Antibiotic resistant strains of the sexually transmitted illness, Neisseria gonorrhea, have been on the rise, and the World Health Organization cites oral sex as a culprit.

 

“Super-Gonorrhea” is a term used for a gonorrhea infection that cannot be treated by conventional antibiotic therapy. Drug resistant strains cause infections that cannot be cured, hence increasing its risk of morbidity and spread to other individuals who think their partner is “cured.”

 

Gonorrhea infection may present with green/yellow discharge emanating from the penile urethra or female vagina or it may be asymptomatic. Additionally the bacteria could colonize or infect the rectum, mouth, or disseminate throughout the body, causing arthritis, rash and multiple other maladies. Untreated gonorrhea can also lead to infertility, pelvic inflammatory disease, and increase one’s risk of acquiring HIV.

 

Oral sex allows an easy route of transmission if condoms aren’t used.  According to Dr. Teodora Wi, WHO Medical Officer, “When you use antibiotics to treat infections like a normal sore throat, this mixes with the Neisseria species in your throat and this results in resistance.”

 

Let me explain. Superbugs develop when a bacteria survives an antibiotic treatment that should have killed it. The surviving bacteria, with its “super genes,” makes offspring that has the same “super genes” capable of withstanding the same antibiotic that didn’t kill its parent. The more exposure a bacteria has to antibiotics that it can withstand, the greater the possibility of it developing antibiotic resistance. Antibiotics used to kill throat infections are not always designed to kill off gonorrhea, hence any gonorrhea sitting in the throat after oral sex can produce resistant progeny.

 

Until recently, gonorrhea would be treated with a single dose of ceftriaxone, ciprofloxacin, or azithromycin. Due to a rise in resistance to these individual medications, the current treatment for gonorrhea infection recommended by the CDC is a single dose of 250 mg of intramuscular ceftriaxone AND 1g of oral azithromycin.

 

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

 

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Tips to Prevent Childhood Drowning

The leading cause of death in children are “unintentional injuries” including drownings.  According to the CDC, 20% of drowning victims are under the age of 14.  And non-fatal drowning victims could sustain brain damage and long term disability.

 

Pools, bathtubs and any body of water pose risks, however this time of year is especially dangerous, because activities surrounding pools, such as BBQs and alcohol use, become distractors to the adults supervising.

 

When it comes to drowning prevention, the following is necessary:

All pools should be enclosed

 

Fence height should be at least 4-5 feet high and the entry gate should self-close and self-latch.

Even if your pool has a fence, be aware that the house who’s hosting the BBQ, play date, or sleep-over may not.

 

And any kiddy pools or ice buckets used for drinks should be dumped out after use and flipped over so they do not become a future threat.

All young children should be within arm’s reach of an adult when swimming

 

The farther you are away from the child you’re supervising, the longer it takes to rescue. With distance between you and the victim, other children may swim in your path and you may lose sight of where the victim submerged. And seconds count. A panicked child under water may also aspirate water into the lungs becoming hypoxic quicker.  Moreover they could be at risk of “secondary drowning” in which water in the larynx triggers a spasm closing up the airway, or water falling into the lungs causes pulmonary edema and respiratory failure days after the water incident.

Do not get distracted

 

Put the phones away.  Adults supervising kids in a pool should not be answering a phone call or on social media.  Moreover, adults should not be drinking alcohol while supervising a child. Reaction time is key, and a drunk adult could become a drowning victim as well.

Remember that drowning is silent

 

Many drownings occur while others are feet away from the victim. Why? Because a submerged victim makes little sound and nearby splashing visually and auditorily obscures the victim’s splashes.

Parents have long learned that when children get quiet during playtime, something could be going wrong.  Use that same Spidey-sense when they are in the pool.

 

Learn CPR and water rescue skills

 

Most CPR classes teach adult, child, and infant CPR.  Having this knowledge and becoming certified could save a life one day.

 

If swimming in open waters, know the weather and sea conditions prior to jumping in.  Life jackets/vests, appropriate for the child’s size, should be worn, even if the child is out of the water, such as in a boat.

Have a safe and healthy summer!

 

 

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

 

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Healthcare workers frighteningly face assault all too often, including verbal, sexual and physical, with some of these instances including gun violence.  This may rise as we attempt to combat the opioid addiction epidemic.

 

Las Vegas unfortunately has seen multiple cases, especially when it comes to shootings that involve medical offices.  This week four people were injured when a patient walked in asking for a walk-in appointment at the Center for Wellness & Pain Care. When he was denied, he shot at employees before turning the gun on himself and committing suicide.  All the victims of the shooting are expected to recover.

 

Unfortunately, this is not the first time gun violence has involved medical personnel for suspected pain related issues.

 

In 2003, David Freeman kidnapped his physician, Dr. Sheldon Mike after he refused to call in a pain medication prescription to the pharmacy.  The Freeman took Dr. Mike by car at gunpoint to a drive-through Walgreens. He was stopped by police and Dr. Mike was shot in the shoulder and sustained a neck wound during the incident, but fortunately survived his injuries.

 

In 2006. Dr. Avi Ostrowsky survived a shooting from a long time patient who had “chronic back pain”.

In 2009, Dr. Edna Makabenta was shot and killed by her patient, Eliseo Santos, when she entered his exam room.  It was reported that Santos was suffering pain from prostate cancer although the exact motive was unknown.

 

Industries involving customer service expose staff to hundreds of clients a day putting them at risk for altercations. However, medical staff are even more vulnerable to violence in the workplace for many reasons. Firstly, health care personnel deal with people who aren’t well, whether it's physical, emotional or mental illness. When one is in pain, or possibly suffering an addiction to narcotics, he/she may not be able to control their anger or emotional outbursts.

 

Secondly, clients of the healthcare industry are more often disgruntled and frustrated with the medical system, whether it be wait times, cost, or lack of getting their desired services.

 

Thirdly, medical staff frequently have to say “no”, or deny services to their clients whether it's a medical insurance issue or an “unsubstantiated request” for pain prescriptions.  With the ongoing opioid epidemic, medical offices feel pressured to deny prescription requests, therefore angering more patients.

Medical facilities strive to ensure the safety of all their patients.  Many are not equipped, however, to protect those in the waiting or exam rooms from gunfire.

 

As we gear up to battle the opioid crisis we need to avoiding thrusting millions of people into narcotic withdrawal.  We should prepare for more disgruntled patients becoming violent when their medication requests are turned down.  Narcotic withdrawal is painful and scary and more needs to be done to help those addicted to narcotics to transition and detox easier.  Moreover, the need for increased security at medical offices is paramount.

 

LearnHealthSpanish.com / Medical Spanish made easy.

 

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

 

 

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June 14th is World Blood Donor Day.  Established by the World Health Organization in 2004, World Blood Donor Day thanks donors and raises awareness for the global need of blood products. Blood banks throughout the country, including American Red Cross and United Blood Services, are holding drives to help keep their stores full for local hospitals and medical centers.

 

Blood products are used for trauma patients,  those whose blood counts are low due to anemia, and many who suffer from blood disorders. One pint of blood could be used to save three lives.  Whole blood donations can last “on the shelf” for 42 days, but platelets, which provide clotting factors, only last for 5 days.

 

Donors are therefore needed year round.  One can donate blood every 60 days and platelets can be donated every week for up to 24 weeks a year. Although 38% of the US population is eligible to donate blood, less than 10% actually do.

 

World Blood Donor Day helps bring much needed blood during the summer months when less people donate. In 2016 a United States National Blood Donation Day was created along with a National Blood Donation Week, with multiple states creating state blood donation days during the first full week of September.

 

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Doc. Daliah putting her blood money where her mouth is.  

 

Campaigns such as these remind people that blood is needed year round.

The World Blood Donor Day slogan this year is “What can you do?”….

Give Blood, Give Now, Give Often…..

 

To find the nearest blood bank near you, visit:

http://www.unitedbloodservices.org/

http://www.redcross.org/give-blood

 

LearnHealthSpanish.com / Medical Spanish made easy.

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

 

 

 

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A Houston boy who went swimming at Texas City Dike over Memorial Day Weekend died days later from reportedly “dry drowning,” or possible “secondary drowning.”

 

“Dry Drowning” sometimes gets confused with secondary drowning. The latter occurs when fluid gets into the lungs when one swims and hours, or days later (out of the water), causes respiratory failure.  As will be discussed below, dry drowning causes a spasm of the vocal cords which inhibits breathing.

 

Frankie, 4 years old, appeared fine until a few days later, his father, Francisco Delgado, Jr., said he appeared to be suffering from a minor, stomach ailment. Then one morning the boy woke up with shoulder pain, and “Out of nowhere, he just woke up. He said ahhh.”  His father told KTRK, “He took his last breath and I didn’t know what to do no more.”

 

Despite efforts by paramedics and the parents, Frankie passed. A GoFundMePage has been created for the family to help with funeral expenses.

What is “Dry Drowning” and “Secondary Drowning”?

Dry Drowning occurs when water touches the first pass of the respiratory tree, one’s vocal cords, larynx.  When water touches this area a reflex is triggered, causing a spasm (laryngospasm) such that the vocal cords constrict and close up the airway. It's a defense mechanism designed to prevent water from falling into the lungs. However, laryngospasm causes immediate hypoxia, lack of oxygen, and if not reversed, the victim will die.  In dry drowning, water never officially reaches the lungs.

 

bronchi_lungs.jpg

 

In Secondary Drowning, water gets inhaled and sits in the respiratory tree and if uncleared through coughing, will sit and prevent proper oxygenation. Moreover the water will irritate the lung linings causing more fluid and inflammation, resulting in pulmonary edema. This could occur hours to days after the water activity.

 

According to Florida Hospital Tampa pediatrician, Dr. James Orlowski, these events are very rare, comprising only 1-2% of drowning incidents.

What are the symptoms?

The symptoms for both “Dry” and “Secondary Drowning” are similar in which the victim could have any of the following:

 

  • Cough

  • Chest Pain

  • Difficulty Breathing

  • Shoulder Pain

  • Neck Pain

  • Confusion

  • Irritability

  • Behavior Changes

  • Fatigue

  • Difficulty speaking

 

to name a few…

Prevention

Horse play in water should be avoided. This includes bathtubs, plastic pools, hot tubs, pools, lakes, ocean, etc.

 

Never swim alone.

 

Swim in areas staffed with lifeguards and/or appropriate supervision. If water does get inhaled watch the child or adult to look for any of the above symptoms. If concerned seek medical help immediately.

 

LearnHealthSpanish.com / Medical Spanish made easy.

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

 

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For centuries, multiple civilizations have used cannabis to treat various medical conditions, including seizures. This week researchers from NYU Langone’s Comprehensive Epilepsy Center found a chemical in marijuana to do just that.

A study published in the New England Journal of Medicine found that a liquid medication containing cannabidiol, one of the many chemicals in marijuana, reduced convulsive seizures in children by half.

Created by GW Pharmaceuticals, Epidiolex, brand name, was the drug used in this study and has not yet received FDA approval.

As opposed to THC, tetrahydrocannabinol, the psychoactive ingredient in marijuana, cannabidiol does not cause euphoria and has been the subject of many studies for its medicinal applications.

In this study, researchers tested 120 children with Dravet’s syndrome and found those given Epidiolex not only suffered less seizures, but 5% of the children were seizure-free during the 14 week trial.

Side effects, however, were reported such as fatigue, vomiting, diarrhea and anorexia (loss of appetite).

What is a seizure?

 

A seizure occurs when there is abnormal electrical activity in the brain.  If the electricity doesn’t conduct properly, brain function gets disrupted. This could lead to convulsions  (involuntary jerking movements), loss of muscle tone, changes in senses such as vision, hearing and smell, loss of bladder control, loss of consciousness and sometimes stroke, brain damage and death.

What is Epilepsy?

 

Epilepsy is a neurological disorder in which a person has recurrent, unprovoked seizures.

What is Dravet Syndrome?

 

Dravet Syndrome is a rare genetic condition that starts in infancy.  Children can suffer a variety of seizures and may eventually suffer from developmental delay and learning disorders.  What makes Dravet Syndrome so severe is the fact that the seizures are refractory to many anti-seizure medications.

 

 

More research needs to be done in this area, but these preliminary findings give parents and the medical community hope that a pharmaceutical option could exist in the near future for these devastating and potentially fatal seizures.

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

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Multiple states in the US currently allow recreational marijuana or medicinal use of cannabis and multiple more states may be following suit in upcoming elections.

Even those who support the legalization have concerns over driver safety and how to determine if one is impaired.

Breathalyzers are currently being developed and tested but are not ready for roadway spot checks.  Moreover, breathalyzers may have difficulty accurately detecting both inhaled and ingested marijuana.

California law enforcement officers are piloting road-side saliva tests but objective data is still lacking regarding the accuracy of oral fluid tests.

Currently when law enforcement tests an impaired driver for marijuana use, a urine test can be performed which only looks for a metabolite called THC-COOH.    Despite its abbreviation it is a non-psychoactive component of marijuana, as opposed to delta-9-tetrahydrocannabinol (delta-9-THC), which does cause euphoria.  Hence the shortcoming to this testing method are twofold, as the non active THC-COOH isn’t even the correct metabolite to measure intoxication and it can linger in the body for weeks, hence not allowing an adequate quantitative measure to determining one’s impairment.

Two medical students, however, figured out what needs to be tested and how.  Graham Lambert and Charles Cullison, both entering their third year at Touro University Nevada, performed research for an American College of Legal Medicine (ACLM) poster contest.

One of the lead researchers and osteopathic medical student Graham Lambert said, “This is an issue because it’s non-psychoactive. It stays in the body for long periods of time, long after any psychoactive effects.” Their research lead them to conclude that testing should instead look for an alternate THC metabolite, 11-OH-THC.

Why?  Let’s break this down.  Now both delta-9-THC and 11-OH-THC are psychoactive compounds that can be tested in the blood.  However law enforcement has to determine whether euphoria was present and a factor in one’s unlawful driving.  Both delta-9-THC and 11-OH-THC crosses the blood brain barrier, a semi-permeable endothelial cell barrier that helps decide what substances can enter and leave the brain.  But 11-OH-THC’s is more readily active and can bind to the brain’s cannabinoid receptors tighter, lasting longer and causing more of a psychoactive effect.

Additionally, 11-OH-THC is a metabolite also seen in high quantities after ingesting marijuana edibles.

 

 

IMAGE FROM SAPAINSOUP.COM

 

In 2012, Sharma et al found the 11-OH-THC to last twice as long in the blood than delta-9-THC, which would make sense due its strong binding properties.  Yet the psychoactive 11-OH-THC will rapidly be metabolized to an inactive form hence its presence on a test will signify activity rather than just “hanging around”.

Once Lambert and Cullison determined this, they went to Assemblyman Steve Yeager, D-Las Vegas, who is Chair of the Assembly Judiciary Committee.  Yeager helped sponsor a bill, AB135 that would convert marijuana testing for drivers from the inaccurate urine test to a blood test that would look for specifically 11-OH-THC.

Also lead researcher and osteopathic medical student, Charles Cullison said, “Blood alone accurately shows the levels of hydroxy (11-OH-THC) and marijuana.”

In regards to getting the bipartisan law passed through the State Senate with a “Veto-less” majority,  Cullison stated, “We couldn’t have done this without the help of many people.”

After Nevada lawmakers passed AB 135, Governor Brian Sandoval signed it into law. The antiquated urine testing will not be used to test drivers pulled over for possible DUI but a blood test instead.

 

The legal limit of marijuana that is measured in nanograms per milliliter ng/ml would be 2 ng/ml for delta-9-THC and 5 ng/ml for 11 Hydroxy-THC.  This does not change with passage of AB135, nor do the circumstances surrounding when to test, as current protocols are in place once a person fails his sobriety test.

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LearnHealthSpanish.com / Medical Spanish made easy.

 

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

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