNITIES.

THE BlueCross AND BlueShield ASSOCIATION'S MISSION IS

TO MAKE AFFORDABLE HEALTH CARE AVAILABLE TO ALL AMERICANS.

NEWS ABOUT OUR INNOVATIONS IS ONLINE AT BCBS.COM

AND ON TWITTER

@BCBSAssociation.

 

 

"SECOND OPINION" IS PRODUCED

IN ASSOCIATION WITH

THE UNIVERSITY OF ROCHESTER MEDICAL CENTER,

ROCHESTER, NEW YORK.

 

-END-