We commonly think of DUI’s, or Driving Under the Influence, a result of drinking alcohol and driving while intoxicated.  However what many people fail to realize is drugs, including prescriptions, could decrease your ability to drive safely, hence putting you at risk for a DUI when alcohol wasn’t even ingested.

A report from the Governors Highway Safety Association (GHSA) and the Foundation for Advancing Alcohol Responsibility found that more fatal crashes were the result of drug use as opposed to alcohol use.

These findings showed that although alcohol was involved in 38% of fatal crashes, prescriptions and illegal drugs were responsible for 44% of driver- related deaths (similar to last year’s findings of 37% and 43% respectively).

Looking deeper they found 58 % of drug related fatal car crashes were the result of marijuana, opioids or both being on board.

According to their report, entitled, Drug-Impaired Driving: Marijuana and Opioids Raise Critical Issues for States, “44% of fatally-injured drivers with known results tested positive for drugs, up from 28% just 10 years prior.”

 

DrugAlcoholComp.jpg

Opioid overdose is currently responsible for 115 deaths per day. And as marijuana becomes legalized throughout the country, more people run the risk of being on a combination of the two, which can be deadly if they get behind the wheel.

“Drugged driving” manifests in less reaction time, poor coordination, memory loss, and distortion of one’s reality or surroundings.

Now what about prescription drugs? California Vehicle Code 23152(e) states, “It is unlawful for a person who is under the influence of any drug to drive a vehicle.”

So what prescription drugs could impair one’s driving?

The obvious ones include the following:

Narcotics such as hydrocodone, oxycodone, morphine, codeine…to name a few

Muscle relaxants such as carisoprodol, cyclobenzaprine, methocarbamol……

Sleep aids such as zolpidem, eszopiclone….

 

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Anti-anxiety medications such as diazepam, lorazepam, alprazolam, clonazepam…..

However surprisingly, these next groups of medications can also cause sedation:

Cholesterol medications such as statins:  lovastatin, atorvastatin, etc. may cause fatigue and recent studies have found them to cause “excessive tiredness”.

Stomach acid suppressants such as proton pump inhibitors:  omeprazole, lansoprazole have been reported to cause vitamin deficiencies such as B12 and magnesium which in turn can cause fatigue.

 

nexium-prevacid-prilosec2

 

Antibiotics that treat many common infections:  Amoxicillin, azithromycin, ciprofloxacin have been known to cause fatigue.

Diuretics for blood pressure and water retention:  hydrochlorothiazide, furosemide cause potassium loss in the urine which may contribute to fatigue

Antihistamines:  anti-allergy medications such as diphenhydramine (Benadryl) are very sedating, which is why they are used in some over the counter sleep aids.  There are some reports that the younger generation of medications such as Zyrtec can cause drowsiness as well.

Blood pressure medications:  these can include the ACE inhibitors such as captopril, enalapril;  calcium channel blockers such as amlodipine; beta blockers such as metoprolol as well as the diuretic family mentioned previously.

Antidepressants: many antidepressants additionally help with anxiety through their sedating effects such as trazodone, paroxetine, and escitalopram to name a few.

Mood stabilizers, anti-seizure medications, and antipsychotics can cause fatigue as well.

Despite the rarity of these types of cases, the potential is still there for one to not only receive a DUI but injure himself or others if the prescription makes him less alert, i.e. decreases his “sobriety.”  Discuss with your medical provider if you feel drowsy after you take your medication and if there are less sedating options.

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

 

Published in Health

Roseanne Barr in, an apology for a tweet in which she alluded to ex-Obama aide, Valerie Jarret, looking as if the “muslim brotherhood & planet of the apes had a baby=vj” cited Ambien as the cause.

ABC News cancelled her hit show Roseanne on Tuesday.

In an apology, the actress tweeted, “I apologize to Valerie Jarrett and to all Americans. I am truly sorry for making a bad joke about her politics and her looks. I should have known better. Forgive me-my joke was in bad taste.”

She later tweeted, “I did something unforgivable so do not defend me. It was 2 in the morning and I was ambien tweeting — it was memorial day too — i went 2 far & do not want it defended — it was egregious Indefensible. I made a mistake I wish I hadn’t but…don’t defend it please.”  CNN reports she also tweeted the following, “Not giving excuses for what I did(tweeted) but I’ve done weird stuff while on ambien — cracked eggs on the wall at 2am, etc.”

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The makers of Ambien, Sanofi, tweeted the following response, “While all pharmaceutical treatments have side effects, racism is not a known side effect of any Sanofi medication.”

Millions of people use Ambien (zolpidem tartrate), a sedative hypnotic, in a 5 mg or 10 mg tablet form, that is used for fast-acting sleep initiation and is famous for not inducing a drowsy feeling the next morning.

Unfortunately multiple users have cited odd side effects such as driving to work in the middle of the night, or cooking breakfast.

According to rxlist.com, side effects of Ambien may include:

 

  • Dizziness
  • Weakness
  • Lightheadedness
  • “Drugged” feeling
  • Daytime drowsiness
  • Tiredness
  • Loss of coordination

 

  • Stuffy nose
  • Nasal irritation
  • Dry mouth
  • Sore throat
  • Nausea
  • Constipation
  • Diarrhea
  • Stomach upset
  • Headache
  • Muscle pain
  • Confusion
  • Insomnia

 

  • Euphoria
  • Ataxia (balance problems)
  • Visual changes
  • memory loss
  • mental/mood/behavior changes (such as new or worsening depression, abnormal thoughts, thoughts of suicide, hallucinations, confusion, agitation, aggressive behavior, or anxiety).

The medication is a gamma-aminobutyric acid (GABA) A agonist, inciting a neurotransmitter cascade that can inhibit activity between neurons, nerve cells.  Lower levels of GABA are linked to sleep disorders, so inciting the GABA receptor as Ambien (zolpidem tartrate) does, can induce sleep.  But once we’re affecting nerve signals other side effects may ensue since the GABA inhibitory neurotransmitter affects the central nervous system.

So odd behavior could be a side effect. However, as with alcohol-induced behavior, exacerbations of feelings or tendencies may occur.  Forming new opinions, which may be racist, would not be a side effect of this medication.

Medical providers warn users to hide car keys, lock of refrigerators and put child locks on stoves and ovens as “sleep walking” behavior could put them and their families at risk.  This also includes posting on social media… so keep phones away from the bed and computers off.

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

 

Published in Health
%PM, %25 %727 %2018 %16:%May

Will a robot replace your doctor?

The University College London Hospital (UCLH) in Bloomsbury London is launching a pilot program replacing some A&E (Emergency Room) physicians with robots.

In response to staff shortages and long wait times, the initiative launched by UCLH and Alan Turing will utilize artificial intelligence to triage patients and reduce wait times.

Robotic technology is already being used in the operating room, rehabilitation centers and for pharmaceutical dispensing.  It’s just a matter of time that they become our main caregiver.

But will patients be pleased?

The Robot Is In…

 

Where’s there’s demand, there’s supply. Patients tired of wait times, crowded waiting rooms, loss of sick leave hours to sit around a medical office or emergency room for half a day will want speed and efficiency.  Kiosks may replace front desk clerks, taking your initial information (chief complaint, name, insurance info.), scanning it and offering you a number, like one given at a bakery.

Robots Don’t Judge

 

Those embarrassed by having symptoms suggestive of having an STD will have less of an issue conveying this information to a machine than a human being.  Gas, discharge, odors may be easier to discuss with someone or something that won’t wince.

 

Doctor-and-patient

 

The Doctor Doesn’t Examine Me Anyway

 

Many patients cite seeing a medical provider and not being examined or asked to undress before an exam. Time constraints, or avoidance of being accused of wrongdoing, have caused some providers to refer out for heart, gynecological, and rectal examinations. Primary care providers who enter the room, say a few words and then promptly leave saying they will “bring in the nurse to review instructions” may not be missed by the patient receiving similar service from a robot.

They can always answer my questions

 

We use Google, Wikipedia and Siri to answer our health questions currently.  No wait time, no office visit, no cost….so a robot answering our questions in layman’s terms will be an easy task.

 

However, and this is the kicker……

Robots Lack Instinct

 

There is no way to replicate the sixth sense humans have when it comes to something being wrong with you. Artificial intelligence cannot provide a “gut feeling.”

Let’s take a urinary tract infection, for example. I have had patients who were new to my office complaining something “felt funny” when they urinated and cited blood in their urine.  A urinalysis may show inflammatory cells, and a robot may correctly diagnose the patient with a bladder infection.  But I as a clinician may be suspicious that this new patient has something that is leaking blood into the urine, from the gynecologic tract maybe? And I’ve diagnosed endometrial and cervical cancer in cases where patients thought they were merely having bladder infections.

One patient presented to me in the emergency room feeling “odd” and suspecting a “UTI.” She was in her 60’s and started to complain of nausea.  Her urine had inflammatory cells so while a culture takes 3 days to complete, I gave her a prescription for antibiotics in case the infection would spread during that time. But her nausea was concerning. The patient requested an injection of nausea medication prior to leaving so I obliged, giving her Compazine.  While observing her for a few minutes, post injection, she began to have shortness of breath.  We decided to look at her heart and came to the conclusion after more testing that she had suffered a heart attack in her sleep the night before and the “odd feeling” she felt the next day wasn’t due to her UTI (which she coincidentally had) but was from a heart attack. She was treated immediately and recovered nicely.

Would a robot have picked up on that?  Multiple web resources include nausea in the list of symptoms associated with a UTI, so could be “blown off” by a robot bundling it with the patient’s urinary complaints. But I learned that nausea could be the first sign of a heart attack, especially in women.

Another case I had as an urgent care physician was the following:

A gentlemen came in saying he “felt fine” but his wife made him come in because he was burping the night before.  Multiple bouts of eructation jogged an ancient memory of mine…..when as a little girl I saw a movie where the pilot was burping multiple times before he passed out and died.  So I came to learn that chronic bouts of burps, or hiccups for that matter, could be a sign of an inferior MI (heart attack). I ran an EKG and blood work, and my instinct was right.  Again I was looking at a patient who unknowingly had a heart attack the night before but thought he had something benign the next day.

So gut instinct, thinking laterally, tapping in on past experience, and acting on hunches is not something a robot can do.  Humans may be satisfied with shorter wait times and receiving antibiotics when they demand them, but the education and intervention a medical provider can provide is priceless.  Too bad cost gets in the way of real medicine.

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

 

Published in Health
%PM, %22 %806 %2018 %18:%May

Heat illness and heat stroke explained

The National Weather Service will soon issue an “excessive heat warning” for many parts of the Southwest United States. Phoenix received their first warning two weeks ago when their temperatures rose to 108 degrees.

What is an “excessive heat warning?”

 

This occurs “within 12 hours of the onset of extremely dangerous heat conditions”. This means that the heat index (air temperature and humidity) will be greater than 105 degrees for more than three hours a day for at least two days in a row and the night-time temperatures will not drop below 75 degrees. Although many of us may live in areas where this occurs each year, the onset can be one of the most dangerous times. Symptoms such as heat cramps, heat exhaustion and heat stroke must be identified.

What are Heat Cramps?

 

At first when one feels symptoms, it may come in the form of heat cramps. Heat cramps are painful spasms that occur in the muscles of the arms and legs and even abdomen. We believe that when one loses fluids and salts from excessive sweating, cramps ensue. It's important in these cases to get the person out of the heat, hydrate them with sips of fluid and electrolytes and massage the body parts affected.

 

water.jpg

 

What is Heat Exhaustion?

 

If one does not leave the heat and come indoors, the next risky event that can occur is heat exhaustion. This worsens as the victim sweats profusely becoming more and more dehydrated. They could also have cramps but nausea may ensue, they may look pale and clammy and their heart rate will increase to try to compensate for the lost fluid. These individuals may become dizzy, weak and even faint. Immediately bring the person indoors, lie them down, elevate the feet, give sips of fluid, cool down the body applying cool and wet cloths to the underarms and body, and contact medical authorities if symptoms continue or worsen.

 

 

MedStar-NS-heat-stroke-right-size-610x420.jpg

IMAGE FROM MEDSTAR

 

What is Heat Stroke?

 

Heat stroke will occur if a vulnerable person does not get out of the heat in time. It is a medical emergency and can be fatal. If an individual has heat stroke 9-1-1 must be called immediately. Bring the victim indoors away from sunlight, lie them down, remove unnecessary clothing, cool their body with cold compresses and watch for signs of rapidly progressive heat stroke in which they have difficulty breathing, seize or lose consciousness. If they are unconscious you cannot give them fluids. Only if they are alert, awake and able to swallow will you be able to give fluids. Do not give medications to reduce the fever such as aspirin or acetaminophen since their body may not be able to metabolize them properly and this could make matters worse.

 

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Who is vulnerable to heat related illness?

 

Young children and elderly individuals may have issues adjusting to the outside environment and may be more prone to dehydration. Those with medical conditions such as heart, lung, thyroid disease can be at risk as well. If you’ve ever suffered from heat stroke you can be vulnerable again. And many medications could make you susceptible such as diuretics, vasodilators and beta-blockers for blood pressure and antidepressants.

The biggest risk comes when we are unprepared. Having an unusual cool week prior to a heat warning could preclude many from taking proper precautions. Staying indoors, checking air conditioning and fan devices to make sure they work properly, wearing cooler clothing is just the beginning. Stocking up and planning to hydrate frequently is paramount because when death occurs to excessive heat, dehydration is the main culprit.

 

UZ

 

Bring your pets indoors, and watch your kids, friends and family members frequently. If they are beginning to succumb to the heat, they may be quiet and not be able to voice it.

 

snappy

 

Avoid drinking alcohol in the heat. It can dehydrate you more and worsen the situation.

Avoid excessive exercise when outdoors and make sure to make use of shady areas.

The summer and early fall offer exciting and fun ways to enjoy nature. Don’t let the heat get to you. Remember….if you can’t take the heat, get out of the…..well heat…….

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

 

Published in Health
%PM, %19 %928 %2018 %21:%May

2018 Ebola outbreak update

Twenty five people have died, and 45 others are suspected to be infected with Ebola in the Democratic Republic of Congo (DRC). The World Health Organization (WHO) has confirmed and reported the outbreak of Ebola on May 8.

This latest outbreak began in villages near Bikoro. New cases later surfaced miles away in Mbandaka, an urban city with a reported population of 1.2 million, located along the banks of the Congo River.

 

Ebola2018_DRC.png

 

Vaccination has begun with ZMapp, a treatment used in the 2014 outbreak that shows promise as a prophylactic measure.

Dr. Karen Duus, Associate Professor of Microbiology and Immunology at Touro University Nevada, explains, “The vaccine is a recombinant Ebola virus protein vaccine that causes a similar type of neutralizing antibody response (as the ZMapp treatment). The neutralizing antibodies coat the virus particle and keep it from binding to the target cells and infecting them.”  Its efficacy, however has not been extensively tested.

 

viv.jpg

 

The DRC had a small outbreak last year but it was contained within 42 days.

The West African Ebola epidemic spanned from the end of December 2013 to 2016 infecting over 28,000 people and killing over 11,300. The epidemic was one of the worst in Ebola’s history and its high mortality rate took countries such as Sierra Leone, Guinea, and Liberia by surprise. A vaccine was not available, and medications such as ZMapp were experimental and not in great supply. Hospitals were not stocked with protective clothing able to prevent the minutest of exposure to the deadly virus. Travel bans were difficult to institute and top that off with a lack of education on what we were dealing with and it was unfortunately the perfect storm for one of the deadliest outbreaks in recent history.

Ebola however emerged far before this. Ebola was named after the Ebola River in Zaire and was first recognized in 1976 when it caused two outbreaks affecting 318 and 284 people respectively.  Multiple small outbreaks have occurred since then, according to the CDC:

1995 – Democratic Republic of Congo –  infected 315

2000 – Uganda – infected 425

2007 – Democratic Republic of Congo – infected 264

 

about-ebola

CYNTHIA GOLDSMITH THIS COLORIZED TRANSMISSION ELECTRON MICROGRAPH (TEM) REVEALED SOME OF THE ULTRASTRUCTURAL MORPHOLOGY DISPLAYED BY AN EBOLA VIRUS VIRION. IMAGE FROM CDC

 

And multiple smaller sporadic cases occurred in the years between.

In January 2016 health officials declared the Ebola outbreak had ended, however cases continued to smolder.

Why this occurs is the virus may not leave the body completely. Its been found to live in semen up to a year and some survivors can suffer a reinfection months later. For example, in 2015 Dr. Ian Crozier successfully fought Ebola but two months after discharge, suffered a severe eye infection which turned out to be Ebola lurking in his eye.

A study in 2015 found Ebola be able to survive outside a human body for days and longer if within a liquid such as water or blood. Mosquitoes are not known to transmit the virus however it can live in bats as well as monkeys and apes. Pets have not been known to contract Ebola from their sick owners but its been postulated that pigs could, if in contact with a victim.

Dr. Duus states that although the virus reservoirs are not clear, “people are most likely infected by butchering or eating infected animals.”

Ebola is a virus from the Flavivirus family that causes a hemorrhagic fever with symptoms of sudden fever, myalgias, headache and sore throat.  It could then progress to nausea and vomiting, liver and kidney issues and internal and external bleeding, ultimately resulting in death in 90% of cases.

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

 

Published in World

Thursday morning Hawaii’s Kilauea shot ash and smoke into the air and blew a volcanic cloud that could reach 30,000 feet into the sky. The volcano has been spewing lava for weeks, prompting thousands of nearby residents to evacuate. Volcanic ash can prompt a multitude of health risks…not only from a particulate standpoint but also from the sulfur dioxide levels. Sulfur dioxide is a colorless, though stinky gas that can cause irritation to skin, eyes, and respiratory system linings.

 

 

1354578168

 

Let’s break these health risks down:

Respiratory Illness

 

Volcanic ash can irritate the respiratory passages causing the following symptoms:

  • Runny nose
  • Sore throat
  • Wheezing
  • Coughing
  • Mucous production
  • Shortness of breath
  • Painful breathing

 

cough1-classicfm

 

Those with asthma, COPD, chronic bronchitis or other respiratory ailments may find themselves having exacerbations of their symptoms. Oxygen requirements will increase. Those requiring oxygen or inhalers will need to have extra supply during this time (medical offices may be closed during ash clean up so don’t wait until the last minute.)

Eye Issues

 

Volcanic ash has large and small particles that can irritate the eyes increasing their sensitivity to light and making vision difficult.  Moreover ash can irritate the cornea and conjunctiva causing redness, discharge and itching.

 

well_eye-tmagArticle

 

Skin Reactions

 

Skin may become irritated during these times and those with skin allergies or eczema may find themselves having flare-ups.

 

Road Visibility

 

During a volcanic eruption, smoke plumes not only change the air quality but also visibility. During times of day when there is less light, road visibility obscures pedestrians and nearby cars. Drivers are urged to avoid the road during these smoky times.

 

driver

 

Water

 

Water quality can become affected by the ash or pH changes if supply becomes  contaminated. Moreover, water use increases for cleanup so shortages may ensue.

Short blood supply


Those who donate blood in nearby areas may be less likely to donate during this difficult time leading to local blood shortages.  Those who can donate blood are urged to contact the American Red Cross, United Blood Services, or Blood Bank of Hawaii.

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

 

Published in Health
%PM, %12 %803 %2018 %18:%May

Which sunscreens work best?

May is Skin Cancer Awareness Month as 5 million cases of skin cancer are diagnosed each year in the United States.  This week, Consumer Reports released its 2018 Annual Sunscreen Guide on the best sunscreens to offer protection against UV (ultraviolet) rays.  They looked at 73 various sunscreen lotions, sprays and sticks, which touted 80 minutes water resistance and an SPF of 30.

The top 5 sunscreens reported are:

La Roche-Posay Anthelios 60 Melt-In Sunscreen Milk, $36 (lotion)

Equate (Walmart) Sport Lotion SPF 50, $5.00 (lotion)

BullFrog Land Sport Quik Gel SPF 50, $8.50 (lotion)

Coppertone WaterBabies SPF 50 Lotion, $9 (lotion)

Trader Joe’s SPF 50+, $6 (spray)

 

How do sunscreens work?

 

Sunscreens use chemicals to disperse or absorb UV rays. Inorganic compounds in sunscreen such a titanium dioxide or zinc oxide attempt to scatter the UV rays. Organic compounds such as PABA and oxybenzone attempt to absorb UV rays so they can’t damage the skin.

 

What’s the difference between UVA and UVB radiation?

 

UVA rays penetrate deeply into both the epidermis and dermis. They can cause premature aging of the skin, wrinkles, and skin cancer.

UVB rays are shorter and primarily affect the epidermis. They are responsible for causing sunburns as well as skin cancer.

 

8ce0498bca5aac49d757b683088b7d4a.jpg

 

What is SPF?

 

SPF stands for Sun Protection Factor. The higher the SPF, the less sun photons enter the skin and cause damage. SPF primarily measures the protection against UVB rays. We multiply the SPF factor by how long it takes one’s skin to burn by the SPF number to determine the protection factor.

In theory, an SPF of 30 suggests your skin, if it burns within 10 minutes without protection, will not burn until 300 minutes has lapsed (30 times 10). However, we find this isn’t always the case.  People sweat or swim and the sunscreen dissipates. Moreover many don’t put on the proper amounts (see below.)

So instead we use SPF as a grade to how much protection the product can offer.

An SPF of 15 blocks 93% of UVB rays

An SPF of 30 blocks 97% of UVB rays

An SPF of 50 blocks 98% of UVB rays

As we see, the relationship is not linear, however the higher the SPF, the more protection we have against UV rays.

 

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IMAGE FROM BADGERBALM

 

Although the SPF alludes to protection against burning, hence UVB rays, a sunscreen may still protect against both UVA rays and UVB rays if it’s a broad spectrum sunscreen.

 

 

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How to apply sunscreen

 

Most people apply sunscreen incorrectly or unevenly.  Lotion needs to be applied at an amount of 2mg/cm2 of skin or 1 teaspoon per body part (chest, arm, leg, face and neck). It should be applied 15 minutes prior to going out into the sun and needs to be reapplied every 2 hours, or more often if swimming or sweating.

CRM_Page_41_Important_Sunscreen_Spots_07-15 (1)

 

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

 

Published in Health

At least one in three adults has high blood pressure and strokes are the 5th leading cause of death in the United States.

In May we raise awareness of both these conditions during American Stroke Monthand National High Blood Pressure Education Month.

Every 40 seconds, someone in the United States suffers a stroke.  And high blood pressure puts one at risk of a stroke, as well as heart disease.

Here are your questions answered.

 

Risk-Factors-For-Heart-Disease-High-Blood-Pressure-700x395-700x395.jpg

 

What do the blood pressure numbers mean?

 

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

Diastolic pressure is the pressure in your arteries between beats while the heart is “filling.”

Both numbers are equally important as elevation of either can increase one’s risk of cardiovascular disease.

What blood pressure level is considered “normal” or “abnormal?”

 

High blood pressure has now been redefined as being greater than 130/80 mmHg, down from 140/90 mmHg.   Last year it was guestimated that 42% of Americans would soon be considered “hypertensive.”

 

blood+pressure+chart

 

What can long-term high blood pressure cause?

 

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

  • Heart attacks
  • Heart failure
  • Stroke
  • Kidney disease
  • Dementia
  • Eye damage – vision loss
  • Erectile dysfunction…to name a few.

How do we treat high blood pressure?

 

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

  • Weight loss
  • Low salt diet
  • Low fat diet
  • Good sleep habits
  • Regular exercise
  • Avoiding tobacco products
  • Limiting alcohol consumption

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

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

 

What is a stroke?

 

A stroke occurs when an area of the brain does not get the proper oxygen and blood flow it needs. There are two major types of stroke:  ischemic and hemorrhagic.

Ischemic strokes are more common than the latter and occur when a clot prevents blood flow to part of the brain.  80% of all strokes fall under ischemic.  It is a likened to a heart attack, except the brain tissue is being deprived of blood and nutrients. Plaques commonly arise from arteriosclerosis that break off travel to the smaller vessels of the brain.

Hemorrhagic strokes are less common and occur when there is a bleed of one of the brain vessels.  The bleed prevents blood flow into the brain since it is seeping outside the brain tissue, causing damage to nearby cells.  The bleeds could occur from high blood pressure or aneurysms that rupture.

What are the signs of a stroke?

Since a clot or bleed usually affect one area of the brain, we see symptoms on one side of the body, many times its contralateral (opposite) side.  We can also see central effects.  The symptoms of stroke include the following:

  • Weakness of one side of the body
  • Loss of balance
  • Numbness on one side of the body
  • Slurred speech
  • Vision issues
  • Headache
  • Facial droop

and more…..

How are strokes treated?

 

If the stroke was caused by a clot (ischemic) immediate treatment includes dissolving/removing the clot.  Aspirin is used initially and if within the proper time frame, tissue plasminogen activator (TPA).  These clots can also be surgically removed and arteries widened to bring blood flow to the brain.

With a hemorrhagic  stroke, we need to stop the bleed and improve flow to the brain.  Controlling the bleed, bypassing the vessel, “clogging” the aneurysm with techniques such as “coiling” (endovascular embolization) are sometimes utilized.

Time is of the essence, so it's crucial to identify the warning signs and call 911 immediately.  The American Stroke Association uses the acronym “FAST” (Facial drooping, Arm weakness, Speech difficulty, and Time to call 911).  The sooner a stroke victim receives medical attention the better the prognosis.

 

 

fast

COURTESY OF THE AMERICAN STROKE ASSOCIATION

 

What are the risk factors for stroke?

 

The following put us at risk of having a stroke.

  • High blood pressure
  • Family history of stroke
  • Diabetes
  • Cardiovascular disease (artery clogging, such as the heart and carotid arteries)
  • Abnormal heart rhythms, such as atrial fibrillation
  • Smoking
  • Drugs
  • Obesity
  • Inactivity
  • Clotting disorder
  • Sleep apnea
  • Being older (greater than 55)
  • African-Americans appear to be more at risk than Caucasians and Hispanics
  • Men seem to be more affected than women

 

How do we prevent strokes?

 

Avoid the following:

  • Excessive drinking
  • Drug use
  • Tobacco products
  • Control blood pressure, sugar and cholesterol
  • Get evaluated by a medical provider if at risk for heart disease or stroke.

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

 

 

Published in Health

Experts report allergy season will worsen each year due to environmental changes.

Allergy season usually begins in March with the start of Spring and can extend to the Fall even leading to new Fall allergies.

Each year we find allergy season starting a few weeks earlier as temperature changes prompt early blooms.

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 extends through the Summer and Fall.

Dr. Jeffrey Demain, Board Certified Allergist and Immunologist reported at the March meeting of the American Academy of Allergy, Asthma and Immunology the following, “We have higher temperatures and expanding levels of carbon dioxide.

“When you look at a pollen grain, there are certain proteins that cause the allergy, they are the allergenic peptides,” he said. “It’s been shown that in rising carbon dioxide, the allergenic peptide of each pollen grain goes up.”

Plants utilize carbon dioxide for respiration as humans use oxygen.  The higher carbon dioxide levels, the higher the pollen counts and proteins in pollens that contribute to allergies.

The increase in storms may contribute to allergy season as well as moisture in the air causes pollen to swell and “explode” into multiple little pollen particles, smaller and easier to breathe in.

Moreover stagnant flood water may cause fungi, mold and spores to grow, also leading to allergies.

The Allergy Capitals Spring 2018 report found many cities are worse off this year than they were in previous seasons. McAllen, TX , Louisville, KY, Jackson, MS, Memphis, TN  and San Antonio, TX ranked in the top 5 in “Most Challenging Places to Live With Spring Allergies.” The copy of the report is below:

AAFA-2018-Spring-Allergy-Capitals-Report

Let’s review allergies…..

What are allergies?

 

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.

What are symptoms of seasonal allergies?

 

Symptoms of allergies could include any or a combination of the following:

  • Sneezing
  • Coughing
  • Wheezing
  • Runny nose
  • Eye watering
  • Red Eyes
  • Itchy eyes
  • Itchy skin
  • Rash
  • Itchy throat
  • Fatigue
  • Congestion….. to name a few.

How do they differ from a cold?

 

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.

Can allergies lead to a cold?

 

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.

Are seasonal allergies dangerous?

 

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.

How can we prevent and treat allergies?

 

Avoiding, or decreasing exposure to the allergen is key.   We suggest the following:

  1. Be aware of your local weather and pollen counts.  If the weather begins to warm and regional vegetation is blooming, allergy season may be upon you sooner than you know.
  2. Avoid outside pollen from coming into your house.  Avoid the urge to open all the windows during Springtime as wind will bring the pollen in.
  3. Clean your air filters.  Replace air filters frequently and consider using HEPA Filters
  4. Wash off pollen from your hair and clothes before you sit on the couch or jump into bed.
  5. Close your car windows when you park.
  6. “Recirculate” the air in your car
  7. Discuss with your medical provider if you are a candidate for medications such as antihistamines, nasal corticosteroids or leukotriene antagonists.  
  8. If you suffer from respiratory illnesses or a chronic medical condition, discuss with your medical provider if you need to start your allergy medication before allergy season hits. Some of these medications may take a couple of weeks to reach therapeutic levels.

How can I find my local pollen counts?


Local tree, ragweed and grass pollen counts can be obtained here.

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

 

 

Published in Health
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5 ways to add years to your life

A study out of Harvard’s TH Chan School of Public Health finds 5 simple lifestyle changes that can add 1-2 decades onto one’s life.

Researchers looked at lifestyle and diet of over 100,000 men and women apart of the Nurses’ Health Study and the Health Professionals Follow-up Study. They found sticking to these lifestyle changes at the age of 50 could give the average woman 14 extra years of life and the average man, 12.

Since cancer and heart disease contribute to hundreds of thousands of deaths a year, study authors suggest the following:

Avoiding Smoking

 

Since smoking has been long linked to early death, due to increase risk of arteriosclerosis and multiple types of cancer, avoiding tobacco products have been found to increase life expectancy.

 

smoking-one-cigarette.jpg

 

Keeping Weight Down

 

Researchers encourage a healthy body weight, more specifically a BMI of 18.5 to 24.9 kg/m2.

 

bmi-chart.png

 

Obesity has been linked to diabetes, heart disease and multiple cancers, so a healthy diet is paramount.

Eating a Healthy Diet

 

Diets rich in vegetables, low sugar fruits, whole grains, fish and healthy fish oils have been found to decrease risk of diabetes, obesity, heart issues and various cancers.

 

Tips-to-Effectively-Follow-the-Mediterranean-Diet

 

Avoiding excess salt, sugar, and saturated fats are key.

Regular Exercise

 

30 minutes a day of moderate to vigorous activity daily has been recommended by multiple medical associations.  I would encourage making sure one’s medical provider evaluates heart health before engaging in vigorous activity.  But walking, swimming, household chores, dancing, and many other activities fall under “moderate activity” that can be safe and provide multiple health benefits.

 

yoga.jpeg

 

“Moderate” Drinking

 

Moderate drinking is defined as no more than one drink a day for women, two drinks a day for men.

 

What-is-a-drink

Image above from CDC

 

However, the health benefits of alcohol consumption are controversial, as many studies have linked alcohol consumption to cancer. Moreover, the sugar levels in alcohol can contribute to diabetes and obesity.

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

 

Published in Health
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