A study finds patients don’t mind their ER doc’s body art.

Researchers from St. Luke’s University Health Network in Bethlehem, Pennsylvania surveyed emergency room patients who rated the providers on a five point Likert scale on their perception of competence, professionalism, caring, approachability, trustworthiness, and reliability in their doctor.  Their findings found patients had “no perceived difference” in the above metrics, “and assigned top box performance in all domains >75% of the time, regardless of physician appearance.”

So Can Medical Students Break out the Nose Ring?

 

No, not so fast.  Although body art is beautiful, and accessorizing with piercings can make our dreary scrubs pop, the average physician is fighting more and more these days to capture the faith of the patient who keeps turning to the web for medical advice.

The above study surveyed patients in emergency rooms….a setting in which patients are desperate to receive care in an emergency and are grateful, on most occasions. What about the oncologist who needs to give somber news about a patient’s cancer?  Would patients appreciate the skull and crossbones tattoo on his neck? Probably not.

 

 

 

Skull-and-Crossbones-Tattoo-Designs-Poison-Pirate.jpg

 

Piercings and tattoos make a statement, tell a story, or add character to the body on which they adorn.   And the attention they command is why I’m such a fan. So I agree that it has no bearing on one’s “competence, professionalism, caring, approachability, trustworthiness, and reliability.”  However, in many medical scenarios the patient needs to feel he is the main focus. Patients want to believe we providers wake up, eat, exercise to maintain our health, dress, and wash our hands for them.  And they’re right…we do. So our personal style, statements and stories are kept to a minimum at work.

It’s unfortunate because I was really hoping to get the following Lord of the Rings tattoo of Aragorn when hubby wasn’t looking….

 

artist--kristian-kimonides--aragorn-tattoo_18179093247.jpg

 

For more on the study see 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 Health

Canadian researchers report women who work 45 hours or more a week are at higher risk of developing diabetes.  Those who work 30-40 hours weekly, however, are not at increased risk.

In this study, published in the British Medical Journal Diabetes Research and Care, study authors looked at 7000 men and women, aged 35-74, who were working a variety of hours per week.  They found men more likely to develop diabetes, especially if they were obese, but women who worked greater than 45 hours/week were 62% more likely to acquire the disease than women who worked “normal working hours.”

This may shock many of us whose normal work week plus housework clocks in at 80-100 hours.  However, extra hours of work increases stress inducing hormones that may contribute to poor sugar metabolism.

Another theory is longer work days may induce more carbohydrate eating for energy.

Study author Peter Smith of the Institute of Work and Health in Toronto said, “If you look at time spent outside of work, women do more care of household members and more routine housework. The only thing women don’t do more of is watching TV and exercising.”

According to the CDC, 23.4 million people in the US have diabetes, and in total 100 million Americans suffer from prediabetes or diabetes.

Previously the 7th leading killer of Americans, diabetes affects so many people that it has now become third leading cause of death in the US. A study in 2017 found 12% of deaths in the US is caused by diabetes, trailing behind heart disease and cancer, ranked at #1 and #2.

What is Diabetes?

 

Diabetes is a disease in which the body doesn’t utilize and metabolize sugar properly.  When we consume food, its broken down into proteins, nutrients, fats, water, and sugar. These components are necessary for cell growth and function.  They get absorbed in the small intestine and make it to the bloodstream.   In order for a cell to utilize sugar, it needs the hormone insulin to help guide it in.  It’s similar to a key that fits in the keyhole of the “door” of the cell, opening it up so sugar can enter.  Insulin is produced in the pancreas, an organ that receives signals when one eats to release insulin in preparation of the sugar load coming down the pike.

Diabetes Explained



So I imagine our mouth like a waiting room, the blood stream like a hallway, and the cells of the body the rooms along the hallway.  Insulin is the key to open the cells’ “doors” allowing sugar to enter.  If the sugar does not get in, it stays in the bloodstream “hallway” and doesn’t feed the cell.  Weight loss occurs, and individuals may become more thirsty as the sugar in the blood makes it fairly osmotic, something the body wants to neutralize, reduce.  The kidneys are going to want dump the excess sugar, so to do so, one would urinate more, again causing thirst.  So when a diabetic loses weight, urinates more frequently and becomes thirsty, you now understand why.

Complications of Diabetes

 

Cardiovascular disease – Sugar is sticky, so it can easily add to atherosclerotic plaques.

Blindness – high sugar content draws in water to neutralize and small blood vessels in the eye can only take so much fluid before they burst.  Moreover, high blood sugar weakens blood vessels.

Kidney disease – the kidneys work overtime to eliminate the excess sugar. Moreover, sugar laden blood isn’t the healthiest when they themselves need nourishment.

Infections – pathogens love sugar. Its food for them.  Moreover blood laden with sugar doesn’t allow immune cells to work in the most opportune environment.

Neuropathy – nerves don’t receive adequate blood supply due to the diabetes-damaged blood flow and vessels, hence they become dull or hypersensitive causing diabetics to have numbness or pain.

Dementia – as with the heart and other organs, the brain needs healthy blood and flow.  Diabetes has been found to increase risk of Alzheimer’s as well.

Type I vs. Type II Diabetes

 

Type I Diabetes, previously called insulin dependent or Juvenile diabetes, occurs when the pancreas doesn’t produce insulin, possibly from the immune system destroying the cells that produce the hormone. When this occurs there is rapid weight loss and death could occur if the cells don’t get the sugar they need.  Insulin has to be administered regularly.

Type II Diabetes, previously called non-insulin dependent or adult-onset diabetes,  occurs in those who began with a fully functioning pancreas but as they age the pancreas produces less insulin, called insulin deficiency, or the insulin produced meets resistance. This is the fastest growing type of diabetes in both children and adults.

What is insulin resistance?

 

Insulin resistance, if using our hallway and door analogy, is as if someone is pushing against the door the insulin is trying to unlock. As we know, those with obesity are at higher risk for diabetes, hence fat can increase insulin resistance. It’s also been associated with an increase in heart disease.

Blood sugar numbers

 

If your fasting blood sugar (glucose) is greater than 126 mg/dl, or your non fasting blood sugar is greater than 200 mg/dl, you may be considered diabetic. Pre-diabetes occurs when the fasting blood sugar is between 100 and 125 mg/dl.  If ignored, and the sugar rises, pre-diabetics may go on to develop diabetes.

 

dmp-blood-sugar-levels-chart

SOURCE DIABETESMEALPLANS.COM

 

Preventing/Controlling Diabetes

 

1/3 of American adults are currently pre-diabetic. Experts predict 1/3 of US Adults will be diabetic by the year 2050. Although genetics plays a big role, decreasing ones sugar intake and maintaining an active lifestyle can help ward of diabetes.

Foods high in sugar and carbohydrates increase one’s risk, so a diet rich in vegetables and lean meats is preferred.

For more information, visit http://www.diabetes.org/.

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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 Health

A study from the Environmental Working Group (EWG) found that most of our meat purchased at the supermarket contains antibiotic resistant bacteria.

The National Antimicrobial Resistance Monitoring System tested bacteria on meat in 2015 and found them to be resistant to one of fourteen antibiotics. These “superbugs” were detected on:

 

  • 71% Pork Chops
  • 79% of Ground Turkey
  • 62% Ground Beef
  • 36% Chicken Breasts, Wings and Thighs tested.

Dr. Gail Hansen, a public health expert and veterinarian states, “Bacteria transfer their antibiotic resistance genes to other bacteria they come in contact with in the environment and in the gastrointestinal tract of people and animals, making it very difficult to effectively treat infections.”

The EWG provides a tip sheet on how to avoid superbugs in meat here.

What is a Superbug?

 

A superbug is a pathogen, most commonly bacteria, that can survive antibiotics that most species would buckle under. Its resistance could be caused by a variety of factors.  Maybe it has a mutation that makes it stronger. Maybe its genetic material shields it from the toxic medicine.  Maybe it’s luck. So shortly after it celebrates surviving the antibiotic assault, it divides to reproduce, making more bacteria. If this progeny bacteria maintain the same genetic material as its parent, or if included, mutation, they can be now be resistant to the antibiotics as well.

_68481070_c0131441-e._coli_bacterium,_tem-spl.jpg

DRUG RESISTANT E. COLI – IMAGE FROM BBC

 

According to the CDC: Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.

Why are superbugs growing on our food?

 

One theory is we give antibiotics to farm animals to keep them healthy, avoid disease and improve their growth.  These antibiotics may be used and consumed so frequently that bacteria learn how to overcome and create new, resilient progeny.

How do we avoid getting sick?

 

The following is a guide on temperature goals for various meats:

food temp.png

 

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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 Health

Although it's been long known that flight attendants are at higher risk of breast cancer and melanoma, new research has found an increase risk in the following additional cancers:

  • non-melanoma (basal cell and squamous cell)
  • thyroid
  • cervical
  • uterine
  • gastrointestinal

Researchers from Harvard T. H. Chan School of Public Health, led by research associate, Irina Mordukhovich, surveyed over 5000 flight attendants as part of the Harvard Flight Attendant Health Study (FAHS) and found a four-fold risk in non-melanoma skin cancer, a two-fold risk in melanoma, and a 51% greater risk of breast cancer, among other malignancy risks.

Those flight attendants with three or more children had even a higher risk of breast cancer.

TIME Magazine reported the following:

“Flight attendants are considered a historically understudied occupational group, so there is a lot we don’t know about their health,” says Mordukhovich. “What we do know for sure is the exposures that both pilots and flight attendants have—the main one being high radiation levels because of cosmic radiation at altitude.” That exposure may not be concerning for people taking individual flights, but for people whose jobs involve flying, that risk may have a negative effect on their health, as the study results suggest.

A 2007 study found an increase risk of heart attacks, respiratory illness, poor sleep, depression and anxiety in cabin crew.

What’s surprising is the average flight attendant does not smoke and maintains a healthy weight, hence thought to live a healthier lifestyle, decreasing heart and cancer risk.  So….

Why are flight attendants at increased risk?

 

Multiple factors can affect those who work high in the skies. These include:

  • cosmic ionizing radiation (radiation coming from outer space with higher levels in the upper earth’s atmosphere)
  • solar radiation from sun flares
  • disruption of their sleep cycle, circadian rhythm (long linked to cancer)
  • exposure to chemicals such as jet fuel, flame retardants and other chemicals.
  • constant exposure to pathogens and communicable diseases (link to cancer not yet determined)
  • not being able to maintain regular hydration and diet

 

airline.jpg

 

How can flight attendants protect themselves?

 

It’s difficult for those who staff airlines to alter their schedule, diet or uniform.  But what’s recommended is the following:

  • wear sunscreen
  • wear long sleeves and skirts/pants
  • maintain good hydration and a regular diet
  • try to ask for regular shifts that allow one to sleep regular cycles
  • if at higher genetic risk for some cancers (BRCA1 and BRCA2 gene mutations) see your medical provider about recommended screening.

The CDC recommends the following:

  • Try to reduce your time working on very long flights, flights at high latitudes, or flights which fly over the poles. These are flight conditions or locations that tend to increase the amount of cosmic radiation the crewmembers are exposed to. You can calculate your usual cosmic radiation exposures. The FAA’s CARI program website allows you to enter information to estimate your effective dose from galactic cosmic radiation (not solar particle events) for a flight.

  • If you are pregnant or planning a pregnancy, it is important to consider your work exposures, including cosmic radiation. If you are pregnant and aware of an ongoing solar particle event when you are scheduled to fly you may want to consider trip-trading or other rescheduling actions if possible.

    • For flight attendants, a NIOSH study found that exposure to 0.36 mSv or more of cosmic radiation in the first trimester may be linked to increased risk of miscarriage.

    • Also, although flying through a solar particle event doesn’t happen often, a NIOSH and NASA study found that a pregnant flight attendant who flies through a solar particle event can receive more radiation than is recommended during pregnancy by national and international agencies.

  • Regarding solar particle events:

Are travelers at risk?

 

Experts have suggested that those who are frequent fliers are still at low risk of being exposed to “too much radiation”.  Traveller.au.com writes: Overall, the amount “is really inconsequential,” said Dr. Edward Dauer, director of radiology at Florida Medical Center in Fort Lauderdale, adding that medical CT scans result in a much higher dose.

Read more:

 

Flight risk: how much radiation do planes expose you to?

 

Therefore medical professionals may suggest flying “in moderation” and checking in for regular check ups.

How can I check my radiation dose?

 

The American Nuclear Society provides a calculator, based on where one lives, how many x-rays, and how many hours one flies, 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 Health

Since 2017 multiple states have declared outbreaks of the Hepatitis A Virus and now the Department of Heath in Ohio (ODH) has declared one as well.

Since the start of 2018, cases in Ohio have risen to 79, double the total number recorded for 2017 in the Buckeye state.

 

hepatitis A

IMAGE FROM CLEVELAND.COM

 

WTOL reports: Ohio’s hepatitis A outbreak cases appear to be primarily among people who use illegal drugs, those who have been incarcerated, people who have had contact with known cases, those also infected with hepatitis C, men who have sex with men, and people experiencing homelessness.

Per the CDC, the below states have reported the following number of cases:

  • California 704  (as of April 11, 2018)
  • Indiana 148  (as of June 21, 2018)
  • Kentucky 760
  • Michigan 846
  • Missouri 125
  • Utah 109 (2018) and 147 (2017)
  • West Virginia  248
  • Arkansas 40 since February, 2018

Last year Colorado reported a doubling of Hepatitis A cases since the previous year.

What is Hepatitis A?

 

Hepatitis A is a disease that affects the liver.  Its caused by a virus (Hepatitis A virus) that is most commonly ingested. Poor hand washing and/or contaminated food are likely culprits. It’s transmitted by the fecal-oral route, where food or drink contaminated by fecal matter enters another person’s GI tract. Sexual transmission of Hepatitis A has been reported during activities involving oral-anal sex.

Hepatitis A can live outside the body for months, so unclean dining areas can be contaminated and transfer to food.

Those who are immunosuppressed run the risk of dying from the infection.

What are the symptoms of Hepatitis A?

 

Symptoms of Hepatitis A include:

Jaundice – yellowing of the skin and eyes

Fever

Abdominal Pain

Fatigue

Dark Urine

Joint Pain

Clay – looking stools

Diarrhea

Nausea

Vomiting

Loss of appetite

Hepatitis-A.jpg

 

What is the treatment for Hepatitis A?

 

There is no specific treatment for hepatitis A.  Most hepatitis A infections resolve on their own.

We usually recommend rest, fluids, and offer medications to help with nausea and vomiting.

For liver injury we avoid medications and alcohol that can worsen liver damage. The liver will usually recover within months after hepatitis A infection.

There are vaccines for Hepatitis A included in the childhood vaccination schedule.  Those older who weren’t vaccinated as a child can get the vaccine from their local provider or health department.  Many states require all health care and food workers to be vaccinated.

The best form of prevention however is good hand washing, dining area hygiene, and cooking food thoroughly.

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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 Health

Disney/Pixar may now include a warning for viewers that some scenes in their latest hit, Incredibles 2, may induce seizures at the request of the National Epilepsy Foundation. Some viewers found the strobe and flashing light scenes to be potential seizure triggers.

Veronica Lewis tweeted the following:

HEALTH ALERT I haven’t seen this mentioned in a lot of places, but the new Incredibles 2 movie (#incredibles2) is filled with tons of strobe/flashing lights that can cause issues for people with epilepsy, migraines, and chronic illness.

 

What is a seizure?

 

A seizure occurs when there is abnormal electrical activity in the brain.  If the electricity doesn’t conduct properly, brain function gets disrupted. This could lead to convulsions  (involuntary jerking movements), loss of muscle tone, changes in senses such as vision, hearing and smell, loss of bladder control, loss of consciousness and sometimes stroke, brain damage and death.

 

HGT0066_neurons-seizure-brain_FS.jpg

 

What is Epilepsy?

 

Epilepsy is a neurological disorder in which a person has recurrent, unprovoked seizures.

Photosensitive epilepsy, in which visual triggers can induce a seizure, occurs in 1 in 4000 of the population.

Can Movies Cause Seizures?

 

In December of 1997, a Pokemon cartoon aired in Japan resulting in over 700 children to the hospital with ailments ranging from dizziness to epilepsy.  It was determined that the rapidly strobing flashes of red and blue lights induced this “Pokemon Shock.”

 

pokemon1

 

A study from Prasad et al in 2012 found no increase risk of seizures with 3D movies than conventional television. They explain why seizures are induced here:

The mechanism in which TV and cinema movies trigger seizures in patients with photosensitive epilepsy is related to several factors including the light intensity, the environment and the frequency of picture frames per second. Normal 2D movies have a frame rate of 24 per second, which may pose a risk for patients with photosensitive epilepsy, but the light intensity in the cinema is very low and there are relatively a few reports of seizures precipitated in cinemas. In contrast, 3D movies project images at 48 frames per second aimed, by the use of colored or polarizing filters, at different eyes and resulting in 24 frames per second per eye. The polarizing effect of 3D films may reduce the light output by around fifty percent leading to a reduced risk to trigger a seizure to people with photosensitive epilepsy. Therefore, the risk of 3D movies to trigger a seizure is around fifty percent less than with conventional 2D movies. However if provocative material such as flashing light is presented the risk can be as high as that for normal 2D movies.

Although there is “insufficient evidence” to connect 3D movies to epilepsy, researchers agree with the need for more study.

Which makes us rely on anecdotal, or testimonial evidence such as the tweet from Veronica Lewis.

“Risky Movies”

 

The following have been suggested on moviehealthcommunity.tumblr.com to have strobe effects or flashing lights that may affect one’s photosensitivity risk of inducing a seizure:

 

  • Ocean’s 8 – fast-moving trains
  • Incredibles 2 - villain weapon
  • Solo, A Star Wars Story – laser fire and sparking electrical equipment
  • Speed Racer – bright headlines, racing cars
  • Deadpool 2 – gunfire, high-speed chase scenes
  • Hostiles -flashes from the gunfire
  • 300 – lightning scenes
  • Avengers, Infinity War – fight scenes, shaking cameras, laser based weapons
  • Iron Man series – strobe and flashing lights
  • Incredible Hulk, 2008 – strobe lights
  • Ready Player One – high-speed chase, shaky camera, flashing lights
  • Tomb Raider, 2018 – strobe lights, shaky cameras
  • A Wrinkle in Time – lightning storm
  • I, Tonya – fast speeds, quick camera shots
  • The Cloverfield Paradox – strobe lights

Although one of my favorite franchises, some of my listeners found the Transformer movies to have similar issues with high speed movements and strobe lights.

Many more movies are listed but the common thread are those with high action, high-speed, strobe lighting, storms, horror, and fast-moving race or fall scenes.

More can be found at moviehealthcommunity.tumblr.com.

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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 Health

Each year 45,000 Americans take their lives. That averages to 123 people a day.  And each suicide affects everyone with whom the  person has regular encounters. So why is it so common?  Here are six reasons people choose to end their life.

They’re Impulsive

 

Many of us have been trained to act on a whim. We quickly reply to a text, pop some food in the microwave, flick the controller while playing a video game…and these quick, instinctive acts are becoming a part of our daily behavior.  So when one has a fleeting thought of suicide, they may be less likely to slow down and think it through.

They Can’t See Around the Problem

 

When tragedy strikes, whether it be an accident, break up, job loss, missed opportunity, some can’t see “the light at the end of the tunnel.”  Many think and navigate through life one step at a time, which may be productive when it comes to tackling tasks, but if they feel the obstacle in front of them is insurmountable they may believe their options are far and few between, with death being the only out.

They Fear Death

 

This is one of the least discussed reasons people commit suicide, but unfortunately more common than we think.  Although most of us fear death and dying, some pathologically can’t handle the thought of it happening out of the blue.  Those who need control and need to plan ahead, may find solace in the fact that they are planning their own death. They can’t control their birth but they can control their death, they believe, and for those who feel they have lost control of their life may find this tragic option welcoming.

They’re Depressed, Really Depressed

 

Hollywood stereotypes depression as a woman sitting on a couch eating ice cream to combat the tears and loneliness of a breakup.  But many have symptoms of severe depression and don’t know it.

 

  • insomnia
  • fatigue
  • wanting to avoid others
  • poor appetite
  • lack of sex drive
  • apathy
  • anxiety
  • sadness
  • tearful
  • mood swings
  • poor memory
  • poor concentration
  • overeating

So many self medicate either by overeating, drinking alcohol, smoking weed, or taking pills, which when wears off, can sink one into a lower funk. Without psychological or medical intervention, one struggles to recover.

They Feel No One Cares About Them

 

Since so many people are undiagnosed when it comes to depression, family members and friends are unaware their loved one is struggling. Going about one’s business may be inferred as indifference by someone suffering from a mood disorder.  “They won’t even notice I’m gone,” pervades their thoughts and worsens their loneliness.

They’re Angry

 

If one feels they’ve been ignored, unheard or wronged, this could incite an “I’ll show ’em” attitude in which their suicide is plotted to be a form of psychological revenge.

Sadly many out there secretly hope they get help but don’t know how to ask for it. It’s up to us to seek them out and guide them to a medical professional who can listen, understand, and work with them.

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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 Health

We commonly think of DUI’s, or Driving Under the Influence, a result of drinking alcohol and driving while intoxicated.  However what many people fail to realize is drugs, including prescriptions, could decrease your ability to drive safely, hence putting you at risk for a DUI when alcohol wasn’t even ingested.

A report from the Governors Highway Safety Association (GHSA) and the Foundation for Advancing Alcohol Responsibility found that more fatal crashes were the result of drug use as opposed to alcohol use.

These findings showed that although alcohol was involved in 38% of fatal crashes, prescriptions and illegal drugs were responsible for 44% of driver- related deaths (similar to last year’s findings of 37% and 43% respectively).

Looking deeper they found 58 % of drug related fatal car crashes were the result of marijuana, opioids or both being on board.

According to their report, entitled, Drug-Impaired Driving: Marijuana and Opioids Raise Critical Issues for States, “44% of fatally-injured drivers with known results tested positive for drugs, up from 28% just 10 years prior.”

 

DrugAlcoholComp.jpg

Opioid overdose is currently responsible for 115 deaths per day. And as marijuana becomes legalized throughout the country, more people run the risk of being on a combination of the two, which can be deadly if they get behind the wheel.

“Drugged driving” manifests in less reaction time, poor coordination, memory loss, and distortion of one’s reality or surroundings.

Now what about prescription drugs? California Vehicle Code 23152(e) states, “It is unlawful for a person who is under the influence of any drug to drive a vehicle.”

So what prescription drugs could impair one’s driving?

The obvious ones include the following:

Narcotics such as hydrocodone, oxycodone, morphine, codeine…to name a few

Muscle relaxants such as carisoprodol, cyclobenzaprine, methocarbamol……

Sleep aids such as zolpidem, eszopiclone….

 

rs-181862-94818213

 

Anti-anxiety medications such as diazepam, lorazepam, alprazolam, clonazepam…..

However surprisingly, these next groups of medications can also cause sedation:

Cholesterol medications such as statins:  lovastatin, atorvastatin, etc. may cause fatigue and recent studies have found them to cause “excessive tiredness”.

Stomach acid suppressants such as proton pump inhibitors:  omeprazole, lansoprazole have been reported to cause vitamin deficiencies such as B12 and magnesium which in turn can cause fatigue.

 

nexium-prevacid-prilosec2

 

Antibiotics that treat many common infections:  Amoxicillin, azithromycin, ciprofloxacin have been known to cause fatigue.

Diuretics for blood pressure and water retention:  hydrochlorothiazide, furosemide cause potassium loss in the urine which may contribute to fatigue

Antihistamines:  anti-allergy medications such as diphenhydramine (Benadryl) are very sedating, which is why they are used in some over the counter sleep aids.  There are some reports that the younger generation of medications such as Zyrtec can cause drowsiness as well.

Blood pressure medications:  these can include the ACE inhibitors such as captopril, enalapril;  calcium channel blockers such as amlodipine; beta blockers such as metoprolol as well as the diuretic family mentioned previously.

Antidepressants: many antidepressants additionally help with anxiety through their sedating effects such as trazodone, paroxetine, and escitalopram to name a few.

Mood stabilizers, anti-seizure medications, and antipsychotics can cause fatigue as well.

Despite the rarity of these types of cases, the potential is still there for one to not only receive a DUI but injure himself or others if the prescription makes him less alert, i.e. decreases his “sobriety.”  Discuss with your medical provider if you feel drowsy after you take your medication and if there are less sedating options.

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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 Health
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Will a robot replace your doctor?

The University College London Hospital (UCLH) in Bloomsbury London is launching a pilot program replacing some A&E (Emergency Room) physicians with robots.

In response to staff shortages and long wait times, the initiative launched by UCLH and Alan Turing will utilize artificial intelligence to triage patients and reduce wait times.

Robotic technology is already being used in the operating room, rehabilitation centers and for pharmaceutical dispensing.  It’s just a matter of time that they become our main caregiver.

But will patients be pleased?

The Robot Is In…

 

Where’s there’s demand, there’s supply. Patients tired of wait times, crowded waiting rooms, loss of sick leave hours to sit around a medical office or emergency room for half a day will want speed and efficiency.  Kiosks may replace front desk clerks, taking your initial information (chief complaint, name, insurance info.), scanning it and offering you a number, like one given at a bakery.

Robots Don’t Judge

 

Those embarrassed by having symptoms suggestive of having an STD will have less of an issue conveying this information to a machine than a human being.  Gas, discharge, odors may be easier to discuss with someone or something that won’t wince.

 

Doctor-and-patient

 

The Doctor Doesn’t Examine Me Anyway

 

Many patients cite seeing a medical provider and not being examined or asked to undress before an exam. Time constraints, or avoidance of being accused of wrongdoing, have caused some providers to refer out for heart, gynecological, and rectal examinations. Primary care providers who enter the room, say a few words and then promptly leave saying they will “bring in the nurse to review instructions” may not be missed by the patient receiving similar service from a robot.

They can always answer my questions

 

We use Google, Wikipedia and Siri to answer our health questions currently.  No wait time, no office visit, no cost….so a robot answering our questions in layman’s terms will be an easy task.

 

However, and this is the kicker……

Robots Lack Instinct

 

There is no way to replicate the sixth sense humans have when it comes to something being wrong with you. Artificial intelligence cannot provide a “gut feeling.”

Let’s take a urinary tract infection, for example. I have had patients who were new to my office complaining something “felt funny” when they urinated and cited blood in their urine.  A urinalysis may show inflammatory cells, and a robot may correctly diagnose the patient with a bladder infection.  But I as a clinician may be suspicious that this new patient has something that is leaking blood into the urine, from the gynecologic tract maybe? And I’ve diagnosed endometrial and cervical cancer in cases where patients thought they were merely having bladder infections.

One patient presented to me in the emergency room feeling “odd” and suspecting a “UTI.” She was in her 60’s and started to complain of nausea.  Her urine had inflammatory cells so while a culture takes 3 days to complete, I gave her a prescription for antibiotics in case the infection would spread during that time. But her nausea was concerning. The patient requested an injection of nausea medication prior to leaving so I obliged, giving her Compazine.  While observing her for a few minutes, post injection, she began to have shortness of breath.  We decided to look at her heart and came to the conclusion after more testing that she had suffered a heart attack in her sleep the night before and the “odd feeling” she felt the next day wasn’t due to her UTI (which she coincidentally had) but was from a heart attack. She was treated immediately and recovered nicely.

Would a robot have picked up on that?  Multiple web resources include nausea in the list of symptoms associated with a UTI, so could be “blown off” by a robot bundling it with the patient’s urinary complaints. But I learned that nausea could be the first sign of a heart attack, especially in women.

Another case I had as an urgent care physician was the following:

A gentlemen came in saying he “felt fine” but his wife made him come in because he was burping the night before.  Multiple bouts of eructation jogged an ancient memory of mine…..when as a little girl I saw a movie where the pilot was burping multiple times before he passed out and died.  So I came to learn that chronic bouts of burps, or hiccups for that matter, could be a sign of an inferior MI (heart attack). I ran an EKG and blood work, and my instinct was right.  Again I was looking at a patient who unknowingly had a heart attack the night before but thought he had something benign the next day.

So gut instinct, thinking laterally, tapping in on past experience, and acting on hunches is not something a robot can do.  Humans may be satisfied with shorter wait times and receiving antibiotics when they demand them, but the education and intervention a medical provider can provide is priceless.  Too bad cost gets in the way of real medicine.

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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 Health
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Heat illness and heat stroke explained

The National Weather Service will soon issue an “excessive heat warning” for many parts of the Southwest United States. Phoenix received their first warning two weeks ago when their temperatures rose to 108 degrees.

What is an “excessive heat warning?”

 

This occurs “within 12 hours of the onset of extremely dangerous heat conditions”. This means that the heat index (air temperature and humidity) will be greater than 105 degrees for more than three hours a day for at least two days in a row and the night-time temperatures will not drop below 75 degrees. Although many of us may live in areas where this occurs each year, the onset can be one of the most dangerous times. Symptoms such as heat cramps, heat exhaustion and heat stroke must be identified.

What are Heat Cramps?

 

At first when one feels symptoms, it may come in the form of heat cramps. Heat cramps are painful spasms that occur in the muscles of the arms and legs and even abdomen. We believe that when one loses fluids and salts from excessive sweating, cramps ensue. It's important in these cases to get the person out of the heat, hydrate them with sips of fluid and electrolytes and massage the body parts affected.

 

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What is Heat Exhaustion?

 

If one does not leave the heat and come indoors, the next risky event that can occur is heat exhaustion. This worsens as the victim sweats profusely becoming more and more dehydrated. They could also have cramps but nausea may ensue, they may look pale and clammy and their heart rate will increase to try to compensate for the lost fluid. These individuals may become dizzy, weak and even faint. Immediately bring the person indoors, lie them down, elevate the feet, give sips of fluid, cool down the body applying cool and wet cloths to the underarms and body, and contact medical authorities if symptoms continue or worsen.

 

 

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IMAGE FROM MEDSTAR

 

What is Heat Stroke?

 

Heat stroke will occur if a vulnerable person does not get out of the heat in time. It is a medical emergency and can be fatal. If an individual has heat stroke 9-1-1 must be called immediately. Bring the victim indoors away from sunlight, lie them down, remove unnecessary clothing, cool their body with cold compresses and watch for signs of rapidly progressive heat stroke in which they have difficulty breathing, seize or lose consciousness. If they are unconscious you cannot give them fluids. Only if they are alert, awake and able to swallow will you be able to give fluids. Do not give medications to reduce the fever such as aspirin or acetaminophen since their body may not be able to metabolize them properly and this could make matters worse.

 

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Who is vulnerable to heat related illness?

 

Young children and elderly individuals may have issues adjusting to the outside environment and may be more prone to dehydration. Those with medical conditions such as heart, lung, thyroid disease can be at risk as well. If you’ve ever suffered from heat stroke you can be vulnerable again. And many medications could make you susceptible such as diuretics, vasodilators and beta-blockers for blood pressure and antidepressants.

The biggest risk comes when we are unprepared. Having an unusual cool week prior to a heat warning could preclude many from taking proper precautions. Staying indoors, checking air conditioning and fan devices to make sure they work properly, wearing cooler clothing is just the beginning. Stocking up and planning to hydrate frequently is paramount because when death occurs to excessive heat, dehydration is the main culprit.

 

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Bring your pets indoors, and watch your kids, friends and family members frequently. If they are beginning to succumb to the heat, they may be quiet and not be able to voice it.

 

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Avoid drinking alcohol in the heat. It can dehydrate you more and worsen the situation.

Avoid excessive exercise when outdoors and make sure to make use of shady areas.

The summer and early fall offer exciting and fun ways to enjoy nature. Don’t let the heat get to you. Remember….if you can’t take the heat, get out of the…..well heat…….

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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 Health
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