A recent analysis from Kaiser Family Foundation found the average younger American does not have a primary care provider (PCP).

Looking at survey answers from 1200 participants,  45% of 18 – 29 year-olds admitted to not having a PCP.  28% of those aged 30-49 and 18% of those aged 50-64 said the same. Those over age 65 were the largest group to have a primary care provider.

Those born between 1981-1996, known as the Millennials, may have different attitudes towards health care.  Keep in mind, they just lived through nearly a decade of recession, computer hacks, Obamacare controversies, and societal distrust of pharmaceutical companies.

PCP’s however are the “quarterback” in one’s healthcare, keeping accurate and thorough records on one’s medical history, addressing immediate and chronic issues, and coordinating where their patient needs to go if a specialist is needed.

But Millennials, instead, are preferring urgent cares, retail clinics, emergency rooms, or using telemedicine for their medical needs.

 

n105-2364-urgent-care-walk-in-clinic-neon-sign

 

However if one, unknowingly, suffers from a chronic condition and has various acute issues, they may be misdiagnosed because they are receiving piecemeal care without someone overseeing them and connecting the dots.

Diseases such as cancer, diabetes, heart disease, syphilis, AIDS, neurological disorders and autoimmune illnesses are just a few that may cause intermittent acute episodes before becoming deadly.  Someone needs to take a step back, look at one’s medical history and properly diagnose, or simply put, see the forest from the trees.

So why the hesitation to commit to a primary care provider?

 

  1. Many aren’t sick.  They don’t need to have follow-up or chronic issues managed so find an urgent care or emergency room visit sufficient for their acute issues.
  2. They prefer not to have a record of their “life story.” Privacy is huge in this generation who has grown up with social media and smartphone pictures logging their every move.  They may want their STD to be long forgotten once they leave the clinic.
  3. They prefer knowing the price ahead of time and having “closure” once the visit is complete.  The concept of seeing a medical provider and then receiving a bill 3 months later and then following up on a condition is foreign to many who want to address an issue once and move on.
  4. They may not be at the same job, hence have the same insurance for long.  It’s common for the average Millennial to explore career paths and do not expect to be at one place of employment for “life”. Hence if their job changes, so will their insurance, and therefore the medical provider list offered.
  5. The internet provides medical advice.  Some feel rather than have a doctor visit to learn about a medical condition, it’s cheaper and more convenient to read the medical article oneself.
  6. “The doctor doesn’t spend time with me anyway.” They more often don’t get out of a doctor visit what we used to with time, hand holding, education and patience with all our questions.  Providers are busy these days and offer short office visits.

Our healthcare system is changing and the needs of the younger generation appear to be better met by clinics that charge up front, address a single issue, and provide convenient hours.   Therefore “primary care” providers will still be needed, however, the art of “primary care” may evolve into a whole new beast.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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
%PM, %14 %824 %2018 %18:%Nov

Health risks from wildfire smoke

As the death toll rises and thousands of acres burn between California’s Camp Fire and Woolsey Fire, those residents lucky enough to escape the flames worry what consequences could result in inhaling the smoke.

What is in wildfire smoke?

 

According to the EPA, smoke emanating from forest and community fires may include any of the following:

  • Carbon dioxide, a respiratory byproduct
  • Carbon monoxide, which competes with oxygen in the blood
  • Wood particles
  • Formaldehyde
  • Acrolein – used as a pesticide
  • Benzene
  • Plastics, and those byproducts after incineration
  • and thousands of different respiratory irritants.

According to the EPA,

Smoke is composed primarily of carbon dioxide, water vapor, carbon monoxide, particulate matter, hydrocarbons and other organic chemicals, nitrogen oxides, trace minerals and several thousand other compounds. The actual composition of smoke depends on the fuel type, the temperature of the fire, and the wind conditions. Different types of wood and vegetation are composed of varying amounts of cellulose, lignin, tannins and other polyphenolics, oils, fats, resins, waxes and starches, which produce different compounds when burned.

What symptoms may individuals experience?

 

Some may have no idea they are breathing in harmful compounds that could affect their lungs and heart.  However, many may experience:

  • Wheeze
  • Cough
  • Difficulty Breathing
  • Chest Pain
  • Mucous Production
  • Dizziness/lightheadedness
  • Fatigue
  • Racing Heart (palpitations)
  • Exacerbation of their lung disease including COPD, asthma, chronic bronchitis
  • Exacerbation of heart conditions such as angina, heart attack, and cardiac arrhythmias.
  • Increased susceptibility to new lung infections as well as flu

What are PM2.5s?

 

PM2.5 are particles less than 2.5 micrometers in diameter that are present in pollution and wildfire smoke that can penetrate deeply into the lung linings.  Larger, coarse particles 10 micrometers in diameter are called PM10.  Both impair lung function as they inflame the lungs and interfere with the work of alveoli that need to oxygenate the blood.  Moreover the small particles can use this pathway to enter the bloodstream. Although the direct health impacts of the fine particulate matter is not clearly defined it is believed that increased PM2.5 levels increase the risk of lung and heart disease as discussed above.

lungs_alveoli-57ffa7fe3df78cbc284e162b

LUNGS AND ALVEOLI (IMAGE FROM THOUGHTCO.)

 

Symptoms may begin at levels greater than 55 µg/m3 .

Which individuals are the most at risk?

 

  • Infants and Children
  • Elderly individuals
  • Those with chronic lung disease, including asthma and emphysema
  • Those at risk for heart disease and stroke
  • Those with diabetes
  • Smokers
  • Pregnant women
  • Those with chronic allergies
  • Pets

How can residents protect themselves?

 

Avoiding the area of wildfires is paramount.  Additionally, the following may be considered:

 

  • Avoid outdoors until air quality reports improve.  Do not rely on how “clear” the air looks.
  • Take heed of wind and air quality advisories.
  • Recirculate the air in your home and car.
  • Keep windows closed.
  • Consult with your medical provider to monitor blood pressure, heart rhythm, lung function and refill any medications you may need BEFORE you feel symptoms.
  • Be wary of facemasks sold as PM2.5 safe as many do not protect against the very small particles. Respirator masks labelled N95 or N100 may provide SOME protection against particulates but not against the toxic fumes such as formaldehyde and acrolein.

 

Editor's note: As a companion read you might also be interested in a story we published in Sept. last year: 5 apps to help you recover from hurricanes and wildfires.

 

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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 Health
%PM, %09 %898 %2018 %20:%Nov

Can pets smell cancer?

An Oregon woman claims her cat helped her detect her breast cancer, and she’s not the first one to claim how furry friends can save lives.

Michelle Pearson adopted a cat, Mia, a few years back from the Humane Society. The one day she pounced on Pearson’s chest, sniffed her breast and directed her owner’s attention to the breast. Days later Michelle was diagnosed with breast cancer.

She states, “All of a sudden out of nowhere, she just got up on my chest and she sniffed that breast and then looked in my face, sniffed the spot again and looked in my face and I tried to shove her off and she came back up and just laid down on that right breast and she looked at me like ‘I’m trying to tell you something.'”

She feels her rescue cat actually “rescued” her.

 

cat-678x381.jpeg

 

A woman in California cited the same miracle. Nancy Best stated her dog, also named Mia, would not stop licking her breast. She was eventually diagnosed with breast cancer.

Sometimes animals may not always be friendly towards a diseased body part. My in-law’s poodle would shower everyone with licks except for one person who she would excessively bark at. He was soon diagnosed with brain cancer.

So, can dogs detect cancer?

 

PBS reports that dogs can smell 40 times better than humans, with over 300 million olfactory receptors in their nose. They can smell parts per trillion, a keen sense that is potentially sharp enough to pick up cancer cells and the smells they produce.

Healthline reports that cancer cells raise polyamine levels which come with an odor.  Moreover if cancer cells incite an immune response, this can expel a scent as well.

In 1989 a case report revealed a woman’s dog tried to bite a mole off her leg which ended up being malignant melanoma.

According to a 2011 study in the journal Gut, Labrador retrievers were able to sniff out colon cancer in 97% of stool samples.

The Italian Ministry of Defense’s Military Veterinary Center was successful in training German Shepherds to recognize prostate cancer proteins in urine to 98% accuracy.

For those of you with a pet pigeon, don’t feel left out. A University of Iowa study found pigeons to be trained to detect breast cancer cells to 85% accuracy.

So despite our animals possessing the power to sense microscopic anomalies, we shouldn’t panic every time they sniff or lick us.  But if they persist on one area of your body, it might be worth getting checked out.

Editor’s note: The folks over at Dogsnaturallymagazine.com also weigh on this topic citing numerous studies and anecdotal evidence all concluding that, yes, it’s very probable that dogs can sniff out ill health. As for cats smelling cancer, well - the research seems to suggest otherwise. Sorry, kitty lovers. =)

 

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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 Health

The FDA has approved a new drug, Xofluza (baloxavir marboxil), to help fight the flu this season.

The antiviral is a single dose and is taken within 48 hours of first signs of flu symptoms.

It is only indicated in those older than 12 years old. The cost is approximately $150 for the single dose.

Current antiviral medications approved by the FDA to shorten the course of the flu include Relenza and Tamiflu. These medications are in a class of neuraminidase inhibitors, which inhibit the release of new viral particles that have replicated in a host (patient).

 

09f1.jpeg

 

Xofluza, however, works sooner, by preventing the virus from replicating within the host cell in the first place.

Therefore this new drug can stop the spread of flu earlier than its predecessors.

NBC News reported the following:

A 2016-2017 STUDY IN 1,436 PEOPLE IN THE U.S. AND JAPAN SHOWED THE ONE-DOSE PILL CUT THE TIME PEOPLE WERE SICK TO 2.5 DAYS, FROM ABOUT 3.3 DAYS. IT CUT HOW LONG PEOPLE HAD A FEVER FROM AN AVERAGE OF 42 HOURS TO JUST ONE DAY. IT ALSO REDUCED WHAT’S CALLED VIRAL SHEDDING FROM FOUR DAYS TO JUST ONE DAY.

 

So the less time one is sick with the flu, the less risk of coming down with a secondary infection such as pneumonia, or other flu related illness.

Moreover if viral shedding is decreased, less family members and contacts can potentially become ill.

Now Xofluza may not prevent the flu in one who has not been exposed because it works by preventing virus that is present from replicating.

Flu symptoms may come abruptly and include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

The most effective way to prevent the flu is avoidance of sick contacts, good hand washing and vaccination.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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 Health
%PM, %17 %737 %2018 %16:%Oct

Viagra should not be vaped

The FDA is warning e-cigarette companies to stop selling vaping products with claims that they contain erectile dysfunction medications.

Consumers are being urged to avoid vaping products claiming to have ingredients such as sildenafil and tadalafil used in Viagra and Cialis respectively as they can interact with other medications (such as nitrates). Moreover there is no data suggesting one’s respiratory lining to be a safe route of absorption of a phosphodiesterase type-5 (PDE-5) inhibitor.

The primary purpose of the lungs is to oxygenate blood and its highly specialized lining is not necessarily designed to absorb nutrients, as does the small intestine.

On the FDA website it states:

THE U.S. FOOD AND DRUG ADMINISTRATION ANNOUNCED TODAY IT HAS ISSUED A WARNING LETTER TO HELLOCIG ELECTRONIC TECHNOLOGY CO. LTD FOR VARIOUS VIOLATIONS OF THE FEDERAL FOOD, DRUG, AND COSMETIC ACT, INCLUDING SELLING TWO E-LIQUIDS THAT CONTAIN THE PRESCRIPTION DRUGS TADALAFIL AND/OR SILDENAFIL, LEADING THE FDA TO DETERMINE THAT THE PRODUCTS ARE UNAPPROVED NEW DRUGS.

 

SILDENAFIL AND TADALAFIL ARE THE ACTIVE PHARMACEUTICAL INGREDIENTS IN FDA-APPROVED PRESCRIPTION DRUGS USED TO TREAT ERECTILE DYSFUNCTION. THESE FDA-APPROVED PRESCRIPTION DRUGS ARE NOT APPROVED FOR INCLUSION IN E-LIQUID PRODUCTS SOLD OVER THE COUNTER AND ARE THEREFORE BEING SOLD ILLEGALLY. IN ADDITION, THE COMPANY IS MARKETING OTHER E-LIQUIDS USED IN E-CIGARETTES IN WAYS THAT CONVEY AND MISLEAD CONSUMERS INTO BELIEVING THAT THE FDA HAS APPROVED THESE TOBACCO PRODUCTS, WHEN IT HAS NOT.

 

LABORATORY ANALYSIS CONDUCTED BY THE FDA CONFIRMED “E-CIALIS HELLOCIG E-LIQUID” CONTAINS THE UNDECLARED DRUGS SILDENAFIL AND TADALAFIL, AND “E-RIMONABANT HELLOCIG E-LIQUID” CONTAINS THE UNDECLARED DRUG SILDENAFIL. THESE UNDECLARED INGREDIENTS ARE PHOSPHODIESTERASE TYPE-5 (PDE-5) INHIBITORS. THESE INGREDIENTS CAN BE ASSOCIATED WITH SIGNIFICANT SAFETY ISSUES AND THE RISK OF SERIOUS ADVERSE EVENTS.

FDA Commissioner Dr. Scott Gottlieb states, “There are no e-liquids that contain prescription drugs that have been proven safe or effective through this route of administration.”

Those Needing Erectile Dysfunction Drugs Should Have Their Heart Checked

 

Companies are looking to expand their market by enticing consumers to vape vitamins, such as B12, and essential oils. Last week, however, a professor of nutrition from New York University, Dr. Charles Mueller, warned against it. He states, “Vitamins need to come with [fat and water] and go through the same gastrointestinal tract to be absorbed.” Moreover respiratory administration of nutrition has not been actively studied.

 

Vaping linked to heart disease and cancer

 

A study published by the American Heart Association found nine different E-cig flavors  to impair blood vessel function, which can impair heart health.

Endothelial cells, which delicately line blood and lymph vessels, were found to become inflamed at low concentrations of some vapor flavors.  And at high concentrations of others, exhibited cell death.  Nitric oxide production, necessary for vessel dilation to improve blood flow, was impaired as well. These are often the same changes seen in early heart disease.

 

sample_01001118_110141.jpg

The 9 flavors (and the chemicals within) cited in the report to cause the endothelial inflammation and/or damage were:

 

  • Vanilla (vanillin)
  • Mint (menthol)
  • Clove (eugenol)
  • Cinnamon (cinnamaldehyde)
  • Strawberry (dimethylpyrazine)
  • Banana (isoamyl acetate)
  • Butter (diacetyl)
  • Eucalyptus/spicy cooling (eucalyptol)
  • Burnt flavor (acetylpyridine)

Strawberry flavoring appeared to have the most adverse effect on the cells.

How many other flavors were not included in this study, so it's unknown how safe they may be.

Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.

In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:

  • Formaldehyde (human carcinogen)
  • Acetaldehyde (carcinogen related to alcohol drinking)
  • Acrolein (highly irritating and toxic)
  • Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
  • Metals (possible carcinogens and toxins)

Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.

A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children).  E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).

The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.

More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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 Health

A rare polio-like illness is startling health officials as multiple states have reported cases of AFM (Acute Flaccid Myelitis).

Since August 2014, the CDC has received reports on 362 cases.

This week we learn of 6 children in Minnesota who have been diagnosed with AFM, which may manifest in symptoms such as sudden muscle weakness, stiffness, slurred speech and facial droop.

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.  Although the exact cause 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.

What is AFM?

 

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.

What causes AFM?

 

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 non polio enterovirus), adenovirus (causing respiratory and GI illness) and flaviviruses (including West Nile) have been suspected.

How common is AFM?

 

Per the CDC, acute flaccid myelitis is rare (less than 1 in a million cases) however currently they report 362 people affected in currently 16 states (down from 39 states in 2016).

How is it diagnosed?

 

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.

Is there a treatment?

 

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.

Is there a vaccine?

 

No.  Until they can identify the exact cause, or causes, health officials cannot create a vaccine.

How does one avoid getting AFM?

 

If we assume its 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-borne 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.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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 Health

Breast cancer affects thousands of men and women each year and screening is unfortunately overlooked all too often.

Many women find mammograms painful and embarrassing hence hesitate when urged to get screened.

And some men may not realize they too have breast tissue and are at risk for breast cancer.

mcdc7_gynecomastia-8col.jpg

 

October is Breast Cancer Awareness Month and #ShirtsOff reminds us to examine ourselves, get screened, and look for changes in our breasts.

Signs of breast cancer include

  • A lump inside the breast or under the arm
  • Breast pain
  • Change in breast shape
  • Dimpling
  • Nipple discharge
  • Nipple bleeding
  • Rash
  • Sore on the breast
  • Discoloration
  • Change in skin texture

How common is breast cancer?

 

1 in 8 women will develop invasive breast cancer over the course of their lifetime. According to the American Cancer Society, an estimated 266,120 cases of invasive breast cancer are expected to be diagnosed in women in the US with 63,960 cases of non-invasive breast cancer, a rise from last year.

40,920 women and 480 men are expected to die this year of breast cancer.

 

What are the risk factors for breast cancer?

 

Risk factors for breast cancer include:

  • Age greater than 50
  • Family History
  • BRAC1 and BRAC2 genetic mutations
  • Alcohol use
  • Never been pregnant or becoming pregnant for the first time over 35 years old
  • Early menarche at age 11 or younger
  • Obesity, especially after menopause
  • Dense breasts
  • Lack of physical activity
  • Use of oral contraceptives
  • Previous “precancerous” tumors such as atypical hyperplasia
  • DES exposure
  • Previous radiation therapy

How is breast cancer staged?

 

Breast cancer is staged based on size of the tumor, if lymph nodes are affected and whether the cancer has spread to distant areas of the body.  Prognosis varies greatly on the stage.

 

Screen-Shot-2012-09-27-at-9.59.51-AM.png

IMAGE ABOVE FROM JOHNSTON HEALTH

 

Is family history a huge factor?

 

85% of breast cancer cases occur in women with NO family history.

 

Screening of breast cancer

 

Mammograms are the first line screening tool for breast cancer and are currently recommended biennial for women aged 50-74.  However for those at higher risk, mammogram screening should start earlier, with possible follow-up ultrasound, and be performed more regularly.

 

FullSizeRender (1)

3-D MAMMOGRAM IMAGE

 

3-D Mammograms use some of the most sensitive technology in screening.

Dr. William Boren, owner of West Valley Imaging in Las Vegas, Nevada, states “3-D Mammograms reportedly find up to 40% more cancers, allowing a topographic view of the tissue.”

Dr. Boren also recommends to “not leave big gaps between screening.  If you start screening at age 40, then continue yearly screens.”

 

mammogram 2018.jpg

 

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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 Health
%PM, %28 %787 %2018 %17:%Sep

October is Breast Cancer Awareness Month

Celebrities such as Julia Louise-Dreyfus, Olivia Newton-John, Christina Applegate and Cynthia Nixon have revealed their breast cancer diagnoses, helping raise awareness for the most common cancer to affect women.  It’s the second most common cause of cancer death in females.

How common is breast cancer?

 

1 in 8 women will develop invasive breast cancer over the course of their lifetime. According to the American Cancer Society, an estimated 266,120 cases of invasive breast cancer are expected to be diagnosed in women in the US with 63,960 cases of non-invasive breast cancer, a rise from last year.

40,920 women and 480 men are expected to die this year of breast cancer.

What are the risk factors for breast cancer?

 

Risk factors for breast cancer include:

  • Age greater than 50
  • Family History
  • BRAC1 and BRAC2 genetic mutations
  • Alcohol use
  • Never been pregnant or becoming pregnant for the first time over 35 years old
  • Early menarche at age 11 or younger
  • Obesity, especially after menopause
  • Dense breasts
  • Lack of physical activity
  • Use of oral contraceptives
  • Previous “precancerous” tumors such as atypical hyperplasia
  • DES exposure
  • Previous radiation therapy

How is breast cancer staged?

 

Breast cancer is staged based on size of the tumor, if lymph nodes are affected and whether the cancer has spread to distant areas of the body.  Prognosis varies greatly on the stage.

 

Screen-Shot-2012-09-27-at-9.59.51-AM.png

IMAGE ABOVE FROM JOHNSTON HEALTH

 

Is family history a huge factor?

 

85% of breast cancer cases occur in women with NO family history.

Screening of breast cancer

 

Mammograms are the first line screening tool for breast cancer and are currently recommended biennial for women aged 50-74.  However for those at higher risk, mammogram screening should start earlier, with possible follow-up ultrasound, and be performed more regularly.

 

FullSizeRender (1)

3-D MAMMOGRAM IMAGE

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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 Health

Another warning has been issued to adults and seniors who mix herbal remedies, over the counter supplements and prescription medications.

A study from the University of Hertfordshire in the UK found 44% of women and 22% of men surveyed mixed their prescription medications with herbal remedies and over the counter supplements.

Individuals may have changes in their metabolism and medication breakdown as they age causing variances in body absorption and efficacy of medications.  Adding supplements or herbal remedies could cause unpredictable reactions.

These effects could include:

  • Less efficacy of prescription medication causing poor blood pressure, sugar, heart rhythm control, for example)
  • Enhanced active compounds of medications taken (possibly causing overdose)
  • Nausea
  • Vomiting
  • Body aches
  • Jaundice
  • Blood thinning causing easy bleeding
  • Renal failure
  • Liver failure
  • Anemia
  • Mania and other personality changes
  • and  more

For example, St. John’s Wort could interfere with the effectiveness of one’s birth control and ginseng could worsen one's hypoglycemia if they are taking insulin.

Grapefruit juice could interfere with the metabolism of a statin, a popular medication used to decrease cholesterol. By raising its levels in the blood, one drink could cause a patient to have increased side effects such as muscle cramps and liver issues.

Iron supplements can interfere with one’s absorption of their thyroid medication, and ginkgo biloba, if taken with a blood pressure medication, could cause the blood pressure to drop even lower. Moreover it can increase bleeding if taken with an anticoagulant.

And if alcohol is mixed with any prescription medication, deadly side effects (such as respiratory depression when used with opiates) can ensue.

So the moral is, just because a supplement states is “natural,” or a frequently consumed food appears to be safe, its combination with medication could prove deadly.

Although the interactions are numerous, the AAFP created a table of common ones:

 

Herbal and Dietary Supplement–Drug Interactions

HERBAL OR DIETARY SUPPLEMENT

DRUG

COMMENT

RECOMMENDATION*

Patients taking oral anticoagulants

Cranberry (juice)

Warfarin (Coumadin)

Interaction possible based on seven reports of increased INR, although a clinical study showed no interactions47

Suspect an interaction if INR elevated

Fish oil

Warfarin

Interaction possible, with case reports showing an elevated INR, although a clinical study showed no effect of fish oil on anticoagulation status8,9

Suspect an interaction if INR elevated

Garlic

Warfarin

Interaction unlikely based on a clinical study that found garlic is relatively safe and poses no serious hemorrhagic risk for closely monitored patients taking warfarin oral anticoagulation therapy10

Suspect an interaction if bruising or bleeding occurs despite an appropriate INR

   

One review found no case reports of interactions with garlic and warfarin11

 

Ginkgo

Warfarin

Interaction possible, though controlled clinical studies show no effect of ginkgo on the kinetics or dynamics of warfarin12,13

Experts recommend caution, although available research does not support this conclusion

 

Aspirin

Interaction suspected based on four case reports of spontaneous bleeding14,15

Suspect an interaction if spontaneous bleeding occurs

Ginseng

Warfarin

Interaction possible based on conflicting research findings

Avoid combination if possible

   

American ginseng (Panax quinquefolius)reduces blood concentrations of warfarin16,17

 
   

Coadministration of warfarin with Asian ginseng (Panax ginseng) did not affect the pharmacokinetics or pharmacodynamics of warfarin18

 

St. John’s wort

Warfarin

Interaction suspected based on decreases in INR in case reports and in a study in 12 healthy volunteers18

Evaluate warfarin response when St. John’s wort is initiated or stopped

Vitamin E (> 400 IU daily)

Warfarin

Interaction suspected based on a single patient (with rechallenge), resulting in an increase in INR19

Evaluate warfarin response when vitamin E is used in combination

   

One clinical trial showed no interaction20

 

Patients taking cardiovascular medications

Eleuthero (Eleutherococcus senticosus) [corrected]

Digoxin

Possible increase in digoxin levels without clinical signs (case report)21

Monitor digoxin level when eleuthero is initiated or stopped [corrected]

St. John’s wort

Digoxin

Suspected decrease in digoxin levels without clinical signs in a controlled study22

Monitor digoxin level when St. John’s wort is initiated or stopped

 

Verapamil (Calan)

Interaction suspected based on decreased bioavailability in a study in eight healthy volunteers23

Increase verapamil dose, if necessary, if diminished response occurs

 

Statins

Interaction suspected based on decreased plasma blood levels in a clinical study24

Monitor serum lipid levels after St. John’s wort is added

Patients taking psychiatric medications

Ginkgo

Atypical antidepressant (trazodone [Desyrel])

Interaction possible based on one case report of coma25

Evaluate for emotional and/or behavioral changes in patient response after ginkgo is initiated or stopped

Ginseng

Monoamine oxidase inhibitors

Interaction possible based on two case reports of manic-like symptoms, headache, and tremulousness17

Avoid combination if possible

St. John’s wort

SSRIs

Interaction suspected based on case reports of drowsiness or serotonin syndrome26

Taper off St. John’s wort when initiating an SSRI

 

Benzodiazepines

Interaction suspected based on pharmacokinetic studies showing decreased serum levels (25 to 50 percent) without clinical signs2729

Adjust the dose of benzodiazepine as needed

 

Tricyclic antidepressants

Interaction possible based on decreased amitriptyline plasma levels but no clinical effects in a study of 12 depressed patients27,30

Monitor patient response after St. John’s wort is initiated or stopped

 


 

INR = International Normalized Ratio; SSRI = selective serotonin reuptake inhibitor.

*— All recommendations have a strength of recommendation taxonomy (SORT) evidence rating of C (consensus, disease-oriented evidence, usual practice, expert opinion, or case series). For information about the SORT evidence rating system, see https://www.aafp.org/afpsort.xml.

Information from references 4 through 30.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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 Health

Currently 5.7 million people in the US suffer from the debilitating cause of dementia and the CDC estimates close to 14 million will be affected by the year 2060.

As we’re surviving other illnesses that could take our lives sooner, such as heart disease and cancer, we as a population are living to an age where brain changes can occur.

Alzheimer’s is the 5th leading cause of death and scientists still struggle to find a cure or means to stave it off.

 

top-10-global-causes-of-deaths-2016.jpg

 

The average age of symptom revelation is 65, but researchers believe the disease may set in sooner. Over 200,000 currently suffer from early onset Alzheimer’s, or onset before age 65.

I believe nightly oxygen or CPAP therapy (Continuous Positive Airway Pressure) might be worth researching as its been postulated that lack of oxygenation can accelerate dementia.

 

What is Alzheimer’s?

 

Alzheimer’s, a progressive disease in which the brain loses function, is most commonly associated with memory loss. As abnormal proteins build up in the brain (beta-amyloid and tau), the plaques and neurofibrillary tangles within the nerve cell (neuron), disrupt communication between nerve cells, so memory can easily start to falter. Many people affected with Alzheimer’s lose newer memories first and then progressively lose old ones.

Normal_vs_Alzheimers_Brain.jpg

However, since the brain is such a dynamic and brilliantly complex organ, a disease that alters its tissue could manifest in a variety of symptoms, beyond memory loss.

These can include:

  • Personality changes
  • Difficulty completing once simple tasks
  • Social withdrawal
  • Labile moods
  • Misplacing commonly used objects
  • Lack of appropriate judgement
  • Issues with problem solving
  • Lack of understanding of spatial and timing concepts

Hence if a family member appears to lose his way driving home, has difficulty dressing himself appropriately, avoids family gatherings, appears to get angry for no apparent reason, or even offers a young baby an object for a much older individual, these may be signs of a dementia such as Alzheimer’s.

Although Caucasians comprise the majority of cases overall, the CDC found among those over 65, African-Americans have the highest rate at nearly 14%, and Hispanics at 12%.

In a recent study, researchers from Northwestern University’s Cognitive Neurology and Alzheimer’s Disease Center found four additional symptoms that may be early signs of Alzheimer’s. These include:

  • Difficulty with speech, vocabulary pool, process and articulating what one wants to say (aphasia)
  • Difficulty writing from a motor and conceptual standpoint
  • Difficulty reading, including comprehension
  • Displaying exaggerated confidence

The study authors state these signs may be overlooked and could be very telling of one’s early disease progression.

To diagnose Alzheimer’s, the medical provider may employ a variety of testing measures including basic history and physical, blood tests to rule out thyroid and vitamin deficiencies, lumbar puncture, CT Scans to rule out bleeds, masses, or stroke, MRI Brain scans, neuropsychological tests, and amyloid PET scans.

Although currently a cure for Alzheimer’s does not exist, there are many  medications being researched to slow down the progression of the disease and a variety of environmental and behavioral interventions could allow the patient to navigate easier with their challenges.

Can Daily Ibuprofen Prevent Alzheimer’s?

How to prevent Alzheimer’s remains up for debate, but healthy diet, weight, exercise, and control of one’s blood pressure and blood sugar have been suggested.

The earlier Alzheimer’s is diagnosed, the easier it may be to manage, hence family members need to learn and look out for the above symptoms.

----

 

 

 

Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. 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 Health
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