Wednesday, 06 December 2017 19:40

IUDs May Cut Cervical Cancer by 30%

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

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

 

 

iud.jpg

T-SHAPED IUD SITTING WITHIN THE UTERUS

 

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

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

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

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

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

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

What is the cervix and what is cervical cancer?

 

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

 

375x321_cervix

HTTP://WWW.WEBMD.COM/WOMEN

 

What causes cervical cancer?

 

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

What are the symptoms of cervical cancer?

 

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

Is cervical cancer treatable?

 

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

Who should get screened for Cervical Cancer?

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

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

What is a Pap Smear?

 

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

 

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

TEK IMAGE/SPL / GETTY IMAGES

 

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

How is an HPV test done?

 

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

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

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

 

Published in News & Information

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

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

  • Premature balding 5.6 X risk

  • Premature graying 5.3 X risk

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

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

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

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

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

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

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

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

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

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Why does our hair turn gray with age?

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

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

 

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IMAGE FROM MADSCI NETWORK

 

What can cause premature graying?

 

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

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

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

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

What causes baldness?

 

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

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

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

How can we prevent heart disease?

 

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

  • Family history of heart disease

  • Personal history of heart disease

  • High Blood Pressure

  • High Cholesterol

  • Diabetes

  • Smoking

  • Obesity

  • Inactivity

  • Males over 40

  • Females who are post menopausal

  • High stress

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

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

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

Thirdly, reduce your risk by the following:

  • Maintain a normal blood pressure

  • Maintain normal blood sugar

  • Maintain normal cholesterol and lipid levels

  • Reduce stress

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

  • Quit smoking

  • Stay active

  • Maintain a healthy weight.

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

 

Published in News & Information

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

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

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

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

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

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

What is a liver fluke?

 

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

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

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

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

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

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

How does one get contract liver flukes?

 

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

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

What are the symptoms of infection with liver flukes?

 

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

  • Fatigue

  • Abdominal Pain

  • Fever

  • Nausea

  • Vomiting

  • Diarrhea

  • Jaundice – yellowing of the skin and whites of eyes

  • Itchy skin

  • Weight loss

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

 

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

 

gallbladder image.jpg

 

What is the treatment for liver flukes?

 

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

 

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

 

Published in News & Information

Civil rights activist, Jesse Jackson, revealed Friday that he’s been diagnosed with Parkinson’s disease.

The 76-year-old two-time Democratic presidential candidate stated he and his family noticed changes three years ago and, “after a battery of tests, my physicians identified the issue as Parkinson’s disease, a disease that bested my father.”

His father, Noah L. Robinson, died in 1997 at the age of 88 of a heart attack and complications of Parkinson’s.

What is Parkinson’s Disease?

 

Parkinson’s disease is the second most common neurodegenerative disorder, next to Alzheimer’s, and the most common movement disorder that affects 1% of the world’s population over 60 years old. In the US, 60,000 new cases are diagnosed each year.  It affects several areas of the brain, primarily the substantia nigra, altering balance and movement by affecting dopamine producing cells.

 

substantia nigra

Image from the Science of Parkinson’s Disease

 

It was first described in 1817 by James Parkinson as a “shaking palsy.”

What are the Symptoms of Parkinson’s?

 

Common symptoms of Parkinson’s include:

  • Stiffness and rigidity

  • Poor balance

  • Tremor at rest, especially a pill-rolling tremor

  • Slow movement

  • Inability to move

  • Shuffling steps, gait

and patients may later develop…

  • Depression

  • Anxiety

  • Memory loss

  • Constipation

  • Decrease ability to smell

  • Difficulty swallowing

  • Erectile dysfunction

  • Pneumonia

  • Fractures from falling

  • Hallucinations

  • Delusions

  • Dementia

Who is at Risk for Parkinson’s?

 

Most cases are idiopathic, meaning the disease arises with no specific cause.  However some cases are genetic and multiple genes have been identified that are associated with the disease.

The average age of onset is 60, but some cases may occur as “early onset”, before the age of 50, and if before the age of 20, it is known as juvenile-onset Parkinson’s.

Men appear to be more affected than women at twice the rate.

Risk may be enhanced with a history of head trauma.

Exposure to herbicides and pesticides has been linked to an increased risk of Parkinson’s as well.

How Quickly do Parkinson’s Symptoms Progress?

 

Average progression rates can last years to decades, however, earlier onset disease may manifest much quicker.

The stages of Parkinson’s are illustrated below:

What-Are-the-Stages-of-Parkinson_s-Disease

How is Parkinson’s treated?

 

Although there is no cure for Parkinson’s, symptoms can be treated by a variety of measures.

  • Levodopa – converts to dopamine in the brain, helping replace the deficient hormone.

  • Carbidopa (Sinemet) – if given with levodopa prevents the latter from being broken down before it reaches the brain.

  • Dopamine agonists – mimic dopamine

  • MAO-B inhibitors – helps block the enzyme MAO-B, which breaks down natural dopamine

  • Other medications including COMT inhibitors, amantadine and anticholinergics

  • Medications to treat anxiety and depression

  • Deep brain stimulation – a surgeon implants electrodes into the brain, allowing stimulation of parts that help regulate movement.

  • Stem cell therapy – being investigated as a means to create dopamine-producing cells

  • Physical and occupational therapy

Famous People Diagnosed with Parkinson’s

  • Michael J. Fox

  • Janet Reno

  • Robin Williams

  • Muhammad Ali

  • Casey Kasem

  • Johnny Cash

  • Linda Ronstadt

  • Pope John Paul II

  • Peanuts creator Charles Schulz

It’s been postulated Adolf Hitler suffered from Parkinson’s as well.

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

 

Published in News & Information
Wednesday, 15 November 2017 17:33

New Blood Pressure Recommendations Released

High blood pressure has now been redefined as being greater than 130/80 mmHg, down from 140/90 mmHg. This will mean close to 103 million more Americans will fall under the “hypertensive” category.

 

Multiple agencies, including the American Heart Association and American College of Cardiology, redefined the guidelines, in practice for the last 14 years, to lower the threshold for high blood pressure from 140/90 to 130/80.

 

Under the old guidelines, 1/3 of US Americans were considered to have high blood pressure.  Now 42% of Americans will be “hypertensive.”

 

In lowering the guidelines, task force members hope to reduce complications associated with high blood pressure and start treatment earlier in those who have not been treated.

 

blood+pressure+chart

 

What do the blood pressure numbers mean?

 

The top number, or systolic pressure, is the pressure the heart exudes during a beat or pumping of the blood.

 

Diastolic pressure is the pressure in your arteries between beats while the heart is “filling.” Both numbers are equally important as elevation of either can increase one’s risk of cardiovascular disease.

What can long term high blood pressure do?

 

Chronic high blood pressure can be dangerous.  It may cause:

 

  • Heart attacks

  • Heart failure

  • Stroke

  • Kidney disease

  • Dementia

  • Eye damage – vision loss

  • Erectile dysfunction…to name a few.

How do we treat high blood pressure?

 

The stages of blood pressure are defined in the chart above.  At the elevated or early stages of high blood pressure the following lifestyle changes will be recommended:

 

  • Weight loss

  • Low salt diet

  • Low fat diet

  • Good sleep habits

  • Regular exercise

  • Avoiding tobacco products

  • Limiting alcohol consumption

  • As a family physician I would also screen for diabetes, high cholesterol, low thyroid, kidney disease and sleep apnea.

  • If blood pressure cannot be controlled and continues to rise, medications may be prescribed to decrease blood volume, or lower the heart rate, or relax the blood vessels.



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

 

Published in News & Information

The World Health Organization has reported an outbreak of the Marburg virus, similar to Ebola, has appeared in eastern Uganda on the border of Kenya.

 

Thus far 5 cases have been reported prompting the WHO to deploy funds to keep the spread contained.

Where did Marburg Originate?

 

Marburg was originally identified in 1967 when two simultaneous outbreaks occurred in Marburg and Frankfurt, Germany. An outbreak in Serbia also occurred that same time.  Since then rare isolated cases have popped up in Kenya, Angola, South Africa, Uganda and the Democratic Republic of the Congo.

What is Marburg virus and its Symptoms?

 

Marburg virus is apart of the same family as Ebola, the Filoviridae.  Just like Ebola, it causes a hemorrhagic fever, where victims may bleed, have fever, vomiting, diarrhea, headaches, muscle aches, rash, red eyes, sore throat and abdominal pain to name a few.

 

marburg-ebola.png

Image from KeyWordSuggest

How is Marburg Transmitted?

 

Marburg virus is transmitted to humans from monkeys and bats such as the African fruit bat and Rousettus bat.  But similarly to Ebola, human to human contact can spread Marburg, especially during body preparation for burial. Saliva, tears, vomit, semen and blood can transmit the Marburg virus from human to human.

 

Greater short-nosed fruit bat (Cynopterus sphinx)

Fruit Bat, Image from Dignited

How is Marburg Treated?

 

There is no treatment currently known for Marburg.  It has an estimated 88% fatality rate.  Its incubation period ranges from 5 days to 2 weeks and those exposed may need to be in isolation for up to 21 days.

 

RNA interfering treatments are being researched to prevent Marburg virus replication in the host.  Its unclear if Zmapp, a treatment for Ebola, is effective in treating Marburg infection. Between 2014 to 2015, 28,610 people were infected with Ebola resulting in 11,380 deaths.  Local officials are being very diligent to make sure Marburg doesn’t follow a similar epidemic path.

 

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

 

Published in News & Information
Tuesday, 07 November 2017 19:37

How Doctors Can Prevent Burnout

A new study from the American Medical Association (AMA), the Mayo Clinic and Stanford University finds 1 in 5 physicians plan to cut back their hours next year and 1 in 50 will leave the profession completely within the next 2 years.

 

Burnout is cited to be the main cause and is one of the biggest threats to health care today. According to AMA President Dr. David Barbe, “An energized, engaged, and resilient physician workforce is essential to achieving national health goals.”

 

And burnout affects all fields of medicine, surpassing 50%, in those including primary care and specialties such as gynecology, neurology, urology, emergency medicine, anesthesiology, cardiology and critical care to name a few.

 

Patients are at risk because if doctors aren’t at the top of their game, things get missed.  

 

Moreover the keen instinct of a clinician is imperative to diagnosing correctly, and this gets blunted when one is emotionally fatigued, or burned out.

Why are Doctors Burning Out?

 

A variety of factors can lead to physician burnout but the following appear to be the most cited:

 

  1. Electronic medical records – these are time-consuming to learn and implement, take time away from patients and may be financially burdensome due to their cost and lack of revenue for those who struggle to type and work with computers.

  2. High patient insurance deductibles – with insurance companies not paying until patients reach their deductible, it forces doctor’s offices to work harder to collect the income needed to run a practice.  Physicians do not want to get into the financial aspect of patient collections and it adds undue stress on an already stressful field.

  3. Red tape – ICD 10 code changes, insurance authorizations, referral forms turn the average day of a physician to less patient care and more bureaucracy.

  4. Less respect – in the old days, doctors were considered heroes and revered greatly.  Today they are frequently blamed for issues such as rising healthcare costs and the opioid epidemic.

  5. Malpractice suit fears – doctors are human and can only combat nature so much.  When one is diagnosed with cancer a physician has to fear that one will accuse him of not diagnosing it “quickly enough”.  When a lab gets ordered, the clinician has to hope that his staff is ensuring that every lab value comes across his desk.  When a prescription is written, he has to hope that the correct medicine is dispensed, works effectively and does not cause an adverse reaction.  And when a referral is made to a specialist, he has to hope all the above issues go well with the second physician or he can be sued for the referral.  And since a doctor sees thousands of patients a year, the odds that he will be sued for something is higher than any other profession.  Moreover, one lawsuit is a enough to bankrupt him.  Pretty darn stressful.

 

What are the signs of burnout?

 

In any profession, the following may be signs of burnout:

 

  • Apathy

  • Exhaustion

  • Poor sleep

  • Negative attitude at work

  • Absence from work

  • Being irritated

  • Feeling empty

  • Dreading going to work

  • Feeling underappreciated

  • Feeling you don’t matter

  • Blame others for mistakes

  • Low energy

  • Thinking about quitting




burnout

 

How to prevent burnout?

 

  1. Find the humor – As Milton Berle once said, “Laughter is an instant vacation”.  Watching a comedy or taking a 10 minute break to watch some funny YouTube clips offers immediate relief and energizes you.  A day without laughter is a day wasted. Charlie Chaplin

  2. Take care of yourself – how can one heal others when he himself needs healing?  So what can you do?  Try Massage, Meditation, Yoga, Exercise, Stress diary, Sleep, Mini vacations, Staycations but most of all…..Take breaks!!

  3. Learn to say “No” – It’s OK to take a day off. Why not take off early on Friday’s?  Or better yet, work a half day on Wednesday to break up the week?  Learn the 4 D’s…..Deflect, Defer, Deter, Delegate…..

  4. Make small goals – too many times we burnout because we failed to meet a goal that was unattainable in the first place.  So we toil for years to become “promoted”, or “wealthy”, or “slim”, or “married”, or “see the world”.  Instead, make smaller attainable goals (find a partner, open auxiliary office, lose 10 lbs, take a trip).

  5. Quit comparing yourself to others – we watch Shark Tank and then wonder what we are doing wrong, not being millionaires.  It’s unrealistic to think you should be “rich by now”.  We will always be inferior to someone else.  So get over it and love who you are and what you’ve accomplished.

  6. Have fun at work – contests, pot luck lunches, lunch room decorating, accent days, dress up days, and end of the week happy hour can spice things up at work.  Plus it increases morale among coworkers and staff.

  7. Be charitable – Doing community service is so rewarding and energizing that having a pet project helping out a local charity may be just what this doctor orders.  You can choose a cause, fundraise, attend charity events or walks, or even create a campaign.

  8. Get a hobby – tap into your artistic side by writing a book, song, article; paint; cook; build; teach; sing; dance; or even ride.

  9. Work on your bucket list- whether its going to a foreign country, learning to speak a new language, buying a vacation property, or even starting a second business, don’t let job burnout deter you.  This may give you the energy and perspective you need.

 

Finally, be around others and have a Bitch and Moan session – it feels so good to complain and gripe. Find others in similar situations as you and you’ll realize that you may have it better than you think.

 

Remember you have to come first and doing so will make you more of a help to others.  Feel great and you’ll make others feel great!

 

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

 

 

Published in News & Information
Tuesday, 24 October 2017 16:44

New Type of Diabetes Discovered: Type 3c

A third type of diabetes has been identified by researchers. Type 3c diabetes may be mistaken for Type 2 diabetes, causing delay of proper treatment.

 

Researchers from the University of Surrey found Type 3c diabetes to be more common in adults than Type 1 diabetes.  Moreover they found that those with Type 3c were twice as likely to have poor blood sugar control than those with Type 2 diabetes.

 

They believe, discussed below, that the diabetes occurs years after injury to the pancreas, the organ that produces insulin.  So a person with Type 3c diabetes will most likely need insulin rather than an oral medication that treats insulin resistance



Study author, Andrew McGovern, writes: …our latest study has revealed that most cases of type 3c diabetes are being wrongly diagnosed as type 2 diabetes. Only 3% of the people in our sample – of more than 2m – were correctly identified as having type 3c diabetes.

 

So if many Type 2 diabetics fail to maintain control with their oral medications that address insulin resistance, they may actually have Type 3c and need insulin instead as low insulin is the cause of their diabetes.  Identifying this early will hopefully prevent some of the complications that occur with long term diabetes.

 

What is diabetes?

 

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

 

Diabetes explained.

 

So I imagine our mouth like a waiting room, the blood stream like a hallway, and the cells of the body the rooms along the hallway.  Insulin is the key to open the cells’ “doors” allowing sugar to enter.  If the sugar does not get in, it stays in the bloodstream “hallway” and doesn’t feed the cell.  

 

Weight loss occurs, and individuals may become more thirsty as the sugar in the blood makes it fairly osmotic, something the body wants to neutralize, reduce. The kidneys are going to want dump the excess sugar, so to do so, one would urinate more, again causing thirst. So when a diabetic loses weight, urinates more frequently and becomes thirsty, you now understand why.

Type I vs. Type II vs. Type IIIc Diabetes.

 

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

 

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

 

Type IIIc diabetes may occur in individuals who suffered damage to their pancreas.  Inflammation/infection of the pancreas (pancreatitis), a pancreatic tumor, or surgery affecting the pancreas may destroy the beta cells that produce insulin.



Complications of Diabetes

 

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



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

 

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

 

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

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

 

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

 

What is insulin resistance?

 

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

Blood sugar numbers

 

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

 

dmp-blood-sugar-levels-chart



SOURCE DIABETESMEALPLANS.COM

Preventing/Controlling Diabetes.

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

 

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

 

For more on the study visit here.

 

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

 

Published in News & Information

A new study out of Pennsylvania State University College of Medicine links textured breast implants to BIA-ALCL, anaplastic large cell lymphoma.

 

Although a rare cancer. researchers believe the lifetime risk is 1 out of every 30,000 women with breast implants and if the numbers are underreported, could be as common as 1 out of every 4000 women with implants.

 

Although the implants are used to augment breast tissue, the malignancy is not a breast cancer but rather a lymphoma.

 

Lymphomas make up the most common of the blood cancers.  The cancer begins in the lymphocytes, cells crucial for maintaining one’s immune system. Two main types of lymphoma are Hodgkin’s and Non Hodgkin's.  Non Hodgkins is more common, and anaplastic large cell lymphoma is a subset if it.

 

 

anaplastic-large-cell-lymphoma-[3-ln072-3].jpg

ANAPLASTIC LARGE CELL LYMPHOMA/PATHPEDIA.COM

In this study, researchers reviewed 115 scientific articles from 1997 – January 2017.  Unlike the report released earlier this year by the FDA, the researchers did not find a link between BIA-ALCL and smooth breast implants.  Of the articles reviewed, 93 cases were cited and the cancer appeared 10 years after the textured implants were placed.

 

According to the American Society of Plastic Surgeons, there are currently 160 cases in the US and a total of 391 worldwide as of September 2017.

 

Last March the FDA reported 9 women had died from anaplastic large cell lymphoma (BIA-ALCL) possibly associated with their breast implant use.  The FDA received 359 reports of BIA-ALCL,  a rare type of non-Hodgkin's lymphoma, 9 of whom died as of February 1, 2017.

This is not the first time a link has been suggested.  6 years ago the World Health Organization suggested a link.  Then in 2011, the FDA identified a possible association between the two.  In 2016, the  Australian Therapeutic Goods Administration reported 46 confirmed cases with 3 deaths relating to breast implants.

 

The report last spring suggested that BIA-ALCL affected both smooth and textured implants. According to the FDA report, 231 of the 359 cancer cases provided information on implant type.   203 were reported to be textured implants and 28 reported to be smooth implants. When it came to silicone vs. saline implants, the FDA said 312 of the 359 reports provided these specifics and of those 186 reported implants filled with silicone gel and 126 reported implants filled with saline.

 

TEXTURED.jpg

 

So neither implant type appeared immune to the risk of BIA-ALCL but it appears the silicone, textured implants carried the most risk.

 

Now the cancer occurred within the breast and the FDA advises physicians to consider the possibility of BIA-ALCL if there appears to be a seroma (fluid filled cavity around the implant) or a contracture (pulling of the skin and tissue) near the implant.

 

In most cases the cancer is treatable, with removal of the implant and the surrounding tissue curative.  In some cases however, radiation of the area or chemotherapy is required.

 

Although 50,000 cases of non-Hodgkin’s lymphoma occurs annually in the US, it is unknown how many cases of BIA-ALCL occur each year.  Moreover, many countries may not have avid reporting systems of breast implant related cancers as we do.  According to the American College of Plastic Surgeons, close to 300,000 women receive breast implants each year, some of which for breast reconstruction after mastectomy for breast cancer.

 

The FDA reminds us that BIA-ALCL is rare and prophylactic breast implant removal is NOT recommended. However we need to be aware and evaluate if one develops swelling, pain, new lumps or asymmetry in the breasts….just as we do for those without implants.

For more on the study, visit here.

 

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

Published in News & Information

On Sunday, Green Bay Packers Quarterback Aaron Rodgers suffered a collarbone fracture and may be out for the season.  Here are your questions answered.

What exactly is a collarbone?

 

The collarbone is another name for the clavicle.  It’s the bone that connects the scapula (shoulder-blade) to the sternum (breastbone).  We have one on each side and it runs horizontally providing shoulder girdle support.  Not only does it provide upper skeletal strength and support but it also protects many major vessels that run underneath it.

 

 

clavicle

Image from AAOS

What’s a collarbone fracture?

 

The clavicle (collarbone) is one of the most common types of bones to fracture during sports injuries.  There are three major Groups or Types of clavicle fractures.

 

Type I – is the most common and occurs in the middle third of the clavicle

 

Type II – is the second most common and occurs distally, or closer to the shoulder.

 

Type III – is the most rare and occurs the most medially, or closer to the rib cage/sternum.

clavicle fractures

 

What are the signs/symptoms of a clavicle fracture?

 

Before bruising and swelling ensue, one will have sharp pain in the area of the collarbone and have difficulty moving his shoulder.

 

So signs of a clavicle fracture include:

 

  • Pain

  • Loss of range of motion of the shoulder

  • A bulge at the fracture site

  • Swelling

  • Bruising

  • Tenderness at the fracture area

  • In young children, not wanting to move the arm on the affected side

 

How are collarbone fractures treated?

 

If the bone has not shifted too significantly, clavicle fractures can be treated non- surgically. Arm slings will be given to decrease the movement of the shoulder girdle.  Pain medication and antiinflammatories may be prescribed, and physical therapy will be instituted immediately to improve range of motion and strength.

 

If the clavicle is displaced significantly from the injury then surgery will be needed to reunite the ends using plates, rods and screws.

 

How long does it take collarbone fractures to heal?

 

In adults, healing could take anywhere from 6-12 weeks.  For children, clavicle fractures may heal sooner.

How does one prevent a collarbone fracture?

 

During sports, protective equipment is key to avoiding injuries from falls and tackles.  As in Aaron Rodger’s and Tony Romo’s cases, being sacked by another large player barreling towards them must be avoided at all costs.

 

Just say NO to sugar.  This will be a hard one for me but if you do it, I will.

 

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

Published in News & Information
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