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.
Mexican researchers had a major breakthrough in treating HPV (Human Papillomavirus), the most common sexually transmitted disease. In fact, the CDC states that almost 80 million Americans are infected with HPV with approximately 14 million people becoming newly infected per year. Those are just the numbers in the U.S. alone.
What exactly is HPV?
HPV is a group of more than 150 related viruses, named for the warts (papillomas) some HPV types can cause. Some other HPV types can lead to cancer. According to the CDC website:
“In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer.
Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.
HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer). Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.”
According to, El Universal, a popular Mexican newsite, a research team at Mexico’s National Polytechnic Institute led by Eva Ramon Gallegos, was able to eliminate HPV in dozens of patients using a non-invasive photodynamic therapy. Which makes us all ask, what is photodynamic therapy? Well, according to cancer.gov:
“Photodynamic therapy (PDT) is a treatment that uses a drug, called a photosensitizer or photosensitizing agent, and a particular type of light. When photosensitizers are exposed to a specific wavelength of light, they produce a form of oxygen that kills nearby cells.”
Sounds like science fiction to me but whatever works! Anyway, according to Ramon’s study, the team was able to eliminate HPV in 100 percent of patients that had no premalignant lesions and in 64.3 percent of subjects with lesions.
Now, I know that viral headlines all across the internet screamed the HPV has been cured but, um - not so fast. There are over 100 different kinds of HPV. Some cause health problems, some do not. Some, but not many, cause cancer. One of the reasons cancer is so hard to cure is because each type of cancer will require a completely different cure. Something that cures cervical cancer, for example, will probably not cure breast cancer. And something that cures type 6,11,16 and 18 (most of the problematic HPV types) types of HPV might not work on other types of HPV.
As pointed out by Liz Highleyman, the editor in chief at www.cancerhealth.com in her A Cure for HPV, not so fast…, there are too many forms of HPV to claim they have all been cured. Highleyman notes the Mexican research only focused on two types of HPV. So, while the research is good news, it’s not exactly a full cure. From her article:
“It’s not clear how photodynamic treatment might eliminate HPV infection, which would seem to require some type of antiviral therapy. But there’s clearly something going on.
Despite the unanswered questions raised by the recent reports, the findings from the Mexican study are good news for people with HPV-associated dysplasia. Photodynamic therapy is well tolerated and noninvasive. Using PDT instead of surgery to remove precancerous tissue could help preserve function in people with anal lesions and the ability to carry a pregnancy in women with cervical lesions.
The news also presents an opportunity to promote HPV vaccination. The new Gardasil 9 vaccine protects against several of the most common cancer-causing HPV types (16, 18, 31, 33, 45, 52 and 58) and two wart-causing types (6 and 11). It is recommended for girls and boys around age 11 or 12, before they become sexually active. However, the FDA recently approved the vaccine for women and men up to age 45, meaning people who were not vaccinated as teens or young adults may still be able to benefit.”
Okay. So perhaps “cures HPV” is too strong a statement. But things seem to be heading in the right direction!
Multiple states are bracing for “early” allergy seasons.
We still have a month left of winter yet grass is sprouting, leaves are growing and flowers are blooming. Add just having a wetter winter and warmer-than-normal temperatures to the mix and this is the perfect recipe for an early allergy season.
Allergy season usually begins with the start of Spring in March. Yet many may start their symptoms as early as February if they are allergic to what’s blooming.
Tree pollens start first in January and then taper off in April. Grass pollen starts to rise in February and March. Finally weed pollens join the party by the Spring and extend through the Summer and Fall.
Here are your questions answered:
Allergies are the result of the immune response to a foreign particulate that our body senses. One could be allergic to pollen, dust, dander, food, insects, mold, metals, transfused blood, grafts, medicine and anything the body senses as a foreign intruder. Even though these may be individually harmless, a hypersensitivity reaction occurs as a result of their intrusion into the body. IgE antibodies find the allergen (intruder) and activate mast cells in the tissue and basophils in the blood. When these cells get activated, they release substances to help protect the body, including histamines, leukotrienes, and cytokines. These help the body attempt to sneeze and cough the allergen out, wall off the antigen, signal more antibodies, or produce tears and nasal secretions to flush it out.
Symptoms of allergies could include any or a combination of the following:
Colds may have very similar symptoms to allergies. However they are different.
The common cold is caused by a virus. When one gets infected by the virus they may feel malaise, fever, and achy. This does not occur with allergies.
Moreover, nasal secretions from allergies are usually clear. In a cold, the mucous could be thicker and with color.
The same holds true with sputum. During an allergy the cough may have little to no mucous and if so, be light-colored. Thick mucus could be a sign of an infection.
An allergic sore throat will seem more dry and scratchy. A sore throat from a cold is more uncomfortable and less easy to soothe.
Allergies may persist or be cyclical. Cold symptoms will usually subside after a few days and rarely persist longer than 10 days.
Yes and no. Allergies should not in and of themselves cause an infection. However they may make one more vulnerable for a virus or bacteria to take over. Hence a bronchitis, sinus infection, or pneumonia could uncommonly follow an asthma attack.
As stated previously, if one is susceptible to colds, an allergic attack could make them vulnerable. Moreover if one suffers from asthma, an allergy attack could incite an asthma attack. Very rarely would we see a life threatening anaphylaxis to an allergen such as pollen.
Avoiding, or decreasing exposure to the allergen is key. We suggest the following:
Local tree, ragweed and grass pollen counts can be obtained here.
In the last 6 months, three cats in Wyoming have tested positive for the plague.
Currently there are no known humans affected, however, under 10 human cases on average occur each year in the United States.
The type of plague the cats tested positive for was bubonic. So here’s the breakdown.
The plague as we know it is most commonly caused by a bacteria called, Yersinia pestis.
The victim usually acquires the plague from being bit by a flea who fed on infected animals such as rodents, or by contact with one who has the plague. Cat scratches from domesticated cats who are infected have been documented as a form of transmission.
Direct contact with infected bodily fluids could spread the plague as well. Pneumonic plague can be spread through a cough or sneeze.
There are three types of plague:
Bubonic – the most common, at first affects the lymph nodes, but may spread to throughout the body
Pneumonic – infects the lungs and may be spread from person to person by respiratory droplet.
Septicemic – infects the blood stream and can be the result of untreated bubonic and pneumonic plague
For all three types of the plague one can have:
But with bubonic plague, one may have large “bubos” or swollen glands in the neck, underarm, or pelvic/groin region.
With pneumonic plague, one may additionally have cough, shortness of breath and blood in their sputum.
Due to the disease spreading quickly, in some cases causing death within 24 hours, antibiotics need to be instituted immediately.
Moreover supportive measures such as IV fluids and oxygen may be needed as well depending on the severity of symptoms.
Flea control is paramount. So insect repellent for humans, and flea control products will help limit bites from the infected insects.
Moreover avoid rodents and clean out areas in and around your house to avoid them from scurrying around.
Let’s face it… Pap Smears aren’t fun. The only test to sample tissue for cervical cancer just happens to be one of the most embarrassing and awkward but it can be one of the most life saving and simple. So what is it and how does it work? Here’s your questions answered.
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 13,000 and kills 4,100 women each year, rising each year. It can affect women of any age but is more common between 20 and 50.
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 it's 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.
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.
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.
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.
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.
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.
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.