This year’s flu season has claimed the lives of at least 6 children and many more adults. It’s widespread in many states, and we are told to brace ourselves for yet another severe flu season as we enter the peak.
However, the number one cause of death when it comes to the flu is pneumonia. And the respiratory depression that appears to come on with these otherwise healthy individuals, appears to affect them within hours. Which raises the question…. Should we be entertaining the possibility that a severe pneumonia strain is affecting us this “flu season” and should we be encouraging pneumonia vaccines as well as the flu vaccine?
The vaccine schedule for children in the US includes the pneumococcal vaccine (PCV13) given at 2 months, 4 months, 6 months, 12 – 15 months of age. Over 2 years of a child, one can get the PPSV23 if they did not receive the PCV13.
Not all young adults get the pneumonia vaccine, however if one if over 65, the CDC recommends the pneumococcal vaccines receiving a dose of PCV13 first, followed by a dose of PPSV23, at least 1 year later.
Now a variety of pathogens can be responsible for pneumonia, including viruses’, fungi, and bacteria other than pneumococcus, but streptococcal pneumonia is the most common cause. If those affected by pneumonia this year were vaccinated, we need to know the strain, meaning specifically what pathogen was responsible for their pneumonia.
Although pneumonia presents with symptoms such as fever, body aches, cough, shortness of breath and sputum production, some individuals may not present with these symptoms when they have pneumonia. Some of the tragic “flu death” cases this year were in adults who initially had a “mild cough”. Since flu symptoms are similar, some may never know if they have pneumonia.
As a result we are telling patients who have the flu to return immediately to the doctor’s office/urgent care/emergency room if they have any of the below symptoms:
and speak with your medical provider regarding other symptoms they may want you to watch out for.
Among the various health issues that plague us during the festive holiday season; flu, colds, heart disease, hypothermia, pneumonia ...we add one more to the list ...Christmas Tree Syndrome.
Christmas Tree Syndrome occurs when one feels ill when they are in close proximity to their Christmas Tree. True the average Christmas tree is a spruce or fir, which rarely should be allergenic, but researchers have found they still carry allergens such as pollen, picked up by nearby plants, and may house mold.
Researchers from State University in New York analyzed the bark and needles of multiple Christmas trees and found multiple cases of mold with their allergy producing spores. And since they are trees from the wild, they provide residence to thousands of critters…aphids, mites, bark beetles and even spiders.
Now we have been living with Christmas trees each season and harmoniously and symbiotically have lived with their crittery inhabitants without being attacked, but that doesn’t mean we aren’t free from symptoms.
Christmas Tree Syndrome includes any of the following symptoms:
Mold and pollen are notorious for being the biggest culprits in causing these types of respiratory symptoms, so the following has been suggested to reduce your risk of Christmas Tree Syndrome:
Tis the season!! Unfortunately not for our hearts. A study back in 2004 found a 5% increase in heart attacks during the Christmas season. Then last year, a study published in the British Medical Journal found Christmas Eve to be especially risky for those who are prone to heart disease. Let’s dissect why….
The cold has long been associated with heart stress. Cold weather causes blood vessel constriction and this adds extra work for the heart. Moreover, it causes less oxygen to reach vital organs, including the heart.
Snow shoveling has been infamous for inciting heart attacks for this same reason. The heart demands extra blood due to the increase in activity and the cold restricts blood flow.
Alcohol, especially in excessive amounts, can put stress on the heart by increasing blood pressure, worsening diabetes, and causing abnormal heart rhythms. Moreover, it interferes with the metabolism of medications, hence many of these may not work at their best. Which brings us to…..
Medical providers take vacation too. And if a patient forgets to refill his medication he may go without during the two weeks of holiday season. Moreover many forget to pack everything they need for a Holiday trip and without anticipating delays, one could be without crucial medication dosing. The heart does not like this.
Holiday travel is never easy. Delays, long lines, the cold, traffic and then…..family. We may love our family but prefer seeing them in small doses. All the family at once can be a little overwhelming for some. As for coping with the in-laws…..well a guide is available for you all here.
Firstly, we must know our risk factors. These include:
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:
Plan ahead by doing the following:
Holiday time should be a happy time. Let’s make it a healthy one!!!
This week the CDC reports a 5th pediatric flu death as we face a season, many have predicted, to be “severe.”
And in previous years, once healthy children and young adults fell victim to severe circulating flu strains prompting parents this year to fear the worse when it comes to theirs or their child’s flu symptoms.
Who can blame them. Flu symptoms can last up to 2 weeks, and most patients are told to go home and rest as antibiotics do not help fight the flu and symptoms will usually “resolve on their own.” This is true, but then why are some people..healthy people…dying?
To understand why people are often misdiagnosed for flu-related illness when something even more serious is occurring, let’s first list the common symptoms of the flu.
As opposed to a cold, in which symptoms are less severe and come on more slowly, the flu seems to hit you within hours. The fatigue may be the first symptom, followed by body aches, scratchy throat, cough, runny nose and fever. The fever could range anywhere from 100 – 106 F. The fever usually lasts 2 days and the majority of those affected by the flu will average symptoms from 3-5 days.
There are multiple ways to die from the flu. The most common cause is pneumonia. A secondary viral or bacterial infection can affect the already weakened lungs. Pneumonia can be deadly, especially if untreated. Symptoms of pneumonia are very similar to the flu: shortness of breath, cough, fever, fatigue, body aches, etc.
Respiratory failure from inflammation can be fatal as well. The flu virus affects the respiratory tree causing acute inflammation and distress of the tissues whose job is to bring oxygen to the blood. Additionally, other organs including the heart may become inflamed, impeding their duties.
Flu can increase one’s risk of heart attack and stroke. A study in 2007 found coming down with the flu doubled one’s risk of heart attack and stroke.
Moreover, having the flu could worsen any disease states already being battled. Hence a diabetic, if suffering from the flu, may struggle to control his blood sugar numbers.
Rarely, some may go into multi-organ failure as a result of septic shock initiated by the flu. This is what killed 21-year-old bodybuilder Kyler Baughman.
But one risk that doesn’t get discussed as much as it should is coming down with an illness during flu season and being mis-diagnosed, a “guilty by association” picture.
Four days before her death, 12-year-old Alyssa Alcaraz was sent home by an urgent care with a flu diagnosis when in fact she had a strep infection in her blood that put her into septic shock.
How will I know when the flu is turning deadly?
Since symptoms of the flu start to resolve in a couple of days, any symptoms beyond those few days should spark suspicions. These can include:
Understanding what the flu virus can affect and not underestimating its severity is paramount in preventing flu fatalities. If symptoms start improving after 2 days it’s a great sign!! However, any symptoms that either do not resolve, lag on for days, evolve into something worse, or recur are red flags that something more than the flu could be going on.
Most importantly, if one has not been vaccinated yet against the flu, they should still consider getting the flu vaccine.
You finally get your dream and are selected to be a contestant on Wheel of Fortune. You get to see Pat Sajak and Vanna White! You win a vacation to some country that you don’t really want to see. You cannot get the cash equivalent. You have to take 10 days off of work to take the free vacation you did not want. You discover that you have to pay the tax on the free vacation.
Or you win a free car. You have a perfectly functioning 3-year-old car. The free car was not really the car you would have selected. You accepted it because it was free. Then you see that you have to pay tax on the list price of the free car. You also discover that the collision insurance and Department of Motor Vehicles registration for the free car are significantly higher than for the car you currently own.
These are examples of why nothing is “free.” This applies to medical care as well. You may have to see the “health care provider” the government program or private insurer makes available to you. You don’t particularly want to see a nurse, but that’s the way the cookie crumbles with free health care. Oh well, you convince yourself that it’s okay because, just like that car on the game show, it was free.
Here’s a new spin on “free.” Yes, your medical care should be free – free from the restraints of government control. Free from the government rules that have raised the price of insurance premiums. The Affordable Care Act mandated ten essential benefits that all insurance plans must include free of out-of-pocket charges to patients. Of course, this does not include the initial out-of-pocket charge: the insurance premium. Insurance premiums shot up over the post-ACA year because the insurance plan has to cover conditions that the insured persons may not even encounter in their own lives. A glaring example is obstetrics coverage in a menopausal female. Preventive and wellness visits are also labelled as free.
Moreover, a recent AMA study revealed that over the last four years the competition in the commercial insurance market has decreased. In over 50 percent of metropolitan areas, representing about 73 million persons, one insurer has half of the market. The more concentrated the market, the higher the premiums.
Remember that free car? We all know and readily accept that car insurance does not pay for the gas and basic maintenance. So why should maintenance medical care be covered by insurance? Car insurance would be unaffordable for most car owners if it paid for gas, oil changes, new mufflers, radios, and batteries. Most states require drivers to have car insurance. If people can’t afford the insurance, they lose the benefit of owning a car.
Similarly, if you lose your health due to long waits or delayed diagnosis because the CT scan was not authorized or poor medication response because you had to take the formulary drug that was not the doctor’s first drug choice for you, the care is not free, but very costly.
The underlying message of free “health care” is disempowering. The message is that we are incapable of taking care of ourselves. Empowerment is having control over our own lives. First, we take charge of our own health by thinking about the choices we make. We choose to not smoke, overindulge in food or drink, or engage in foolhardy behaviors. Second, we decide what is important for our own health. If you do not want insurance coverage for obstetrics or fertility treatment because you are 50 years old and do not want children, there should be a less expensive insurance product available to you. Third, we need to be free to choose our own doctor as well as the treatment the doctor—not the invisible third-party payer—recommends.
The promised free health care would increase the payroll taxes on all workers, even if that worker does not want that particular brand of free medical care. The next time you hear that medical care is free, just think about that “free” car that is the wrong color, is too small, has uncomfortable seats, inadequate headroom, and overall is not what you really want.
Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the Association of American Physicians and Surgeons (AAPS). Her opinions are her own. This is an edited column that originally appeared at www.pennypressnv.com, reprinted with permission.
Giving Tuesday was created in 2012 to encourage generosity and altruism. The holidays are an ideal time to share our blessings and fortunes with others who may be less fortunate. Many charities find this time the busiest of the year and funds are needed to help the great work they do, hence #GivingTuesday couldn’t come at a more opportune time. Donations of any size can be life saving.
However, some of us may be on very tight budgets and unable to donate money. No worries …. Giving Tuesday is not just about monetary donations. There are TONS of meaningful ways one can give to help others.
The winter season is a challenging time for many of our blood banks and every 3 seconds, someone needs blood. When one donates a pint of blood it can help save up to 3 lives. And it doesn’t cost a cent.
The American Red Cross is accepting blood donations. Local blood drives can be found at redcross.org.
Vitalant has locations throughout the country that can accept your blood donation as well. Contact Vitalant here.
Collecting non perishable food items from your pantry, neighbors or coworkers can be done quickly, easily and when taken to a shelter or organization can feed hungry and malnourished people in your community.
How many of us have saved our clothes from high school hoping we’ll fit into them again? Well we won't ...so why hold on to a lost dream. Tons of clothes in your closet can clothe those in need of the community…and an extra benefit is now you’ll create extra space in your closet.
Many shelters and charities need all hands on deck during this time of year. Churches and temples organize community events as well and could use the extra manpower. Donating your time is worth hundreds of dollars for charities who sometimes need to hire people to help them accomplish the great work they do.
This is easy and fun where the neighborhood comes together to donate items they wish to sell, and all the money raised goes to a charity of choice.
Some families could use a service or product that your company provides. Offering a family in need of some surplus or an hour of your time could go a long way.
The fastest growing addiction in the US is online shopping. Ads pop up on our social media, news feeds and email. Boxes pile up in your closet of unopened packages. And then one day you notice you purchased the same item twice! Are you addicted to online shopping or any shopping for that matter? Let’s break down this latest epidemic.
A “Compulsive Buying Disorder (CBD)” was first described in the early 20th century as a compulsive disorder that left the patient with debt. Later in the century its classification was debated and eventually included with the personality disorders.
Compulsive buying is known as “oniomania” where one buys impulsively and excessively to the point that it leaves them in financial hardship. And despite their financial issues they continue to make purchases. We’ve used the term “shopaholics” to describe those addicted to shopping but compulsive buying connotes the lack sense of financial ruin that can ensue. The spending is an attempt to satisfy a need that never gets fulfilled.
Compulsive buying disorder may be seen in those who suffer from mania and bipolar disorder. During manic episodes excessive spending may occur. Additionally we may see CBD co-morbidly in those who suffer from eating, gambling, substance use, and mood disorders.
Compulsive online shopping occurs when purchases are made online, without much thought or planning, and at a frequency where it may interfere with one’s life. People who might have never become a compulsive shopper in a traditional store may become easily addicted to online shopping. Those who are compulsive online shoppers may exhibit any of the following:
So compulsive online shopping, as well as compulsive buying disorder, can affect relationships, employment, finances and health.
Various sources have put the range at 5-8% of the US population.
When one is able to shop from the comfort of one’s desk or work station, the “ease” factor drives more shopping. Avoiding the need to leave work or home to battle traffic and weather and long lines, is one of the biggest draws. Moreover, those who hate going into a store or dressing room, concerned others will see the sizes of clothes they are trying on, can now shop in the privacy in their own home. Additionally shopping allows one to fight the boredom they have at work or home and give one a sense of accomplishment. And once one has a successful and satisfying purchase, the reward centers of the brain are activated making one want to shop more.
Hence, shrewd marketing will appeal to the human psyche by any of the following:
Don’t give in to the ads. People must realize they are being bombarded with some of the most creative marketing manipulation known to mankind. We can’t fall for it. Why are we letting our smart devices dictate to us what we need in our closets, pantries or garages?
But to fight the urge to shop online excessively, we must:
If needed, compulsive shopping can be treated with therapy as well as medications including SSRI’s, selective serotonin reuptake inhibitors, which are efficacious in those with impulsive personalities or obsessive-compulsive disorder.
Multiple states have mobilized their #LocktheClock forces to put an end to biannual time changes. Last year California passed Proposition 7, making Daylight Saving Time year-round and permanent. Other states who have proposed legislation include the following:
Some states had put forth legislation to be on Atlantic Standard Time, a time zone one hour ahead of Eastern Standard Time that essentially puts them on year-round Daylight Saving Time. These include Connecticut, Massachusetts and Rhode Island.
Multiple health risks have been cited in scientific literature during the “Spring Forward” and are cited below, including car accidents, heart attacks and workplace injuries.
Dr. Paul Kalekas, an Internal Medicine and Attending Physician at Valley Hospital Medical Center who has practiced in Nevada for years, states, “It’s time this gets done.”
Nevada’s original bill failed to pass in Congress a few years back so he and other physicians are working to resubmit legislation.
Senator Marco Rubio (R-FL) has introduced the Sunshine Protection Act to make daylight savings time the new, permanent standard time. States with areas exempt from daylight savings time may choose the standard time for those areas.
However, critics worry that states choosing their own time may disrupt the time zone uniformity.
So how did we end up here in the first place?
This ritual began in ancient civilizations, when daily schedules would be adjusted to the change in daylight. Later Benjamin Franklin wrote an essay for Parisians entitled “An Economical Project for Diminishing the Cost of Light” in 1784 explaining how less candles could be used if people woke up earlier, making more use of natures early light.
Two new cases of “smartphone blindness” has been described in the last month. One case was a gentleman in China who was playing games on his phone at night and suffered a retinal artery occlusion or “eye stroke.” Another case was a woman in China, who was also playing on her phone at night but she sustained a bleed in her left eye. Just as those who suffer from cerebral strokes, a “lack of blood flow” to the retina, or layer of the eye that helps create visual images, can be caused by a clot or hemorrhage. Apparently these can be induced with excessive focusing and eye strain. This may result in temporary or permanent blindness.
Some people are being evaluated for stroke or transient ischemic attacks when they come to the ER complaining of recurrent “temporary blindness” after checking their smartphone in the dark. This phenomenon, known as ‘smartphone blindness’, has been experienced by many of us when we have the sensation of dimmed vision or poor visual acuity, feeling punished for peeking at our email when we should be sleeping.
In 2016, doctors reviewed the cases of two women who experienced episodes of “temporary blindness”; as the ladies put their cell phones down, one eye could not see the cell phone for 15 minutes. Their vision restored after this length of time.Doctors investigated the cases thoroughly with a variety of medical tests including MRI’s and couldn’t find the cause.
Finally they conclude these transient episodes of “vision loss” were harmless, in that one eye was being used to look at the phone and the other eye needed time to “catch up”. When the women, as many of us do, check our phones, one eye is snugly closed and resting on a pillow while the other is available to look at the phone. When the ladies would turn over, the closed eye didn’t have a chance to catch up to the increased brightness of the phone screen, hence having a dimmed view.
If one uses both eyes to look at the screen, this phenomenon does not happen.
Studies surfaced a few years ago where great lengths of smartphone use can cause retinal detachment. In these cases the layer of the retina which focuses images, detaches from the back of the eye, causing serious vision loss. Though there are treatments, if not treated early can cause permanent blindness in the affected eye since the retina loses its blood and oxygen supply when detached. A woman from China had been using her smartphone for 2-3 hours in the dark each night when this occurs.
Smartphones have also been linked to myopia, nearsightedness and sleeping disorders as the blue light emitted from the screen can disrupt melatonin production.
A recent study found that 30% of adults spend more than 9 hours a day using their smartphone. Physicians recommend avoiding extended use, adjust settings to black text on white background, and with this recent case study, use both eyes to look at the screen when using the phone at night.
Increasing the size of the font helps your eyes since they don’t need to strain as much to read. Try to look at your smartphone with a distance of 1 1/2 feet. Blinking often helps rest the eyes as well and keeps them lubricated and moist.
Additionally, avoid using the phone in the dark, but in a lit room.
Finally its good to use the 20,20,20 rule. After every 20 minutes of use, look away at something 20 feet away for 20 seconds. This may help avoid eye strain from excessive smartphone use.
Stock photos of “healthcare workers” who attend patients—physicians are no longer distinguishable—usually feature a stethoscope draped around the neck.
But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”
The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence, and the rubber tubes by sophisticated electronic gizmos costing at least ten times as much as the humble stethoscope.
High tech is wonderful and increasingly capable, but if the stethoscope is dying, so is the art of clinical medicine.
The proper use of the stethoscope requires the doctor to touch, listen to the patient, and spend some time with a living person, not a computer. Patient and physician must cooperate: “Stop breathing,” “Take a big deep breath,” “Lean forward,” and so on.
It may be true, as Dr. James Thomas said, that graduates in internal medicine and emergency medicine miss as many as half of murmurs using a stethoscope. There are several reasons for this. One is not taking enough time to listen in a quiet room, and failing to perform the special maneuvers required to bring out an otherwise inaudible murmur (lean forward and exhale fully, turn onto your left side, squat then stand up, etc.).
The other is inadequate training. There are excellent recordings of heart sounds and murmurs, which of course would take time away from the time-devouring electronic medical record or “systems-based” medicine. And a recording is not the same thing as a live patient. Much of today’s teaching in physical diagnosis may be by “patient instructors”—paid actors pretending to be patients, who are evaluating the students as the students examine them. Rounds may be in a conference room, focused on the electronic record, instead of at the bedside.
In the old days, all the members of the team got to examine a real patient who had an interesting finding, with the patient’s permission and under the supervision of an attending physician. It seemed to me that patients usually enjoyed being the center of attention and the star of the show, and hearing the professor discuss their case. We learned how to help patients to sit up, and about hairy chests, layers of extra insulation, noisy lung sounds, shortness of breath, and other impediments to an easy examination.
The stethoscope is not just for heart murmurs. It’s for finding subtleties in careful, slow measurement of the blood pressure. It’s for extra or abnormal heart sounds. One can sometimes hear evidence of vascular problems inside the skull, or in the arteries supplying the brain, kidneys, or limbs. Or signs of intestinal obstruction. One can check to make sure a breathing tube is in the right place.
I don’t know of any bedside technologic wonders for examining the lungs. The stethoscope can detect sensitive signs of heart failure, pneumonia, fluid in the chest, collapsed lung, or airway obstruction. One can listen frequently to monitor changes in the patient’s status—much more efficiently than bringing the portable x-ray machine around.
The stethoscope works even when the power is off, the batteries are dead, the computer is down, or some circuit in the ultrasound device is malfunctioning. It works in facilities too poor to have the latest technology, or with patients who can’t afford to pay for a more expensive examination.
The stethoscope has tremendous capabilities in trained hands. Patients might want to evaluate whether they have a clinician who knows how to use it or is just carrying around a prop or status symbol. If you have symptoms suggestive of a heart or lung problem, does the doctor listen to all the lung fields—upper, mid, and lower, front and back? To at least four places for heart sounds? Are you asked to cough, say “e,” whisper something, take deep breaths or slow quiet ones, or do other maneuvers if something in the history or examination suggests a possible problem? Is the tv off, and are visitors asked to be quiet?
Everybody including doctors loves fancy technology. But before we toss out the old reliable tools, backed by two centuries of experience, how about some serious comparative studies like those the proponents of evidence-based medicine constantly demand?
Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views are her own. This is an edited version of her column that originally appeared in pennypress.com. Reprinted with permission.