Tuesday, 29 August 2017 18:23

Hurricane Harvey: How You Can Help

The Category 4 hurricane that hit southeast Texas Friday evening is expected to cause “widespread devastation” to the area.

 

Torrential downpours are expected to continue as power outages, floods, raging waters, and the potential for tornadoes threaten coastal and inland residents.

 

Hurricane Harvey, although weakening, is expected to hover over the next few days bringing more deadly conditions.

 

After the initial flooding and torrential downpour subside, Hurricane Harvey will put thousands of residents at risk for major health issues.

 

In addition to drowning, falls and other deadly injuries, victims of Harvey may endure the following:

Malnourishment

 

Many of those who did prepare for the storm may not have stored plenty of food, especially healthy fresh food. Those trapped in their homes may find the food they did store contaminated by flood water.

 

Infectious disease

 

The World Health Organization states that floods bring water borne diseases such as cholera, typhoid fever, leptospirosis and Hepatitis A. Vector borne diseases include Zika, malaria, dengue hemorrhagic fever, yellow fever, and West Nile.

 

Mosquitos initially get washed away during the storm, but the resulting puddles of water take weeks to dry and make ideal breeding grounds for insects.

 

The water gets dirty pretty quickly. People touching the flood water need to wash their hands thoroughly before eating or preparing food.

 

Moreover due to the moisture that seeped into walls and floors of houses, mold can grow and cause a variety of respiratory issues among other physical ailments. Massive disinfecting needs to take place before coming home to flood water contaminated residencies.

 

Chemical exposure

 

Chemicals from garages and fuel seeping into flood water expose victims to many compounds such as benzene, toluene and xylene that can cause a multitude of health effects including those that affect breathing, skin, the gut, balance, thought, and memory.

Psychological

 

When one loses their home, neighborhood, income, treasured belongings and more, it’s devastating. Post traumatic stress disorder may ensue.

 

To combat these risks, medical personnel and the CDC are preparing. Among food, shelter and clothes, paper products, sanitizer, cleaning supplies, tetanus vaccinations and counselors will be needed in mass quantities.

How can we help?

 

Blood supplies will be needed as residents who routinely donate have evacuated the area. Donating blood at your local blood bank may be shipped to the area in need.

 

United Blood Services have locations throughout the country that can accept your blood Donation. Contact UBS here.

 

The American Red Cross is accepting donations. On their website, they ask to visit redcross.org, call 1-800-RED CROSS or text the word REDCROSS to 90999 to make a $10 donation.

 

The Salvation Army is also accepting donations online and by calling 1-800-SAL-ARMY (725-2769).

 

The Red Cross and Salvation Army may also need local volunteers to help set up shelters.  Contact the above numbers.

 

Local volunteers are asked to donate supplies to nearby recreation centers housing evacuees.

 

Supply drives in out-of-state locations may not be accepted directly but could help local charities who need to ship supplies to the affected area.



 

LearnHealthSpanish.com / Medical Spanish made easy.

 

 

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

Published in News & Information

22,186 cases of swine flu have been reported in India, with the death toll reaching 1094.  This is a four-fold rise in deaths from last year.

 

The hardest hit areas appear to be Maharashtra with 437 deaths followed by Gujarat with 297 casualties.

What is the Swine Flu?

 

Swine Flu is the H1N1 Influenza A virus.  It originated in pigs before infecting humans. Current swine flu is not contracted from swine but passed between humans.

How deadly is Swine Flu?

 

The 2009 Swine Flu pandemic killed over 12,000 people in the US, and 200,000 people worldwide.  Many who die, do so from viral or bacterial pneumonia, although dehydration can also play a role.

Is the current outbreak in India the same virus that caused the 2009 pandemic?

 

No.  In 2009 the predominant strain of H1N1 was the California strain. This was replaced last year with the Michigan strain.

Do we have a vaccine against the Swine Flu?

 

Yes.  In the US, the trivalent and quadrivalent flu vaccines have included H1N1 since 2010.  These vaccines would include the following strains (according to the CDC):

 

  • an A/California/7/2009 (H1N1)–like virus,

  • an A/Hong Kong/ 4801/2014 (H3N2)–like virus, and

  • a B/Brisbane/60/2008–like virus (Victoria lineage)

with an additional B virus called B/Phuket/3073/2013-like virus (B/Yamagata lineage) for the quadrivalent vaccine.

 

Currently the World Health Organization (WHO) recommends changing the Northern Hemisphere flu vaccine to:

 

  • For H1N1, an A/Michigan/45/2015-like virus

  • For H3N2, an A/Hong Hong/4801/2014-like virus

  • For B, Brisbane/60/2008-like virus (belonging to the Victoria lineage)

with an additional B virus called B/Phuket/3073/2013-like virus (B/Yamagata lineage) for the quadrivalent vaccine.

What are symptoms of the Swine Flu?

Symptoms can include:

 

  • Fever

  • Cough

  • Chills

  • Sore Throat

  • Headache

  • Body Aches

  • Diarrhea

  • Vomiting

 

Who is at risk for Swine Flu?

 

Any child or adult could be at risk for H1N1 infection. However, the 2009 outbreak appeared to predominantly affect younger adults. One theory proposed for why this occurred was older individuals might have been immune having been exposed to the H1N1 during the 1950’s and when it reemerged in the 1970s.  Moreover 40 million Americans were vaccinated against swine flu in the 1970’s.

 

Those, however, at high risk for a severe Swine Flu infection include those who are pregnant, children under 2, asthmatic or other lung conditions, diabetic, immunocompromised (HIV, transplant recipient), sickle-cell, elderly, those in a nursing home, and patients with heart, liver or kidney disease.

How is Swine Flu treated?

 

Many times the H1N1 flu symptoms will last a week and then subside on their own. Some patients will need antivirals such as Tamiflu or Relenza. Any worsening symptoms (persistent fever, vomiting, diarrhea, chest pain, dizziness, confusion, lethargy), should prompt immediate evaluation by one’s medical provider.

How can we avoid Swine Flu?  Do face masks work?

 

swine-story_650_022415095428.jpg

 

 

Prevention of swine flu is best accomplished through vaccination, avoidance of affected individuals and good hand washing. Face masks generally are not recommended, but the CDC provides some guidance with these tables:




            Setting

Persons not at increased risk of severe illness from influenza

(Non-high risk persons)

Persons at increased risk of severe illness from influenza (High-Risk Persons) 3

Community

No 2009 H1N1 in community

Facemask/respirator not recommended

Facemask/respirator not recommended

2009 H1N1 in community: not crowded setting

Facemask/respirator not recommended

Facemask/respirator not recommended

2009 H1N1 in community: crowded setting

Facemask/respirator not recommended

Avoid setting.

If unavoidable, consider facemask or respirator 45

Home

Caregiver to person with influenza-like illness

Facemask/respirator not recommended

Avoid being caregiver. If unavoidable, use facemask or respirator

Other household members in home

Facemask/respirator not recommended

Facemask/respirator not recommended

Occupational (non-health care)

No 2009 H1N1 in community

Facemask/respirator not recommended

Facemask/respirator not recommended

2009 H1N1 in community

Facemask/respirator not recommended but could be considered under certain circumstances

Facemask/respirator not recommended but could be considered under certain circumstances

Occupational (health care)6

Caring 7 for persons with known, probable or suspected 2009 H1N1 or influenza-like illness

Respirator

Consider temporary reassignment. Respirator





  1. The effectiveness of respirators and facemasks in preventing transmission of 2009 H1N1 (or seasonal influenza) in various settings is not known. Use of a facemask or respirator is likely to be of most benefit if used correctly and consistently when exposed to an ill person.  (Ref. a) MacIntyre CR, et al.  EID 2009;15:233-41. b) Cowling BJ, et al. Non-pharmaceutical interventions to prevent household transmission of influenza. The 8th Asia Pacific Congress of Medical Virology, Hong Kong, 26-28 February 2009.)

  2. For the purpose of this document, respirator refers to N95 or any other NIOSH-certified filtering facepiece respirator.

  3. Persons at increased risk of severe illness from influenza (i.e. high-risk persons) include those groups at higher risk for severe illness from seasonal influenza, including:  children younger than 5 years old;  persons aged 65 years or older;  children and adolescents (younger than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;  pregnant women;  adults and children who have pulmonary, including asthma, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders, such as diabetes; adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV); and, residents of nursing homes and other chronic-care facilities.

  4. The optimal use of respirators requires fit testing, training and medical clearance. Proper use is recommended to maximize effectiveness. The use of facemasks may be considered as an alternative to respirators, although they are not as effective as respirators in preventing inhalation of small particles, which is one potential route of influenza transmission.  There is limited evidence available to suggest that use of a respirator without fit-testing may still provide better protection than a facemask against inhalation of small particles. Respirators are not recommended for children or persons who have facial hair (see FDA websiteExternal Web Site Icon).

  5. Use of N95 respirators or facemasks generally is not recommended for workers in non-healthcare occupational settings for general work activities.  For specific work activities that involve contact with people who have influenza-like illness (ILI) (fever plus at least either cough or sore throat and possibly other symptoms like runny nose, body aches, headaches, chills, fatigue, vomiting and diarrhea), such as escorting a person with ILI, interviewing a person with ILI, providing assistance to an individual with ILI, the following are recommended: a) workers should try to maintain a distance of 6 feet or more from the person with ILI; b) workers should keep their interactions with the ill person as brief as possible; c) the ill person should be asked to follow good cough etiquette and hand hygiene and to wear a facemask, if able, and one is available; d) workers at increased risk of severe illness from influenza infection (see footnote 3) should avoid people with ILI (possibly by temporary reassignment); and, e) where workers cannot avoid close contact with persons with ILI, some workers may choose to wear a facemask or N95 respirator on a voluntary basis  (See footnote 1). When respirators are used on a voluntary basis in an occupational work setting, requirements for voluntary use of respirators in work sites can be found on the OSHA websiteExternal Web Site Icon.

  6. See case definitions of confirmed, probable, and suspected 2009 influenza A (H1N1). Also see infection control in the health care setting. When respiratory protection is required in an occupational setting, respirators must be used in the context of a comprehensive respiratory protection program as required under OSHA’s Respiratory Protection standard (29 CFR 1910.134). This includes fit testing, medical evaluation and training of the worker.

  7. “Caring” includes all activities that bring a worker into proximity to a patient with known, probable, or suspected 2009 H1N1 or ILI, including both providing direct medical care and support activities like delivering a meal tray or cleaning a patient’s room.

 

Setting

Recommendation

Home (when sharing common spaces with other household members)

Facemask preferred, if available and tolerable, or tissue to cover cough/sneeze

Health care settings (when outside of patient room)

Facemask, if tolerable

Non-health care setting

Facemask preferred, if available and tolerable, or tissue to cover cough/sneeze

Breastfeeding

Facemask preferred, if available and tolerable, or tissue to cover cough/sneeze



LearnHealthSpanish.com / Medical Spanish made easy.

 

 

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

Published in News & Information

The report released Monday revealed the 41 year old pro-golfer had the following in his system when he was found asleep in his car on the side of the road while the lights were on and turning signal was flashing:  Ambien, Xanax, Dilaudid, Vicodin and Delta-9 carboxy THC (tetrahydrocannabinol).

Woods had undergone spinal fusion surgery weeks prior.

Vicodin is a narcotic made of hydrocodone and acetaminophen.  It is used for pain and most commonly prescribed post-operatively.

Dilaudid is hydromorphone, a stronger narcotic.

Xanax is a benzodiazepine used for sedation, relaxation and to lower anxiety.

Ambien is a hypnotic type of sedative used for sleep and works within 15 minutes of ingestion.

Delta-9 carboxy THC (tetrahydrocannabinol) is the psychoactive ingredient in marijuana.

None of these medications are to be used while driving. Additionally none should ever be used in combination. The respiratory depression of one narcotic combined with the sedative effect of the benzodiazepine or hypnotic could cause death.

Woods entered a plea of not guilty to DUI, as alcohol was not involved and a mixture of medications was to blame, but it's been reported a deal was made among prosecutors including a lesser charge of reckless driving and a stint in a “diversion program.”

Last month Woods stated he completed a private intensive program on his own. On Monday he stated, “Recently, I had been trying on my own to treat my back pain and a sleep disorder, including insomnia, but I realize now it was a mistake to do this without medical assistance.”

Polypharmacy, or taking multiple medications at the same time, can increase the risk of serious adverse events if the drugs act synergistically or mask side effects of one another.

Many overdoses occurring with pain pills may not always be a quantity issue with the narcotic but rather a mixture of the narcotic with another medication such as those taken by Tiger Woods.  He was lucky to still be alive when found as were those pedestrians or drivers on the street that evening.

LearnHealthSpanish.com / Medical Spanish made easy.

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

Published in News & Information

The CDC reports 3.4 million Americans suffer from epilepsy based on their 2015 data.  This number rose from 2.3 million in 2010.  470,000 of these cases are children.

 

According to their website, the CDC reports 1.2% of the population suffers from “active epilepsy.”  Active epilepsy is defined in adults as those having one or more seizures in the past year and requiring medication daily to control them. In children it means they currently have a seizure disorder.

 

The exact explanation for the rise in cases is unclear, however population growth and improved testing has been cited.

 

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

 

 

Epilepsy and seizures can be caused by a multitude of factors including genetics, brain trauma, tumors, infection, damage during birth, and stroke.

Can cell phones cause seizures?

 

Data has been limited linking seizure activity to cell phone use. However, some studies have found a modest link.

 

In 2016, Kouchaki et al tested mobile phone radiation in mice and concluded “continued and prolonged contact with the mobile phone radiation might increase the risk of seizure attacks and should be limited.”

 

Also in 2016, a study published in Epilepsy and Behavior by Tatum et al found texting to induce a “new type of brain rhythm.”

 

In 2013, Cinar et al examined the effects of electromagnetic waves (EMWs) on humans and suggested the following, “acute exposure to EMW may facilitate epileptic seizures, which may be independent of EMW exposure time. This information might be important for patients with epilepsy. Further studies are needed.”

 

In 2006, Ferreri et al found mobile phone “emissions” to increase human brain excitability, implying this could affect those with epilepsy.

 

More research therefore needs to be done investigating why epilepsy cases are on the rise and if cell phone radiation plays any role.

 

LearnHealthSpanish.com / Medical Spanish made easy.

 

 

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

 

Published in News & Information

You’ll know when you’re seriously taking your nutrition seriously. Instead of simply logging what you eat and drink and monitoring your calories burned on the MyPlate app, you’ll be playing it like a game -- plugging in different snacks and meal combinations ahead of time -- chasing the perfect day of macronutrient consumption.

 

I’ve been using the MyPlate app by Livestrong for over three months now, and since I’m finally meeting my daily protein goal of 142 grams pretty regularly, I’m turning my focus to managing what percentage of my calories come from protein, fats and carbohydrates -- the macronutrients, or macros if you want to sound cool.

 

The MyPlate app uses recommendations for macronutrient consumption taken from The Zone Diet, which is 40 percent of your calories from carbohydrates, 30 percent from protein and 30 percent from fats. Achieving the perfect day of macronutrient consumption takes careful planning and is even harder than eating a gram of protein for each pound of your body weight.

 

The closest thing to a perfect day of macronutrient consumption I’ve managed was 39 percent of calories from carbohydrates, 33 percent from fats and 29 percent from protein. Those meals consisted of the following:

Breakfast (600-700 calories)

Shredded Beef and Bean Chili Cheese Sandwich

Slow cook some boneless beef cuts on low-to-medium heat with a can of kidney beans, a can of chili beans and a can of whole tomatoes. Add tomato paste. I add a bit of Sweet Baby Ray’s Barbecue Sauce and a squeeze of mustard as well. Spice it up with chili powder, cayenne and black pepper. Cook for eight hours or until the beef is falling apart.

 

Pour a cup of chili over a sliced hamburger bun like an open-faced sandwich. Sprinkle shredded cheddar over the chili. You can add a fried egg to make the shredded beef and bean chili and egg breakfast sandwich and boost your protein consumption further.

Chocolate Whey Protein Milkshake

Blend four ounces of 2% milk with one scoop of Super Advanced Whey Protein (either chocolate or vanilla), a third cup of strawberries, half a banana, and half a peach, or apple, or orange -- whatever you want. You can even blend vegetables.

 

Whey is the best way to reach your daily protein goals without breaking the bank or eating too much tuna or eggs. Plus, mixing whey with milk adds slower-acting casein protein and healthy fats. Adding juice adds more carbs, but a splash of orange juice with your milkshake is actually fantastic. If I’m already using an orange I hold the orange juice, though.

 

Macronutrient Breakdown: 35 percent carbs, 39 percent protein and 26 percent fats. This is an ideal breakfast given the caloric intake and macronutrient breakdown. There’s even room for more carbohydrates and fats, which you could get from adding a fried egg and a few more fruits to the smoothie.

Snack (60 calories)

Newman’s Own High-Protein Pretzels

While 18 pretzels result in 22 grams of carbohydrates consumed, Newman’s Own High-Protein Pretzels also carry 5 grams of protein per serving. Plus, all profits go to charity, and the pretzels are delicious despite their lack of salt and overall healthiness. I generally only eat half a serving after my big breakfast.

Lunch (500-600 calories)

Tuna Cottage Cheese Half Sandwich

The easiest way to cut carbs is to make sandwiches with one slice of bread instead of two. Open a can of white tuna in water and drain it. Stir in a tablespoon or two of cottage cheese instead of mayonnaise, salad dressing or Miracle Whip. You’ll cut down on the fat, and it’s a nice little protein boost to an already high-protein lunch. Mix in some chopped onion and celery if you like, and add salt and pepper to taste. I sprinkle a bit of shredded cheddar cheese on the tuna, and use a teaspoon or so of Durkee’s Famous Sauce (because a tablespoon is 80 calories) and a tablespoon of spicy brown mustard on my bread.

Chicken and Rice Soup

Bring four cans of reduced sodium chicken broth to a boil and add chopped carrots, onion and celery. After the vegetables are cooked thoroughly, add two cans of chicken breast and two cups of rice. Season with salt and pepper to taste, or add a few teaspoons of Frank’s Red Hot Cayenne Pepper Sauce if you like it spicy.

 

I don’t usually have a glass of 2% milk with lunch, but I did on this day.

 

Macronutrient Breakdown: 59 percent carbs, 25 percent protein, 16 percent fats. While this lunch isn’t close to macronutrient consumption perfection, it keeps your protein consumption consistent and made up for the carbohydrates I didn’t eat for breakfast. Ideally, you would attempt to keep your macronutrient goals consistent for each meal, but that’s an even more difficult game to win and requires even more planning.

Snack (160 calories)

Planter’s Honey Roasted Peanuts

A serving of 39 Planter’s Honey Roasted Peanuts is 13 grams of fat, but fats are better than carbs when you’re turning your body into a fat-burning machine. Those 39 peanuts also carry seven grams of protein and seven grams of carbs with them, making them the ideal snack to make you feel full without packing on carbs.

Dinner (120-250 calories)

Baked Garlic Chicken Thighs

Pre-heat your oven to 325 degrees Fahrenheit and prepare chicken thighs by washing and removing the skin. Lightly grease a deep pan with extra virgin olive oil and finely chop some garlic. Place the chicken thighs in the pan and then flip them, just to get oil on both sides. Then sprinkle garlic over each side, along with any other spices you’d like to use. Bake to an internal temperature of 165 degrees Fahrenheit.   

 

Macronutrient Breakdown: 0 percent carbs, 33 percent protein and 67 percent fats. Again, this meal hardly meets the macronutrient goals of 40 percent carbs, 30 percent protein and 30 percent fats. But it does make up for my carb-heavy, fat-light lunch. I’ll usually eat this with a side of green beans or other vegetable to get some carbs into the mix. You can even slice up the chicken and add it to an alfredo sauce to eat over whole grain pasta if you want to work in more carbs.

Snack (200-250 calories)

Chocolate Casein Protein Milkshake

Whey protein is digested and absorbed by muscles quickly, whereas casein protein will continue to feed your muscles all night while you sleep, leaving you more refreshed in the morning. That’s why cottage cheese or a glass of milk are recommended before bed. The casein proteins in dairy products make for the best way to help your muscles recover and continue burning fat while you sleep.

 

Don’t use acidic fruits in your evening protein shake or you’ll subject yourself to potential heartburn that could keep you up all night. Stick to strawberries and bananas -- no oranges.

 

As you can see, The Zone Diet requires careful planning, and chasing the perfect day of macronutrient consumption starts with figuring out the right foods to consume. Once you narrow those down, you can mix and match in order to consume 40 percent of your calories from carbs, 30 percent from protein and 30 percent from fats at every meal.

--

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, Free Talk Live

Published in News & Information
Tuesday, 08 August 2017 16:05

Tuberculosis: Your Questions Answered

Tuberculosis (TB), once called “Consumption”, has been one of the deadliest lung infections in history.  With recent advances death rates have drastically dropped, but currently 1/3 of the world’s population is infected with TB and worldwide it ranks in the top 3 causes of death.

What is Tuberculosis?

 

TB was first discovered in 1882 by Robert Koch. It  is caused by the bacteria, Mycobacterium tuberculosis.  It’s an acid-fast staining bacteria (significant for diagnosis purposes) and it needs oxygen to survive, hence the lungs offer the perfect environment for this pathogen to grow.

How is Tuberculosis passed?

 

TB is passed by aerosol/droplet transmission so when someone coughs, sneezes, or passes respiratory fluid they could transmit TB.  It may also grow on contaminated surfaces.

What are symptoms of Tuberculosis infection?

 

Symptoms may include the following:

  • Coughing > 3 weeks

  • Coughing up blood (hemoptysis)

  • Pain with coughing and/or breathing

  • Weight loss

  • Fatigue

  • Fever

  • Night sweats

  • Chills

  • Loss of appetite

How is Tuberculosis diagnosed?

 

If a patient has any of the above symptoms the first test needed is a Chest X Ray.  The chest x ray may show an effusion (fluid), consolidation (area of the lung obscured with fluid/infection infiltrate), and lymphadenopathy (lymph node swelling). Ghon’s lesions (a necrotic, calcified focus of infection) and a Ghon’s complex (a Ghon’s lesion with lymph node involvement) may be seen as well.

Cultures of the sputum/mucous can be done but they take 4-6 weeks.  Acid-fast staining can be done on the sputum which will give a quicker diagnosis.

Can Tuberculosis spread?

 

Yes. 15-20% of the cases can be extrapulmonary. Meaning “beyond the lung”, one could have extrapulmonary TB, with infections affecting the gastrointestinal tract, genitourinary tract, lymph nodes and lining of the brain.

 

Sometimes TB may disseminate throughout the lungs and body, this is called Miliary TB.  Miliary TB can spread to the above areas as well as heart, brain, and bone.

TB may also become “latent” and reactivate at a later date.

How is Tuberculosis treated?

 

Active TB needs to be treated for 6-9 months. The following medications include:

 

  • Isoniazid (INH)

  • Rifampin (Rifadin, Rimactane) (RIF)

  • Ethambutol (Myambutol) (EMB)

  • Pyrazinamide (PZA)

  • Initially we prescribe a 2 month “intensive phase” treatment of the above four drugs.  Then its followed by a “continuation phase” of only INH and RIF.

  • For latent TB cases we prescribe a 9 month regimen of INH.

  • Health care providers watch for liver toxicity and, especially with INH, vitamin B6 deficiency.

 

Is there a vaccine for Tuberculosis?

 

Yes. The BCG Vaccine was created in the 1920’s and it is the most common vaccine given outside of the US. Due to cost and its lack of efficacy (only 50% effective) it's not given during routine vaccination here in the US. Moreover, it may interfere with PPD skin tests used for screening, as one vaccinated will show a positive result.

How do we screen for Tuberculosis?

 

The Mantoux, purified protein derivative (PPD) skin tests are given subcutaneously in the arm and read 48-72 hours later, looking for a red marking.

 

ppd

mar97table1.gif

 

Two steps are done a week apart to ensure against false negatives.

IGRA – Interferon Gamma Release Assay blood tests, such as QuantiFERON®, can be done and provides results within 24 hours.  It is beginning to replace the PPD test for screening in many healthcare settings.

Who is at risk for acquiring TB?

 

High risk populations include the following:

  • Healthcare workers

  • Prisoners

  • Homeless shelters

  • Nursing homes

  • Alcoholics

  • Chronically debilitated

  • Those with HIV

Where is TB the most common?

 

Countries with the highest TB rates include:

  • India

  • Indonesia

  • China

  • Nigeria

  • South Africa

  • Philippines

  • Pakistan

  • Bangladesh

 

50% of all cases in the US are immigrants coming from any of the above countries.

How does one prevent TB?

 

In addition to vaccination, and treating household/close contacts of those infected with TB, prevention includes the following:

  • Education

  • Homes with good ventilation

  • Avoidance of sick household contacts

  • Avoid close quarters with large amounts of people



LearnHealthSpanish.com / Medical Spanish made easy.

 

 

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

 

 

Published in News & Information

A study published this week in Lancet Global Health reveals, without increasing access to treatment, the number of cases of blindness will rise from 36 million cases reported in 2015 to 115 million by 2050.

The cause is the growing aging population, even though the actual percentage of the population with visual impairment is declining.

 

Factors leading to blindness may include diabetes, stroke, macular degeneration, retinal detachment, cataracts, glaucoma, and trauma.

 

In addition to these startling numbers of vision loss, moderate to severe visual impairment cases are set to surpass 550 million by 2050.

 

Study author, Rupert Bourne of Anglia Ruskin University, reviewed population based data from over 188 countries and found currently 200 million people suffer from moderate to severe visual impairment.

Bourne states, “Interventions provide some of the largest returns on investment. They are some of the most easily implemented interventions in developing regions.”

 

He continues, “They are cheap, require little infrastructure and countries recover their costs as people enter back into the workforce.”

 

Even minimal visual impairment can prevent those affected from obtaining a driver’s license or performing many activities, resulting in economic hardship.

 

The study authors hope this news could help shape future public health policies as well as encourage more investment into cataract surgeries and access to eyewear.

 

One is deemed “legally blind” when their central visual acuity falls under 20/200 (in the better eye under the best corrected circumstances) or their visual field is 20 degrees or less.

Childhood Vision Impairment

 

According to Prevent Blindness Northern California, 3% of children under 18 in the US are blind or visually impaired, despite maximum correction efforts.

 

In 2015, the American Community Survey (ACS) reported 455,000 children in the US with vision impairment.  Of these, 62,000 are legally blind, according to the 2015 Annual Report from the American Printing House for the Blind (APH).

 

Sadly, not all states have schools for the blind.

 

Leslie Jones, marketing and special events director of Nevada Blind Children’s Foundation (NBCF), tells us, “Nevada is one of a handful of states without a school for the blind, and what resources are available through the Clark County School District are severely limited (there are just 11 Teachers for the Visually Impaired {TVIs} for more than 500 visually-impaired students needing resources from the Vision Services department).”

 

Foundations such as the NBCF try to fill the gap with services these children need.

 

Jones states, “Nevada Blind Children’s Foundation (NBCF) works alongside CCSD to provide additional after-school educational and adapted recreational programs and services to ensure that these underserved children are given what they need to succeed in the classroom and in life.”

 

A child’s development and windows for learning necessitate early intervention.  Programs slow to enroll or lacking funding burdens blind children more as they fall behind in learning and development.  Building schools for the blind, such as in Nevada, will help thousands of children lessen their disability.

 

To help the Nevada Blind Children’s Foundation, please visit: here.

 

nv blind children

Dr. Daliah Wachs with Children from NBCF – Lady Bug Ball 2017

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Published in News & Information
Wednesday, 02 August 2017 17:29

Eating too FAST makes you FAT

Fast food has become the staple of many American and European diets and we’ve seen obesity rise.  True more people take public or private transportation to work over walking, and many have given up smoking every time they had a hunger itch, but the most popular reason for our waistline increase is fast food. But is it the caloric content of the fast food that’s fueling the obesity epidemic, or the speed at which its ingested?

 

What is Fast Food?

 

According to the Merriam-Webster dictionary, Fast Food is “food that can be prepared and served quickly”.  A burger, shake and fries is considered fast food but so is a take away salad or sandwich.  It’s implied that fast food is a meal that is not made fresh but made previously and preserved such that it can taste fresh when needed to be served.

How Caloric is Fast Food?

 

According to CalorieKing, a McDonald’s Big Mac is 540 calories.  A large order of fries is 510 calories.  So a meal over 1000 calories is obviously not the healthiest choice.

 

But let’s return back to the sandwich alone. While a Big Mac is 540 calories, CalorieKing finds Chick-Fil-A’s Cobb Salad (without dressing) 500 calories.  Bob Evans Restaurant’s Cobb Salad is 516 calories.




fast food.jpg

 

Now on the same site a Tuna Salad Sandwich (5 oz) w. mayo, 3 oz Bread is 679 calories.

So are we becoming obese eating cobb salads and tuna salad for lunch just as one would eat a Big Mac?  We don’t know since people don’t study cobb and tuna salad eating consumers. My guess is no.

 

Are we eating too fast?

 

Yes, and so fast that I believe it could be messing with our metabolism.

 

Think back to caveman days.  We had to chew.  And not on a soft sesame seed bun, but chew our meat.  Nuts and vegetables took a chewing as well.  Food was more scarce so it was savored and meals weren’t on the run while on a subway or at a stop light in one’s car.

 

Previous studies have shown that eating slowly and chewing it multiple times allow the body’s signals to trigger the satiety sensation sooner, hence one would eat less.

So gulping down a burger in 5 bites could be accomplished prior to the brain receiving the signal that it should be satisfied.

 

Now the metabolism issue.  Fast food could contain sugars, fats and preservatives that alter metabolism.  But eating on the run could cause metabolism issues in and of itself.

 

When a body senses that the food source is short-lived, unpredictable, and coming at a speed preventing proper absorption of nutrients, it may slow down metabolism to allow the body to make the most of what it has.  Eating a meal slow and methodical may be the most successful way to not only feel full but to eat less and lose weight.

 

I suggest a study be done looking at two groups of people eating the same food with the same caloric content but differing on the speed at which they eat it.

 

I suggest to you all to take an extra 15 minutes to complete your meal than what you’re accustomed to and determine if you see results after a few weeks.

 

Of course avoiding fast food would be the most beneficial for our weight but if you must eat fast food, eat it slowly.

 

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LearnHealthSpanish.com / Medical Spanish made easy.

 

 

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

Published in News & Information
Saturday, 29 July 2017 22:09

Men: How to Salvage Your Sperm Count

A study this week, reported in BBC, found men’s sperm count to drop 50% over the last 40 years.  This sparked rumors that humans could eventually become “extinct”.

Researchers from Hebrew University in Jerusalem and Icahn School of Medicine in New York analyzed 42,000 male participants involved in 185 studies from the period 1973 to 2011, looking at men from North America, Australia, New Zealand and Europe and found close to a 60% drop in sperm count, although semen volume remained stable.  Men from South Africa, Africa and Asia appeared to retain their sperm numbers.

So let’s break this down….

 

What’s in a sperm count/semen analysis?

 

Let’s review some anatomy.  Sperm is produced in the seminiferous tubules within the testes.  Once formed they travel to the epididymis, where they mature and are stored.  During ejaculation, the mature sperm travel from the epididymis through the vas deferens to the ampulla, meeting with seminal fluid (produced by the seminal vesicles, prostate and bulbourethral glands) to become semen.

 

When a couple is having fertility issues, a semen analysis will be ordered.  This looks at a variety of factors.

 

Volume – Sperm can’t dry up and need a medium in which to travel.  Seminal fluid can amount to 1.5-5 ml (1/4-1 teaspoon).  A decrease in this amount could imply issues with any of the above organs or a blockage.

 

Concentration – Sparse sperm in an ejaculate makes it more difficult to fertilize an egg, hence concentration of sperm should be close to 20 million sperm/ml of semen.

 

Motility – Sperm need to swim and compete with others, hence sluggish sperm don’t have a chance in …..well….the Fallopian tube.  Close to half of the sperm analyzed should be moving.

 

Shape/Morphology – sperm need to be the appropriate shape to maximize success in fertilization. At least half of the sperm in each sample should be of normal shape.

 

Liquefaction – initial ejaculate is thick to enable an easier passage of the package of sperm. Then it needs to thin, liquefy, to allow the sperm to travel and swim.  Normal liquefaction time is 15-30 minutes.

 

Color – semen color is usually whitish-gray but brown could signify blood, green could mean infection, yellow could signify a change due to medications, chemicals and sometimes age.

Other factors are noted such as the acidity (pH), white blood cell composition, and fructose.

 

What causes low sperm count

Multiple issues could account for a drop in sperm count.  These include:

  • Hormones in our food

  • Endocrine disruptors in our cosmetics

  • Chemical exposure such as solvents, herbicides, pesticides and benzenes

  • Obesity

  • Electronics sitting on our lap

  • Antibodies attacking our sperm

  • Heavy metal exposure

  • Radiation

  • High Stress

  • Anabolic steroid use and some medications

  • Varicoceles – swelling of the veins in the testicle disrupting transport of sperm

  • Infection

  • Tumors

 

and the list goes on.

 

How to protect your sperm count

So to protect your sperm count, we recommend the following:

 

  • Keep it cool – Testicles that overheat produce less sperm, so avoid laptops or anything that could heat up the groin.

  • Avoid tight fitting underwear – same issue.  Testicles closer to the body heat up so let them hang low and away keeps things cool.

  • Avoid tobacco products

  • Avoid alcohol

  • Decrease caffeine consumption

  • Avoid pesticides and chemicals

  • Avoid hot tubs

  • Decrease stress



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LearnHealthSpanish.com / Medical Spanish made easy.

 

 

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

 

Published in News & Information
Friday, 28 July 2017 21:06

Get six-pack abs and never do crunches

Crunches and sit-ups used to be the go-to exercise for those pursuing six-pack abs, but we know a lot more about the effects of those movements on the body. Crunches are one of the worst exercises for the lower back and can contribute to herniated disc injuries. And if you’ve already had surgery for a herniated disc like me, crunches can bring back that pain in the lower back. That’s why in my pursuit of six-pack abs I’ve ditched the crunch, but still manage to find exercises that blast the abdominal region without causing lower back pain. Here are six exercises that will make your six-pack pop without hurting your lower back.

1. The ab wheel

Instead of doing weighted crunches, which put even more pressure on your lower back than your upper-body weight already does, I substitute a 1 minute ab workout on the ab wheel.

 

Weighted crunches are just like any other weightlifting exercise: they build muscle, but sometimes sacrifice flexibility and even cause injury. While it’s important to build the abdominal muscles in order for them to be seen, it’s far more important to lose body fat, and you can’t just target abdominal fat. That’s not how fat-burning works. In order to show off your six-pack abs, your body fat needs to be between six and 13 percent, so you can do all the crunches you want and never see your abs.

 

That’s why you can get away with doing a more controlled exercise that you will feel in your abs and not your back. By “controlled” I mean it requires entire body control and tends to work your core muscles. Add controlled exercises like the ab wheel into a workout regiment that’s already designed for burning a lot of fat, and you won’t miss the crunches at all.

2. Boat pose

Another exercise that requires total body control and works the abs is the boat pose. This is where you lean back from a seated position with your feet suspended in the air and your hands at your sides. Do this for a minute and you’ll feel your abs going to work to keep your feet suspended, but your lower back won’t bark at you because there’s no movement involved with the lower back. Your back should be straight the entire time.

3. Crunchy frog

Another controlled exercise that’s a play on crunches, the crunchy frog starts from the boat pose, but with your arms outstretched at your sides. Then you bring your legs into your chest and wrap your arms around them before returning to boat pose and repeating the action. This variation on the crunch doesn’t force you to lift your upper-body weight using your lower back as the fulcrum. Instead, you lift your lower-body weight using your butt as the fulcrum. It’s a fantastic exercise that you will feel working all six muscles in your six-pack abs, as well as the lower abdominal muscles.

4. Bicycle crunches

Unlike traditional crunches, bicycle crunches don’t require your lower back to act as a fulcrum to lift your upper-body weight. Instead, alternately bringing your legs back towards your chin, and with your hands behind your head, turning into your leg and touching your opposite elbow to your knee takes pressure off the lower back. They can also end up being quite the cardio workout that will burn a ton of fat if you do them quickly, but a controlled motion is always best to avoid injury.

5. Leg Lifts    

Again, avoiding the lifting of your upper-body weight while using your lower back as a fulcrum is the key to avoiding lower back pain. While leg lefts use your lower back as a fulcrum, you’re lifting your lower-body weight rather than your upper-body weight, which is easier on the lower back than traditional crunches.

 

Just lay flat on the floor and slowly lift your feet to a 90-degree angle. Then slowly lower them back to the ground. You’ll feel this working your entire abdominal region and the upper part of your thighs and your back won’t be barking because of leg lifts.

6. Forearm plank (with variations)

More and more people are using static exercises like the forearm plank in the place of crunches. Why? Because there’s no movement, which means no risk to joints or the back. It’s also really difficult.

 

Push-ups have been a staple exercise for such a long time because they safely build muscle in multiple muscle groups. You can feel push-ups working your chest, biceps, triceps, abs and even upper back -- and all you’re lifting is your own body weight. Well, forearm planks are similar, except instead of lifting your body weight, you’re suspending it.

 

Get in a push-up position but lift yourself up by your forearms and stay there for a minute. It will be one of the hardest exercises you do -- until you try the variations of the forearm plank.

You can work the sides of your abdominal region by supporting your body weight on just one forearm. Put your left forearm on the ground and turn sideways, looking to your right and keeping the side of your left foot planted on the ground. Keep your back straight while suspending yourself. Stay in this position for a minute, if you can. Then do the other side.

 

Again, building up your ab muscles is only half the battle (or a third of the battle, really). Your six-pack abs will never be seen if you don’t burn the fat around those muscles, so work in 20-minute sprint sessions or jump rope interval training to shed that fat.

 

Of course, none of this does any good if you’re not focusing on nutrition as well. You can do all the ab exercises you want, but you won’t get any closer to showing off your six-pack abs if you keep eating fatty foods or too many calories.

 

The pursuit of six-pack abs is like the game of golf with calories being the strokes. You can limit your strokes on the golf course in two ways: through your short game and your long game. You can focus on chipping and putting or driving off the tee, but one without the other is still going to inflate your score. Focus on both and you’ll start shaving strokes. Focus on both exercise and nutrition and you’ll start shaving calories, allowing your six-pack abs to show.

 

Consuming tons of protein will also help. Whey protein is especially best after workouts because it not only feeds your abdominal muscles but helps you burn fat when you’re not working out. Getting enough sleep is also important, as is eating within an hour of waking up. Also, breakfast should be your biggest meal of the day, with lunch next largest and dinner the smallest. Snacking is most important, as smaller meals and more snacking increases your metabolism to burn fat all day.

 

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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, Free Talk Live

Published in News & Information