Tis the season!! Unfortunately not for our hearts. A study back in 2004 found a 5% increase in heart attacks during the Christmas season. Then last year, a study published in the British Medical Journal found Christmas Eve to be especially risky for those who are prone to heart disease. Let’s dissect why….
The cold has long been associated with heart stress. Cold weather causes blood vessel constriction and this adds extra work for the heart. Moreover, it causes less oxygen to reach vital organs, including the heart.
Snow shoveling has been infamous for inciting heart attacks for this same reason. The heart demands extra blood due to the increase in activity and the cold restricts blood flow.
Alcohol, especially in excessive amounts, can put stress on the heart by increasing blood pressure, worsening diabetes, and causing abnormal heart rhythms. Moreover, it interferes with the metabolism of medications, hence many of these may not work at their best. Which brings us to…..
Medical providers take vacation too. And if a patient forgets to refill his medication he may go without during the two weeks of holiday season. Moreover many forget to pack everything they need for a Holiday trip and without anticipating delays, one could be without crucial medication dosing. The heart does not like this.
Holiday travel is never easy. Delays, long lines, the cold, traffic and then…..family. We may love our family but prefer seeing them in small doses. All the family at once can be a little overwhelming for some. As for coping with the in-laws…..well a guide is available for you all here.
Firstly, we must know our risk factors. These include:
and even short stature has been cited as a potential risk factor.
As you can see, many of us can be at risk for heart disease. Therefore, secondly, we should be evaluated with an EKG, echocardiogram and any other exams our medical provider and/or cardiologist deem necessary.
Thirdly, reduce your risk by the following:
Plan ahead by doing the following:
Holiday time should be a happy time. Let’s make it a healthy one!!!
Two new cases of “smartphone blindness” has been described in the last month. One case was a gentleman in China who was playing games on his phone at night and suffered a retinal artery occlusion or “eye stroke.” Another case was a woman in China, who was also playing on her phone at night but she sustained a bleed in her left eye. Just as those who suffer from cerebral strokes, a “lack of blood flow” to the retina, or layer of the eye that helps create visual images, can be caused by a clot or hemorrhage. Apparently these can be induced with excessive focusing and eye strain. This may result in temporary or permanent blindness.
Some people are being evaluated for stroke or transient ischemic attacks when they come to the ER complaining of recurrent “temporary blindness” after checking their smartphone in the dark. This phenomenon, known as ‘smartphone blindness’, has been experienced by many of us when we have the sensation of dimmed vision or poor visual acuity, feeling punished for peeking at our email when we should be sleeping.
In 2016, doctors reviewed the cases of two women who experienced episodes of “temporary blindness”; as the ladies put their cell phones down, one eye could not see the cell phone for 15 minutes. Their vision restored after this length of time.Doctors investigated the cases thoroughly with a variety of medical tests including MRI’s and couldn’t find the cause.
Finally they conclude these transient episodes of “vision loss” were harmless, in that one eye was being used to look at the phone and the other eye needed time to “catch up”. When the women, as many of us do, check our phones, one eye is snugly closed and resting on a pillow while the other is available to look at the phone. When the ladies would turn over, the closed eye didn’t have a chance to catch up to the increased brightness of the phone screen, hence having a dimmed view.
If one uses both eyes to look at the screen, this phenomenon does not happen.
Studies surfaced a few years ago where great lengths of smartphone use can cause retinal detachment. In these cases the layer of the retina which focuses images, detaches from the back of the eye, causing serious vision loss. Though there are treatments, if not treated early can cause permanent blindness in the affected eye since the retina loses its blood and oxygen supply when detached. A woman from China had been using her smartphone for 2-3 hours in the dark each night when this occurs.
Smartphones have also been linked to myopia, nearsightedness and sleeping disorders as the blue light emitted from the screen can disrupt melatonin production.
A recent study found that 30% of adults spend more than 9 hours a day using their smartphone. Physicians recommend avoiding extended use, adjust settings to black text on white background, and with this recent case study, use both eyes to look at the screen when using the phone at night.
Increasing the size of the font helps your eyes since they don’t need to strain as much to read. Try to look at your smartphone with a distance of 1 1/2 feet. Blinking often helps rest the eyes as well and keeps them lubricated and moist.
Additionally, avoid using the phone in the dark, but in a lit room.
Finally its good to use the 20,20,20 rule. After every 20 minutes of use, look away at something 20 feet away for 20 seconds. This may help avoid eye strain from excessive smartphone use.
Stock photos of “healthcare workers” who attend patients—physicians are no longer distinguishable—usually feature a stethoscope draped around the neck.
But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”
The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence, and the rubber tubes by sophisticated electronic gizmos costing at least ten times as much as the humble stethoscope.
High tech is wonderful and increasingly capable, but if the stethoscope is dying, so is the art of clinical medicine.
The proper use of the stethoscope requires the doctor to touch, listen to the patient, and spend some time with a living person, not a computer. Patient and physician must cooperate: “Stop breathing,” “Take a big deep breath,” “Lean forward,” and so on.
It may be true, as Dr. James Thomas said, that graduates in internal medicine and emergency medicine miss as many as half of murmurs using a stethoscope. There are several reasons for this. One is not taking enough time to listen in a quiet room, and failing to perform the special maneuvers required to bring out an otherwise inaudible murmur (lean forward and exhale fully, turn onto your left side, squat then stand up, etc.).
The other is inadequate training. There are excellent recordings of heart sounds and murmurs, which of course would take time away from the time-devouring electronic medical record or “systems-based” medicine. And a recording is not the same thing as a live patient. Much of today’s teaching in physical diagnosis may be by “patient instructors”—paid actors pretending to be patients, who are evaluating the students as the students examine them. Rounds may be in a conference room, focused on the electronic record, instead of at the bedside.
In the old days, all the members of the team got to examine a real patient who had an interesting finding, with the patient’s permission and under the supervision of an attending physician. It seemed to me that patients usually enjoyed being the center of attention and the star of the show, and hearing the professor discuss their case. We learned how to help patients to sit up, and about hairy chests, layers of extra insulation, noisy lung sounds, shortness of breath, and other impediments to an easy examination.
The stethoscope is not just for heart murmurs. It’s for finding subtleties in careful, slow measurement of the blood pressure. It’s for extra or abnormal heart sounds. One can sometimes hear evidence of vascular problems inside the skull, or in the arteries supplying the brain, kidneys, or limbs. Or signs of intestinal obstruction. One can check to make sure a breathing tube is in the right place.
I don’t know of any bedside technologic wonders for examining the lungs. The stethoscope can detect sensitive signs of heart failure, pneumonia, fluid in the chest, collapsed lung, or airway obstruction. One can listen frequently to monitor changes in the patient’s status—much more efficiently than bringing the portable x-ray machine around.
The stethoscope works even when the power is off, the batteries are dead, the computer is down, or some circuit in the ultrasound device is malfunctioning. It works in facilities too poor to have the latest technology, or with patients who can’t afford to pay for a more expensive examination.
The stethoscope has tremendous capabilities in trained hands. Patients might want to evaluate whether they have a clinician who knows how to use it or is just carrying around a prop or status symbol. If you have symptoms suggestive of a heart or lung problem, does the doctor listen to all the lung fields—upper, mid, and lower, front and back? To at least four places for heart sounds? Are you asked to cough, say “e,” whisper something, take deep breaths or slow quiet ones, or do other maneuvers if something in the history or examination suggests a possible problem? Is the tv off, and are visitors asked to be quiet?
Everybody including doctors loves fancy technology. But before we toss out the old reliable tools, backed by two centuries of experience, how about some serious comparative studies like those the proponents of evidence-based medicine constantly demand?
Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views are her own. This is an edited version of her column that originally appeared in pennypress.com. Reprinted with permission.
As August approaches, the CDC is asking health care professionals to be on the lookout and report any suspected cases of AFM (Acute Flaccid Myelitis), a paralyzing illness resembling polio, as cases may peak during this time.
Last year a total of 233 cases were confirmed in 41 states. This year 11 have been reported and an additional 57 cases are being investigated. Cases have been reported in California, Maryland, Nebraska, North Carolina, Pennsylvania, Texas, Utah and West Virginia this year.
IMAGE ABOVE FROM CDC
Last year, California, Colorado and Texas appeared to be the worst hit with 15, 16 and 31 cases respectively. Experts are urging states to report any cases of suspected AFM as the above map could be an under-representation of true numbers.
On their website, the CDC reports the following:
The “48 states” refers to cases since 2014. 90% of the cases occurred in children under the age of 4.
The age range of children affected appear to be 3-14. A 6-year-old boy in Washington State died in 2016 and was the first death to be linked to this mysterious illness. His parents reported he had felt ill, became dizzy and within hours suffered swelling in the brain and paralysis. Despite medical efforts, he passed.
In 2018 parents of two children who died from AFM accused the CDC of hiding their deaths.
Although the exact cause of AFM is unknown, health experts are considering a variety of possibilities. They have actually been investigating this since 2014 when reports of AFM began to surface across the United States.
AFM stands for Acute Flaccid Myelitis. It’s a condition that occurs suddenly, causing inflammation of the brain and spinal cord, causing loss of muscle tone and reflexes. Although limb weakness is the primary symptom, patients could also exhibit slurred speech, facial drooping, and in serious cases inability to breath due to paralysis of the respiratory muscles. Mild cases appear to resolve but serious cases can cause residual paralysis or death. Children appear to be more affected than adults.
Although health officials do not know for certain, due to its rapid onset, a pathogen such as a virus seems highly likely. With the 2013-2014 outbreak, some of the cases tested positive for enterovirus (EV-D68), but it is not conclusive whether this was the exact cause or just coincidentally found in the patients tested.
Some postulate a combination of viruses may be a factor or an autoimmune disease. Although Guillain-Barre syndrome causes acute limb weakness and paralysis when the immune system begins attacking the nervous system, the report that many individuals feel feverish or ill prior, seem to point to a pathogen as the primary cause although the latter is not being ruled out. Virus families such as enterovirus (including polio and nonpolio enterovirus), adenovirus (causing respiratory and GI illness) cocksackieviruses and flaviviruses (including West Nile) have been suspected.
Per the CDC, acute flaccid myelitis is rare (less than 1 in a million cases) however currently they report 570 cases have been confirmed since the outbreak began in August 2014.
Medical professionals look at a variety of factors.
Medical professionals look at a variety of factors.
History: how the paralysis/loss of muscle tone began and which limbs did it affect first
Laboratory tests and CSF (cerebrospinal fluid) testing: to look for signs of infection
MRI of the brain: which may show gray matter involvement in a case of AFM.
There is no standard treatment that has been proven effective, however depending on the severity of the symptoms, health professionals can consider a variety of options including steroids, IVIG, interferon, antivirals and supportive measures. Some physicians are using “nerve transfers”, similar to a transplant, to help children regain control of their limbs.
No. Until they can identify the exact cause, or causes, health officials cannot create a vaccine.
If we assume it’s a pathogen causing the illness, avoiding contact with sick individuals, being up-to-date on one’s vaccines and good hand-washing are imperative. Although we do not know if AFM is caused by a mosquito-born illness, avoiding mosquitoes would be wise as well. More therefore needs to be researched to determine why and how those individuals with AFM were infected.
One of the leading causes of death in hospitalized patients is much more complex than once thought.
Septicemia is an infection that enters one’s blood stream. This can result in Sepsis, a life threatening condition that occurs in response to the blood infection. Its definition has been fluid over the years as more research reveals it’s a disease process.
IMAGE FROM TRISTATEHOSPITAL.ORG
Now researchers in a study published in JAMA describe 4 separate subtypes of Sepsis. These include:
α phenotype had fewer abnormal laboratory values and less organ dysfunction;
those with the β phenotype were older, had greater chronic illness, and were more likely to present with renal dysfunction;
those with the γ phenotype were more likely to have elevated measures of inflammation (eg, white blood cell count, premature neutrophil count [bands], erythrocyte sedimentation rate, or C-reactive protein), lower albumin level, and higher temperature; and those with the δ phenotype had elevated serum lactate levels, elevated levels of transaminases, and hypotension
Dr. Christopher Seymour of the University of Pittsburgh School of Medicine, states in Medical Express, “Right now, our treatment approach to sepsis is basically ‘one size fits all,’ whether you are a 40-year-old with influenza complicated by [a] staff infection or an 80-year-old with multiple comorbidities and biliary sepsis,” he said, adding that international sepsis practice guidelines recommend the same bundle of care for everyone.”
Current goals in medicine aim to treat the patient rather than the disease, and as we need to individualize treatment for those with high blood pressure, cancer and diabetes, we need to as well with acute, deadly diseases such as sepsis.
The Trump Administration has vowed to put an end to “surprise medical bills.” But this may be easier said than done.
Reports of “sticker shock” have exponentially grown over the years and consumers want transparency of what their health care visit is going to cost. However, the average physician, nurse practitioner, physician assistant, hospital, medical center, etc. don’t know themselves until the insurance company sends an EOB “Explanation of Benefits” delineating what is discounted, what is covered, and what is the patient responsibility.
So to start, President Trump is asking Congress to address those charges incurred by “out of network” facilities to which patients go to in an emergency setting. Wanting to hold “insurance companies and hospitals accountable,” President Trump wants to put an end to patients getting charged for “services they did not know anything about, and sometimes services they did not have any information on.”
Can he do it? Politicians on both sides of the aisle want to help curb health care costs, but both sides want to get the credit. There’s race to see who could do more for healthcare before the 2020 election.
There’s a few reasons why cost transparency in an emergency medical setting is challenging.
Firstly, insurance companies aren’t transparent to hospitals. They only inform the medical facility of the out of pocket costs once they take weeks to review the claim. This can be streamlined and cut down in time with software, but same day pricing by an insurance company is impeded by the need to see if the patient paid (or will pay) their premiums that month, or if they are still employed and have the same active insurance.
Secondly, patients don’t always know what their diagnosis is when they walk up to the front counter. Some may think they have a “cold,” but actually end up having a bout of pneumonia. Some may think they have a “stomach bug,” but after CT confirmation, learn they have appendicitis. Hence until the medical provider performs the evaluation and testing, a diagnosis and then “cost to treat”, cannot be given.
Finally, patients may not prefer the “cost factor” added into their facilities’ decision making. If they pay a certain amount for a visit and end up needing more pain control, a repeat breathing treatment, or some extra bandages, they may not want to have to take out their wallet, sort of speak, each time they need more services.
As a physician who, for years, pleaded with insurance companies to give us an idea of what they would want a patient to pay, I’m for any campaign to increase price transparency and offer patient’s more choice. However, since medicine and health can be unpredictable, coming up with predictable “costs” may prove difficult.
Those who have had their appendix removed may be at 3X greater risk of later developing Parkinson’s.
Researchers at Case Western Reserve University and University Hospitals Cleveland Medical Center looked at 62 million health records from 26 institutions throughout the US and found that those who had an appendectomy, surgical removal of the appendix, had a 3-fold risk of developing Parkinson’s later in life.
Internal medicine second year resident and study author, Dr. Mohammed Z. Sheriff, states,
Researchers suggest more research to be done, with investigational focus on gut health as it relates to neurological health.
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.
It was first described in 1817 by James Parkinson as a “shaking palsy.”
Common symptoms of Parkinson’s include:
and patients may later develop…
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 increase risk of Parkinson’s as well.
Average progression rates can last years to decades, however, earlier onset disease may manifest much quicker.
Although there is no cure for Parkinson’s, symptoms can be treated by a variety of measures.
36 lots of losartan potassium and losartan potassium/hydrochlorothiazide have been initiated by Torrent Ltd Pharmaceuticals due to a detection of N-Nitroso-N-methyl-4-aminobutyric acid (NMBA). NMBA, according to Toronto Research Chemicals, is a known carcinogen in a wide range of animal species. There have been no reports of users becoming ill and the recall is being done out of precaution.
N-Nitroso-N-methyl-4-aminobutyric acid (NMBA) was the third chemical detected resulting in the latest two recalls of losartan, an angiotensin receptor blocker commonly used to treat hypertension (high blood pressure). It is believed to have been created during the manufacturing process of the generic drug.
The FDA reports:
Earlier this Fall, ScieGen Pharmaceuticals, Inc. recalled certain lots of irbesartan, a similar angiotensin receptor blocker used in blood pressure management.
The recalls initially began last summer when FDA recalled a number of lots of valsartan due to an “impurity,” N-nitrosodimethylamine (NDMA) that is known to cause cancer in animals. Weeks later they additionally found traces of N-nitrosodiethylamine (NDEA).
According to Reuters, earlier last summer, the MHRA, Medicines and Healthcare Products Regulatory Agency, located in the UK, said the appearance of the impurity, NDMA, came after a change in the process for making valsartan at one facility owned by Zhejiang Huahai Pharmaceuticals, a company in Linhai, China.
In animals, NDMA is known to cause liver and lung cancer. In humans its carcinogenic risk is unknown, however the CDC states it may cause liver function impairment and cirrhosis.
With NDEA, data is limited, but due to its classification as a nitrosamine and its prevalence in tobacco smoke it is classified as a probable human carcinogen.
According to New Jersey Department of Health’s website, NDEA has been linked to liver, lung and gastrointestinal tract cancer in animals.
Losartan, valsartan and irbesartan are medications in the class of angiotensin receptor blockers (ARBs) used for high blood pressure and congestive heart failure.
Those taking either tablet for their blood pressure are urged to not abruptly stop their medication but rather check with their medical provider and pharmacy to see if their particular prescription is involved in the recall.
I suspect more recalls will follow as processes may be similar across multiple pharmaceutical facilities and NMBA, NDMA and NDEA are byproducts that may not be individually unique to just one “brand” of medication manufacturing.
A synthetic alcohol, named Alcarelle, or “Alcosynth,” has been shown to give one the same effects of alcohol without the nasty hangover the next day.
Dr. Professor Nutt, apparently has been working on this for decades, as a PhD student since the early 1980’s. The synthetic alcohol is slated to hit the market in 5 years.
He told the Guardian:
We know where in the brain alcohol has its ‘good’ effects and ‘bad’ effects, and what particular receptors mediate that – Gaba, glutamate and other ones, such as serotonin and dopamine.
“The effects of alcohol are complicated but … you can target the parts of the brain you want to target.”
Alcohol stimulates GABA, a neurotransmitter that can reduce activity of nerve cells making one sluggish. Alcohol also inhibits glutamate which is an excitatory neurotransmitter. But the euphoric feeling one gets may be caused by alcohol’s stimulation of dopamine.
Hence if a drink that acts as ethanol, isn’t actually alcohol, side effects such as drowsiness, stomach upset and liver disease could potentially be bypassed.
Professor Nutt has not revealed the ingredients of his concoction but some resources cite it may be a benzodiazepine derivative, although last year he denied the rumors of using the Valium-like chemicals.
It’s a constellation of symptoms that occur post-partying…..and include headache, muscle ache, nausea, anxiety, moodiness, wanting to avoid light and loud sounds, eye redness, thirst and dizziness, though some hangovers may have many more symptoms.
They could be caused by a variety of factors:
Other theories suggesting lactic acid build up, withdrawal from drinking the night before, and congeners that are compounds that vary in alcohol types (red wine vs vodka).
So how can you cure your hangover?
Hydrate people, hydrate. Alcohol is a diuretic, which means it makes you urinate more and lose valuable fluid and salts. Water is the easiest, most tolerable, cheapest way to hydrate. Take it slow so you don’t vomit. And not scotch and water. Just water….
An empty stomach is an irritable one. While most sources say eat a “greasy breakfast,” I would recommend balanced breakfast with protein. Give the stomach acid something to chew on but make it easily digestible. Remember the alcohol irritated your gut so you need to go easy on it. Baby steps, but healthy baby steps
Take a short, brisk walk. The adrenaline gets the blood pumping and can help with the headache. The cool air outside will feel good when you inhale and some endorphins will release. This may help with your headache.
Chinese researchers back in 2013 found Sprite to be the best hangover cure and even though we don’t have many other studies to back it up, the sweet and bubbly it provides makes your head and tummy feel better.
Sports Drinks add the salts you lost from alcohol’s diuretic features. Though many of us don’t like the taste, those who do find it a nice way to hydrate.
Originally it was a treatment to ward off rabies. One would, after being bit by a dog, put a piece of dog hair on the wound. A treating fire-with-fire strategy. It later was used for hangovers. Treating a hangover with a chaser of alcohol was supposed to elevate moods and lessen the withdrawal. To date there is not enough scientific support to recommend hair of the dog.
Want to avoid a hangover? Here’s how:
Firstly, try to avoid getting drunk. Set your limits and stick to it.
Secondly, drink plenty of water throughout the night and once you get home.
Finally, don’t drink on an empty stomach to “speed up the buzz.” Your empty gut will absorb alcohol quicker so eat a good nutritious meal prior to partying.
Avoid popping anti-inflammatories or Tylenol once you get home because your stomach and liver are already irritated from the alcohol and this may make matters worse. But if any of the above “cures” don’t help, you may need to use these as a last resort.
The 78 year-old iconic game show host has revealed last week that he has Stage 4 pancreatic cancer, vowing to “fight this” deadly malignancy.
However, in an interview with Business Insider, he admitted to having a Milky Way and diet soda for breakfast every day, “A Diet Coke or a Diet Pepsi or a Diet Dr. Pepper,” especially on taping days.
A Stage 4 is given to cancer that has spread to other parts of the body.
Each year over 55,000 Americans are diagnosed with pancreatic cancer, whose 5-year survival rate is 5%. Older individuals who are healthy can do as well as those who are younger when diagnosed with advanced stage of the disease. However some sources cite the median survival time is between 2 and 6 months if the cancer is diagnosed at a late stage.
Known risk factors for pancreatic cancer include:
Artificial sweeteners have been linked to diabetes and diabetes is a risk factor for pancreatic cancer. Their relationship to pancreatic cancer, however, still remains controversial.