White House Physician, Navy Rear Adm. Dr. Ronny Jackson, performed President Donald Trump’s annual physical last week are released the following results:

From Politico:

President Donald J. Trump has completed his first periodic physical examination as President of the United States. I performed and supervised the examination with appropriate specialty consultations and diagnostic testing. The exam was conducted January 12, 2018 at the Walter Reed National Military Medical Center.

The purpose of this exam was to provide the public with an update of the President’s current health status and to ensure the President continues to enjoy all the benefits of good health. This examination focused on evidence-based health screening and disease prevention.

With President Trump's consent, I release the following health information:

Vital Statistics

Age: 71 years, 7 months

Height: 75 inches

Weight: 239 pounds

Resting heart rate: 68 bpm

Blood pressure: 122/74 mm

Hg Pulse-oximetry: 99% room air

Temperature: 98.4 degrees F

Physical Examination by System (to include studies)

Eyes: Uncorrected visual acuity was 20/30 bilaterally, with corrected visual acuity of 20/20 bilaterally. Visual fields were normal. Fundoscopic exam was normal bilaterally. Intraocular pressures were normal bilaterally. No ocular pathology was discovered.

Head/Ears/Nose/Throat: Normal exam of the head, ears, nose, mouth, and throat.

Dental: Healthy teeth and gums.

Neck: Normal thyroid exam. No noted lymphadenopathy. Auscultation of the carotid arteries normal.

Pulmonary: Lungs clear to auscultation. A screening Low Dose CT of the chest demonstrated no pulmonary pathology.

Cardiac: Heart exam normal. Regular rhythm. No murmurs or other abnormal heart sounds noted. ECG with normal sinus rhythm, rate of 71, normal axis, and no other significant findings. Transthoracic Echocardiogram demonstrated normal LV systolic function, EF 60-65%, normal LV chamber size and wall thickness, no wall motion abnormalities. RV normal, atria grossly normal, all valves normal. Exercise Stress Echocardiogram demonstrated above average exercise capacity based on age and sex, and normal heart rate, blood pressure, and cardiac output response to exercise. No evidence of ischemia noted and wall motion was normal in all images.

Gastrointestinal: Normal exam. No masses, hepatomegaly or splenomegaly noted. Normal optical colonoscopy with no polyps or abnormal findings completed June 2013. Repeat colonoscopy not indicated and was deferred until next periodic physical exam.

Genitourinary: Normal exam.

Extremities/Musculoskeletal: Normal throughout. Full range of motion in all joints. Strong distal pulses and good capillary refill in all extremities. No swelling or edema noted.

Neurological: Examination of cranial nerves, cerebellar function, deep tendon reflexes, motor function, and sensory system all normal. Cognitive Screening Exam using the Montreal Cognitive Assessment was normal with a score of 30/30.

Dermatologic: Normal exam. No evidence of melanoma , basal cell carcinoma, squamous cell carcinoma, or any other significant dermatologic disease.

Laboratory Results

Lipid Panel:

Total cholesterol: 223 (mg/dL)

Triglycerides: 129 (mg/dL)

HDL cholesterol: 67 (mg/dL)

LDL cholesterol: 143 (mg/dL)

Cholesterol to HDL ratio: 3.3\

Complete Blood Count:

WBC: 5.5 (K/UL)

HGB: 16.1 (g/dL)

HCT: 48.7 (%)

PLT: 241 (K/UL)

Extended Metabolic Panel:

Fasting Blood Glucose: 89 (mg/dL)

BUN: 19.0 (mg/dL)

CREAT: 0.98 (mg/dL)

ALT: 27 (U/L)

AST: 19 (U/L)

Hemoglobin AlC: 5.0 (%)

Vitamin D: 20.0 (ng/ml)

PSA: 0.12 (ng/ml)

TSH: 1.76 (ulU/ml)

Urinalysis:

Appearance: Clear

Protein: Negative

Ketones: Negative

Glucose: Negative

Blood: Negative

Past Medical History

• Hypercholesterolemia

• Rosacea

Past Surgical History

Appendectomy (age 11)

Social History

• No past or present use of alcohol.

• No past or present use of tobacco.

Medications

Rosuvastatin (Crestor), 10 mg daily to lower cholesterol.

Acetylsalicylic Acid (Aspirin), 81mg daily for cardiac health.

Finasteride (Propecia), 1 mg daily for prevention of male pattern hair loss.

Ivermectin Cream (Soolantra), As needed for treatment of Rosacea

Multivitamin (Centrum Silver), Daily for overall health maintenance.

Immunizations

  • • Prevnar 13 (to prevent pneumococcal pneumonia) and Twinrix (to prevent hepatitis A/B) given.
  • • Routine vaccinations, to include seasonal influenza, all up to date.
  • • All indicated travel vaccinations up to date.

Summary

The President’s overall health is excellent. His cardiac performance during his physical exam was very good. He continues to enjoy the significant long term cardiac and overall health benefits that come from a lifetime of abstinence from tobacco and alcohol. We discussed diet, exercise and weight loss. He would benefit from a diet that is lower in fat and carbohydrates and from a routine exercise regimen. He has a history of elevated cholesterol and is currently on a low dose of Rosuvastatin. In order to further reduce his cholesterol level and further decrease his cardiac risk, we will increase the dose of this particular medication. The President is currently up to date on all recommended preventive medicine screening tests and exams.

All clinical data indicates that the President is currently very healthy and that he will remain so for the duration of his Presidency.

President Trump is in “excellent health.”

 

At the above height and weight, Donald Trump’s BMI is 29.9 placing him in the overweight category just shy of the 30 BMI cut off for obesity.

His blood pressure and heart rate are excellent for his age, especially in the absence of a blood pressure medication.

His pulse oximetry demonstrating the oxygenation of his blood is excellent as well.

An uncorrected vision test of 20/30 means that without glasses, the president has near perfect vision.

A low dose CT of the chest is not routine during annual physicals in non-smokers, but is reassuring that he most likely doesn’t suffer from lung cancer, the number one cancer killer in America.

His EKG, which evaluates electrical abnormalities of the heart secondary to disease or heart attack, confirmed the ideal heart rate.

His echocardiogram, and ultrasound evaluating heart structures and pump activity, demonstrated no heart failure or issues with the filling or pumping of blood, as well as confirming normal anatomy (valves, wall thickness, etc).

A stress test evaluates for cardiac ischemia, or loss of blood flow to heart muscle during rest and exercise, and was normal as well.

A normal colonoscopy in 2013 suggests his next screening colonoscopy wouldn’t be performed until 2023 unless he had pain, rectal bleed, changes in his stool, or any risk factors for colon cancer.

The Montreal Cognitive Assessment was given to evaluate cognitive function and is not routinely done during annual physicals.  This was performed and passed with a 30/30 score.  The test evaluates memory, orientation, visuospatial and executive brain function, recall, concentration and language fluency.  An example is shown here.

His cholesterol is elevated but his good cholesterol is strong and his ratio of cholesterol to HDL is well within goal.

cholesterol-levels-chart

 

The remaining blood tests looked very good, especially his HBA1C and blood glucose evaluating for diabetes.

Of note is his Vitamin D level which appears low-normal and could put him at risk for osteoporosis.  It does not appear a bone density test, Dexa scan, was performed.

A PSA of 0.12 is reassuring as well although is not recommended as a screening test for prostate cancer.

It's been suggested that President Trump loses 10-15 lbs and increases his exercise activity.

My opinion, for a 71-year-old man with high cholesterol, President Trump is way ahead of the curve.  I’m a fan of Crestor, his cholesterol lowering medication, and credit his lipid profile numbers to his use of the statin.  His weight is an issue but I think the White House has a bowling alley, chefs who could make asparagus taste like meat, and secret service who wear fitbits.  I think he’ll be just fine.

This is a developing story.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

Published in News & Information
Tuesday, 16 January 2018 17:41

What to do in case of a nuclear attack

When Hawaii residents Saturday morning received this alert (later retracted):

 

false-alert-message.jpg

the rest of the country asked themselves, “What would I have done if I received this alert?”

So I think we can all agree we’re unprepared. Some scoff by saying, “Well we wouldn’t survive anyway!”  Actually, you can survive a nuclear attack.  Here’s how…

It’s never too early to prepare

Firstly, know your shelters. There are two types:

Blast shelters offer some protection against the blast, heat, fire and initial radiation.

Fallout shelters offer some protection against the radiation from the fallout products.

Many public buildings in your city can act as fallout shelters.  These may be schools, hotels, subway tunnels, or below ground pubs.  However if your city doesn’t post or have either, you are more likely to be urged to “Shelter in Place”, which we’ll discuss later.

Secondly, make an “Emergency Kit” that has all your important papers, passports, medications, first aid, pet supplies, food and water.

Ready.gov suggests the following:

 

  • Water – one gallon of water per person per day for at least three days, for drinking and sanitation
  • Food – at least a three-day supply of non-perishable food
  • Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert
  • Flashlight
  • First aid kit
  • Extra batteries
  • Whistle to signal for help
  • Dust mask to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
  • Moist towelettes, garbage bags and plastic ties for personal sanitation
  • Wrench or pliers to turn off utilities
  • Manual can opener for food
  • Local maps
  • Cell phone with chargers and a backup battery
  • Radio (battery operated) so you can be up to date with what is occurring and be told when it's safe to exit your shelter

Consider adding the following items to your emergency supply kit based on your individual needs:

  • Prescription medications
  • Non-prescription medications such as pain relievers, anti-diarrhea medication, antacids or laxatives
  • Glasses and contact lense solution
  • Infant formula, bottles, diapers, wipes, diaper rash cream
  • Pet food and extra water for your pet
  • Cash or traveler’s checks
  • Important family documents such as copies of insurance policies, identification and bank account records saved electronically or in a waterproof, portable container
  • Sleeping bag or warm blanket for each person
  • Complete change of clothing appropriate for your climate and sturdy shoes
  • Household chlorine bleach and medicine dropper to disinfect water
  • Fire extinguisher
  • Matches in a waterproof container
  • Feminine supplies and personal hygiene items
  • Mess kits, paper cups, plates, paper towels and plastic utensils
  • Paper and pencil
  • Books, games, puzzles or other activities for children

Where do I find shelter?

It’s best to get to a building that has a basement. Below ground is obviously safer than above ground. Moreover being surrounded by concrete or even brick is better than stucco.

Mic.com also suggests that the center of a building offers more protection than other rooms as illustrated below:

NTVhNGZjZTExMiMvVGdsSTY0MFlLZ0dxczdRTHI4bE9oYXlyaTFnPS83OHgwOjg4N3g3NjYvZml0LWluLzc2MHgwL2ZpbHRlcnM6Zm9ybWF0KGpwZWcpOnF1YWxpdHkoODApOm5vX3Vwc2NhbGUoKTpmb3JtYXQoanBlZykvaHR0cDovL3MzLmFtYXpvbmF3cy5jb20vcG9saWN5bWljLW.jpg

The farther away you are from the blast the safer, however, you do not want to be in your car in bumper to bumper traffic during an attack either.

Shelter in Place

If you don’t know where to go, than bunker down. If you have a basement go there. If not find an interior room with no windows and start praying.

What if I’m outside?

There is always the possibility that someone may be in the middle of a picnic when a nuclear attack hits.  If that’s the case, and you can’t get indoors, Ready.gov suggests the following:Do not look at the flash or fireball – it can blind you.

 

  • Take cover behind anything that might offer protection.
  • Lie flat on the ground and cover your head. If the explosion is some distance away, it could take 30 seconds or more for the blast wave to hit.
  • Take shelter as soon as you can, even if you are many miles from ground zero where the attack occurred – radioactive fallout can be carried by the winds for hundreds of miles.
  • If you were outside during or after the blast, get clean as soon as possible, to remove radioactive material that may have settled on your body.
  • Remove your clothing to keep radioactive material from spreading. Removing the outer layer of clothing can remove up to 90% of radioactive material.
  • If practical, place your contaminated clothing in a plastic bag and seal or tie the bag. Place the bag as far away as possible from humans and animals so that the radiation it gives off does not affect others.
  • When possible, take a shower with lots of soap and water to help remove radioactive contamination. Do not scrub or scratch the skin.
  • Wash your hair with shampoo or soap and water. Do not use conditioner in your hair because it will bind radioactive material to your hair, keeping it from rinsing out easily.
  • Gently blow your nose and wipe your eyelids and eyelashes with a clean wet cloth. Gently wipe your ears.
  • If you cannot shower, use a wipe or clean wet cloth to wipe your skin that was not covered by clothing.

What about potassium iodide tablets?

These tablets help protect your thyroid from taking up radioactive iodine, as they saturate the organ. It’s an inexpensive pill that will protect one against thyroid cancer but not the other medical sequelae of nuclear exposure such as bone marrow injury and skin irritation.

The false nuclear attack alert Hawaii residents received enlightened the rest of the country on how unprepared the average American is. It’s about time we have a game plan and cities educate their citizens on where and how to protect themselves.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

Published in News & Information

A recent study out of Denmark finds frequent and prolonged use of ibuprofen to affect men’s fertility and sex drive.

Researchers out of the University of Copenhagen in Denmark found 600 mg of ibuprofen (three 200mg over the counter tablets) twice a day for 6 weeks could have an anti-androgenic effect, meaning decrease the effect of man’s testosterone.

The “compensated hypogonadism” reported, caused by a depletion of sex hormones, was seen within two weeks of the ibuprofen use. This can result in loss of libido and a decrease in sperm production. Long term sequelae could include hair loss and decrease in muscle mass.

Fortunately, this effect was reversible once medication use ceased.

According to the study of 31 males between the ages of 18 and 35, published in Proceedings of the National Academy of Sciences of the United States of America, the following was reported:

In the men, luteinizing hormone (LH) and ibuprofen plasma levels were positively correlated, and the testosterone/LH ratio decreased. Using adult testis explants exposed or not exposed to ibuprofen, we demonstrate that the endocrine capabilities from testicular Leydig and Sertoli cells, including testosterone production, were suppressed through transcriptional repression. This effect was also observed in a human steroidogenic cell line. Our data demonstrate that ibuprofen alters the endocrine system via selective transcriptional repression in the human testes, thereby inducing compensated hypogonadism.

LH stimulates the testicles to secrete testosterone.  Since LH is a hormone produced by the pituitary, low testosterone levels mean the inhibitory effect of the ibuprofen occurred at the testicular level.

test and lh.jpg

IMAGE ABOVE FROM TASEERLABS.COM

 

Ibuprofen is a medication known as an NSAID (non steroidal anti-inflammatory), used as an analgesic, antipyretic (fever reducer) and anti inflammatory and used for a variety of conditions.  If an athlete suffers a sprain or fracture, for example, he may take 800 mg of ibuprofen three times a day for weeks at a time.

With the rising opioid epidemic and restrictive prescribing rules many states are implementing, many medical providers are switching to NSAIDS for pain control of their patients.

Other risks associated with NSAIDS include GI bleed, renal and liver issues and heart disease.

For more on this study read here.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

 

Published in News & Information

The California Department of Public Health (CDPH) has issued guidelines on how to limit radiation from cell phone use which may cause cancer.

For years we’ve contemplated over cell phones causing cancer, specifically brain cancer.  Each year a study debunks this theory, but months later a report surfaces that reignite the debate.  And no matter how many studies disprove a cancer link, we worry because we are 24/7 glued to our phones, or the phones are glued to us.  Many of us don’t even own a landline anymore as we find it financially obtuse to pay monthly fees for a wall jack we don’t use.  We take our phones with us to school, work, the dinner table, and even the toilet.  If it wasn’t for the lack of waterproofing, many of us would take our phones with us into the shower.  We are geographically closer to our phones than own children. Something’s got to bite us in the butt……

Earlier this year a Superior Court Judge in California ordered the state to release papers discussing the risk of long-term cell phone use.  According to sanfrancisco.cbslocal.com, “The documents were written by the state’s Environmental Health Investigations branch and are believed to contain cell phone radiation warnings and recommendations for public use.  But the state refused to hand them over when requested by a director at University of California, Berkeley School of Public Health.”  Joel Moskowitz, Ph.D in turn sued the state saying this data should be public record and won. He’s been researching the subject and cited an increased brain cancer risk with cell phone use over 10 years.

Children are the most susceptible with their developing brains.  The following recommendations were recommended for both adults and children:

  • Keeping the phone away from the body

  • Reducing cell phone use when the signal is weak

  • Reducing the use of cell phones to stream audio or video, or to download or upload large files

  • Keeping the phone away from the bed at night

  • Removing headsets when not on a call

  • Avoiding products that claim to block radio frequency energy. These products may actually increase your exposure.

What do cell phones emit?

Cell phones emit radio waves. These are a form of non-ionizing radiation that provides an energy source through radio frequency.  Ionizing radiation is emitted by x rays, cosmic rays, and radon, and have been linked to cancer as it is a high frequency, high energy form of electromagnetic radiation. Non-ionizing radiation include radio waves, microwaves, visible light, UV light, infrared, and lasers. Although UV radiation may cause skin cancer, the other sources are deemed less dangerous than their ionizing radiation counterparts.

Can cell phone use cause cancer?

One of the more recent studies unveiled in May of 2016 reported cell phone radiation caused brain tumors in mice.  Rats exposed to the radiofrequency radiation for 7-9 hours a day, seven days a week, were more prone to develop the malignant gliomas as well has tumors in the heart.  This study was not intended to be translated to human risk, but of course it made headlines and scared us silly.

Prior to this, in 2011, the World Health Organization’s International Agency for Research on Cancer (IARC) classified cell phone use and other radiofrequency electromagnetic fields as “possibly carcinogenic to humans.”

However, multiple studies have been done, as descriptively outlined by the National Cancer Institute, and are assuring us that there is no imminent danger by our daily use of cell phones.  The NCI also provides recommendations from the CDC, FDA, and FCC stating not enough evidence exists to establish a link between cell phones and cancer.

Can cell phone radiation injure our body’s cells?

Although arguments continue over cell phone radiation causing cancer, it has been proven that heat is given off.  Many people complain their ear gets hot after lengthy cell phone use and studies have yet to determine if cell  phone heat can cause oncogenic changes in cells.  They’ve studied if the radiation affects metabolic activity, and a team led by Dr. Nora Volkow, head of the National Institute on Drug Abuse, found visible brain activity changes on the side the cell phone was being used.  They recommended after this study keeping the cell phone away from the body and using a lower radiation emitting phone.

So now what?

We wait and see.  My suggestion is to not overdo it with our phones.  Use the speaker setting when practical so as to not consistently hug the phone to your skull.  Take breaks in between lengthy calls.  Text when appropriate to minimize exposure as well.

Or do what I do when I talk to my mother, hold the phone 3 feet away from my head.  I can still hear her…..just fine……

Published in News & Information
Tuesday, 19 December 2017 16:08

The Office Holiday Party: Do’s and Don’ts

The work holiday party is one of the most anticipated events of the year.  Free food, free drink and for 4-6 hours you can be in the same room as your boss without any risk of being told “you’re fired”.  But…..many of us make mistakes, HUGE mistakes, while tipsy and letting our guard down could be the biggest career buster ever.  Plus, there are some missed opportunities the office Holiday party offers to make your overall work life better. So let’s get right down to it.

Don’t

1. Flirt with the boss

 

Your superior in any office setting should be the last one you try to cuddle up to.  Good management knows there is ALWAYS someone watching and, these days, recording on their phone, so they do not want to be seen in an uncomfortable situation, appearing to be flirting with you. You can complement them, sure, but hands off!

2. Drink too much

 

This gets us all into trouble.  Yes the alcohol is usually free and a flow’n but this will lead to your downfall.  Your guard is down, you become flirty, you blurt out secrets, those that the whole team knows but would be never caught dead saying……and sometimes the clothes come off on the dance floor.  Please drink in moderation.

3. Drive drunk

 

Never, never, never plan on driving that night if you plan to drink. Car Service, Uber, Taxi, designated drivers are a must.

4.  Let anyone tag you on Facebook

 

The next morning will be full of regret as it is, no need to cement it in infamy.

5. Skip on the whole soiree

 

Holiday season is swarming with good parties. And chances are there are two other parties calling your name that same night.  Make sure you hit the office party FIRST.  You can get too distracted or drunk at the other parties such that you never make it across town, safely.  Again, don’t drive if you plan to drink.

 

singing.jpg

 

6.  Take the mic

This is where I take a fall (as you can see above).  A microphone is sitting up on the stage, waiting, just waiting for someone to grab it and spout out some one liners.  I fear getting close to it until the head boss makes opening remarks. Then I feel the need to interrupt him and “take over from here”.  Let your boss have the mic.  He/She’s the head honcho, let them have their glory.  They’re paying for the party……

 

7.  Gossip

 

Never, never use this opportunity to gossip. That’s what the staff lounge is for.  It’s a positive night. Don’t bring negativity.

 

8.  Tell off the office bully

 

You may feel protected with all your work peeps surrounding you but one day he/she will get you alone and ….payback.  Instead wishing them some holiday cheer…..may bring out the good in the jerk.

9.  Sleep with your coworker

 

Everyone is watching you so your hopes of secretly hooking up is already circulating social media. If you want to begin a relationship that’s fine, but hoping it's on the down low will never happen.  People at parties pretend to be distracted, but someone is always watching.

 

10.  Discuss work

 

Never, never, never discuss work at the office Holiday party.  And please don’t ask for a raise!!! Will never happen. Even if your boss is drunk, he will forget about it by the New Year.

 

11.  Don’t be quiet

 

Being antisocial is not the way to go either. Mix, mingle and look like you’re having a good time. Even if you’re not.  If you have to leave early due to boredom, blame it on diarrhea.  This may be the only party you EVER get invited to.

 

Do’s

1. Thank the boss and the planning committee

 

Even though they may roll their eyes at you as you compliment them (since anyone volunteering for a planning committee in the first place probably isn’t your best bud at work), they secretly enjoy the complement.

 

2.  Get up and sing (if you can sing)

 

This is the only time your boss and team will see your other talents.  Sans beer bonging, show off your talents….dance moves, pipes, even fashion sense…. if you’re good.

 

3.  Let the boss know you’re happy at work

 

Don’t kiss up, but as you thank him, let him know you love your job.  This will be a take home message that can go a long way.

 

4. Tip the bartender

 

This is a no brainer.

 

bartender-mixologist-1.jpg

 

5. Have fun!!

 

It’s the holidays!  Let’s celebrate!! Truly the most wonderful time of the year!!!

 

xmas party 2017.jpg

JOHN SHAFFER, DALIAH WACHS, AND TOM HUMM

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

Published in News & Information
Tuesday, 12 December 2017 21:46

Wildfire Smoke Health Risks

As the California Wildfires roar into a second week, those residents lucky enough to escape the flames worry what consequences could result in inhaling the smoke.

What is in wildfire smoke?

 

According to the EPA, smoke emanating from forest and community fires may include any of the following:

  • Carbon monoxide, which competes with oxygen in the blood

  • Carbon dioxide, a respiratory byproduct

  • Wood particles

  • Formaldehyde

  • Acrolein – used as a pesticide

  • Benzene

  • Plastics, and those byproducts after incineration

  • and thousands of different respiratory irritants.

According to the EPA,

Smoke is composed primarily of carbon dioxide, water vapor, carbon monoxide, particulate matter, hydrocarbons and other organic chemicals, nitrogen oxides, trace minerals and several thousand other compounds. The actual composition of smok depends on the fuel type, the temperature of the fire, and the wind conditions. Different types of wood and vegetation are composed of varying amounts of cellulose, lignin, tannins and other polyphenolics, oils, fats, resins, waxes and starches, which produce different compounds when burned.

What symptoms may individual's experience?

 

Some may have no idea they are breathing in harmful compounds that could affect their lungs and heart.  However, many may experience:

  • Cough

  • Wheeze

  • Difficulty Breathing

  • Chest Pain

  • Mucous Production

  • Dizziness/lightheadedness

  • Fatigue

  • Racing Heart (palpitations)

  • Exacerbation of their lung disease including COPD, asthma, chronic bronchitis

  • Exacerbation of heart conditions such as angina, heart attack, and cardiac arrhythmias.

  • Increased susceptibility to new lung infections as well as flu  

What are PM2.5s?

 

PM2.5 are particles less than 2.5 micrometers in diameter that are present in pollution and wildfire smoke that can penetrate deeply into the lung linings.  Larger, coarse particles 10 micrometers in diameter are called PM10.  Both impair lung function as they inflame the lungs and interfere with the work of alveoli that need to oxygenate the blood.  Moreover the small particles can use this pathway to enter the bloodstream. Although the direct health impacts of the fine particulate matter is not clearly defined it is believed that increased PM2.5 levels increase the risk of lung and heart disease as discussed above.

 

lungs_alveoli-57ffa7fe3df78cbc284e162b

LUNGS AND ALVEOLI (IMAGE FROM THOUGHTCO.)

 

Symptoms may begin at levels greater than 55 µg/m3 .

Which individuals are the most at risk?

 

  • Infants and Children

  • Elderly individuals

  • Those with chronic lung disease, including asthma and emphysema

  • Those at risk for heart disease and stroke

  • Those with diabetes

  • Smokers

  • Pregnant women

  • Those with chronic allergies

  • Pets

How can residents protect themselves?

 

Avoiding the area of wildfires is paramount.  Additionally, the following may be considered:

  • Avoid outdoors until air quality reports improve.  Do not rely on how “clear” the air looks.

  • Take heed of wind and air quality advisories.

  • Recirculate the air in your home and car.

  • Keep windows closed.

  • Consult with your medical provider to monitor blood pressure, heart rhythm, lung function and refill any medications you may need BEFORE you feel symptoms.

  • Be wary of facemasks sold as PM2.5 safe as many do not protect against the very small particles. Respirator masks labelled N95 or N100 may provide SOME protection against particulates but not against the toxic fumes such as formaldehyde and acrolein.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

Published in News & Information
Wednesday, 06 December 2017 19:40

IUDs May Cut Cervical Cancer by 30%

A new study suggests intrauterine contraceptive devices (IUDs) may fight off the virus that causes cervical cancer.

Researchers from the University of Southern California’s Keck School of Medicine found the small T-shaped device may stimulate an immune response against the sexually transmitted Human Papilloma Virus (HPV) virus which causes cervical cancer.

 

 

iud.jpg

T-SHAPED IUD SITTING WITHIN THE UTERUS

 

IUDs are a favorite among women as they do not involve taking a daily hormone pill and can provide contraceptive protection for years.  There are two main types:

The ParaGard IUD is a non hormonal implant made of copper. The copper wards of sperm allowing contraception up to 12 years.

Hormonal IUDs, such as Mirena, release progestin, a hormone similar to progesterone, to the local environment, thickening the cervical mucous to prevent sperm from reaching the egg.  Hormonal IUDs may also prevent ovulation. Additionally, IUDs can alter the lining of the uterus such that if a fertilized egg does occur, it may not be able to nest in the uterus without proper lining.

But both IUDs can stimulate an immune response that is both a deterrent to sperm and now suggested to viruses such as HPV.

Vaccines against the HPV virus exist and are given to 11-12 year old girls with the maximum age at which one could receive the vaccine, 26 years old.

If more research confirms this is the case, then those women who have not been vaccinated or are too old to receive the vaccine against cervical cancer may benefit from using an IUD.

What is the cervix and what is cervical cancer?

 

The uterus looks similar to a light bulb. The larger top portion being where the fetus develops, and the bottom, narrower area, the cervix. The cervix thins and dilates during childbirth, as you’ve heard in the movies “she’s only 7 cm!” and then after childbirth becomes narrow again.  It affects nearly 12,000 and kills 4,000 women each year. It can affect women of any age but is more common between 20 and 50.

 

375x321_cervix

HTTP://WWW.WEBMD.COM/WOMEN

 

What causes cervical cancer?

 

The most common cause is HPV (Human Papillomavirus), especially HPV-16 and HPV-18.  This is acquired through unprotected sex, so condom use is encouraged. Thus its one of the most preventable causes of cancer.  Additionally, there are 3 vaccines for HPV currently approved by the FDA, Gardasil, Gardasil 9, and Cervarix.

What are the symptoms of cervical cancer?

 

Early cervical cancer may not be symptomatic but as it develops it may cause an odor, pain with urination, pelvic pain and bleeding. This bleeding may occur after sex, a pelvic exam, or intermittent bleeding not associated with a menstrual cycle.

Is cervical cancer treatable?

 

Yes.  Early detection is key and can be done by a Pap Smear, explained below.  Multiple treatments are available including surgery, chemotherapy,  radiation therapy, and targeted therapy such as Bevacizumab (Avastin®) which prevents new blood vessel growth that can feed a tumor.

Who should get screened for Cervical Cancer?

The USPSTF (United States Preventive Services Task Force) recommends the following:

Screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.

What is a Pap Smear?

 

It is the cytology (cell analysis) of the cervix. Years ago, a cytobrush would collect the cells and the medical provider would “smear” it onto a slide, place fixative, and then send it to the laboratory for the pathologist to analyze it. Now ThinPrep® Pap tests are used more commonly as the cells from the brush are placed into a container with fixative, and this vial is sent to the pathologist to spin down and analyze.

 

cervical-smear-test-equipment-97358274-575db1493df78c98dc633c53

TEK IMAGE/SPL / GETTY IMAGES

 

In order to obtain the cells from the cervix, the medical provider needs to use a speculum to open the vaginal canal and allow access to the uterus. A woman may be in the lithotomy position…lying on one’s back on the exam table with her feet in stirrups and knees bent. During the speculum exam, the medical provider may take cultures to test for common vaginal infections such as yeast, bacteria vaginosis, or sexually transmitted illnesses such as gonorrhea and chlamydia. After the speculum exam, the provider may perform a pelvic exam with her gloved hand to examine the uterus and ovaries, evaluating for tenderness, shape, size and masses.

How is an HPV test done?

 

An HPV test can be done with the cells obtained during the Pap Smear. The laboratory evaluates the cells to see if the HPV virus that causes cervical cancer is present.

In summary the thousands of deaths that occur each year to cervical cancer can be prevented with simple testing, such as the Pap Smear. Discuss with your medical provider when cervical cancer screening is best for you.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

Published in News & Information

A new study out of India suggests both premature balding and graying are linked to heart disease.

Researchers from the UN Mehta Institute of Cardiology in Gujarat, India evaluated 2000 men (1200 healthy and 790 with heart disease) and found those who began to lose their hair and hair color before the age of 40 had the following risk elevation when it came to heart disease:

  • Premature balding 5.6 X risk

  • Premature graying 5.3 X risk

To put this into perspective, obesity was associated with a 4.1 greater risk. So alopecia (hair loss) and canities (graying/whitening of the hair) appeared to be more of a culprit than one of the most infamous risk factors there is.

This study therefore suggests those before age 40, showing early receding hair lines and gray hair, may want to be evaluated for cardiac risk factors.

In April, a study was presented at the EuroPrevent 2017 conference of the European Society of Cardiology suggested a link between how much a man grays or whitens when he ages and plaque buildup within the coronary arteries, the main arteries that supply the heart muscle.

Those researchers looked at 545 men and evaluated them by the degree of hair whitening where a 1 was given to those with all black hair, up to a 3 with equal amounts of black and gray/white hair, to a 5 where they had all gray/white hair. Computed tomography coronary angiography was used to evaluate the amount of atherosclerosis (plaque build up) in the coronary arteries.

Those men who scored 3 or more appeared to have higher risk of plaque build up. These findings were independent of cardiac risk factors such as age, diabetes, high blood pressure, high cholesterol, smoking and family history of heart disease.

According to lead author in this earlier study, Dr. Irini Samuel, a cardiologist at Cairo University in Egypt stated,

“Atherosclerosis and hair graying occur through similar biological pathways and the incidence of both increases with age. Our findings suggest that, irrespective of chronological age, hair graying indicates biological age and could be a warning sign of increased cardiovascular risk.

More research is needed on cutaneous signs of risk that would enable us to intervene earlier in the cardiovascular disease process.”

She continued, “If our findings are confirmed, standardization of the scoring system for evaluation of hair graying could be used as a predictor for coronary artery disease.”

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Why does our hair turn gray with age?

Our hair color is determined by our melanin production, a combination of pigments (eumelanin and pheomelanin) that can vary, with less eumelanin giving rise to blond hair, more giving rise to brunette hair and pheomelanin responsible for the red, auburn hues.

Melanocytes inject their pigment into the keratin cells that produce hair.  As we age these may slow down.  Another cause of “going gray” is hydrogen peroxide builds up in the hair follicle, causing oxidative stress, which in turn prevents rich colors from being displayed. The lack of pigment will cause hair to appear white.

 

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IMAGE FROM MADSCI NETWORK

 

What can cause premature graying?

 

Many of us begin to see gray hair in our 30’s. Some in our 20’s. Different ethnicities gray at different ages. If one is gray by age 20 that would be considered very premature.

We’ve heard about stress, hormones, and nutritional deficiencies being linked to loss of hair color, but studies have not been able to prove this definitively.

Researchers are still trying to determine why one would gray faster and what significance it has on our health.

Now one might say “If everyone grays then everyone is at risk for heart disease.”  Heart disease is common and the number one killer and graying is almost ubiquitous in the older population. But this study starts to make one wonder if the amount, accelerating of….even the pattern of graying are significant, then this could clue us in on who is at risk for early, preventable, heart disease.

What causes baldness?

 

Hair is made in follicles within the skin and grows for about three years until it sheds and new hair grows. Hair loss (alopecia) occurs when hair follicles shrink and smaller, thinner hairs grow, lasting shorter and shorter times.

Genetics play a huge factor, with the most influential genes coming from mother’s X chromosome, which came from her father. So maternal and paternal genes can both be responsible for baldness.

Sex hormones, androgens, can cause male pattern baldness.  Medications (such as anabolic steroids), illness such as low thyroid and diabetes, and cancer can cause hair loss as well.  A recent study found Prostaglandin D2 protein may block hair growth in those who suffer male pattern baldness. It’s believed 80% of men under 70 will have some receding hairline.

How can we prevent heart disease?

 

Firstly, we must know our risk factors. These include:

  • Family history of heart disease

  • Personal history of heart disease

  • High Blood Pressure

  • High Cholesterol

  • Diabetes

  • Smoking

  • Obesity

  • Inactivity

  • Males over 40

  • Females who are post menopausal

  • High stress

and even short stature has been cited as a potential risk factor.

As you can see, many of us can be at risk for heart disease.

Therefore secondly, we should be evaluated with an EKG, echocardiogram and any other exams our medical provider and/or cardiologist deem necessary.

Thirdly, reduce your risk by the following:

  • Maintain a normal blood pressure

  • Maintain normal blood sugar

  • Maintain normal cholesterol and lipid levels

  • Reduce stress

  • Maintain a balanced diet, rich in potassium-rich foods such as fruits and vegetables

  • Quit smoking

  • Stay active

  • Maintain a healthy weight.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

Published in News & Information

A study finds many Vietnam veterans may have contracted liver flukes decades ago that could now cause pancreatitis, liver disease and/or bile duct cancer.

The Department of Veterans Affairs commissioned a study that looked at bile duct cancer and liver flukes that may have been ingested by veterans while on tour in Southeast Asia during the Vietnam War.

This was in response to a story reported by the Associated Press in which 700 cases, of cholangiocarcinoma, bile duct cancer, were seen in VA facilities over the last 15 years.

The current small study looked at 50 blood samples, finding 20% of which to be positive for liver flukes.  Most participants were not aware they were infected.  If infection did later lead to cancer, symptoms would come late in the diagnosis.

Tropical medicine specialist, Sung-Tae Hong, from Seoul National University in South Korea, stated he was “surprised” by the results and admits to more research needing to be done.

Cholangiocarcinoma is still rare, however if Vietnam veterans are at increased risk due to their fish consumption while on duty, they need to be followed closely by their medical provider. Stool tests could be done to look for parasite eggs, and blood tests may look for antibodies fighting the infection.

What is a liver fluke?

 

Liver flukes are parasites that infect the liver and bile duct.  There are multiple species.  The disease Fasciola hepatica and Fasciola gigantica cause is called fascioliasis. Symptoms may range from none to severe liver disease.  But the liver flukes associated with bile duct cancer include Opisthorchis viverrini, O. felineus, and Clonorchis sinensis.  According to the US Department of Veterans Affairs:

The irritation and scarring caused by liver fluke infection can lead to bile duct cancer.

Two parasites are commonly involved. One is Opisthorchis verrini, which is found in Southeast Asian countries, including Thailand, Lao People’s Democratic Republic, Vietnam, and Cambodia. The other is Clonorchis sinensis, which is common in rural areas of Korea and China.

Eating raw or undercooked fish infected with these parasites introduces the pathogen into the GI system where it can hide out in the liver and bile ducts for decades.

In 2007, Sripa et al discussed how close to 600 million people were at risk of being infected with liver flukes.

In 2011, Lim et al wrote, “More than 35 million people worldwide are infected. The exceptionally high incidence of cholangiocarcinoma in Thailand and Korea is attributed to the high prevalence of liver fluke infection in these areas.”

How does one get contract liver flukes?

 

In addition to ingesting undercooked contaminated fish, liver flukes can infect multiple mammals, such that eating infected cattle or sheep liver (if undercooked) could transmit the parasite.  Ingesting vegetables washed with contaminated water could introduce the fluke into a person as well.

Medical News Today recommends boiling all untreated water and to avoid water from a stream near where cattle and sheep live.

What are the symptoms of infection with liver flukes?

 

Although some people with liver flukes may exhibit no symptoms at all, some may incur:

  • Fatigue

  • Abdominal Pain

  • Fever

  • Nausea

  • Vomiting

  • Diarrhea

  • Jaundice – yellowing of the skin and whites of eyes

  • Itchy skin

  • Weight loss

What is the prognosis of cholangiocarcinoma (bile duct cancer)?

 

According to cancer.net, the 5 year survival, meaning living 5 years past diagnosis, is 30%, assuming the cancer stays locally.  If the cancer spreads to regional lymph nodes prognosis  for 5 year survival drops to 24%. Distant spread of the cancer reduces the 5 year survival rate to 2%.

 

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What is the treatment for liver flukes?

 

Anti-Parasitic medications, such as triclabendazole, have proven effective against Fasciola. Praziquantel has been effective in fighting Opisthorchis infections.

 

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

Published in News & Information

Thanksgiving (and the in-laws) has come and gone. And now we have lots of leftovers. And lots of pets. Can pets eat Thanksgiving table scraps and leftovers?

Let’s look at what they can and cannot eat.

Dogs

 

dog

 

According to the American Kennel Club, dogs can eat the following (in moderate amounts):

  • Turkey, Chicken, Beef (remove all bones so they don’t get swallowed and perforate the gut)

  • Ham

  • Shrimp

  • Salmon

  • Eggs

  • Cheese

  • Peanut Butter

  • Bread (without raisins)

  • Popcorn

  • Corn

  • Honey

  • Coconut

Avoid the following in dogs:

May be toxic; cause nausea, vomiting and diarrhea; kidney damage; pancreatitis due to high fat content, or intestinal obstruction.

  • Onions

  • Garlic

  • Avocado

  • Raisins

  • Grapes

  • Chocolate

  • Cinnamon

  • Ice cream

  • Almonds

  • Macadamia nuts

  • Alcohol

  • Nutmeg

  • Mushrooms

  • Energy drinks

  • Fatty/fried foods

 

In addition to my dog Apollo, I have 4 cats.  So they’re begging for Thanksgiving leftovers as well.

Cats

 

cat-1

 

Fluffy can eat – but again only in moderation:

  • Meat

  • Fish

  • Grains

  • Vegetables (though many stick their nose up at it)

  • Eggs

  • Cheese

  • Butter

Avoid similar foods as with dogs due to toxicity and also (according to Vetsnow)

  • Alcohol

  • Artificial Sweeteners

  • Raw fish and eggs

  • Coffee, tea and energy drinks

Fish

 

fish

 

Yes, even Nemo can join in for Thanksgiving leftovers.

It appears fish can eat many types of meat and vegetables and even cooked rice but be careful of toxins and cooking oils.

Parakeet

 

parakeet

I don’t have any of these and if I did, I doubt I’d share my turkey with it. But according to pethelpful.com, many fruits, vegetables, breads and nuts (chopped up without shell) can be eaten by birdie.

I hope everyone had a healthy and wonderful Thanksgiving!!!

 

 

 

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Published in News & Information

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