For years, men have voiced frustration when their medical providers insisted on a cardiac workup prior to initiating an ED prescription. Some thought it was because they’d have a heart attack during sex. But it’s not. Erectile dysfunction is a vascular issue, and if the vessels of the penis are compromised, how does one know his heart vessels aren’t as well?
Now in a recent study from John Hopkins School of Medicine found an increase risk of stroke, heart attack and cardiac arrests in those men who suffered from erectile dysfunction. Study author, Michael Blaha, professor of Medicine, states, “Our findings suggest that clinicians should perform further targeted screening in men with erectile dysfunction, regardless of other cardiac risk factors and should consider managing any other risk factors — such as high blood pressure or cholesterol — that much more aggressively.”
Last December, a study published in the Journal of Vascular Medicine, found the same risk factors leading to erectile dysfunction are also culprits in heart disease.
Risk factors shared by both erectile dysfunction and heart disease include:
Last year, researchers from Mount Sinai Medical Center, Florida International University and Baptist Health South Florida reviewed multiple studies and found a link between erectile dysfunction and compromised blood vessels whose endothelium (lining) demonstrated impaired vessel relaxation. This is necessary for both erections as well as blood flow to the heart and rest of the body.
Moreover carotid media-intima thickness, a marker of atherosclerosis, appeared to be correlated to erectile dysfunction as well.
Both studies remind us that if one bodily function is impaired, other organs may be quietly suffering the same impairment.
I like to credit the pharmaceutical companies that created erectile dysfunction drugs with saving millions of men’s lives as:
Young men aren’t immune to cardiovascular disease and need to be screened as well if they have issues starting or maintaining erections.
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.
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.
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.
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.
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.
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.
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.
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.
There is new hope that states with adult-use and medical marijuana laws on the books and states considering legalization or decriminalization will finally be able to stop worrying about the Drug Enforcement Agency (DEA) commandeering their police officers and sheriff’s deputies to enforce federal marijuana prohibition. A bipartisan group of United States’ Senators and Representatives introduced the Strengthening the Tenth Amendment Entrusting States (STATES) Act on Thursday. It’s intent is to allow states to determine what marijuana laws are right for them.
Republican Cory Gardner of Colorado and Democrat Elizabeth Warren of Massachusetts introduced the bill in the Senate. Republican David Joyce of Ohio and Democrat Earl Blumenauer of Oregon are co-sponsors of the bill they introduced in the House of Representatives. Upon introduction of the bill, its creators emphasized that their legislation would not make marijuana legal throughout the country – as if the name of the bill and its acronym weren’t revealing enough.
The bill’s bipartisan group of writers wants everyone to know the STATES Act is a states’ rights bill and not a legalize marijuana bill for obvious reasons – the biggest being that legislation ending federal marijuana prohibition would never pass Congress let alone get the support of Donald Trump, who said he’ll “probably” back the bill. But any legislation even misrepresented as a marijuana legalization bill would do lasting damage to the cannabis movement that has seen economies, government budgets, infrastructure and education improve while crime, opioid overdoses, suicides and healthcare costs decrease in states with adult-use or medical marijuana laws.
With the STATES Act, it will be nigh impossible for Conservatives to justify their opposition of the bill by calling it an endorsement of drug use. Politicians representing states that border states with adult-use or medical marijuana laws could claim the bill would only stretch their law enforcement and judicial budgets even thinner, but they couldn’t misrepresent the legislation to their constituents as an attempt to legalize marijuana. They could even request additional federal funding to address the increased law enforcement and judicial workload they anticipate, but they couldn’t vote “no” with the excuse of “I’m not about to legalize marijuana.” I mean, they could say that in their defense, but not without subjecting themselves to ridicule.
Another reason the bipartisan crafters of the STATES Act are making cannabis a states’ rights issue is because it appeals to a majority of the public. A Gallup poll conducted in June 2016 found that 55 percent of Americans prefer government power to be concentrated at the state level instead of the federal level, and Republicans are are four times as likely to support state power.
Giving more power to the states appeals to Republicans, Libertarians and even some Democrats. Hell, I’m a Socialist, and I support small government because I know Socialism, like all forms of governing, works most effectively and efficiently in people’s behalf when the number of people it governs is small and when that population is concentrated in a governable geographic area. Why? The answer was provided by the late Alan Thicke back in 1978: “Now, the world don't move to the beat of just one drum. What might be right for you, may not be right for some.”
Those are, of course, the opening lyrics to the “Diff’rent Strokes” theme song, and a more true statement could not be uttered let alone sung. The United States is a vast country that spans the spectrum of both geography and demography, which makes it difficult to govern. Americans experience such differing circumstances that what might be right for you, may not be right for some. Hell, in my home state of Montana you can drive eight hours and never leave the state, but the geography and the people change immensely. What works in the West probably won’t work in the East and vice versa. Marijuana legalization might be right for Californians, but it may not be right for Nebraskans. The STATES Act would allow states to choose what cannabis laws work best for their residents.
This isn’t the first time a bipartisan bill has been introduced to strengthen states’ rights to adopt and enforce marijuana laws as they see fit. I was on Capitol Hill as a student lobbyist for Students for Sensible Drug Policy five years ago when H.R. 1523, the Respect State Marijuana Laws Act of 2013, was before the 113th Congress. It too sought to allow states to decide the legality of adult-use and medical marijuana by altering the Controlled Substances Act to exclude persons acting in compliance with state marijuana laws.
We felt way back then that this would be our path to ending federal marijuana prohibition, and while we weren’t going to get federal legalization, it was a compromise we were willing to make to appeal to Conservatives and get the legislation passed. I left the reception held after our lobby day filled with hope after hearing Democratic Congressman from Colorado Jared Polis and famed Conservative Grover Norquist agreeing that cannabis was an issue for states to decide by and for their respective residents.
According to Congress.gov, that bill is still before Congress, lost and forgotten by the Subcommittee on Crime, Terrorism, Homeland Security and Investigations since April 30, 2013. It has 28 cosponsors in the House, six of which are Republicans. The House version of the STATES Act already has 14 cosponsors in the House plus the two Representatives who assisted in drafting the bill. Eight are Republicans, so the new bipartisan bill is already appealing to more Conservatives than H.R. 1523.
This bipartisan group has high hopes for the STATES Act given what’s occurred since H.R. 1523 was introduced. The STATES Act does what H.R. 1523 would have. It amends the Controlled Substances Act to exclude persons acting in compliance with state and tribal marijuana laws. But it doesn’t eliminate all federal oversight. Distribution of cannabis at transportation facilities and rest stops would remain federally illegal and enforced. The STATES Act does a lot more than allow states to determine their own marijuana laws, though. It also addresses some of the issues that have resulted from states legalizing adult-use or medical marijuana, which should appeal to both sides of the aisle.
Back in 2011, I wrote that cannabis would be America’s best cash crop ever – even bigger than tobacco. Marijuana consumption has already far surpassed my expectations upon its legalization for adult- and medical-use, but industrial hemp is what’s going to make cannabis America’s best cash crop ever. It grows like a weed if you’ll forgive the pun, and can be used for virtually anything. It’s a stronger fiber than cotton and can be used to make textiles that last longer so our clothes don’t fall apart in the wash. It will make stronger rope, hopefully saving mountain and rock climbers’ lives, and cowboys, cowgirls and sailors headaches. Hemp seeds are also rich in fatty acids, protein, fiber and other important nutrients. Hemp can even be used as fuel, which ExxonMobil will no doubt exploit given its investment into biofuels. All that algae research ended up being nothing more than a good PR campaign because hemp is a much less intensive biofuel to produce than algae. You can even build a house out of something called hempcrete, and cannabis can also relieve your pain without getting you high. That’s right, cannabidiol, better known as CBD, has been proven to have pain-relieving, anti-inflammatory, and anti-anxiety properties without the psychoactive effects of THC. So cannabis can clothe you, feed you, shelter you, transport you and your things, relieve your pain, and even save your life while creating jobs and improving our environment by oxygenating the air. Along with solar and wind energy industries, industrial hemp will be one of the biggest contributors to the health of America’s economy and environment for years to come.
The STATES Act would make cannabis transactions legal, allowing cannabis providers to take methods of payment besides cash and store that money in a bank. Cannabis providers have had a justifiable fear of depositing their profits in federal banks subject to federal law. The federal government could seize those assets like they seize vehicles used to traffic drugs. No criminal charges need to be brought against the cannabis providers for them to lose their money either, as asset forfeiture is a civil action, not criminal.
Since its legalization in Colorado, many cannabis providers have hired motorcycle couriers to pickup and deliver literal saddlebags of money to be deposited in a safe somewhere. One California dispensary owner reportedly delivers $40,000 in cash in the trunk of his car every month simply to pay his taxes. The STATES Act would make those trips a thing of the past and likely result in fewer instances of theft.
So is 2018 finally the year federal marijuana prohibition ends? Some people think so, but ultra-Conservatives could get in the way, just as they did on a cannabis bill for veterans just last week. The STATES Act probably won’t have many supporters from the religious right, which will be its biggest obstacle to overcome. But now more than ever before, Senators and Representatives on both sides of the aisle are going to be more willing to consider the end of federal marijuana prohibition given what we’ve all learned from the experimentation spearheaded by states. Kentucky, Tennessee and Virginia could all adopt medical marijuana laws this year, and if that doesn’t surprise you consider where we were five years ago, when Maryland relaxing criminal penalties for seriously ill people using marijuana was considered a win for cannabis advocates.
Your Senators and Representatives are not experts on cannabis and need you to inform them on the issue, so here’s a guide on how to do so most effectively. You’ll want to appeal to the humanity in them. Politicians are not cold robots. When they hear a story about someone using cannabis to treat their chronic back pain that otherwise would keep them bedridden, they can probably relate to that. They especially want to know if cannabis helped you kick your opioid addiction. They have friends and family struggling with the same problems with which the rest of us struggle, so speak or write from the heart. The facts will only bore them to the point they tune you out.
If you like this, you might like these Genesis Communications Network talk shows: America’s Healthcare Advocate, The Bright Side, The Dr. Daliah Show, Dr. Asa On Call, Dr. Coldwell Opinion Radio, Good Day Health, Health Hunters, Herb Talk, Cannabis A to Z
Anthony Bourdain, the famous world traveler, chef and Parts Unknown host was found dead in his room at Le Chambard, a luxury hotel in eastern France. The cause of death was hanging and local prosecutor, Christian de Rocquigny du Fayel said there was, “no reason to suspect foul play.”
Another tragic loss to suicide. I did not know Mr. Bourdain personally, but like most folks, I knew all about his world travels from his really fantastic CNN show - Parts Unknown.
I certainly don’t know what haunted Mr. Bourdain enough to take his own life so I won’t speculate. He leaves behind him a daughter, family, friends and legions of fans. It’s odd to think, “But he seemed like he was so happy - on TV!” Right? We like to think that we know people because we see them on TV, or in films, or through social media. We don’t.
His death, it seems has shocked Mr. Bourdain’s friends and colleagues. Usually, there are warning signs of depression and / or other things before an apparent suicide attempt. It really sounds, from what I’ve read, that no one had any idea he was suffering from whatever it was that drove him to take his own life.
Mr. Bourdain’s long time girlfriend, the actress, activist Asia Argento released a quick statement saying he was, “my love, my rock, my protector … I am beyond devastated.” Condolences seem to be coming in from all over the world which shows the vast reach of lives Mr. Bourdain has touched.
While suicide, or even a high suicide rate is nothing new in densely populated cities. In the US, the suicide rate has dramatically risen, with some states having an increase of 30% over previous decades. Nevada was the only state to report a decline (of 1%) while North Dakota reported a staggering increase of 57%. The report finds all sorts of factors as the cause - mental health, public health, addiction, alcoholism, economic hardship - to name a few. Just last week the fashion industry lost Kate Space who was unknown to me but was something of an icon in her field. And today we’ve lost Anthony Bourdain. Sadly, we all know it won’t be long before we lose someone else.
And suicide makes people - angry at the victim. And I understand. Bourdain’s long time friend, actress Rose McGowan broke down crying in a now deleted clip where she flat out screams at him that she’s “So mad at you.” Suicide is selfish. And I would probably feel the same way if a close friend of mine committed suicide. But I find it hard to judge someone I don’t know. So all I feel about Mr. Bourdain’s suicide is a tinge of sadness at a life lost too soon. He was only 61 years old and he certainly had a lot more to offer the world. Or maybe he didn’t. We just don’t know the struggles people face.
And so I can only offer the exact thing that everyone else is offering. Words.
Anthony Bourdain - Rest in peace.
I’ve been in pursuit of six-pack abs since the start of 2018, but a broken bone in my foot limited my ability to do cardiovascular exercises to cut the belly fat that covers up my abs. During that time I was doing the 10-minute abs workout on Livestrong’s MyPlate app, but have since purchased a Fitbit Alta and begun using the Fitbit app to log my caloric consumption and exertion.
While I have been doing some of the workouts available for free by Fitbit Coach, and I still do the 10-minute abs workout on the MyPlate app occasionally, Runtastic’s Six Pack app is my new go-to exercise app since acquiring promotional access to their workouts membership. Here’s why:
I used to do the 10-minute abs workout on MyPlate two or three times because the exercises were so easy. I’ve since added more time and more repetitions to make the workout more difficult as I’ve become more fit.
Runtastic’s Six Pack app is far from easy. Sure, at level one you’ll wonder how this app will ever shred your abs, but once you get to level two, you’ll be in a world of hurt, which is good. I burn more calories and build more muscle in the 17 minutes I spend doing Runtastic’s Six Pack exercises than I did in the 20 minutes it took to complete the MyPlate abs workout twice. How do I know? Because I sweat way more and am way more exhausted after the Runtastic workout than I am after the MyPlate workout. And each workout gets more and more difficult.
Despite asking how well you performed the exercises included in the Fitbit Coach workouts, that information doesn’t personalize the workout for you. Runtastic doesn’t bother asking whether you were able to complete all the repetitions of specific exercises. It just expects you to complete all the repetitions and asks you if you “want to go the extra mile,” adding another set of a surprise exercise. Runtastic then adds a few more repetitions to your next workout, and I like that. Progressively increasing exercise intensity is what builds muscle and burns fat. Pushing yourself a little harder each time you workout is how six-pack abs start showing through, and I can actually tell that my ab muscles are growing thanks to Runtastic’s Six Pack app.
No Runtastic Six Pack abs exercise is the same as one you’ve done previously because Runtastic alternates the order of your workouts’ exercises. Doing the same exercises in the same order makes each exercise easier to complete each time you workout. You’ll create muscle memory in the most literal sense. Back when I was a bodybuilding, gym rat, I would do the exercises in my workout in a different order to shock my body. If you’ve ever done bench press at the beginning of your workout and then at the end the next time, you know the struggle of completing all your bench repetitions at the end of your workout as opposed to the beginning. The same is true of your abs. Leg lifts are pretty easy when they’re the first exercise of your workout, but put them at the end and you’ll be reaching deep into your core for all the strength it can muster. You’ll actually be able to feel your six-pack abs developing.
I’m pretty dedicated when it comes to my health, but I’m probably just like you: I don’t love to exercise unless that exercise is playing some sort of sport. I don’t need much motivation to play baseball, tennis or go for a bike ride, but I’m not thinking about exercising while at home watching the game. That’s why I love that Runtastic reminds me when my next exercise is due. I don’t always do it right that second, but I don’t often forget that it must be done that day.
Before I turned on the reminders I managed to ignore the Six Pack app for quite some time. It took me weeks to get through level one because I didn’t do an exercise for a week. I immediately realized my mistake upon attempting my first workout after the week off. It shouldn’t have been as hard as it was, and I don’t know how I discovered the Runtastic reminders, but it could have been one of the helpful tips Runtastic gives when you complete your workout.
I still don’t have six-pack abs, but I’m more confident than I’ve ever been since starting the Runtastic Six Pack app workouts.
If you like this, you might like these Genesis Communications Network talk shows: America’s Healthcare Advocate, The Bright Side, The Dr. Daliah Show, Dr. Asa On Call, Dr. Coldwell Opinion Radio, Good Day Health, Health Hunters, Free Talk Live
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.”
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….
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.
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.
Roseanne Barr in, an apology for a tweet in which she alluded to ex-Obama aide, Valerie Jarret, looking as if the “muslim brotherhood & planet of the apes had a baby=vj” cited Ambien as the cause.
ABC News cancelled her hit show Roseanne on Tuesday.
In an apology, the actress tweeted, “I apologize to Valerie Jarrett and to all Americans. I am truly sorry for making a bad joke about her politics and her looks. I should have known better. Forgive me-my joke was in bad taste.”
She later tweeted, “I did something unforgivable so do not defend me. It was 2 in the morning and I was ambien tweeting — it was memorial day too — i went 2 far & do not want it defended — it was egregious Indefensible. I made a mistake I wish I hadn’t but…don’t defend it please.” CNN reports she also tweeted the following, “Not giving excuses for what I did(tweeted) but I’ve done weird stuff while on ambien — cracked eggs on the wall at 2am, etc.”
The makers of Ambien, Sanofi, tweeted the following response, “While all pharmaceutical treatments have side effects, racism is not a known side effect of any Sanofi medication.”
Millions of people use Ambien (zolpidem tartrate), a sedative hypnotic, in a 5 mg or 10 mg tablet form, that is used for fast-acting sleep initiation and is famous for not inducing a drowsy feeling the next morning.
Unfortunately multiple users have cited odd side effects such as driving to work in the middle of the night, or cooking breakfast.
According to rxlist.com, side effects of Ambien may include:
The medication is a gamma-aminobutyric acid (GABA) A agonist, inciting a neurotransmitter cascade that can inhibit activity between neurons, nerve cells. Lower levels of GABA are linked to sleep disorders, so inciting the GABA receptor as Ambien (zolpidem tartrate) does, can induce sleep. But once we’re affecting nerve signals other side effects may ensue since the GABA inhibitory neurotransmitter affects the central nervous system.
So odd behavior could be a side effect. However, as with alcohol-induced behavior, exacerbations of feelings or tendencies may occur. Forming new opinions, which may be racist, would not be a side effect of this medication.
Medical providers warn users to hide car keys, lock of refrigerators and put child locks on stoves and ovens as “sleep walking” behavior could put them and their families at risk. This also includes posting on social media… so keep phones away from the bed and computers off.
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?
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.
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.
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.
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……
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.
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.
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.
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.
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.
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.
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.
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.
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…….
Twenty five people have died, and 45 others are suspected to be infected with Ebola in the Democratic Republic of Congo (DRC). The World Health Organization (WHO) has confirmed and reported the outbreak of Ebola on May 8.
This latest outbreak began in villages near Bikoro. New cases later surfaced miles away in Mbandaka, an urban city with a reported population of 1.2 million, located along the banks of the Congo River.
Vaccination has begun with ZMapp, a treatment used in the 2014 outbreak that shows promise as a prophylactic measure.
Dr. Karen Duus, Associate Professor of Microbiology and Immunology at Touro University Nevada, explains, “The vaccine is a recombinant Ebola virus protein vaccine that causes a similar type of neutralizing antibody response (as the ZMapp treatment). The neutralizing antibodies coat the virus particle and keep it from binding to the target cells and infecting them.” Its efficacy, however has not been extensively tested.
The DRC had a small outbreak last year but it was contained within 42 days.
The West African Ebola epidemic spanned from the end of December 2013 to 2016 infecting over 28,000 people and killing over 11,300. The epidemic was one of the worst in Ebola’s history and its high mortality rate took countries such as Sierra Leone, Guinea, and Liberia by surprise. A vaccine was not available, and medications such as ZMapp were experimental and not in great supply. Hospitals were not stocked with protective clothing able to prevent the minutest of exposure to the deadly virus. Travel bans were difficult to institute and top that off with a lack of education on what we were dealing with and it was unfortunately the perfect storm for one of the deadliest outbreaks in recent history.
Ebola however emerged far before this. Ebola was named after the Ebola River in Zaire and was first recognized in 1976 when it caused two outbreaks affecting 318 and 284 people respectively. Multiple small outbreaks have occurred since then, according to the CDC:
1995 – Democratic Republic of Congo – infected 315
2000 – Uganda – infected 425
2007 – Democratic Republic of Congo – infected 264
And multiple smaller sporadic cases occurred in the years between.
In January 2016 health officials declared the Ebola outbreak had ended, however cases continued to smolder.
Why this occurs is the virus may not leave the body completely. Its been found to live in semen up to a year and some survivors can suffer a reinfection months later. For example, in 2015 Dr. Ian Crozier successfully fought Ebola but two months after discharge, suffered a severe eye infection which turned out to be Ebola lurking in his eye.
A study in 2015 found Ebola be able to survive outside a human body for days and longer if within a liquid such as water or blood. Mosquitoes are not known to transmit the virus however it can live in bats as well as monkeys and apes. Pets have not been known to contract Ebola from their sick owners but its been postulated that pigs could, if in contact with a victim.
Dr. Duus states that although the virus reservoirs are not clear, “people are most likely infected by butchering or eating infected animals.”
Ebola is a virus from the Flavivirus family that causes a hemorrhagic fever with symptoms of sudden fever, myalgias, headache and sore throat. It could then progress to nausea and vomiting, liver and kidney issues and internal and external bleeding, ultimately resulting in death in 90% of cases.