Re: Greetings and question

December 22, 2007

Dave,

There is probably not too much of an increase in risk working in a pet

store for someone with CLL as compared to someone without. There

are several notable exceptions, including toxoplasmosis, which is often

caught from changing cat liter, cryptococcus and coccidiosis from

pigeons. But even with all of the pigeon droppings in Manhattan, we

do not see this very often in patients. Most infections do not

cross species, so the infections of pets often will not affect

humans. The greatest risk to someone with CLL would still be

someone else.

With that being said, there are certain precautions that could be taken

to at least be safe, like wearing gloves and a mask when cleaning cages,

etc. It is important to not let the disease from controlling your

life if it does not have to. The most important thing is to make

sure your doctor knows. Therefore, if someone were to become sick,

they could be appropriately covered with antibiotics. For example,

Bactrim prophylaxis, which many CLL patients are on, does prevent

toxoplasmosis.

Rick Furman, MD

At 09:16 PM 12/21/2007, you wrote:

I would like to add my greetings

for a Happy and Healthy Christmas and

Holiday season to all here. I also thank all of you who take the

time

to post, especially and Dr. Furman who are so generous with

their

time in responding to all the questions.

My question is in regards to a position from which I recently

resigned. I accepted this position working in a Pet Store some

months

back because of the health insurance offered. I had recently left a

job where the health insurance had been cut drastically. Obviously I

wasn't thinking clearly when I accepted this Pet Shop position. I

was

thinking only of getting covered again by decent health insurance.

The

position included handling and cleaning the cages of mice, rats,

hamsters etc along with greeting all the Dogs that came into the

store

with owners. The store also offered vaccination services for dogs

and

cats which means that I was exposed to the freshly vaccinated pets.

I was dx in 2003 and had six rounds of RF in 05. My counts are

rising

so I am looking at treatment again maybe in 08. In any case when I

was

bitten for the second time by a Hamster, I decided I should probably

resign and pay for the Cobra and look elsewhere.

I am now looking for something that would substantiate the fact that

a

person such as myself or any of us would be putting their health in

jeopardy by working in a Pet Store so as to justify my resignation.

Any of you reading this I am sure realizes the danger I had put

myself

in. But I have searched everywhere trying to find something that

would

demonstrate this danger specifically to someone not as familiar as

you

with the dangers of the Pet Store environment. I have searched

every site I can think of and can't find anything that would

demonstrate specific danger to someone with CLL caused by working in

a

Pet Store. If anyone has a thought as to where I would find

something

in writing to show this danger to a person not familiar with CLL, I

would be most appreciative. My WBC also increased from 35K to 70K

during the Period I was employed there, but fortunately there were

no

other affects. And the white count jump may have been a

coincidence,I

guess. I apologize for the length of this post, but Dr. Furman if

you

have read this, would you advise a patient of yours to resign as I

did

or would you think I may have overreacted by leaving this postion?

Thanks everyone and again, Merry Christmas. Dave

December 23, 2007

Dr. Furman wrote of Bactrim prophylax. Is this drug be used for other infections besides bladder infection? My husband, Don, who has stage 4 CLL, gets reoccurring bladder infections. Would it benefit him to be on Bactrim prophylatically.

Thank you, Ida Krall

Re: Greetings and question

Dave,

There is probably not too much of an increase in risk working in a pet store for someone with CLL as compared to someone without. There are several notable exceptions, including toxoplasmosis, which is often caught from changing cat liter, cryptococcus and coccidiosis from pigeons. But even with all of the pigeon droppings in Manhattan, we do not see this very often in patients. Most infections do not cross species, so the infections of pets often will not affect humans. The greatest risk to someone with CLL would still be someone else.

With that being said, there are certain precautions that could be taken to at least be safe, like wearing gloves and a mask when cleaning cages, etc. It is important to not let the disease from controlling your life if it does not have to. The most important thing is to make sure your doctor knows. Therefore, if someone were to become sick, they could be appropriately covered with antibiotics. For example, Bactrim prophylaxis, which many CLL patients are on, does prevent toxoplasmosis.

Rick Furman, MD

At 09:16 PM 12/21/2007, you wrote:

I would like to add my greetings for a Happy and Healthy Christmas and

Holiday season to all here. I also thank all of you who take the time

to post, especially and Dr. Furman who are so generous with their

time in responding to all the questions.

My question is in regards to a position from which I recently

resigned. I accepted this position working in a Pet Store some months

back because of the health insurance offered. I had recently left a

job where the health insurance had been cut drastically. Obviously I

wasn't thinking clearly when I accepted this Pet Shop position. I was

thinking only of getting covered again by decent health insurance. The

position included handling and cleaning the cages of mice, rats,

hamsters etc along with greeting all the Dogs that came into the store

with owners. The store also offered vaccination services for dogs and

cats which means that I was exposed to the freshly vaccinated pets.

I was dx in 2003 and had six rounds of RF in 05. My counts are rising

so I am looking at treatment again maybe in 08. In any case when I was

bitten for the second time by a Hamster, I decided I should probably

resign and pay for the Cobra and look elsewhere.

I am now looking for something that would substantiate the fact that a

person such as myself or any of us would be putting their health in

jeopardy by working in a Pet Store so as to justify my resignation.

Any of you reading this I am sure realizes the danger I had put myself

in. But I have searched everywhere trying to find something that would

demonstrate this danger specifically to someone not as familiar as you

with the dangers of the Pet Store environment. I have searched

every site I can think of and can't find anything that would

demonstrate specific danger to someone with CLL caused by working in a

Pet Store. If anyone has a thought as to where I would find something

in writing to show this danger to a person not familiar with CLL, I

would be most appreciative. My WBC also increased from 35K to 70K

during the Period I was employed there, but fortunately there were no

other affects. And the white count jump may have been a coincidence,I

guess. I apologize for the length of this post, but Dr. Furman if you

have read this, would you advise a patient of yours to resign as I did

or would you think I may have overreacted by leaving this postion?

Thanks everyone and again, Merry Christmas. Dave

More new features than ever. Check out the new AOL Mail!

December 25, 2007

When Bactrim is used for prophylaxis in CLL patients, it is specifically for the

prevention of pneumocystis pneumonia. For prophylaxis it is administered just

three times a week. For the treatment of urinary tract infections or other

infections, it must be taken twice-a-day. Therefore, the Bactrim that CLL

patients take will not cover the other infections.

There are many reasons why CLL patients develop recurrent infections. The most

" classic " is hypogammagloblinemia (low antibody levels). This can be often

helped with IV IG infusions.

There are other prophylaxis that patients can be on (Valtrex, etc.). I

encourage everyone to speak with their physicians regarding them.

Regarding urinary tract infections, they are not the typical infection that we

see CLL patients develop. I would encourage making sure none of the causes of

recurrent urinary tract infections (big prostate, urinary retention) are being

missed.

Rick Furman, MD

Re: Greetings and question

Dave,

There is probably not too much of an increase in risk working in a pet store

for someone with CLL as compared to someone without. There are several notable

exceptions, including toxoplasmosis, which is often caught from changing cat

liter, cryptococcus and coccidiosis from pigeons. But even with all of the

pigeon droppings in Manhattan, we do not see this very often in patients. Most

infections do not cross species, so the infections of pets often will not affect

humans. The greatest risk to someone with CLL would still be someone else.

With that being said, there are certain precautions that could be taken to at

least be safe, like wearing gloves and a mask when cleaning cages, etc. It is

important to not let the disease from controlling your life if it does not have

to. The most important thing is to make sure your doctor knows. Therefore, if

someone were to become sick, they could be appropriately covered with

antibiotics. For example, Bactrim prophylaxis, which many CLL patients are on,

does prevent toxoplasmosis.